Kidney function and daily emtricitabine/tenofovir disoproxil fumarate pre-exposure prophylaxis against HIV: results from the real-life multicentric demonstrative project PrEP Brazil.

BACKGROUND: Pre-Exposure Prophylaxis (PrEP) has demonstrated efficacy in the reduction of sexually transmitted HIV infections. The prolonged use of tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) co-formulation (TDF/FTC), however, may result in augmented risk of renal toxicity. We aimed to evaluate changes in the estimated Glomerular Filtration Rate (eGFR) in a real-world population setting of participants enrolled in PrEP Brazil, a 48-week prospective, open-label, demonstration study to assess the feasibility of daily oral TDF/FTC used by men who have sex with men and transgender women at high-risk of HIV infection, all over 18 years old. METHODS: Kidney function was assessed by serial measurement of serum creatinine and eGFR with the Modification of Diet in Renal Disease Study (MDRD) formula on weeks 4, 12, 24, 36 and 48. Adherence to PrEP was assessed by dosing TDF concentration in dried blood spots at weeks 4 and 48, measured by liquid chromatography-mass spectrometry or mass spectrometry. RESULTS: Of 392 participants completing the 48-week follow-up protocol with TDF blood detectable levels and eGFR measures, 43.1% were young adults, of Caucasian ethnic background (57.9%), with BMI below 30 kg/m2, without arterial hypertension. At screening, median eGFR was 93.0 mL/min/1.73 m2. At week 4 follow-up, 90 (23% of the study population) participants presented reductions in eGFR greater than 10 mL/min/1.73 m2 as compared to baseline eGFR, some as large as 59 mL/min/1.73 m2, but with no clinical outcomes (adverse events and renal adverse events) severe enough to demand TDF/FTC discontinuation. A negative relationship was observed between TDF blood levels and eGFR at weeks 4 (r = - 0.005; p < 0.01) and 48 (r = - 0.006; p < 0.01). CONCLUSIONS: These results suggest that the renal function profile in individuals on TDF/FTC may be assessed on week 4 and then only annually, allowing a more flexible medical follow-up in primary care centers.

Medidas de biossegurança na assistência de enfermagem a pacientes hemodialíticos: revisão integrativa / Medidas de bioseguridad en la atención de enfermería a pacientes en hemodiálisis: revisión integradora / Biosafety measures in nursing care to hemodialysis patients: integrative review

Objetivo: compreender o conhecimento dos profissionais de enfermagem acerca das medidas de biossegurança na prevenção de agravos à saúde durante a assistência em hemodiálise. Método: revisão integrativa da literatura realizada nas bases de dados da LILACS e BDENF e no diretório de revistas da SciELO. Foram identificadas 691 obras. Após aplicados os critérios de inclusão e exclusão, a amostra final foi composta por 12 artigos. Resultados: os profissionais de enfermagem aderem parcialmente às medidas de biossegurança e compreendem sua necessidade, assim como detêm conhecimento sobre a temática, muito embora esse mesmo conhecimento não tenha sido aplicado em sua totalidade na assistência. Conclusão: os profissionais detêm conhecimento acerca das medidas de biossegurança e reconhecem a necessidade da sua aplicação como instrumento efetivo no desempenho das suas atividades laborais, adotando e recomendando a sua utilização. No entanto, existem lacunas do conhecimento entre o discurso e a prática assistencial. Considerações finais: condições precárias da Atenção Primária à Saúde implicam em desestruturação de resposta adequada em momentos de emergências sanitárias.

Objective: to understand the knowledge of nursing professionals about biosafety measures in the prevention of health problems during hemodialysis care. Method: integrative review of the literature performed in LILACS and BDENF databases and in the directory of SciELO journals. 691 works were identified. After the inclusion and exclusion criteria were applied, the final sample consisted of 12 articles. Results: nursing professionals partially adhere to biosafety measures and understand their need, as well as have knowledge about the theme, even though this same knowledge has not been applied in its entirety in care. Conclusion: professionals have knowledge about biosafety measures and recognize the need for their application as an effective instrument in the performance of their work activities, adopting and recommending their use. However, there are gaps in knowledge between discourse and care practice.

Objetivo: comprender el conocimiento de los profesionales de enfermería sobre las medidas de bioseguridad en la prevención de problemas de salud durante el cuidado de la hemodiálisis. Método: revisión integradora de la literatura realizada en bases de datos LILACS y BDENF y en el directorio de revistas SciELO. Se identificaron 691 obras. Después de aplicar los criterios de inclusión y exclusión, la muestra final consistió en 12 artículos. Resultados: los profesionales de enfermería se adhieren parcialmente a las medidas de bioseguridad y comprenden su necesidad, así como tienen conocimiento sobre el tema, a pesar de que este mismo conocimiento no se ha aplicado en su totalidad en el cuidado. Conclusión: los profesionales tienen conocimientos sobre las medidas de bioseguridad y reconocen la necesidad de su aplicación como un instrumento eficaz en el desempeño de sus actividades laborales, adoptando y recomendando su uso. Sin embargo, existen brechas en el conocimiento entre el discurso y la práctica del cuidado.

Influence of age on the haemoglobin concentration of malaria-infected patients in a reference centre in the Brazilian Amazon

Anaemia is amongst the major complications of malaria, a major public health problem in the Amazon Region in Latin America. We examined the haemoglobin (Hb) concentrations of malaria-infected patients and compared it to that of malaria-negative febrile patients and afebrile controls. The haematological parameters of febrile patients who had a thick-blood-smear performed at an infectious diseases reference centre of the Brazilian Amazon between December 2009-January 2012 were retrieved together with clinical data. An afebrile community control group was composed from a survey performed in a malaria-endemic area. Hb concentrations and anaemia prevalence were analysed according to clinical-epidemiological status and demographic characteristics. In total, 7,831 observations were included. Patients with Plasmodium falciparum infection had lower mean Hb concentrations (10.5 g/dL) followed by P. vivax-infected individuals (12.4 g/dL), community controls (12.8 g/dL) and malaria-negative febrile patients (13.1 g/dL) (p < 0.001). Age, gender and clinical-epidemiological status were strong independent predictors for both outcomes. Amongst malaria-infected individuals, women in the reproductive age had considerably lower Hb concentrations. In this moderate transmission intensity setting, both vivax and falciparum malaria are associated with reduced Hb concentrations and risk of anaemia throughout a wide age range.

Slow clearance of Plasmodium vivax with chloroquine amongst children younger than six months of age in the Brazilian Amazon

Plasmodium vivax is the most widespread parasite causing malaria, being especially prevalent in the Americas and Southeast Asia. Children are one of the most affected populations, especially in highly endemic areas. However, there are few studies evaluating the therapeutic response of infants with vivax malaria. This study retrospectively evaluated the parasitaemia clearance in children diagnosed with vivax malaria during the first five days of exclusive treatment with chloroquine (CQ). Infants aged less than six months old had a significantly slower parasitaemia clearance time compared to the group of infants and children between six months and 12 years old (Kaplan-Meier survival analysis; Wilcoxon test; p = 0.004). The impaired clearance of parasitaemia in younger children with vivax malaria is shown for the first time in Latin America. It is speculated that CQ pharmacokinetics in young children with vivax malaria is distinct, but this specific population may also allow the detection of CQ-resistant parasites during follow-up, due to the lack of previous immunity. .

Emoção e cuidado na assistência à criança com câncer: percepções da equipe de Enfermagem / Emoción y cuidado en la asistencia a niños con cáncer: percepciones del personal de enfermería / Emotion and care in the assistance to children with cancer: perceptions of nursing staff

Introdução: o câncer infantil estimula profundas emoções no profissional de enfermagem, o qual se depara com uma ansiedade contínua causada por fatores extenuantes que abrangem desde questões de sobrecarga física à demanda psicológica intensa. Esta pesquisa surge da necessidade de aprofundar conhecimentos acerca da assistência dos profissionais de enfermagem à criança portadora de câncer. Objetivos: conhecer aspectos emocionais relacionados à assistência à criança com câncer, através da pesquisa qualitativa, e dessa maneira buscou-se evidenciar as percepções e os possíveis desafios vivenciados pelos profissionais da equipe de enfermagem no contexto de sua prática profissional. Métodos: a coleta de dados foi realizada mediante entrevistas semiestruturada com 14 profissionais da Equipe de Enfermagem, sendo escolhido como campo de estudo o Setor de Quimioterapia Ambulatorial (Hospital-Dia Peter-Pan) e o Setor de Internamento (Bloco C) do Hospital Infantil Albert Sabin, localizado na cidade de Fortaleza-Ceará. Os dados foram submetidos à análise de conteúdo. A partir da análise dos dados, foi possível identificar as seguintes categorias temáticas que desvelaram as emoções e os sentimentos que a equipe de enfermagem esboça na ação de cuidar de uma criança com câncer, sendo elas "o cuidar: sentimentos e significados" e "significado de vivenciar a morte: lidando com as emoções". Conclusão: apesar da sobrecarga emocional a que estão expostos, os profissionais mantém o compromisso na assistência às crianças, entretanto evidencia-se a necessidade de suporte emocional para assisti-las, pois existe tendência para exaustão emocional, desânimo e fracasso. Reforça-se a importância da capacitação multidisciplinar e contínua desses profissionais e da promoção e da prevenção em saúde no ambiente de trabalho(AU)

Introducción: el cáncer infantil estimula emociones profundas en el equipo de enfermería, estos profesionales enfrentan una continua ansiedad causada por factores agotadores, que van desde cuestiones de la carga física a las exigencias psicológicas intensas. Este estudio surge de la necesidad de promover el conocimiento de los cuidados de enfermería para los niños con cáncer. Objetivo: comprender los aspectos emocionales relacionados con esta práctica profesional, a través de la investigación cualitativa, y exponer las percepciones y los posibles desafíos experimentados por equipo de enfermería en el contexto de su práctica profesional. Métodos: la recogida de datos se realizó por medio de entrevistas semi-estructuradas con 14 profesionales de enfermería, y fueron elegidos para la recolección de datos: el Sector de Quimioterapia (Hospital Día Peter Pan) y el Sector de Internación (Bloque C - Hospital Infantil Albert Sabin), que se encuentra en la ciudad de Fortaleza, Ceará. Los datos fueron sometidos a análisis de contenido. A partir del análisis de datos, fue posible identificar los temas que dieron a conocer las emociones y sentimientos que el equipo de enfermería demuestra durante la acción de cuidar de un niño con cáncer, ellos son "el cuidado: los sentimientos y significados" y "la experiencia de la muerte: manejo de las emociones". Conclusiones: los profesionales de enfermería, a pesar de la sobrecarga emocional a los que están expuestos, mantienen un compromiso con el cuidado de la salud de los niños; sin embargo, hay la necesidad de soporte emocional para ayudarles, porque existe una tendencia al agotamiento emocional, el desánimo y el fracaso. Subrayamos la importancia de la formación multidisciplinar y permanente para estos profesionales y la importancia de la prevención y promoción de la salud laboral(AU)

Pediatric cancer stimulates deep emotions in professional nursing, and this is faced with a continuous anxiety caused by extenuating factors ranging from issues of physical overload of the intense psychological demands.This research emerges from the need to deepen knowledge about the care of nursing for children with cancer. The study aimed to identify the emotional aspects associated to the care of children with cancer, through qualitative research, and this way we sought to expose the perceptions and potential challenges experienced by nursing staff in the context of their professional practice. Data collection was accomplished through semi-structured interviews with 14 professionals of the nursing staff. Was selected as the site for data collection: Department of Outpatient Chemotherapy (Day Hospital Peter Pan), and Sector Internment (Block C) of the pediatric Hospital Albert Sabin, located in the town of Fortaleza, Ceará. The data were submitted to content analysis. Based on the data analysis, it was possible to identify two thematic categories that unveiled the emotions and feelings that nursing staff expresses in the action of caring for a child with cancer, they are "care: feelings and meanings" and "meaning of experience death: dealing with emotions". It was concluded that, spite of emotional overload to which they are exposed, respondents, maintains its commitment in providing assistance to children, however highlights the need for emotional support to to assist them, because there is a tendency for emotional exhaustion, discouragement and failure. This reinforced the importance of multidisciplinary and continuous training of these nurses and nursing technicians and promotion and health prevention in the workplace(AU)