A influência da pandemia de Covid-19 em crianças e adolescentes com Transtorno do Espectro Autista / The influence of the Covid-19 pandemic on children and adolescents with autism spectrum disorder / Influencia de la pandemia de Covid-19 en niños y adolescentes con trastorno del espectro autista

O objetivo do estudo foi avaliar a influência do isolamento social causado pela pandemia da COVID-19 em pacientes com Transtorno do Espectro Autista (TEA), atendidos em um serviço especializado. Foi realizado um estudo transversal do tipo observacional e descritivo por meio da aplicação de um formulário de 51 perguntas. Participaram do estudo 45 responsáveis por crianças e adolescentes com TEA, acompanhados na Policlínica Naval de São Pedro da Aldeia (PNSPA), no período de julho a novembro de 2021. Foram abordados aspectos demográficos, sociais, clínicos e comportamentais dos pacientes e familiares. Os resultados indicaram que a maioria dos pacientes era do sexo masculino (86,7%) com média de idade de 10,4 anos, sendo 57,8% TEA nível 1. Observou-se alterações comportamentais em 88,9% dos pacientes, sendo essas alterações consideradas como negativas por 57% dos responsáveis. Foi necessário o ajuste nas medicações em 51,1% dos pacientes que já usavam medicações no período, a maioria deles por causa de modificações no comportamento. Não houve diferença estatisticamente significativa quando avaliamos as modificações comportamentais por sexo (p-valor 0,471), nível do TEA (p-valor 0,128), idade (p-valor 0,460), número de irmãos (p-valor 0,903), modificações medicamentosas (p-valor 0,280) e isolamento social (p-valor 0,553). Observou-se que a manutenção das terapias e a participação nas atividades escolares foi fator protetor quando analisamos as modificações de comportamento (RP para ambos = 0,86). Em conclusão, o estudo mostrou o impacto da pandemia de COVID-19 em pacientes com TEA, pelo elevado percentual de mudanças comportamentais, especialmente aquelas consideradas negativas, independentemente de os pacientes terem permanecido ou não em isolamento social.

The aim of the study was to assess the influence of social distancing caused by the COVID-19 pandemic in patients with Autistic Spectrum Disorder (ASD), treated at a specialized unit. It was performed a cross-sectional observational and descriptive study with 45 guardians of children and adolescents with ASD, treated at an outpatient clinic, from July to November 2021. Guardians were asked to fill out a 51-question form that addressed demographic, social, clinical, and behavioral aspects of patients and family members. The results showed that the most patients are male (86.7%) with a mean age of 10.4 years; 57.8% had level 1 ASD. There were behavioral changes in 88.9% of patients; such changes were considered negative by 57% of the guardians. Medication adjustment was necessary for 51.1% of the patients who were already using medications in the period, most of them because of changes in behavior. There was no statistically significant difference when behavioral changes were evaluated by gender (p-value 0.471), ASD level (p-value 0.128), age (p-value 0.460), number of siblings (p-value 0.903), changes in medication (p-value 0.280) and social distancing (p-value 0.553). The continuation of therapies and participation in school activities was a protective factor when we analyzed changes in behavior (PR for both = 0.86). In conclusion, the research indicates that the COVID-19 pandemic had an impact on ASD patients, which could be noticed by the high percentage of occurrence of behavioral changes, especially those considered negative, regardless of whether the patients practiced social distancing or not.

El objetivo del estudio fue evaluar la influencia del distanciamiento social causado por la pandemia de COVID-19 en pacientes con Trastorno del Espectro Autista (TEA), atendidos en una unidad especializada. Se realizó un estudio transversal observacional y descriptivo con 45 tutores de niños y adolescentes con TEA, atendidos en una consulta externa, de julio a noviembre de 2021. Se pidió a los tutores que rellenaran un formulario de 51 preguntas que abordaba aspectos demográficos, sociales, clínicos y conductuales de los pacientes y sus familiares. Los resultados mostraron que la mayoría de los pacientes son varones (86,7%) con una edad media de 10,4 años; el 57,8% presentaba un TEA de nivel 1. Hubo cambios conductuales en el 88,9% de los pacientes; dichos cambios fueron considerados negativos por el 57% de los tutores. Fue necesario ajustar la medicación en el 51,1% de los pacientes que ya la utilizaban en ese periodo, la mayoría de ellos debido a cambios en el comportamiento. No hubo diferencias estadísticamente significativas cuando se evaluaron los cambios de comportamiento en función del sexo (p-valor 0,471), el nivel de TEA (p-valor 0,128), la edad (p-valor 0,460), el número de hermanos (p-valor 0,903), los cambios de medicación (p-valor 0,280) y el distanciamiento social (p-valor 0,553). La continuación de las terapias y la participación en actividades escolares fue un factor protector cuando analizamos los cambios en el comportamiento (PR para ambos = 0,86). En conclusión, la investigación indica que la pandemia de COVID-19 tuvo un impacto en los pacientes con TEA, que pudo ser notado por el alto porcentaje de ocurrencia de cambios de comportamiento, especialmente los considerados negativos, independientemente de que los pacientes practicaran o no el distanciamiento social.

Pertinencia de los laboratorios de simulación como herramienta de educación avanzada en salud / Relevance of simulation laboratories as a tool for advanced health education

RESUMEN El constante perfeccionamiento del proceso educativo del hombre demanda el enriquecimiento de las prácticas de la educación avanzada. Es preciso efectuar transformaciones en el trabajo educativo, por lo que resulta indispensable que se oriente de forma tal que permita potenciar en cada estudiante aquellos aspectos que le faciliten conocer, de una manera más significativa, el momento histórico en que viven. Los simuladores virtuales, como método de aprendizaje en ciencias médicas, son potenciadores del aprendizaje y ayudan a evadir el obstáculo de horas limitadas en la práctica clínica, grupos numerosos, inconsistencias en la observación de enfermedades de alto riesgo o inusuales. En Cuba, la utilización de estos no ha sido explotada al máximo. Los estudios que han evaluado la efectividad de estos simuladores en la mejoría del desempeño de los profesionales de la salud, han arrojado resultados muy positivos, pero el elevado precio de los simuladores ha constituido la mayor barrera para su completa introducción en Cuba. Este trabajo expresa la posición de los autores sobre la pertinencia de los laboratorios de simulación como herramienta de educación avanzada en salud. El uso de los laboratorios de simulación en la educación médica, es una práctica positiva en el perfeccionamiento de las competencias profesionales y ofrece la seguridad de la atención sanitaria; no es un sustituto de la práctica supervisada en entorno real, sino un complemento deseable para una pericia segura y efectiva que permite desarrollar habilidades, conocimientos y actitudes, es decir, capacidades para su óptimo desempeño.

ABSTRACT The constant improvement of the educational process of man demands the enrichment of the practices of advanced education. It is necessary to carry out transformations in the educational work, so it is essential that it be oriented in such a way that it allows each student to enhance those aspects that make it easier for them to know, in a more significant way, the historical moment in which they live. Virtual simulators, as a learning method in medical sciences, are learning enhancers and help to avoid the obstacle of limited hours in clinical practice, large groups, inconsistencies in the observation of high-risk or unusual diseases. In Cuba, the use of these has not been exploited to the maximum. The studies that have evaluated the effectiveness of these simulators in improving the performance of health professionals have yielded very positive results, but the high price of the simulators has constituted the greatest barrier to their full introduction in Cuba. This work expresses the position of the authors on the relevance of simulation laboratories as a tool for advanced health education. The use of simulation laboratories in medical education is a positive practice in the improvement of professional skills and offers the security of health care, it is not a substitute for supervised practice in a real environment, but a desirable complement to an expertise safe and effective, which allows developing skills, knowledge and attitudes, that is, capacities for optimal performance.

Is there a Role for Antenatal Corticosteroids in Term Infants before Elective Cesarean Section?

OBJECTIVE: Cesarean section (CS) delivery, especially without previous labor, is associated with worse neonatal respiratory outcomes. Some studies comparing neonatal outcomes between term infants exposed and not exposed to antenatal corticosteroids (ACS) before elective CS revealed that ACS appears to decrease the risk of respiratory distress syndrome (RDS), transient tachypnea of the neonate (TTN), admission to the neonatal intensive care unit (NICU), and the length of stay in the NICU. METHODS: The present retrospective cohort study aimed to compare neonatal outcomes in infants born trough term elective CS exposed and not exposed to ACS. Outcomes included neonatal morbidity at birth, neonatal respiratory morbidity, and general neonatal morbidity. Maternal demographic characteristics and obstetric data were analyzed as possible confounders. RESULTS: A total of 334 newborns met the inclusion criteria. One third of the population study (n = 129; 38.6%) received ACS. The present study found that the likelihood for RDS (odds ratio [OR] = 1.250; 95% confidence interval [CI]: 0.454-3.442), transient TTN (OR = 1.,623; 95%CI: 0.556-4.739), and NIUC admission (OR = 2.155; 95%CI: 0.474-9.788) was higher in the ACS exposed group, although with no statistical significance. When adjusting for gestational age and arterial hypertension, the likelihood for RDS (OR = 0,732; 95%CI: 0.240-2.232), TTN (OR = 0.959; 95%CI: 0.297-3.091), and NIUC admission (OR = 0,852; 95%CI: 0.161-4.520) become lower in the ACS exposed group. CONCLUSION: Our findings highlight the known association between CS-related respiratory morbidity and gestational age, supporting recent guidelines that advocate postponing elective CSs until 39 weeks of gestational age.

Is there a role for antenatal corticosteroids in term infants before elective cesarean section?

Abstract Objective Cesarean section (CS) delivery, especially without previous labor, is associated with worse neonatal respiratory outcomes. Some studies comparing neonatal outcomes between term infants exposed and not exposed to antenatal corticosteroids (ACS) before elective CS revealed that ACS appears to decrease the risk of respiratory distress syndrome (RDS), transient tachypnea of the neonate (TTN), admission to the neonatal intensive care unit (NICU), and the length of stay in the NICU. Methods The present retrospective cohort study aimed to compare neonatal outcomes in infants born trough term elective CS exposed and not exposed to ACS. Outcomes included neonatal morbidity at birth, neonatal respiratory morbidity, and general neonatal morbidity. Maternal demographic characteristics and obstetric data were analyzed as possible confounders. Results A total of 334 newborns met the inclusion criteria. One third of the population study (n=129; 38.6%) received ACS. The present study found that the likelihood for RDS (odds ratio [OR]=1.250; 95% confidence interval [CI]: 0.454-3.442), transient TTN (OR=1.,623; 95%CI: 0.556-4.739), and NIUC admission (OR=2.155; 95%CI: 0.474-9.788) was higher in the ACS exposed group, although with no statistical significance. When adjusting for gestational age and arterial hypertension, the likelihood for RDS (OR=0,732; 95%CI: 0.240-2.232), TTN (OR=0.959; 95%CI: 0.297--3.091), and NIUC admission (OR=0,852; 95%CI: 0.161-4.520) become lower in the ACS exposed group. Conclusion Our findings highlight the known association between CS-related respiratory morbidity and gestational age, supporting recent guidelines that advocate postponing elective CSs until 39 weeks of gestational age.

Câncer gestacional - importância do conhecimento e aprimoramento da equipe de enfermagem / Gestational cancer - importance of knowledge and improvement of the nursing team / Cáncer gestacional: importancia del conocimiento y mejora del equipo de enfermería

Introdução: Câncer gestacional pode ocorrer durante a gravidez ou a lactação e até um ano. Quando diagnosticado tardiamente predispõe a mulher a um quadro mais agressivo, com comprometimento dos linfonodos e, consequentemente, do sistema linfático. No Brasil o câncer gestacional é considerado um problema de saúde pública de complexidade elevada. Objetivos: Discutir sobre as condutas de Enfermagem frente à assistência de mulheres com câncer gestacional; descrever o conceito de câncer gestacional e caracterizar os diagnósticos indicados para câncer na gestação; identificar intervenções de Enfermagem à gestante com câncer. Material e Método: Pesquisa de revisão integrativa, com busca feita pela Biblioteca Virtual em Saúde (BVS), considerando artigos publicados em português entre os anos de 2014 até 2017. Resultados: Compuseram a amostra 12 estudos, os quais buscaram responder a uma questão norteadora. O tema é complexo e há poucos estudos sobre assistência de Enfermagem para gestantes e parturientes com câncer oncológico, capazes de guiar as ações/intervenções com segurança e qualidade. Conclusão: A dificuldade de identificação dos sintomas e a propedêutica limitada parecem atrasar o diagnóstico, impactando na sobrevida global das mulheres no período gestacional. Importante intervir de forma preventiva e oferecer apoio psicológico à gestante e à família.(AU)

Introduction: Gestational cancer can occur during pregnancy or lactation and up to one year. When diagnosed late, it predisposes the woman to a more aggressive condition, with lymph node involvement and, consequently, the lymphatic system. In Brazil, gestational cancer is considered a public health problem of high complexity. Objectives: To discuss the nursing behavior regarding the care of women with gestational cancer; know the concept of gestational cancer and characterize the indicated diagnoses for cancer in pregnancy; identify nursing interventions for pregnant women with cancer. Material and Method: Research integrative review, with search by the Virtual Health Library (VHL), considering articles published in Portuguese between 2014 and 2017. Results: The sample comprised 12 studies, which sought to answer the guiding question of the study. The theme is complex and there are few studies on nursing care for pregnant women and parturients with cancer, able to guide actions/interventions with safety and quality. Conclusion: The difficulty in identifying symptoms and limited propaedeutics seem to delay diagnosis, impacting the overall survival of women during pregnancy. It is important to intervene in a preventive manner and offer psychological support to pregnant women and their families.(AU)

Introducción: El cáncer gestacional puede ocurrir durante el embarazo o la lactancia y hasta un año. Cuando se diagnostica tarde, predispone a la mujer a una afección más agresiva, con afectación de los ganglios linfáticos y, en consecuencia, del sistema linfático. En Brasil, el cáncer gestacional se considera un problema de salud pública de alta complejidad. Objetivos: Discutir el comportamiento de enfermería con respecto al cuidado de mujeres con cáncer gestacional; conocer el concepto de cáncer gestacional y caracterizar los diagnósticos indicados para cáncer en el embarazo; identificar intervenciones de enfermería para mujeres embarazadas con cáncer. Material y Método: Revisión integradora de investigación, con búsqueda en la Biblioteca Virtual en Salud (BVS), considerando artículos publicados en portugués entre 2014 y 2017. Resultados: La muestra comprendió 12 estudios, que buscaron responder a la pregunta orientadora del estudio El tema es complejo y existen pocos estudios sobre cuidados de enfermería para mujeres embarazadas y parturientas con cáncer, capaces de guiar acciones/intervenciones con seguridad y calidad. Conclusión: La dificultad para identificar los síntomas y la propedéutica limitada parecen retrasar el diagnóstico, afectando la supervivencia general de las mujeres durante el embarazo. Es importante intervenir preventivamente y ofrecer apoyo psicológico a la mujer embarazada y su familia.(AU)

Herlyn-Werner-Wunderlich and Prader-Willi syndromes: more than a coincidence?

A neonate with a prenatal diagnosis of left renal agenesis was born at 33 weeks gestation. A postnatal abdominal ultrasound confirmed the absence of the left kidney and revealed two non-divergent hemiuteri, consistent with the diagnosis of Herlyn-Werner-Wunderlich syndrome. During admission, significant axial hypotonia was noted, warranting additional investigations. Brain ultrasounds and MRI were normal, as were a preliminary metabolic study and comparative genomic hybridisation array. DNA methylation testing confirmed the diagnosis of Prader-Willi syndrome. The baby was discharged after 70 days, breast feeding and with modest hypotonia improvement.

Sporotrichosis in HIV-infected patients: report of 21 cases of endemic sporotrichosis in Rio de Janeiro, Brazil.

Sporotrichosis is endemic in Rio de Janeiro, Brazil, and cases have been reported to be associated with HIV. This article describes the clinical manifestations and evolution of sporotrichosis in HIV-positive patients and constitutes the largest case series reported to date. There were 21 HIV-positive patients with sporotrichosis diagnosed by the recovery of the etiologic agent from 1999-2009. Sixteen patients (76.2%) were men and five (23.8%) were women, with a mean age of 41.2 years. Seven of these individuals were previously unaware of their HIV infection. Mean CD4 count was 346.4 cells/µl. The most frequent clinical presentations of sporotrichosis in these patients were the lymphocutaneous and disseminated form (seven patients each, 33.3%), followed by the widespread cutaneous form in five (23.8%), and fixed form in the remaining two (9.5%). In patients with the disseminated forms, clinical manifestations involved the skin in six, mucosa (nasal, oral, or conjunctival) in four, bone in two, and meninges in two. Eleven (52.4%) patients received itraconazole and eight (38.1%) amphotericin B contributing to an overall cure rate of 81%. Spontaneous cure was observed in one patient. The clinical forms of sporotrichosis varied according to the patients' immune status. The results demonstrate the importance of sporotrichosis as an opportunistic infection associated with AIDS in countries where the mycosis occurs.

Disseminated sporotrichosis as a manifestation of immune reconstitution inflammatory syndrome.

We describe two cases of disseminated sporotrichosis as a manifestation of immune reconstitution inflammatory syndrome. After the initiation of highly active anti-retroviral therapy, one patient presented disseminated lesions, whereas the other patient's preexisting lesions worsened and became more extensive. Simultaneously, their CD4 T cell counts increased and HIV viral loads decreased.