Endogenous peripheral hydrogen sulfide is propyretic: its permissive role in brown adipose tissue thermogenesis in rats.

NEW FINDINGS: What is the central question of this study? In fever, the most striking response in the acute phase reaction of systemic inflammation, plasma H2 S concentration increases. However, the role of endogenous peripheral H2 S in fever is unknown. What is the main finding and its importance? Endogenous peripheral H2 S is permissive for increased brown adipose tissue thermogenesis to maintain thermal homeostasis in cold environments as well as to mount fever. This finding expands the physiological role of the gaseous modulator as a key regulator of thermal control in health (thermal homeostasis) and disease (fever in systemic inflammation). ABSTRACT: In recent years, hydrogen sulfide (H2 S) has been reported as a gaseous modulator acting in several tissues in health and disease. In animal models of systemic inflammation, the plasma H2 S concentration increases in response to endotoxin (bacterial lipopolysaccharide, LPS). The most striking response in the acute phase reaction of systemic inflammation is fever, but we found no reports of the peripheral action of H2 S on this thermoregulatory response. We aimed at investigating whether endogenous systemic H2 S modulates LPS-induced fever. A temperature datalogger capsule was inserted in the abdominal cavity of male Wistar rats (220-270 g) to record body core temperature. These animals received an i.p. injection of a systemic H2 S inhibitor (propargylglycine; 50 or 75 mg kg-1 ), immediately followed by an i.p. injection of LPS (50 or 2500 µg kg-1 ), and were exposed to different ambient temperatures (16, 22 or 27°C). At 22°C, but not at 27°C, propargylglycine at 75 mg kg-1 significantly attenuated (P < 0.0001) the fever induced by LPS (50 µg kg-1 ), indicating a modulatory (permissive) action of endogenous peripheral H2 S on brown adipose tissue (BAT) thermogenesis. Evidence on the modulatory role of peripheral H2 S in BAT thermogenesis was strengthened when we discarded (i) the possible influence of the gas on febrigenic signalling (when measuring plasma cytokines), and (ii) its interaction with the nitric oxide pathway, and mainly when (iii) we carried out physiological and pharmacological activations of BAT. Endogenous peripheral H2 S modulates (permits) BAT activity not only in fever but also during maintenance of thermal homeostasis in cold environments.

EBUS-TBNA in mediastinal staging of non-small cell lung cancer: comparison with pathological staging.

OBJECTIVE: Although EBUS-TBNA combined with EUS-FNA or EUS-B-FNA stands as the primary approach for mediastinal staging in lung cancer, guidelines recommend mediastinoscopy confirmation if a lymph node identified on chest CT or showing increased PET scan uptake yields negativity on these techniques. This study aimed to assess the staging precision of EBUS/EUS. METHODS: We conducted a retrospective study comparing the clinical staging of non-small cell lung cancer patients undergoing EBUS/EUS with their post-surgery pathological staging. We analyzed the influence of histology, location, tumor size, and the time lapse between EBUS and surgery. Patients with N0/N1 staging on EBUS/EUS, undergoing surgery, and with at least one station approached in both procedures were selected. Post-surgery, patients were categorized into N0/N1 and N2 groups. RESULTS: Among the included patients (n = 47), pathological upstaging to N2 occurred in 6 (12.8%). Of these, 4 (66.7%) had a single N2 station, and 2 (33.3%) had multiple N2 stations. The adenopathy most frequently associated with upstaging was station 7. None of the analyzed variables demonstrated a statistically significant difference in the occurrence of upstaging. PET scan indicated increased uptake in only one of these adenopathies, and only one was visualized on chest CT. CONCLUSIONS: Upstaging proved independent of the studied variables, and only 2 patients with negative EBUS/EUS would warrant referral for mediastinoscopy. Exploring other noninvasive methods with even greater sensitivity for detecting micrometastatic lymph node disease is crucial.

Tuberculosis screening in the European migrant population: a scoping review of current practices.

Responding to a surge in new tuberculosis (TB) cases among migrants from high-incidence countries, low-incidence European nations have heeded World Health Organization recommendations by implementing TB screening in this population. This review aims to synthesise evidence on current screening strategies for active TB and latent tuberculosis infection (LTBI) in European high-income countries, and their main barriers and interventions. PubMed, Web of Science and Scopus were searched from March to April 2023, including articles in English, published in the last decade, pertaining to screening strategies for active TB or LTBI in Europe focused on migrants, excluding those exclusively composed of refugees, asylum seekers or other migrant populations. 32 studies fit the criteria. Screening in migrants varies between countries regarding timing, population, screening location and diagnosis. Furthermore, some barriers prevent migrants from benefiting from screening, namely physical, cultural and professional barriers. Additional research is needed to determine the patterns through which regular migrants adhere to current screening strategies in European countries.

Frontal cutaneous and bone sarcoidosis: an example of the contiguous spread of granulomas.

Sarcoidosis is a multisystemic granulomatous disease of unknown origin. It has been argued that the skin is one of the entry doors of the possible antigen that causes sarcoidosis and after entering the skin, the causal agent may progress to the underlying bone. We report four cases with development of sarcoidosis in old scars located on the forehead, and contiguous bone involvement of the frontal bone. In most cases scar sarcoidosis was the first manifestation of the disease, and in most cases it was asymptomatic. Two patients never required treatment, and in all cases the frontal problem improved or remained stable spontaneously or under sarcoidosis treatment. Scar sarcoidosis in the frontal area may have contiguous bone damage. This bone involvement does not seem to be associated with neurological extension.

Interleukin-6 in COVID-19 Severity Stratification.

Background: The increase in the number of patients with COVID-19 on a global scale made the early recognition of severe forms of the disease essential. Considering that IL-6 acts as a pro-inflammatory mediator, mediating acute phase responses, the objective of this study was to assess its value in the early severity stratification of SARS-CoV2 infection. Materials and Methods: It was a prospective study included IL-6 measurement in patients with SARS-CoV2 infection upon admission to the emergency department. Two groups were considered (Group I: patients without hospitalization criteria; Group II: patients with hospitalization criteria). Analyzed variables were serum levels of IL-6, C-reactive protein, ferritin, d-dimers, sociodemographics, ventilator support, ICU admission, mortality, dates of diagnosis, hospitalization, and discharge. For the statistical analyses, Mann-Whitney test, Pearson's chi-square test, area under the receiver operating characteristic curve, Youden index, and Spearman correlation were applied. Results: A total number of 117 patients were included. Mean age was significantly higher for group II (72,35±15,39 years; p<0,001). No statistically significant difference was seen between the groups regarding gender (p=0,111). The IL-6 values showed an excellent power of discrimination for the need for hospitalization (AUC=0,888; p<0,001) and the need for ICU admission (AUC=0,897; p=7.9 × 10-5). Also, its cut-off value of 12,4pg/mL for the need for hospitalization and 42,95 pg/mL for the need for ICU admission was determined. Positive correlation was seen between IL-6 value and length of stay [r(35)=0,380; p=0,020]. Three deaths were observed among patients with hospitalization criteria (8,1%). Conclusion: The value of IL-6 at admission seems to independently influence the probability of hospitalization (general ward or ICU) and its duration.

Metformin improves neurobehavioral impairments of streptozotocin-treated and western diet-fed mice: Beyond glucose-lowering effects.

Brain insulin resistance has been pointed to as a possible link between diabetes and neuropsychiatric disorders; therefore, therapeutic approaches using anti-diabetic drugs to improve insulin levels or signaling could prevent type 1 (T1D) and type 2 diabetes mellitus (T2D)-induced brain dysfunction. The present study aimed to determine whether metformin exerts beneficial effects on metabolic and neurobehavioral outcomes in the streptozotocin (STZ)-induced T1D model and western diet (WD)-induced obesity model in male Swiss mice. T1D was induced by intraperitoneal injection of STZ (50 mg/kg, for five consecutive days). The animals were then treated daily with saline or metformin (200 mg/kg/day, oral gavage), and a battery of tests recapitulating different neurobehavioral anomalies related to anxiogenic/depressive-like phenotype was conducted after 18 days. WD-induced obesity was modeled in mice by high-fat and high-fructose diet (HFFD) feeding for 15 days. In the sequence, control and diet-induced obesity mice were treated daily with saline or metformin (200 mg/kg/day), and a battery of behavioral tests was performed after 17 days. STZ injection and WD feeding induced metabolic and neurobehavioral impairments in mice. Remarkably, metformin improved the metabolic and neurobehavioral parameters in WD-induced obesity mice. Moreover, metformin ameliorated STZ-induced neurobehavioral deficits while it failed to improve the associated metabolic impairments. The beneficial effects of metformin in STZ-induced neurobehavioral impairments were not mediated by improving peripheral insulin signaling. Our results suggest that conventional diabetes treatment could be repurposed to simultaneously improve neurobehavioral symptoms and diabetes.

Switching from high-fat feeding (HFD) to regular diet improves metabolic and behavioral impairments in middle-aged female mice.

Obesity represents a risk factor for metabolic syndrome and cardiovascular and psychiatric disorders. Excessive caloric intake, particularly in dietary fats, is an environmental factor that contributes to obesity development. Thus, the observation that switching from long-standing dietary obesity to standard diet (SD) can ameliorate the high-fat diet-induced metabolic, memory, and emotionality-related impairments are particularly important. Herein we investigated whether switching from the high-fat diet (HFD) to SD could improve the metabolic and behavioral impairments observed in middle-aged females C57Bl/6 mice. During twelve weeks, the animals received a high-fat diet (61 % fat) or SD diet. After 12-weeks, the HFD group's diet was switched to SD for an additional four weeks. It was observed a progressive deleterious effect of HFD in metabolic and behavioral parameters in mice. After four weeks of HFD-feeding, the animals showed glucose intolerance and increased locomotor activity. A subsequent increase in the body mass gain, hyperglycemia, and depressive-like behavior was observed after eight weeks, and memory impairments after twelve weeks. After replacing the HFD to SD, it was observed an improvement of metabolic (loss of body mass, normal plasma glucose levels, and glucose tolerance) and behavioral (absence of memory and emotional alterations) parameters. These results demonstrate the temporal development of metabolic and behavioral impairments following HFD in middle-age female mice and provide new evidence that these alterations can be improved by switching back the diet to SD.

A selanylimidazopyridine (3-SePh-IP) reverses the prodepressant- and anxiogenic-like effects of a high-fat/high-fructose diet in mice.

OBJECTIVE: While chronic feeding with high-fat or high-sugar diets is known related to obesity and type 2 diabetes, later data have indicated that it is also related to depression and anxiety appearance. In this regard, multi-target drugs raise considerable interest as promising therapeutic solutions to complex diseases. Considering the pharmacological effects of the imidazopyridine-derivative moiety imidazo[1,2-a]pyridine and the organoselenium molecules, the combination of both could be a feasible strategy to develop efficient drugs to handle obesity and related comorbidities, for example dyslipidemia and mood disorders. METHODS: The antidepressant- and anxiolytic-like properties of a selanylimidazopyridine compound, 2-Phenyl-3-(phenylselanyl)imidazo[1,2-a]pyridine (3-SePh-IP), were evaluated on high-fat/high-fructose diet (HFFD)-fed female Swiss mice. KEY FINDINGS: Our results showed that a short-term HFFD (16 days) could promote a significant body weight gain, hypercholesterolemia, glucose intolerance, and anxiety- and depressive-like behaviour in mice. Concomitant treatment with 3-SePh-IP (10 mg/kg; i.p.) attenuated the HFFD-induced increase in cholesterol levels and blunted the anxiety- and depressive-like behaviour in mice. CONCLUSIONS: 3-SePh-IP holds multimodal pharmacological properties, which provide a rationale for further studies, for example to assess the underlying mechanisms linked to its anxiolytic- and antidepressive-like activities.

Impact of different fructose concentrations on metabolic and behavioral parameters of male and female mice.

Clinical evidence has shown that a high consumption of sugar-sweetened beverages is a risk factor for developing obesity and metabolic syndrome. There has also been increasing interest in the potential effects of high-fructose intake on behavior. The present study evaluated sex differences in behavioral and metabolic characteristics in response to chronic fructose intake in mice. Swiss mice (3-months-old) had access to tap water or fructose-water solution (at 15% or 30% w/v) ad libitum for nine weeks. After the 8 weeks, the mice were submitted to a battery of behavioral tests. A glucose tolerance test was performed one day after these behavioral tests, and the next day blood was collected for biochemical analysis. At a 15% concentration, fructose-intaking resulted in higher plasma cholesterol levels and glucose intolerance in mice that paralleled with a passive stress-coping behavior in the female mice and lower self-care behavior in the male and the female mice. At a 30% concentration, fructose-intaking resulted in higher body mass gain and higher plasma cholesterol and triglycerides levels in the male and the female mice, whereas glucose intolerance was more pronounced in the male mice. Spatial memory impairments and lower self-care behavior were observed in the male and the female mice, while passive stress-coping behavior was observed only in the female mice. Collectively, high-fructose intake induces metabolic and behavioral alterations in mice, with the males being more susceptible to glucose metabolism dysfunctions and the females to depressive-like endophenotypes.

EBUS-TBNA in mediastinal staging of non-small cell lung cancer: comparison with pathological staging

ABSTRACT Objective: Although EBUS-TBNA combined with EUS-FNA or EUS-B-FNA stands as the primary approach for mediastinal staging in lung cancer, guidelines recommend mediastinoscopy confirmation if a lymph node identified on chest CT or showing increased PET scan uptake yields negativity on these techniques. This study aimed to assess the staging precision of EBUS/EUS. Methods: We conducted a retrospective study comparing the clinical staging of non-small cell lung cancer patients undergoing EBUS/EUS with their post-surgery pathological staging. We analyzed the influence of histology, location, tumor size, and the time lapse between EBUS and surgery. Patients with N0/N1 staging on EBUS/EUS, undergoing surgery, and with at least one station approached in both procedures were selected. Post-surgery, patients were categorized into N0/N1 and N2 groups. Results: Among the included patients (n = 47), pathological upstaging to N2 occurred in 6 (12.8%). Of these, 4 (66.7%) had a single N2 station, and 2 (33.3%) had multiple N2 stations. The adenopathy most frequently associated with upstaging was station 7. None of the analyzed variables demonstrated a statistically significant difference in the occurrence of upstaging. PET scan indicated increased uptake in only one of these adenopathies, and only one was visualized on chest CT. Conclusions: Upstaging proved independent of the studied variables, and only 2 patients with negative EBUS/EUS would warrant referral for mediastinoscopy. Exploring other noninvasive methods with even greater sensitivity for detecting micrometastatic lymph node disease is crucial.

A importância do ensino e aprendizagem de técnicas de primeiros socorros para leigos: revisão integrativa / The importance of teaching and learning first aid techniques for laypersons: integrative review / La importancia de la enseñanza y el aprendizaje de las técnicas de primeros auxilios para los profanos: revisión integradora

Objetivo: analisar, a importância do ensino e aprendizagem sobre técnicas de Primeiros Socorros para leigos. Métodos: revisão integrativa nas bases de dados LILACS, MEDLINE via PUBMED, BDENF, CINAHL, SCOPUS e biblioteca Cochrane, sem recorte de tempo. Os descritores utilizados foram.: "Educação da População", "Educação em saúde", "Primeiros Socorros" e "Emergências", em inglês foram delimitados e cruzados os descritores.: "Population Education", "Health Education", "First aid" e "Emergencies" os operadores booleanos AND e OR. A amostra foi composta por 11 artigos. Resultados: capacitações em primeiros socorros têm um impacto significativo principalmente ao se aplicar questionários pré e pós-intervenções, pois os erros cometidos anteriormente já se transformavam em acertos. Conclusão: as intervenções educativas realizadas em escolas e comunidades levam a propagação de conhecimento e aprendizagem, podendo assim tangenciar a formação de multiplicadores, resultando em uma sociedade informada.

Objective: to analyze, the importance of teaching and learning about First Aid techniques for lay people. Methods: integrative review in the databases LILACS, MEDLINE via PUBMED, BDENF, CINAHL, SCOPUS and Cochrane library, without a time cut. The descriptors used were: "Population Education", "Health Education", "First Aid" and "Emergencies", in English the Boolean operators AND and OR were delimited and crossed the descriptors: "Population Education", "Health Education", "First aid" and "Emergencies". The sample consisted of 11 articles. Results: first aid trainings have a significant impact mainly when applying pre- and post-intervention questionnaires, because the mistakes previously made were already transformed into successes. Conclusion: the educational interventions carried out in schools and communities lead to the propagation of knowledge and learning, thus being able to tangent the formation of multipliers, resulting in an informed society.

Objetivos:analizar, la importancia de la enseñanza y el aprendizaje de las técnicas de Primeros Auxilios para los profanos. Métodos:revisión integradora en las bases de datos LILACS, MEDLINE a través de PUBMED, BDENF, CINAHL, SCOPUS y biblioteca Cochrane, sin corte de tiempo. Los descriptores utilizados fueron: "Population Education", "Health Education", "First Aid" y "Emergencies", en inglés se delimitaron y cruzaron los siguientes descriptores: "Population Education", "Health Education", "First aid" y "Emergencies" los operadores booleanos AND y OR. La muestra estaba compuesta por 11 artículos. Resultados: las formaciones en primeros auxilios tienen un impacto significativo sobre todo cuando se aplican los cuestionarios previos y posteriores a la intervención, ya que los errores cometidos anteriormente se transformaron en aciertos. Conclusión: las intervenciones educativas llevadas a cabo en las escuelas y comunidades conducen a la propagación del conocimiento y el aprendizaje, pudiendo así tangibilizar la formación de multiplicadores, dando lugar a una sociedad informada.

Considerações éticas relacionadas às condutas terapêuticas de pacientes terminais / Ethical considerations related to the therapeutic management of terminally ill patients / Consideraciones éticas relacionadas con la conducta terapéutica de los pacientes terminales

Objetivo: Conhecer as considerações éticas relacionadas às condutas terapêuticas das equipes de saúde frente aos pacientes terminais. Metodologia: Trata-se de um estudo exploratório de natureza qualitativa. Realizado no período de dezembro de 2020, através do acesso ao Banco de Teses e Dissertações da CAPES, considerando que este, coordena o Sistema de Pós-graduação brasileiro. Resultados: Foram identificadas seis classes semânticas, de modo que a mesma formulou a seguinte distribuição de contextos temáticos: Classe 1 Paciente terminal; Classe 2 Condutas médicas; Classe 3 Manejo terapêutico; Classe 4 Protocolos clínicos e aspectos metodológicos dos estudos; Classe 5 Dependências metodológicas e Classe 6 Suporte clínico na terminalidade Dependências metodológicas. Discussão: A morte e a vida tornam-se um impasse enfrentado pelos profissionais de saúde, pois existem fatores decisivos na vida de cada paciente em situação terminal com nenhuma esperança de cura, envolvendo assim questões éticas. Conclusão: Portanto, torna-se necessário que as instâncias de saúde assegurem protocolos, treinamentos e aporte psicológicos para esses profissionais que atuam diretamente com pacientes em situações terminais de vida, para que possa haver uma ressignificação do processo de cuidado com pacientes e segurança na tomada de decisões por parte dos profissionais de saúde, e assim possa preservar a ética.

Objective: To know the ethical considerations related to the therapeutic behavior of health teams towards terminal patients. Methodology: This is an exploratory study of a qualitative nature. Carried out in January 2020, through access to the CAPES Theses and Dissertations Bank, considering that it coordinates the Brazilian Postgraduate System. Results: Six semantic classes were identified, so that it formulated the following distribution of thematic contexts: Class 1 Terminal patient; Class 2 Medical conducts; Class 3 Therapeutic management; Class 4 Clinical protocols and methodological aspects of the studies; Class 5 Methodological dependencies and Class 6 Clinical support in terminality Methodological dependencies. Discusson: Death and life become an impasse faced by health professionals, as decisive there are factors in the life of each patient in a terminal situation with no hope of cure, thus involving ethical issues. Conclusion: Therefore, it is necessary that health institutions ensure protocols, training and psychological support for these professionals who work directly with patients in terminal situations, so that there can be a new meaning for the process of patient care and safety in decision-making by health professionals, and thus can preserve ethics.

Objetivo: Conocer las consideraciones éticas relacionadas con las conductas terapéuticas de los equipos de salud frente a los pacientes terminales. Metodología: Se trata de un estudio exploratorio de carácter cualitativo. Realizado en el período de diciembre de 2020, a través del acceso al Banco de Tesis y Disertaciones de la CAPES, considerando que este, coordina el Sistema de Pós-graduación brasileño. Resultados: Se identificaron seis clases semánticas, por lo que se formuló la siguiente distribución de contextos temáticos: Clase 1 Paciente terminal; Clase 2 Conductas médicas; Clase 3 Manejo terapéutico; Clase 4 Protocolos clínicos y aspectos metodológicos de los estudios; Clase 5 Dependencias metodológicas y Clase 6 Apoyo clínico en la terminalidad Dependencias metodológicas. Discusión: La muerte y la vida se convierten en un impasse al que se enfrentan los profesionales de la salud, porque hay factores decisivos en la vida de cada paciente en situación terminal sin esperanza de curación, lo que implica cuestiones éticas. Conclusión: Por lo tanto, se hace necesario que las instancias de salud garanticen protocolos, capacitación y apoyo psicológico para estos profesionales que trabajan directamente con los pacientes en situaciones de vida terminal, para que pueda haber una resignificación del proceso de atención al paciente y seguridad en la toma de decisiones por parte de los profesionales de la salud, y así poder preservar la ética.

Vade mecum sobre o morrer e a morte / Vade mecum about dying and death / Vademécum acerca de morir y la muerte

Resumo Considerando o impacto da morte em múltiplos aspectos da coletividade humana, este artigo reflete sobre como diferentes culturas, em épocas distintas, relacionaram-se com esse tema, buscando interpretar os vários significados associados à finitude. Para tanto, o estudo parte de uma revisão bibliográfica de abordagem qualitativa. Constata-se que as civilizações que se sucederam ao longo dos séculos têm em comum uma série de barreiras para compreender e aceitar a morte. E, a despeito de novos paradigmas socioculturais, da liberdade de expressão e de toda a evolução tecnológica que caracterizam a sociedade contemporânea, a desmistificação da morte ainda requer empenho. Em sua conclusão, o texto enfatiza a necessidade de ampliar discussões e estratégias para enfrentar as questões relacionadas à finitude humana, levando em conta que novas ressignificações conceituais sempre emergem com o progresso da ciência.

Abstract Considering the impact of death on multiple aspects of human collectivity, this article reflects on how different cultures, at different times, related to this theme, seeking to interpret the various meanings associated with finitude. Therefore, the study starts with a literature review of a qualitative approach. It found that civilizations that have succeeded each other over the centuries have in common a number of barriers to understanding and accepting death. And, despite new sociocultural paradigms, freedom of expression and all the technological evolution that characterize contemporary society, the demystification of death still requires commitment. In its conclusion, the text emphasizes the need to broaden discussions and strategies to address issues related to human finitude, considering that new conceptual re-significations always emerge with the progress of science.

Resumen Considerando el impacto de la muerte en múltiples aspectos de la colectividad humana, este artículo reflexiona sobre cómo diferentes culturas, en diferentes momentos, se relacionaron con este tema, buscando interpretar los diversos significados asociados a la finitud. Por lo tanto, el estudio parte de una revisión bibliográfica de un enfoque cualitativo. Se constata que las civilizaciones que se han sucedido a lo largo de los siglos tienen en común una serie de barreras para comprender y aceptar la muerte. A pesar de los nuevos paradigmas socioculturales, la libertad de expresión y toda la evolución tecnológica que caracteriza a la sociedad contemporánea, la desmitificación de la muerte aún requiere compromiso. En su conclusión, el texto enfatiza la necesidad de ampliar las discusiones y estrategias para abordar cuestiones relacionadas con la finitud humana, teniendo en cuenta que siempre surgen nuevas resignificaciones conceptuales con el progreso de la ciencia.

Contribuição do Modified Early Warning Score (MEWS) para conduta clínica precoce / Modified early warning score (mews) contribution to early clinical management

Objetivo: Avaliar a utilização do protocolo Modified Early Warning Score (MEWS) no gerenciamento do tempo de avaliação clínica. Métodos: Revisão integrativa da literatura nas bases de dados LILACS, MEDLINE via PUBMED, BDENF e CINAHL, sem recorte de tempo. Os descritores utilizados foram: Inpatients, Critical Care e Clinical Deterioration, com os operadores booleanos AND e OR. A amostra foi composta por 15 artigos. Resultados: Observou-se que o tempo de reavaliação clínica esteve entre 20 minutos e 72 horas, onde o tempo médio para a primeira avaliação foi de 17,5 horas, considerando as avaliações iniciais mínimas de 20 minutos e avaliação máxima de 48 horas. Quando identificados MEWS progressivo, o desfecho clínico levou a óbitos em menos de 30 dias, principalmente quando se relaciona escores de dois a oito com deterioração severa a partir do nível quatro. Conclusão: O MEWS apresenta-se como importante coadjuvante na relação entre a classificação de risco e o tempo de avaliação clínica. Contudo, se faz necessário o investimento em educação permanente nos serviços com vistas a capacitação de profissionais, impactando no julgamento clínico, formulação do plano de ação e determinação do tempo para reavaliação do paciente durante a internação. (AU)

Objective: Evaluate the use of the Modified Early Warning Score (MEWS) protocol in the management of clinical evaluation time. Methods: Integrative review of the literature in the LILACS, MEDLINE databases via PUBMED, BDENF and CINAHL, without cutting time. The descriptors used were: Inpatients, Critical Care and Clinical Deterioration, with the Boolean operators AND and OR. The sample consisted of 15 articles. Results: It was observed that the clinical reassessment time was between 20 minutes and 72 hours, where the average time for the first evaluation was 17.5 hours, considering the minimum initial evaluations of 20 minutes and maximum evaluation of 48 hours. When progressive MEWS was identified, the clinical outcome led to deaths in less than 30 days, especially when scores from two to eight are related to severe deterioration from level four onwards. Conclusion: The MEWS presents itself as an important adjunct in the relationship between risk classification and the time of clinical evaluation. However, it is necessary to invest in permanent education in the services in order to train professionals, impacting on clinical judgment, formulation of the action plan and determination of time for reevaluation of the patient during hospitalization. (AU)

Objetivo: Evaluar el uso del protocolo Modified Early Warning Score (MEWS) en el manejo del tiempo de evaluación clínica. Métodos: Revisión integradora de la literatura en las bases de datos LILACS, MEDLINE a través de PUBMED, BDENF y CINAHL, sin reducir el tiempo. Los descriptores utilizados fueron: pacientes hospitalizados, cuidados críticos y deterioro clínico, con los operadores booleanos AND y OR. La muestra constaba de 15 artículos. Resultados: Se observó que el tiempo de reevaluación clínica fue de entre 20 minutos y 72 horas, donde el tiempo promedio para la primera evaluación fue de 17.5 horas, considerando las evaluaciones iniciales mínimas de 20 minutos y la evaluación máxima de 48 horas. Cuando se identificaron los MEWS progresivos, el resultado clínico condujo a muertes en menos de 30 días, especialmente cuando las puntuaciones entre dos y ocho se deterioraron severamente desde el nivel cuatro en adelante. Conclusión: El MEWS se presenta como un complemento importante en la relación entre la clasificación del riesgo y el momento de la evaluación clínica. Sin embargo, es necesario invertir en la educación permanente en los servicios a fin de capacitar a los profesionales, lo que repercute en el juicio clínico, la formulación del plan de acción y la determinación del tiempo de reevaluación del paciente durante la hospitalización. (AU)