A 2-year retrospective study on pleural effusions: A cancer centre experience.

BACKGROUND: Cytopathological examination of pleural effusions is a fast and minimally invasive method for verification of the presence of neoplastic cells. We report our 2-year experience using a categorised diagnostic system and reporting risks of malignancy (ROMs) for each defined category. METHODS: Cytological reports of patients between November 2016 and October 2018 were collected, with results primarily classified into a five-tiered classification scheme. Immunohistochemistry markers used in cytology and their results were also recorded. Final agreement to histology and overall test performance was calculated for cases with available concomitant (up to 3 months) pleural biopsies. RESULTS: A total of 519 samples from 385 patients were collected, being 29 (5.6%) classified as non-diagnostic, 291 (56%) as negative, 28 (5.4%) as atypical, 30 (5.8%) as suspicious and 141 (27.2%) as positive. Most requested markers were calretinin, TTF1, Ber-EP4 and Gata-3, being conclusive in 45 (76.3%) cases. Total cyto-histological agreement was achieved in 49 (80.3%) specimens, with an overall sensitivity and specificity of 69.4% and 93.3%, respectively. Positive predictive value was 96.2% and negative predictive value was of 56%. ROM for each diagnostic category was 50% for non-diagnostic, 44% for negative, 50% for atypical, 83.3% for suspicious and 96.2% for positive. CONCLUSIONS: Our 2-year retrospective study has shown a high specificity and positive predictive value for pleural cytology. The use of a five-tiered system has also shown to be highly effective, with a concordantly progressive higher ROM for the assigned diagnostic categories.

Randomized crossover trial of endotracheal tube suctioning systems use in newborns.

BACKGROUND: Maintaining endotracheal tube patency is critical for neonates receiving mechanical ventilation. Endotracheal tube suctioning removes accumulated secretions preventing potential adverse events, however is also potentially hazardous to the patient. OBJECTIVE: To compare respiratory rate, arterial blood oxygen saturation, heart rate and pain in newborns undergoing endotracheal tube suctioning with closed (CS) and open (OS) systems. METHODS: Randomized crossover trial with 13 newborns from two Brazilian hospitals. The respiratory rate, arterial blood oxygen saturation, heart rate and pain (Premature Infant Pain Profile) were analysed: immediately before (T1), during (T2), immediately after (T3), 10 min after (T4) and 30 min (T5) after endotracheal suctioning. RESULTS: The majority (11/85·0%) of the newborns were premature and 45% weighed less than 1000 g. No statistically significant difference was identified according to the use of CS or OS to all the parameters investigated. The main results demonstrated that in T2 arterial blood oxygen saturation was higher with CS (CS 93·0%; OS 89 · 0%; p = 0·561). In T3 there was an increase in respiratory rate average only with the use of OS (T1 50·0; T3 56·0). The pain score in T2 and heart rate in T3 were higher with OS without significant differences (p = 0·114; p = 0·479, respectively). CONCLUSION: There was no significant difference in the studied clinical parameters or presence and intensity of pain according to the two investigated techniques of endotracheal tube suctioning. RELEVANCE TO CLINICAL PRACTICE: This research can provide support for clinical practice regarding endotracheal tube suctioning of newborns describing that the use of closed systems was similar to the open system regarding pain presence and intensity, as well as, in the clinical effects analysed, in accordance with other studies produced in this field.

Carvedilol as secondary prophylaxis for variceal bleeding in hepatosplenic schistosomiasis.

BACKGROUND: Upper variceal bleeding (UVB) is a possible complication of portal hypertension secondary to hepatosplenic schistosomiasis (HSS). Propranolol is a non-selective beta-blocker used as secondary prophylaxis for UVB, but no previous studies have addressed carvedilol effects in rebleeding prevention. METHODS: A retrospective exploratory study of 57 patients with chronic HSS and index UVB treated with endoscopic variceal ligation and propranolol or carvedilol was conducted. The primary outcome was UVB-free time in the first 12 mo after the initial bleeding episode. RESULTS: Propranolol was used for secondary UVB prophylaxis in 43 (75.4%) participants (median dose 80 [interquartile range - IQR 60-80] mg/d) and carvedilol in 14 (24.6%) participants (median dose 12.5 [IQR 7.9-25.0] mg/d). During a 12-mo follow-up, rebleeding was observed in 13 (22.8%) patients, 9 (20.9%) of those treated with propranolol and 4 (28.6%) treated with carvedilol (p=0.715). Mean time from the beginning of drug prophylaxis to rebleeding was 6±3 mo and there was no difference between that for propranolol vs carvedilol subgroups. Portal vein thrombosis did not influence the bleeding recurrence in either subgroup. CONCLUSION: Carvedilol may be equally effective as propranolol in preventing secondary UVB in HSS at 12-mo follow-up.

Primary health care essential and derivative attributes in children and adolescents with leprosy / Atributos esenciales y derivados de la atención primaria de la salud en niños y adolescentes con lepra / Atributos essenciais e derivados da atenção primária à saúde em crianças e adolescentes com hanseníase

ABSTRACT Objective: to assess the presence and extension of Primary Health Care essential and derivative attributes in the assistance provided to children and adolescents with leprosy. Method: a cross-sectional study of an evaluative nature, with a quantitative approach. The information was obtained through interviews with nurses and physicians (n=37) working at Primary Health Care units in the care of children and adolescents with leprosy in the municipality of Parauapebas, Pará, Brazil, between October 2021 and February 2022. Mean, minimum, maximum and standard deviation values were used in the descriptive analyses, as well as the Levene test, Student's t-test. Pearson's Correlation Coefficient and a 5% confidence level. Results: 45.9% of the study participants had attended up to two training programs in leprosy care and 32.4% were trained in minors with the disease. When analyzing the mean values of each attribute, low orientation of the service provided and lower values of the general mean were observed in the analysis of attributes related to Access and Continued Care (score 3.4, SD±1.3; and score 3.8, SD±1.7 respectively). There was a regular positive correlation in most of the evaluated attributes and a significant strong positive correlation between care coordination and Professional/Community Orientation: r=0.601 and r=0.651, respectively. Conclusion: there is evidence of weaknesses in health care for children and adolescents with leprosy related to low service orientation; however, qualification in Care coordination exerts a positive influence on Professional orientation and Community orientation with an impact on service surveillance.

RESUMEN Objetivo: evaluar la presencia y la extensión de los atributos esenciales y derivados de la Atención Primaria de la Salud en la asistencia de niños y adolescentes con lepra. Método: estudio transversal, de naturaleza evaluativa y enfoque cuantitativo. Toda la información se obtuvo por medio de entrevistas realizadas entre octubre de 2021 y febrero de 2022 con enfermeros e médicos (n=37) que trabajan en unidades de Atención Primaria de la Salud en la asistencia de niños y adolescentes con lepra del municipio de Parauapebas, Pará, Brasil. En los análisis descriptivos se utilizaron los valores de media, mínimo, máximo y desvío estándar, además de las pruebas de Levene y t de Student, el Coeficiente de Correlación de Pearson y nivel de confianza del 5%. Resultados: el 45,9% de los participantes del estudio había asistido a un máximo de dos programas de capacitación en la atención de enfermos de lepra y el 32,4% se había capacitado en menores de edad que sufren el problema. Al analizar las medias de los valores de cada atributo, se observó escasa orientación del servicio prestado y valores inferiores a la media general en el análisis de los atributos relacionados con Acceso y Asistencia continuada (puntuación de 3,4; DE±1,3; y 3,8 DE±1,7 respectivamente). Se observó una correlación positiva regular en la mayoría de los atributos evaluados y una fuerte correlación y significativa entre Coordinación de la asistencia y Orientación profesional/comunitaria: r=0,601 y r=0,651, respectivamente. Conclusión: se detecta evidencia de debilidades en la atención de la salud en niños y adolescentes con lepra relacionadas a la escasa orientación del servicio; sin embargo, la calificación en la Coordinación de la asistencia ejerce una influencia positiva positivamente sobre la Orientación profesional y la Orientación comunitaria, con un efecto en la vigilancia de los servicios.

RESUMO Objetivo: avaliar a presença e extensão dos atributos essenciais e derivados da Atenção Primária à Saúde no atendimento à criança e ao adolescente com hanseníase. Método: estudo transversal, de natureza avaliativa, com abordagem quantitativa. As informações foram obtidas por meio de entrevistas com enfermeiros e médicos (n=37) atuantes em unidades da atenção primária à saúde no atendimento à criança e ao adolescente com hanseníase no município de Parauapebas, Pará, Brasil, entre os meses de outubro de 2021 a fevereiro de 2022. Utilizou-se nas análises descritivas os valores de média, mínimo, máximo e desvio padrão, e os testes de Levene, Teste t- Student e Coeficiente de Correlação de Pearson e nível de confiança de 5%. Resultados: dos participantes do estudo, 45,9% possuíam até dois treinamentos em cuidados com hanseníase e 32,4% com capacitação em menores com o agravo. Ao analisar as médias dos valores de cada atributo, observou-se baixa orientação do serviço prestado e valores inferiores da média geral na análise dos atributos relativos ao Acesso e Atendimento continuado (score 3,4; DP±1,3 e 3,8 DP±1,7 respectivamente). Observou-se correlação positiva regular na maioria dos atributos avaliados e correlação positiva forte significativa entre coordenação do cuidado com Orientação Profissional/Comunitária, respectivamente (r= 0,601) e (r= 0,651). Conclusão: há evidências de fragilidades nos cuidados de saúde em crianças e adolescentes com hanseníase relacionados à baixa orientação do serviço, contudo, a qualificação na Coordenação do Cuidado influencia positivamente na Orientação Profissional e na Orientação Comunitária com impacto na vigilância dos serviços.

Neurodesenvolvimento infantil: relato de avaliação psicológica sem uso de técnicas padronizadas / Child neurodevelopment: Reporting psychological assessment without using standardized techniques

O estudo teve como objetivo avaliar aspectos do desenvolvimento cognitivo e socioemocional de criança em idade pré-escolar encaminhada devido a problemas no neurodesenvolvimento, utilizando-se de técnicas não padronizadas de avaliação psicológica. Na fase 1 de avaliação da menina de 6 anos de idade aconteceram: anamnese com familiares e seções individuais com a criança, quando se identificou inviabilidade da testagem psicológica. Na fase 2 da coleta de dados ocorreram: observação sistemática do comportamento (em sessões lúdicas, realizadas individualmente e em grupo de crianças) e entrevistas com equipe escolar. Os registros comportamentais foram analisados quanto à natureza, frequência e intensidade das respostas, e as entrevistas quanto ao seu conteúdo. Os dados foram interpretados segundo teorias do neurodesenvolvimento, neuropsicologia e psicologia cognitiva. Os resultados indicaram que a criança tem dificuldades em entender e seguir as instruções verbais; a resolução de problemas é geralmente feita via raciocínio concreto; há baixa frequência e qualidade da comunicação social; constantes falhas de controle inibitório relacionam-se com a alta intensidade de sinais de intolerância à frustração. São sugeridos prejuízos moderados na capacidade de raciocínio geral, falhas atencionais, alterações no nível de atividade motora e dificuldades no desenvolvimento socioemocional. Por outro lado, como potencialidade identificada cita-se o histórico positivo de engajamento em treino de habilidades sociais em sala de aula, o que sugere bom prognóstico e deve ser valorizado em plano terapêutico futuro. Conclui-se sobre a importância do estudo de técnicas não padronizadas de avaliação psicológica para identificação adequada de déficits cognitivos, afetivos, comportamentais e seus impactos na vida do paciente.

The study aimed to evaluate aspects of the cognitive and socioemotional development of children (preschool age) referred due to problems in neurodevelopment, using non-standardized psychological assessment techniques. In phase 1 of the evaluation of the 6-year-old girl, there were: anamnesis with family members and individual sections with the child. It was concluded that the use of psychological testing was not feasible. In phase 2 there were: systematic observation of behavior (in play sessions, carried out individually and in a group of children) and interviews with school staff. The behavioral records were analyzed as to the nature, frequency and intensity of the responses, and the interviews according to their content. The data were interpreted based on theories of neurodevelopment, neuropsychology and cognitive psychology. The results indicated the child has difficulties in understanding and following verbal instructions; problem solving is usually done via concrete reasoning; there is low frequency and quality of social communication; constant failures of inhibitory control are related to the high intensity of signs of frustration intolerance. Moderate impairments in general reasoning ability, attentional failures, changes in the level of motor activity and difficulties in socioemotional development are suggested. On the other hand, the identified potentiality is the positive history of engagement in training social skills in the classroom, which suggests a good prognosis and should be valued in the future therapeutic plan. We conclude about the importance of studying non-standardized psychological assessment techniques for the proper identification of cognitive, affective, behavioral deficits and their impact on the patient's life.

Peptidomic comparison and characterization of the major components of the venom of the giant ant Dinoponera quadriceps collected in four different areas of Brazil.

Despite the noxious effects inflicted by Dinoponera ant's envenomation, the information about the biological properties and composition of their venom is still very limited. Ants from the genus Dinoponera are believed to be the world's largest living ants with a body length of 3cm. Their occurrence is restricted to tropical areas of South America. In this work, we study the venom of the giant Dinoponera quadriceps ant collected in 4 different regions of Brazil. By using a combination of complementary mass spectrometric approaches, we aim at: (i) characterizing the venom composition of these ants; (ii) establishing a comparative analysis of the venom from four geographically different regions in Brazil. This approach demonstrates that ant venom is a copious source of new compounds. Several peptides were identified and selected for "de novo sequencing". Since most of the new peptides showed similarities with antimicrobial peptides (AMPs), antimicrobial assays were performed with the purpose of evaluating their activity. In regard to the comparative study of the four regions, we observed not only major differences in the venom compositions, but also that the venoms collected in closest areas are more similar than the ones collected in distant regions. These observations seem to highlight an adaption of the ant venoms to the local environment. Concerning the biological assays, the peptides called Dq-3162 and Da-3177 showed a wide-ranging antimicrobial activity. The characterization of new AMPs with a broad spectrum of activity and different scaffolds may aid scientists to design new therapeutic agents and understand the mechanisms of those peptides to interact with microbial membranes. The results obtained betoken the biotechnological potential of ant's venom. BIOLOGICAL SIGNIFICANCE: For the first time this manuscript describes an extensive proteomics characterization of the D. quadriceps venom. In addition this study reports the variation in venom composition of primitive ants from 4 geographically different areas of Brazil. The results reveal the presence of ~335 compounds for each venom/area and inter-colony variations were observed. 16 new peptides were characterized and 2 of them were synthesized and biologically assayed. These findings highlight the considerable and still unexplored diversity of ant's venom which could be used as valuable research tools in different areas of knowledge.

Anti-HCV reactive blood donors: clinical and epidemiological factors associated with false-reactive results.

BACKGROUND: In certain clinical settings, false-reactive anti-hepatitis C virus (HCV) results are rare because the majority of persons being tested have evidence of liver disease and the specificity of the screening assays is high. However, among healthy populations, such as blood donors, mainly in regions with a low prevalence of HCV infection, this situation does occur. In this study, we sought to assess clinical, epidemiological, and laboratory characteristics of blood donors with false-reactive anti-HCV screening tests. METHODS: This retrospective cross-sectional study included 537 anti-HCV reactive blood donors referred to a tertiary care centre for liver diseases. RESULTS: The mean age was 36.5+/-11.2 years and 71.8% were men. Blood donors of older age (P=0.010), history of alcohol abuse (P=0.039), past transfusion (P<0.001), intravenous drug use (P<0.001), and with antibody against core antigen of hepatitis B virus reactivity (P=0.003) were less likely to have a false-reactive anti-HCV result. By multivariate analysis, only the absence of parenteral risk factors (prior transfusion and intravenous drug use) was independently associated with false-reactive anti-HCV tests. CONCLUSION: Blood donors with reactive anti-HCV screening tests with no risk factors for parenterally acquired HCV infection are more likely to present with false-reactive results.