Suporte imediato de vida na pessoa em situação crítica: Contributos da intervenção do enfermeiro / Immediate life support to critical patients: Nursing care contributions / Soporte vital inmediato en situaciones críticas: Contribuciones de la intervención de enfermería

Resumo Enquadramento: As ambulâncias de suporte imediato de vida (SIV) possibilitam ao enfermeiro capacidade de intervenção em contexto pré-hospitalar, suportada pelo seu conhecimento técnico-científico, protocolos complexos de atuação e regulação médica por telemedicina. Objetivo: Analisar os contributos da intervenção dos enfermeiros SIV, na evolução do estado clínico da pessoa em situação crítica (PSC). Metodologia: Estudo quantitativo, descritivo-correlacional, retrospetivo, realizado em meios SIV, na região norte de Portugal. Analisados 574 registos clínicos eletrónicos, entre 01 de novembro e 31 de dezembro de 2019, que correspondem ao mesmo número de pessoas avaliadas. Utilizada a escala National Early Warning Score (NEWS) para avaliar a evolução clínica da PSC. Resultados: Observou-se uma evolução positiva do score NEWS da PSC, após a intervenção do enfermeiro SIV (M = 4,43 ± 3,901 vs 3,34 ± 3,329; sig < 0,001). Em sentido inverso, o risco clínico diminuiu significativamente após a intervenção do enfermeiro. Conclusão: Demonstrou-se a relevância da intervenção do enfermeiro SIV no contexto pré-hospitalar, enquanto garantia de segurança, qualidade e melhoria contínua dos cuidados à PSC.

Abstract Background: Immediate life support (ILS) ambulances allow nurses to intervene in pre-hospital settings, supported by their technical-scientific knowledge and complex protocols of action and regulation through telemedicine. Objective: To analyze the contributions of nursing interventions in the evolution of the clinical state of critical patients. Methodology: Quantitative, descriptive-correlational, retrospective, and observational study conducted in ILS settings in northern Portugal. A total of 574 electronic clinical records were analyzed between 1 November and 31 December 2019, corresponding to the same number of people evaluated. The National Early Warning Score (NEWS) was used to assess the clinical evolution of critical patients. Results: There was a positive evolution of the NEWS score of critical patients after the intervention of ILS nurses (M = 4.43 ± 3.901 vs. 3.34 ± 3.329; sig < 0.001). Similarly, the clinical risk of critical patients decreased after the nurse's intervention. Conclusion: This study demonstrated the importance of nurses in prehospital care, as a guarantee of safety, quality, and continuous improvement of care for critical patients.

Resumen Marco contextual: Las ambulancias de soporte vital inmediato (SVI) permiten al personal de enfermería intervenir en un contexto prehospitalario, con el apoyo de sus conocimientos técnico-científicos y de complejos protocolos de actuación y regulación médica a través de la telemedicina. Objetivo: Analizar las aportaciones de la intervención del personal de enfermería del SVI en la evolución del estado clínico de la persona en situación crítica (PSC). Metodología: Estudio cuantitativo, descriptivo-correlacional, retrospectivo, realizado en centros de SVI del norte de Portugal. Se analizaron 574 historias clínicas electrónicas entre el 1 de noviembre y el 31 de diciembre de 2019, correspondientes al mismo número de personas evaluadas. Se utilizó la escala National Early Warning Score (NEWS) para evaluar la evolución clínica de la PSC. Resultados: Se observó una evolución positiva en el score NEWS de la PSC, tras la intervención del personal de enfermería del SVI (M = 4,43 ± 3,901 vs 3,34 ± 3,329; sig < 0,001). Por el contrario, el riesgo clínico disminuyó significativamente tras la intervención del personal de enfermería. Conclusión: Se demostró la relevancia de la intervención del personal de enfermería del SVI en el contexto prehospitalario, como garantía de seguridad, calidad y mejora continua en la atención a la PSC.

Prevalence and molecular characterization of carbapenem-resistant Enterobacterales in patients from a public referral hospital in a non-metropolitan region of Brazil during and post the SARS-CoV-2 pandemic.

Antimicrobial resistance (AMR) poses a global threat, with carbapenem-resistant Enterobacterales (CRE) representing a significant concern due to limited therapeutic options. This study investigated the prevalence of carbapenemase genes in CRE strains isolated from tracheal aspirates of patients at a Brazilian university hospital between January 2020 and August 2023. Bacterial identification was conducted using MALDI-TOF, while carbapenemase genes were detected by qPCR. Demographic and clinical data were collected, and univariate analysis was performed using the chi-square test (p < 0.05). Variables with p ≤ 0.10 were further investigated using the chi-square test for linear trend, along with stratified analysis. Out of 1,133 samples, 111 (9.79%) showed CRE growth, with 46 isolates included in the final sample, predominantly comprising Klebsiella pneumoniae (65.21%) and Serratia marcescens (19.57%). The blaKPC gene was prevalent (78.26%), while blaNDM was detected in 21.74% of cases. The identified population was predominantly male (67.39%), elderly (69.57%), white (56.52%), unmarried (63.04%), and had a low level of education (56.52%). Most patients (69.57%) were in the intensive care unit and remained hospitalized for more than 30 days (76.08%). There was a significant inverse trend between Klebsiella pneumoniae and age (p = 0.045), as well as a direct linear trend between blaNDM and the annual increase in COVID-19 cases in Brazil (p = 0.050). A high probability of finding non-Klebsiella pneumoniae bacteria was observed in patients with prolonged hospital stays, independent of COVID-19 (p = 0.006) and the type of resistance genes (p = 0.020). The persistent prevalence of CRE, especially with blaKPC, underscores the urgency of effective control measures.

Synthesis of 5-Selenosubstituted Spirocyclopenta[b]pyridine-2,5-dien-4-ones and Benzo[h]quinolines via Radical Cyclization of Arylethynylpyridines.

A practical strategy for obtaining novel 5-seleno-substituted spirocyclopenta[b]pyridines-2,5-dien-4-ones and benzo[h]quinolines via radical cyclization is reported. The synthetic protocol explores the reaction between arylethynylpyridines and diorganyl diselenides in acetonitrile as solvent and Oxone® as oxidant at 82 °C. This easy-to-handle, eco-friendly metal-free approach was carried out under an open atmosphere, affording functionalized organoselenium compounds in good to excellent yields. Control experiments and scale-up test were performed to demonstrate the efficiency of this methodology.

Hydrodynamic Evaluation of a Filtering Hydrocyclone for Solid Particle/Water Separation.

A conventional hydrocyclones is a versatile equipment with a high processing capacity and low maintenance cost. Currently, several studies aim to alter the typical structure of the conventional hydrocyclone in order to modify its performance and purpose. For this, filtering hydrocyclones have emerged, where a porous membrane replaces the conic or cylindrical wall. During the operation of this equipment, in addition to the traditionally observed streams (feed, underflow, and overflow), there is a liquid stream resulting from the filtration process, commonly referred to as filtrate. This work proposes to numerically investigate the solid particle/liquid water separation process in a filtering hydrocyclone using the commercial software Ansys CFX® 15.0. The proposed mathematical model for the study considers three-dimensional, steady state and turbulent flow, using the Eulerian-Eulerian approach and the Shear Stress Transport (SST) turbulence model. This study presents and analyzes the volume fraction, velocity, and pressure fields, along with flowlines and velocity profiles. The results indicate that the proposed model effectively captures the fluid dynamic behavior within the filtering hydrocyclone, highlighting higher pressures near the porous membrane and a higher concentration of solid particles in the conical region, with water being more concentrated in the cylindrical part of the hydrocyclone. Additionally, the findings show that the volumetric flow rate of the filtrate significantly influences the internal flow dynamics, with conventional hydrocyclones demonstrating higher pressure gradients compared to the proposed filtering hydrocyclone.

Assessing the burden of disease of gram-negative bloodstream infections in a Brazilian hospital: A retrospective cohort study from 2015 to 2019.

Objectives: This study aimed to estimate the disease burden of BSIs caused by gram-negative bacteria (GNB-BSIs) in a Brazilian hospital from 2015 to 2019, measured in disability-adjusted life-years (DALYs). Methods: A retrospective cohort study of adult patients with GNB-BSI was conducted from April 01, 2015 to March 31, 2019. This study was carried out in a 356-bed private hospital with a 68-bed medical intensive care unit located in Salvador, Brazil. Demographic and clinical data were collected through a review of medical records. DALYs were estimated using Monte Carlo Simulations, using life tables for Brazilians estimated for 2020 and the Global Burden of Diseases 2010 (GBD 2010). Results: A total of 519 GNB-BSI episodes in 498 individuals were identified. The mean age was 59.92 ± 17.97 years, with 61.1% being male. The most common bacterial infections were Klebsiella pneumoniae and Escherichia coli (66.5%), whereas carbapenem-resistant gram-negative bacteria (CR-GNB) accounted for 32.7% of cases. The highest overall DALYs were observed in 2018 (752, 95% confidence interval [CI]: 520-1021 with Brazilian Life Tables and 782, 95% CI: 540-1062 with GBD 2010). Infections due to CR-GNB had the highest DALYs, particularly, in 2017, reaching 7050 (95% CI: 3200-12,150 with Brazilian Life Tables and 7350, 95% CI: 3350-12,700 with GBD 2010) DALYs per 1000 patient days and an estimated mortality rate of 40% per 1000 patient days. Conclusions: The persistently high DALYs associated with CR-GNB raise alarming concerns, potentially leading to over 300 deaths per 1000 patient days in the coming years. These findings underscore the urgency of addressing GNB-BSI as a significant public health issue in Brazil. These results are expected to provide helpful information for public health policymakers to prioritize interventions for infections due to antibiotic-resistant bacteria.

Enhanced carbon dioxide drainage observed in digital rock under intermediate wetting conditions.

Carbon dioxide (CO 2 ) trapping in capillary networks of reservoir rocks is a pathway to long-term geological storage. At pore scale, CO 2 drainage displacement depends on injection pressure, temperature, and the rock's interaction with the surrounding fluids. Modeling this interaction requires adequate representations of both capillary volume and surface. For the lack of scalable representations, however, the prediction of a rock's CO 2 storage potential has been challenging. Here, we report how to represent a rock's pore space by statistically sampled capillary networks (ssCN) that preserve morphological rock characteristics. We have used the ssCN method to simulate CO 2 drainage within a representative sandstone sample at reservoir pressures and temperatures, exploring intermediate- and CO 2 -wet conditions. This wetting regime is often neglected, despite evidence of plausibility. By raising pressure and temperature we observe increasing CO 2 penetration within the capillary network. For contact angles approaching 90 ∘ , the CO 2 saturation exhibits a pronounced maximum reaching 80 % of the accessible pore volume. This is about twice as high as the saturation values reported previously. For enabling validation of our results and a broader application of our methodology, we have made available the rock tomography data, the digital rock computational workflows, and the ssCN models used in this study.

Variation in Soluble Sugars in Arabica Coffee Cherry Fruits.

The maturation of Arabica coffee fruits is influenced by both endogenous and external factors. The stage of fruit maturation affects the chemical composition of the beans, which in turn impacts the quality of the coffee beverage. During maturation, the fruit peel changes colour from green to red (cherry), signalling the optimal harvest time and suggesting high fruit quality. However, the degree of redness can vary, indicating different levels of maturity. This study aimed to explore the variation in soluble sugar accumulation in relation to the redness of coffee fruit tissues. We classified ripe fruits into six ripeness categories based on the intensity of the red colour of the epicarp, measured using a colourimeter. We analysed total soluble sugar, sucrose, and starch in three parts: coat (exocarp + mesocarp), coat juice (obtained by squeezing the coat), and beans. Our findings reveal that the variation in sugar in the endosperm does not correspond to changes in the coat, suggesting separate regulation of sugar accumulation, particularly sucrose, which is crucial for coffee quality. Our data indicate that there is no transfer of sucrose and reducing sugars from the red coat to the bean.

Interference of Streptococcus agalactiae Blitz Therapy in Staphylococcus aureus Microbiological Diagnosis in Subclinical Bovine Mastitis.

Bovine mastitis is an important and costly disease to dairy cattle. Diagnostic methods usually performed in Brazil are somatic cell counts (SCC) and milk microbiology. Low bacteria shedding in milk implies no colony growth in microbiological tests and false negative results. Streptococcus agalactiae and Staphylococcus aureus are principal pathogens of mixed mastitis. However, S. agalactiae has a higher bacterial release from the mammary gland than S. aureus, affecting microbiological sensitivity to diagnose S. aureus. This study aimed to estimate the SCC and total bacterial count (TBC) from cows according to pathogen isolated in milk and to evaluate variation in S. aureus diagnosis by a microbiological test during S. agalactiae treatment, which is called blitz therapy. Both S. agalactiae and S. aureus presented high SCC means, although S. agalactiae showed shedding of bacteria 2.3 times greater than S. aureus. Microbiological sensitivity to S. aureus increased for 5 months during S. agalactiae treatment. The prevalence of S. agalactiae fell after 5 months of therapeutic procedures. The prevalence of S. aureus increased to 39.0. The results showed that due to high sensitivity, the polymerase chain reaction (PCR) could be used at the beginning of blitz therapy with the goal of S. agalactiae eradication from the dairy herd.

Utilization of metal and radionuclide concentrations to assess the influence of shrimp farming on the geochemical characteristics of sediments.

This article assesses the environmental impacts of aquatic biota cultivation, focusing on shrimp farming in Brazil's Northeast, as this practice has proven to be one of the main sources of economic growth in the region. For this purpose, sediment samples were collected from areas impacted and not directly impacted by shrimp farming, and concentrations of key geochemical parameters such as salinity, various elements (K, P, Cu, Mn, Pb, Zn, Al, Ca, Fe, Mg, and Na), and natural radionuclides (K-40, Ra-226 and Ra-228) were compared using statistical tools. Element concentrations were determined using ICP-OES, and naturally occurring radionuclide concentrations were obtained through gamma spectrometry. Statistical tests, such as ANOVA and/or Mann-Whitney, cluster analysis, and principal component analysis, were applied to the results. Additionally, the ERICA Tool software was employed to estimate deleterious effects on both human and non-human biota. Descriptive statistics reveal variability in sediment parameters around shrimp farming. ANOVA and Mann-Whitney tests compare concentrations of shrimp farm sediment and not directly impacted sediment, showing non-significant differences for most elements. pH and salinity, crucial for shrimp health, exhibit higher values in shrimp farm sediment. Alkali and alkaline earth metals, including K and Na, show no significant differences. Factor and cluster analyses suggest that certain elements, mainly radionuclides, are influenced by sediment variability. Hazard indices for naturally occurring radionuclides indicate negligible risk to both human and non-human biota, reinforcing the absence of adverse effects from shrimp farming activities. This study provides a comprehensive analysis of the environmental impacts of shrimp farming, emphasizing the importance of monitoring geochemical parameters for coastal environmental management.

Current knowledge on leptospirosis in cats: A systematic review with metanalysis on direct detection, serological response, and clinical data.

Leptospirosis is a neglected bacterial zoonosis that affects a wide range of mammals, with important implications from a One Health perspective. Over the past years feline leptospirosis has gained increased attention in the scientific community. Here we describe a systematic review with meta-analysis that followed the PRISMA guidelines, with an additional PROSPERO registration. The study provides global seropositivity, urinary shedding rates, global serogroup distribution, descriptive data of leptospires that had been isolated from cats and clinical and laboratory features presented by symptomatic cats with acute disease. The search was carried out in six different databases, with the identification of 79 reports describing leptospiral infection in cats. The pooled frequency of seroreactive cats was 11% (95% CI: 9%-13%), with Javanica and Pomona as the most frequent serogroups found. Frequency for urinary shedding was 8% (95% CI: 5%-10%), with L. interrogans identified in most samples. A total of 16 isolates were isolated from cats, with Bataviae as the most frequent serogroup. Twenty symptomatic cats with confirmed leptospiral infection were identified. Anorexia, lethargy, polydipsia, and bleeding disorders were the clinical signs most frequently reported. The results suggest that cats from some locations are exposed to leptospires and may act as urinary shedders of this pathogen, thus indicating a possible role of this species in disease transmission. Clinical data indicates that acute infection is mostly atypical when compared to dogs, and due to difficulties to define an archetypal clinical presentation in cats, feline leptospirosis is likely to be underdiagnosed disease in this species.

In vivo anti-inflammatory activity of BACCHARIN from BRAZILIAN green PROPOLIS.

Baccharin is one of the major compounds found in Brazilian green propolis and its botanical source, Baccharis dracunculifolia. Considering the biological effects of propolis and B. dracunculifolia, this study aims to evaluate the analgesic and anti-inflammatory potential of baccharin. The neurodepressor potential was performed by the open field test, analgesia by mechanical stimulation with Dynamic Plantar Aesthesiometer, and by thermal stimulation with Hargreaves apparatus. In addition, the anti-inflammatory potential was achieved by the paw edema assay, histopathological evaluation, and NF-kB expression. Doses of 2.5, 5, and 10 mg/kg of baccharin were evaluated. After euthanasia, plantar tissue was collected and prepared for histology. As a result, analgesic activity was observed at a dose of 10 mg/kg of baccharin in thermal stimulation under an inflammatory process and anti-inflammatory potential at a dose of 5 mg/kg of baccharin from the second hour in the paw edema test. A decrease in cellular infiltrate and down-modulation of NF-kB, besides the reduction of edema in the histopathology was observed. There was no evidence of kidney and liver toxicity and neurodepressive potential at the doses tested. Thus, baccharin has a promising anti-inflammatory effect possibly associated with antiedematogenic activity by inhibiting mediators such as prostaglandins, inhibiting the migration of polymorphonuclear cells, and modulating NF-kB expression.

Citronellal: a natural aldehyde with important properties.

Among the several terpenes existing in nature, Citronellal, a monoterpene aldehyde, deserves to be highlighted for its biological properties that have been pointed out in numerous studies. This work aimed to conduct a literature review on its biological properties. Citronellal is a prominent compound in the essential oils of Cymbopogon genus plants. Apart from being employed as a fragrance ingredient in aromas, fragrances, and cosmetics, it is also used as an intermediate in synthesising (-)-menthol. Various studies have demonstrated Citronellal's potential as an antibacterial compound, particularly anti-Staphylococcus and Escherichia bacteria. Citronellal also has antifungal properties against several fungi, especially fungi of the genus Candida. The studies found showed that Citronellal also has insecticidal, acaricidal, antiparasitic, anaesthetic, antiviral, antioxidant, antinociceptive, cardioprotective, antihypertensive, anti-inflammatory, antidiabetic, and anticancer properties.

Telescoping Synthesis of 4-Organyl-5-(organylselanyl)thiazol-2-amines Promoted by Ultrasound.

In this work, we describe the synthesis of new 4-organyl-5-(organylselanyl)thiazol-2-amine hybrids through a one-pot two-step protocol. The transition metal-free method involves the use of ultrasound as an alternative energy source and Oxone® as oxidant. To obtain the products, a telescoping approach was used, in which 4-organylthiazol-2-amines were firstly prepared under ultrasonic irradiation, followed by the addition of diorganyl diselenides and Oxone®. Thus, 16 compounds were prepared, with yields ranging from 61 % to 98 %, using 2-bromoacetophenone derivatives and diorganyl diselenides as easily available starting materials.

Gingival squamous cell carcinoma in 2 lions under managed care.

Neoplasia is one of the main causes of euthanasia in geriatric captive nondomestic felids. However, few studies have examined oral tumors in these animals. We describe here the clinicopathologic features of gingival squamous cell carcinoma (SCC) in 2 lions (Panthera leo) from separate zoologic collections. In both cases, the lions had a history of sialorrhea, bloody oral discharge, and anorexia. Autopsy findings in both lions were similar and were characterized by poorly circumscribed, friable, and bloody gingival masses with grossly apparent invasion of the mandibular bone; a pathologic fracture was observed in 1 case. Histologically, the masses consisted of poorly circumscribed, unencapsulated, densely cellular proliferations of neoplastic epithelial cells arranged in irregular islands, cords, and anastomosing trabeculae with formation of keratin pearls, which, coupled with positive immunohistochemistry for pancytokeratin, were diagnostic for SCC. Although no metastases were found in either animal, both lions were ultimately euthanized because of poor prognosis.

Evaluation of Extraction Methods to Detect Noroviruses in Ready-to-Eat Raw Milk Minas Artisanal Cheese.

This study aimed to assess two homogenization methods to recover norovirus from Minas artisanal cheese (MAC) made with raw bovine milk obtained from four microregions of the Minas Gerais state, Brazil, with different ripening times and geographical and abiotic characteristics. For this purpose, 33 fiscal samples were artificially contaminated with norovirus GI and GII, and Mengovirus (MgV), used as an internal process control (IPC). TRIzol® reagent and Proteinase K homogenization methods were evaluated for all samples were then subjected to RNA extraction using viral magnetic beads and RT-qPCR Taqman® for viral detection/quantification. Proteinase K method showed better efficiency results for both norovirus GI and GII, with means recovery efficiency of 45.7% (95% CI 34.3-57.2%) and 41.4% (95% CI 29.1-53.6%), respectively, when compared to TRIzol method (16.6% GI, 95% CI 8.4-24.9%, and 12.3% GII, 95% CI 7.0-17.6%). The limits of detection for norovirus GI and GII for this method were 101GC/g and 103GC/g, respectively, independent of cheese origin. MgV was detected and revealed in 100% success rate in all types of cheese, with mean recovery efficiency of 25.6% for Proteinase K, and 3.8% for the TRIzol method. According to cheese origin, Triangulo Mineiro MAC had the highest mean recovery rates for the three viral targets surveyed (89% GI, 87% GII, and 51% MgV), while Serro MAC showed the lowest rates (p < 0.001). Those results indicate that the proteinase K adapted method is suitable for norovirus GI and GII detection in MAC and corroborated MgV as an applicable IPC to be used during the process.

Micro-Addition of Silver to Copper: One Small Step in Composition, a Change for a Giant Leap in Biocidal Activity.

The use of copper as an antimicrobial agent has a long history and has gained renewed interest in the context of the COVID-19 pandemic. In this study, the authors investigated the antimicrobial properties of an alloy composed of copper with a small percentage of silver (Cu-0.03% wt.Ag). The alloy was tested against various pathogens, including Escherichia coli, Staphylococcus aureus, Candida albicans, Pseudomonas aeruginosa, and the H1N1 virus, using contact exposure tests. Results showed that the alloy was capable of inactivating these pathogens in two hours or less, indicating its strong antimicrobial activity. Electrochemical measurements were also performed, revealing that the small addition of silver to copper promoted a higher resistance to corrosion and shifted the formation of copper ions to higher potentials. This shift led to a slow but continuous release of Cu2+ ions, which have high biocidal activity. These findings show that the addition of small amounts of silver to copper can enhance its biocidal properties and improve its effectiveness as an antimicrobial material.

Helminths of Wied's marmoset (Callithrix kuhlii (Coimbra-Filho, 1985) (Primates: Callitrichidae)) from the Atlantic Forest, Southern Bahia State, Brazil.

Callithrix kuhlii is present in forest mosaics, edge habitats, and abandoned fields in the Atlantic Forest. In Bahia and Minas Gerais. This study aimed to identify helminths from C. kuhlii and relate them to the clinical data, weights, and indices of the liver and gonads. Necropsies were performed on 13 adult marmosets that were run over on the BA-001 highway. A principal component analysis (PCA) was conducted to describe the relationships between the variables investigated. Fifty-one helminths were collected from 30.77% (4/13) of the marmosets analyzed. Helminths were classified based on their morphological and morphometric characteristics. Primasubulura jacchi (Marcel, 1857), Platynosomum illiciens (Dougherty, 1946), and Prosthenorchis confusus (Dougherty, 1946) were the species identified, with prevalence rates of 7.69%, 7.69%, and 15.38%, respectively. In addition, this is a new host record of P. confusus. The two main axes of the PCA explained a high variability (PCA=67.7%), indicating reduced weight and indices of the organs of parasitized animals. This study expands the knowledge on parasites of C. kuhlii and its vulnerability to parasites, contributing to constructing an epidemiological profile of environmental health.