High volume online hemodiafiltration: a global perspective and the Brazilian experience / Hemodiafiltração on-line de alto volume: uma perspectiva global e a experiência brasileira

ABSTRACT Online hemodiafiltration (HDF) is a rapidly growing dialysis modality worldwide. In Brazil, the number of patients with private health insurance undergoing HDF has exceeded the number of patients on peritoneal dialysis. The achievement of a high convection volume was associated with better clinical imprand patient - reported outcomes confirming the benefits of HDF. The HDFit trial provided relevant practical information on the implementation of online HDF in dialysis centers in Brazil. This article aims to disseminate technical information to improve the quality and safety of this new dialysis modality.

RESUMO A hemodiafiltração (HDF) on-line é uma modalidade dialítica em rápido crescimento no mundo. No Brasil, o número de pacientes com planos de saúde privados tratados por HDF já ultrapassa aquele de pacientes em diálise peritoneal. O alcance de um alto volume convectivo associado à redução de desfechos clínicos e do risco de morte confirmam os benefícios da HDF. Dados nacionais do estudo HDFit forneceram informações práticas relevantes sobre a implementação da HDF on-line em clínicas de diálise no Brasil. O objetivo desta publicação é a disseminação de informações técnicas que possam auxiliar na utilização, com qualidade e segurança, dessa nova modalidade dialítica.

Cause-Specific Excess Mortality During the COVID-19 Pandemic (2020-2021) in 12 Countries of the C-MOR Consortium.

BACKGROUND: This study investigated cause-specific mortality rates in 12 countries during the COVID-19 pandemic in 2020 and 2021. METHODS: We collected weekly cause-specific mortality data from respiratory disease, pneumonia, cardiovascular disease (CVD) and cancer from national vital statistic databases. We calculated excess mortality for respiratory disease (excluding COVID-19 codes), pneumonia, and CVD in 2020 and 2021 by comparing observed weekly against expected mortality based on historical data (2015-2019), accounting for seasonal trends. We used multilevel regression models to investigate the association between country-level pandemic-related variables and cause-specific mortality. RESULTS: Significant reductions in cumulative mortality from respiratory disease and pneumonia were observed in 2020 and/or 2021, except for Georgia, Northern Ireland, Kazakhstan, and Ukraine, which exhibited excess mortality for one or both causes. Australia, Austria, Cyprus, Georgia, and Northern Ireland experienced excess cumulative CVD mortality in 2020 and/or 2021. Australia, Austria, Brazil, Cyprus, Georgia, Northern Ireland, Scotland and Slovenia, experienced increased crude cumulative cancer mortality during 2020 and/or 2021 compared to previous years. Among pandemic-related variables, reported COVID-19 incidence was negatively associated with increased cancer mortality, excess respiratory, (2020) and pneumonia (2021) mortality, and positively associated with respiratory and CVD mortality (2021). Stringency of control measures were negatively associated with excess respiratory disease, CVD, and increased cancer mortality (2021). CONCLUSIONS: This study provides evidence of substantial excess mortality from CVD, and notable reductions in respiratory disease and pneumonia in both years across most countries investigated. Our study also highlights the beneficial impact of stringent control measures in mitigating excess mortality from most causes in 2021.

Notified cases of mpox in the city of Rio de Janeiro, Brazil: a descriptive study, 2022.

OBJECTIVE: To describe the profile of cases of mpox in the city of Rio de Janeiro between June and November 2022. METHODS: This was a descriptive study of secondary data obtained from mpox notification forms. Socioeconomic, clinical and spatial data were analyzed. RESULTS: Of the 928 cases, 93.7% were male, 85.0% cisgender male, 65.6% homosexual, 41.8% between 30 and 39 years old, and 41.0% were of White race/skin color. A total of 34.5% had immunosuppression due to illness, and 41.9% reported their HIV status as being positive. The most prevalent signs and symptoms were: skin lesions (96.6%), especially with multiple manifestations (67.8%) in the genital region (46.1%), in addition to fever (58.3%), adenomegaly (43.3%) and headache (38.7%). Most notifications occurred in public services (81.3%) and in hospital care (51.3%). CONCLUSION: The study revealed high incidence of mpox, especially among young, cisgender and homosexual men. Most cases were mild, with genital lesions, progressing to cure without hospitalization. Person-to-person transmission was predominant.

Childhood-onset systemic lupus erythematosus (cSLE) and malignancy: a nationwide multicentre series review.

BACKGROUND: Increased malignancy frequency is well documented in adult-systemic lupus erythematosus (SLE), but with limited reports in childhood-onset SLE (cSLE) series. We explored the frequency of malignancy associated with cSLE, describing clinical and demographic characteristics, disease activity and cumulative damage, by the time of malignancy diagnosis. METHOD: A retrospective case-notes review, in a nationwide cohort from 27 Pediatric Rheumatology centres, with descriptive biopsy-proven malignancy, disease activity/damage accrual, and immunosuppressive treatment were compiled in each participating centre, using a standard protocol. RESULTS: Of the 1757 cSLE cases in the updated cohort, 12 (0.7%) developed malignancy with median time 10 years after cSLE diagnosis. There were 91% females, median age at cSLE diagnosis 12 years, median age at malignancy diagnosis 23 years. Of all diagnosed malignancies, 11 were single-site, and a single case with concomitant multiple sites; four had haematological (0.22%) and 8 solid malignancy (0.45%). Median (min-max) SLEDAI-2 K scores were 9 (0-38), median (min-max) SLICC/ACR-DI (SDI) score were 1 (1-5) Histopathology defined 1 Hodgkin's lymphoma, 2 non-Hodgkin's lymphoma, 1 acute lymphoblastic leukaemia; 4 gastrointestinal carcinoma, 1 squamous cell carcinoma of the tongue and 1 anal carcinoma; 1 had sigmoid adenocarcinoma and 1 stomach carcinoid; 3 had genital malignancy, being 1 vulvae, 1 cervix and 1 vulvae and cervix carcinomas; 1 had central nervous system oligodendroglioma; and 1 testicle germ cell teratoma. CONCLUSION: Estimated malignancy frequency of 0.7% was reported during cSLE follow up in a multicentric series. Median disease activity and cumulative damage scores, by the time of malignancy diagnoses, were high; considering that reported in adult series.

Childhood-onset systemic lupus erythematosus (cSLE) and malignancy: a nationwide multicentre series review

Abstract Background Increased malignancy frequency is well documented in adult-systemic lupus erythematosus (SLE), but with limited reports in childhood-onset SLE (cSLE) series. We explored the frequency of malignancy associated with cSLE, describing clinical and demographic characteristics, disease activity and cumulative damage, by the time of malignancy diagnosis. Method A retrospective case-notes review, in a nationwide cohort from 27 Pediatric Rheumatology centres, with descriptive biopsy-proven malignancy, disease activity/damage accrual, and immunosuppressive treatment were compiled in each participating centre, using a standard protocol. Results Of the 1757 cSLE cases in the updated cohort, 12 (0.7%) developed malignancy with median time 10 years after cSLE diagnosis. There were 91% females, median age at cSLE diagnosis 12 years, median age at malignancy diagnosis 23 years. Of all diagnosed malignancies, 11 were single-site, and a single case with concomitant multiple sites; four had haematological (0.22%) and 8 solid malignancy (0.45%). Median (min-max) SLEDAI-2 K scores were 9 (0-38), median (min-max) SLICC/ACR-DI (SDI) score were 1 (1-5) Histopathology defined 1 Hodgkin's lymphoma, 2 non-Hodgkin's lymphoma, 1 acute lymphoblastic leukaemia; 4 gastrointestinal carcinoma, 1 squamous cell carcinoma of the tongue and 1 anal carcinoma; 1 had sigmoid adenocarcinoma and 1 stomach carcinoid; 3 had genital malignancy, being 1 vulvae, 1 cervix and 1 vulvae and cervix carcinomas; 1 had central nervous system oligodendroglioma; and 1 testicle germ cell teratoma. Conclusion Estimated malignancy frequency of 0.7% was reported during cSLE follow up in a multicentric series. Median disease activity and cumulative damage scores, by the time of malignancy diagnoses, were high; considering that reported in adult series.

A enfermeira que virou ilustração e os quilombolas contra a covid-19 no Pará / The nurse who became an illustration and the quilombolas against covid-19 in Pará / La enfermera que se convirtió en ilustración y los quilombolas contra el covid-19 en Pará

Este artigo tem como objetivo descrever as experiências de comunicação sobre saúde, desenvolvidas com comunidades quilombolas na Amazônia, através de mídias sociais durante a pandemia de covid-19. A disseminação de mensagens educativas foi uma das alternativas utilizadas pelas organizações quilombolas e por seus parceiros, para proporcionar informação e orientação sobre saúde. São apresentadas experiências acumuladas a partir das ações desenvolvidas por voluntários, no período de 2020 a 2022. Entre as mídias digitais e as estratégias utilizadas, destacam-se os cards digitais produzidos e distribuídos, principalmente, por meio do aplicativo de mensagens WhatsApp. Refletimos sobre a importância do uso das mídias sociais como instrumentos de comunicação educacional para a promoção da saúde e prevenção da covid-19, em uma era tecnológica que potencializa trocas intensas de informações e conhecimentos. No caso abordado, a educação sobre saúde, através de mídias sociais/digitais, mostrou-se um instrumento essencial para a minimização dos impactos da covid-19 na população quilombola

This article aims to describe the health communication experiences developed with quilombola commu-nities in the Amazonia through social media in the covid-19 pandemic. The dissemination of educational messages was one of the alternatives used by quilombola organizations and their partners to provide health information and guidance. Accumulated experiences are presented based on the actions carried out by volunteers in the period from 2020 to 2022. Among the digital media and strategies used, most important are the digital cards produced and distributed mainly through the WhatsApp Messenger. We reflect on the importance of using social media as educational communication tools for health promotion and prevention of covid-19, in a technological era that intensifies intense exchanges of information and knowledge. In the case approached here, health education through social/digital media proved to be an essential tool for minimizing the impacts of covid-19 on the quilombola population

Este artículo tiene como objetivo describir las experiencias de comunicación en salud desarrolladas con comunidades quilombolas de la Amazonia a través de las redes sociales durante la pandemia de covid-19. La difusión de mensajes educativos fue una de las alternativas utilizadas por las organizaciones quilombolas y por sus aliados para proporcionar información y orientación sobre salud. Se presentam experiencias acumuladas a partir de las acciones desarrolladas por voluntarios en el periodo de 2020 a 2022. Entre los medios digitales y estrategias utilizados, se destacan las tarjetas digitales producidas y distribuidas principalmente a través de la aplicación de mensajería WhatsApp. Reflexionamos sobre la importancia de utilizar los medios sociales como herramientas de comunicación educativa para la promoción de la salud y la prevención de la covid-19, en una era tecnológica que potencia intensos intercambios de información y conocimiento. En el caso relatado, la educación para la salud a través de medios sociales/digitales demostró ser una herramienta esencial para minimizar los impactos de la covid-19 en la población quilombola

Core Competencies Self-Assessment and Patient-Practitioner Orientation during the First Year of a Brazilian Orthopedic Residency / Autoavaliação de competências fundamentais e orientação médico durante o primeiro ano de residência ortopédica brasileira

Abstract Objective Training a competent physician requires to direct the resident profile of graduate students for practice activities. We sought to identify the doctor-patient relationship orientation and the self-assessment of the core competencies, which they pointed out needed to be developed. Methods All 56 orthopedic residents admitted between 2016 and 2019 participated in the present prospective observational study. The Patient Practitioner Orientation Scale (PPOS) and a self-assessment questionnaire were answered at the beginning and end of the first year of residency (R1) in Orthopedics and Traumatology. We calculated mean and standard deviation for PPOS items and scores and analyzed them through the paired t-test. Self-Assessment Questionnaire answer options were "yes" or "I need to improve it" and skills were classified in decreasing order of the frequency of "I need to improve it" responses with description of absolute number and percentage. We compared frequencies using Fisher Test. P-values < 0.05 were considered statistically significant. GraphPad Prism 8.4.3 (GraphPad Software, San Diego, CA, USA) and Microsoft Excel (Microsoft Corporation, Redmond, WA, USA) were used for statistical analysis. Results In the period between the beginning and the end of R1, the total PPOS mean score significantly decreased from 4.63 to 4.50 (p= 0.024), more biomedical-focused. Around one-third of the residents identified competencies of patient care, practice-based learning and improvement, and interpersonal and communication skills as needed to improve. Conclusions The PPOS and self-assessment activities could promote reflection practices and are possible tools for learner-centered competency assessment. Biomedical guidance tends to prevail as the training of physicians progresses, and periodic self-assessments can be worked on to build a growth mindset.

Resumo Objetivo A formação de um médico competente requer direcionar o perfil de pós-graduação residente para atividades práticas. Buscou-se identificar a orientação de relacionamento médico-paciente e a autoavaliação das competências fundamentais que eles apontaram que precisavam ser desenvolvidas. Métodos Todos os 56 residentes em ortopedia admitidos entre 2016 e 2019 participaram do presente estudo observacional prospectivo. A Escala de Orientação Médico-Paciente (Patient Practitioner Orientation Scale [PPOS, na sigla em inglês]) e um questionário de autoavaliação foram respondidos no início e no final do primeiro ano de residência (R1) em Ortopedia e Traumatologia. Calculamos o desvio médio e padrão para itens e pontuações de PPOS e os analisamos através do teste t emparelhado. As opções de resposta do Questionário de Autoavaliação foram "sim" ou "preciso melhorar" e as habilidades foram classificadas na ordem decrescente da frequência das respostas "preciso melhorar" com descrição de número absoluto e percentual. Comparamos frequências usando o teste de Fisher. Consideramos significativos valores-p < 0,05. Os programas GraphPad Prism 8.4.3 (GraphPad Software, San Diego, CA, EUA) e Microsoft Excel (Microsoft Corporation, Redmond, WA, EUA) foram utilizados para análise estatística. Resultados No período entre o início e o final do R1, a média total de PPOS diminuiu significativamente, de 4,63 para 4,50 (p= 0,024), mais focada em biomédica. Cerca de um terço dos residentes identificou competências do cuidado ao paciente, aprendizagem e melhoria baseadas na prática e habilidades interpessoais e de comunicação, como necessitando melhorar. Conclusões As atividades de PPOS e autoavaliação podem promover práticas de reflexão e são possíveis ferramentas para avaliação de competência centrada no aluno. A orientação biomédica tende a prevalecer à medida que a formação dos médicos progride e as autoavaliações periódicas podem ser trabalhadas para construir uma mentalidade de crescimento.

Low-energy amplitude-modulated electromagnetic field exposure: Feasibility study in patients with hepatocellular carcinoma.

BACKGROUND: Patients with advanced hepatocellular carcinoma (HCC) and poor liver function lack effective systemic therapies. Low-energy electromagnetic fields (EMFs) can influence cell biological processes via non-thermal effects and may represent a new treatment option. METHODS: This single-site feasibility trial enrolled patients with advanced HCC, Child-Pugh A and B, Eastern Cooperative Oncology Group 0-2. Patients underwent 90-min amplitude-modulated EMF exposure procedures every 2-4 weeks, using the AutEMdev (Autem Therapeutics). Patients could also receive standard care. The primary endpoints were safety and the identification of hemodynamic variability patterns. Exploratory endpoints included health-related quality of life (HRQoL), overall survival (OS). and objective response rate (ORR) using RECIST v1.1. RESULTS: Sixty-six patients with advanced HCC received 539 AutEMdev procedures (median follow-up, 30 months). No serious adverse events occurred during procedures. Self-limiting grade 1 somnolence occurred in 78.7% of patients. Hemodynamic variability during EMF exposure was associated with specific amplitude-modulation frequencies. HRQoL was maintained or improved among patients remaining on treatment. Median OS was 11.3 months (95% confidence interval [CI]: 6.0, 16.6) overall (16.0 months [95% CI: 4.4, 27.6] and 12.0 months [6.4, 17.6] for combination therapy and monotherapy, respectively). ORR was 24.3% (32% and 17% for combination therapy and monotherapy, respectively). CONCLUSION: AutEMdev EMF exposure has an excellent safety profile in patients with advanced HCC. Hemodynamic alterations at personalized frequencies may represent a surrogate of anti-tumor efficacy. NCT01686412.

A brazilian nationwide multicenter study on deficiency of deaminase-2 (DADA2).

INTRODUCTION: The deficiency of ADA2 (DADA2) is a rare autoinflammatory disease provoked by mutations in the ADA2 gene inherited in a recessive fashion. Up to this moment there is no consensus for the treatment of DADA2 and anti-TNF is the therapy of choice for chronic management whereas bone marrow transplantation is considered for refractory or severe phenotypes. Data from Brazil is scarce and this multicentric study reports 18 patients with DADA2 from Brazil. PATIENTS AND METHODS: This is a multicentric study proposed by the Center for Rare and Immunological Disorders of the Hospital 9 de Julho - DASA, São Paulo - Brazil. Patients of any age with a confirmed diagnosis of DADA2 were eligible for this project and data on clinical, laboratory, genetics and treatment were collected. RESULTS: Eighteen patients from 10 different centers are reported here. All patients had disease onset at the pediatric age (median of 5 years) and most of them from the state of São Paulo. Vasculopathy with recurrent stroke was the most common phenotype but atypical phenotypes compatible with ALPS-like and Common Variable Immunodeficiency (CVID) was also found. All patients carried pathogenic mutations in the ADA2 gene. Acute management of vasculitis was not satisfactory with steroids in many patients and all those who used anti-TNF had favorable responses. CONCLUSION: The low number of patients diagnosed with DADA2 in Brazil reinforces the need for disease awareness for this condition. Moreover, the absence of guidelines for diagnosis and management is also necessary (t).

Chronic kidney disease in patients with childhood-onset systemic lupus erythematosus.

BACKGROUND: Lupus nephritis (LN) is a frequent manifestation of childhood-onset systemic lupus erythematosus (cSLE) with a potential risk for kidney failure and poor outcomes. This study aimed to evaluate stages III, IV, and V of chronic kidney disease (CKD) and investigate risk factors for CKD in cSLE patients. METHODS: We performed a nationwide observational cohort study in 27 pediatric rheumatology centers, including medical charts of 1528 cSLE patients. Data were collected at cSLE diagnosis, during follow-up, and at last visit or death, between September 2016 and May 2019. RESULTS: Of 1077 patients with LN, 59 (5.4%) presented with CKD, 36/59 (61%) needed dialysis, and 7/59 (11.8%) were submitted for kidney transplantation. After Bonferroni's correction for multiple comparisons (p < 0.0013), determinants associated with CKD were higher age at last visit, urinary biomarker abnormalities, neuropsychiatric involvement, higher scores of disease activity at last visit and damage index, and more frequent use of methylprednisolone, cyclosporine, cyclophosphamide, and rituximab. In the regression model analysis, arterial hypertension (HR = 15.42, 95% CI = 6.12-38.83, p ≤ 0.001) and biopsy-proven proliferative nephritis (HR = 2.83, 95%CI = 1.70-4.72, p ≤ 0.001) increased the risk of CKD, while children using antimalarials had 71.0% lower CKD risk ((1.00-0.29) × 100%) than children not using them. The Kaplan-Meier comparison showed lower survival in cSLE patients with biopsy-proven proliferative nephritis (p = 0.02) and CKD (p ≤ 0.001). CONCLUSIONS: A small number of patients manifested CKD; however, frequencies of dialysis and kidney transplantation were relevant. This study reveals that patients with cSLE with hypertension, proliferative nephritis, and absence of use of antimalarials exhibited higher hazard rates of progression to CKD. A higher resolution version of the Graphical abstract is available as Supplementary information.

Formyl peptide receptors are involved in CTX-induced impairment of lymphocyte functions.

Crotoxin (CTX) is a neurotoxin that is isolated from the venom of Crotalus durissus terrificus, which displays immunomodulatory, anti-inflammatory, and anti-tumoral effects. Previous research has demonstrated that CTX promotes the adherence of leukocytes to the endothelial cells in blood microcirculation and the high endothelial venules of lymph nodes, which reduces the number of blood cells and lymphocytes. Studies have also shown that these effects are mediated by lipoxygenase-derived mediators. However, the exact lipoxygenase-derived eicosanoid involved in the CTX effect on lymphocytes is yet to be characterized. As CTX stimulates lipoxin-derived mediators from macrophages and lymphocyte effector functions could be modulated by activating formyl peptide receptors, we aimed to investigate whether these receptors were involved in CTX-induced redistribution and functions of lymphocytes in rats. We used male Wistar rats treated with CTX to demonstrate that Boc2 (butoxycarbonyl-Phe-Leu-Phe-Leu-Phe), an antagonist of formyl peptide receptors, prevented CTX-induced decrease in the number of circulating lymphocytes and increased the expression of the lymphocyte adhesion molecule LFA1. CTX reduced the T and B lymphocyte functions, such as lymphocyte proliferation in response to the mitogen Concanavalin A and antibody production in response to BSA immunization, respectively, which was prevented by the administration of Boc2. Importantly, mesenteric lymph node lymphocytes from CTX-treated rats showed an increased release of 15-epi-LXA4. These results indicate that formyl peptide receptors mediate CTX-induced redistribution of lymphocytes and that 15-epi-LXA4 is a key mediator of the immunosuppressive effects of CTX.

Taming the SARS-CoV-2-mediated proinflammatory response with BromAc®.

Introduction: In the present study, the impact of BromAc®, a specific combination of bromelain and acetylcysteine, on the SARS-CoV-2-specific inflammatory response was evaluated. Methods: An in vitro stimulation system was standardized using blood samples from 9 healthy donors, luminex assays and flow cytometry were performed. Results and discussion: BromAc® demonstrated robust anti-inflammatory activity in human peripheral blood cells upon SARS-CoV-2 viral stimuli, reducing the cytokine storm, composed of chemokines, growth factors, and proinflammatory and regulatory cytokines produced after short-term in vitro culture with the inactivated virus (iSARS-CoV-2). A combined reduction in vascular endothelial growth factor (VEGF) induced by SARS-CoV-2, in addition to steady-state levels of platelet recruitment-associated growth factor-PDGFbb, was observed, indicating that BromAc® may be important to reduce thromboembolism in COVID-19. The immunophenotypic analysis of the impact of BromAc® on leukocytes upon viral stimuli showed that BromAc® was able to downmodulate the populations of CD16+ neutrophils and CD14+ monocytes observed after stimulation with iSARS-CoV-2. Conversely, BromAc® treatment increased steady-state HLA-DR expression in CD14+ monocytes and preserved this activation marker in this subset upon iSARS-CoV-2 stimuli, indicating improved monocyte activation upon BromAc® treatment. Additionally, BromAc® downmodulated the iSARS-CoV-2-induced production of TNF-a by the CD19+ B-cells. System biology approaches, utilizing comprehensive correlation matrices and networks, showed distinct patterns of connectivity in groups treated with BromAc®, suggesting loss of connections promoted by the compound and by iSARS-CoV-2 stimuli. Negative correlations amongst proinflammatory axis and other soluble and cellular factors were observed in the iSARS-CoV-2 group treated with BromAc® as compared to the untreated group, demonstrating that BromAc® disengages proinflammatory responses and their interactions with other soluble factors and the axis orchestrated by SARS-CoV-2. Conclusion: These results give new insights into the mechanisms for the robust anti-inflammatory effect of BromAc® in the steady state and SARS-CoV-2-specific immune leukocyte responses, indicating its potential as a therapeutic strategy for COVID-19.

Association between multidrug-resistant bacteria and outcomes in intensive care unit patients: a non-interventional study.

Background: In intensive care units (ICUs), infections by multidrug-resistant (MDR) microorganisms should be monitored to prevent healthcare-associated infections (HAIs). Methods: From 2018 to 2020, we investigated all medical records of patients admitted to the ICU of a public university hospital. All patients colonized/infected by MDR microorganisms and submitted to active surveillance cultures (ASCs) were included. Results and discussion: Male patients prevailed, and 9.5% were positive for MDR bacteria. In-hospital deaths were statistically significant (p < 0.05) for older patients, patients with orotracheal tube use during previous and current hospitalization, and patients with high blood pressure, cardiac and pulmonary diseases, and chronic kidney disease. Carbapenem resistant Enterobacteriaceae was the most frequently resistance profile, followed by extended-spectrum beta-lactamase. The diagnosis or evolution of HAIs was statistically significant (p < 0.0001) for patients treated with meropenem and vancomycin, and in-hospital deaths occurred in 29.5% of patients using polypeptides while the use of macrolides reduced the odds for mortality. The BRADEN Scale demonstrated that 50% of the patients were at high risk of dying. Conclusion: Patients hospitalized in the ICU, colonized or infected by MDR bacteria, using invasive medical devices, and with underlying medical conditions presented increased mortality rates. The prescription of meropenem and vancomycin should be carefully monitored once patients using these antimicrobials already have or develop an HAI.

Complicação e retenção de cateter central de inserção periférica em recém-nascido: relatos de casos / Complicación y retención de catéter central de inserción periférica en recién nacido: informes de casos / Complication and retention of peripheral insertion central catheter in newborn: case reports

Objetivo: relatar casos de complicação e retenção de cateter central de inserção periférica em recém-nascidos. Método: Relato de caso sobre dois casos de enovelamento e retenção de cateter central de inserção periférica em uma Unidade de Terapia Intensiva Neonatal de um hospital no Sul do Brasil, entre maio e outubro de 2022. Resultados: No primeiro caso ocorreu dificuldade na remoção do cateter logo após sua inserção, com necessidade de remoção cirúrgica. No segundo identificou-se pela radiografia o enovelamento na fossa antecubital do membro superior neonatal, sem migração da ponta para região central, apesar de apresentar refluxo sanguíneo, sendo removido por tração manual. Conclusão: a formação de novelos ou nós em cateter central de inserção periférica e retenção tratam-se de complicações raras. Estar atento a este acontecimento possibilita a construção de evidências e estratégias de prevenção e manejo adequado na prática profissional.

Objetivo: reportar casos de complicación y retención de catéter central de inserción periférica en recién nacidos internados en la Unidad de Terapia Intensiva Neonatal. Método: estudio descriptivo, del tipo relato de caso, realizado entre mayo y octubre de 2022, en un hospital en el Sur de Brasil. Resultados: se han identificado dos casos de ennegrecimiento/formación de nudo y retención de catéter central de inserción periférica. En el primer caso ocurrió dificultad en la extracción del catéter inmediatamente después de su inserción, con necesidad de extracción quirúrgica. En el segundo caso, se identificó por la radiografía el ennegrecimiento en la fosa antecubital del miembro superior neonatal, sin migración de la punta hacia la región central, a pesar de presentar reflujo sanguíneo, siendo removido por tracción manual, sin resistencia e intercorgencias. Conclusión: la formación de ovillos o nudos en catéter central de inserción periférica y retención se tratan de complicaciones raras. Estar atento a este acontecimiento posibilita la construcción de evidencias y estrategias de prevención y manejo adecuado en la práctica profesional.

Objective: to report cases of complication and retention of central peripheral insertion catheter in newborns admitted to the Neonatal Intensive Care Unit. Method: descriptive case report study, conducted between May and October 2022, in a hospital in southern Brazil. Results: two cases of node folding/formation and retention of central peripheral insertion catheter were identified. In the first case, there was difficulty in removing the catheter soon after its insertion, requiring surgical removal. In the second case, the folding in the antecubital fossa of the neonatal upper limb was identified by radiography, without migration from the tip to the central region, despite presenting blood reflux, being removed by manual traction, without resistance or intercurrences. Conclusion: the formation of skeins or nodes in central catheter of peripheral insertion and retention are rare complications. Being aware of this event enables the construction of evidence and prevention strategies and proper management in professional practice.

A brazilian nationwide multicenter study on deficiency of deaminase-2 (DADA2)

Abstract Introduction The deficiency of ADA2 (DADA2) is a rare autoinflammatory disease provoked by mutations in the ADA2 gene inherited in a recessive fashion. Up to this moment there is no consensus for the treatment of DADA2 and anti-TNF is the therapy of choice for chronic management whereas bone marrow transplantation is considered for refractory or severe phenotypes. Data from Brazil is scarce and this multicentric study reports 18 patients with DADA2 from Brazil. Patients and methods This is a multicentric study proposed by the Center for Rare and Immunological Disorders of the Hospital 9 de Julho - DASA, São Paulo - Brazil. Patients of any age with a confirmed diagnosis of DADA2 were eligible for this project and data on clinical, laboratory, genetics and treatment were collected. Results Eighteen patients from 10 different centers are reported here. All patients had disease onset at the pediatric age (median of 5 years) and most of them from the state of São Paulo. Vasculopathy with recurrent stroke was the most common phenotype but atypical phenotypes compatible with ALPS-like and Common Variable Immunodeficiency (CVID) was also found. All patients carried pathogenic mutations in the ADA2 gene. Acute management of vasculitis was not satisfactory with steroids in many patients and all those who used anti-TNF had favorable responses. Conclusion The low number of patients diagnosed with DADA2 in Brazil reinforces the need for disease awareness for this condition. Moreover, the absence of guidelines for diagnosis and management is also necessary (t).

Ensino em psiquiatria cultural: rumo a uma atitude decolonial / Teaching in cultural psychiatry: towards a decolonial attitude

Resumo: Introdução: O presente ensaio é baseado na experiência de ensino do Programa de Psiquiatria Social e Cultural da Universidade de São Paulo (ProSol)e em fundamentações teóricas do campo da psiquiatria cultural. Desenvolvimento: Neste ensaio, destaca-se a importância do ensino em psiquiatria cultural para a formação de residentes na psiquiatria. A psiquiatria brasileira, ao longo de sua história, ficou marcada pela absorção dos conhecimentos advindos dos países desenvolvidos com pouca preocupação com a realidade brasileira. O ensino dos aspectos culturais, dentro da psiquiatria, possibilita reativar a importância da realidade e especificidade brasileiras para o ensino dos residentes. Conclusão: A tese central deste ensaio é que o ensino de psiquiatria cultural é uma forma de decolonização do ensino, na medida em que torna os psiquiatras mais aptos para enfrentar os vários cenários clínicos de um país diverso e cheio de contradições como o Brasil.

Abstract: Introduction: This essay is based on the teaching experience of theTranscultural Psychiatry Program at the University of São Paulo (ProSol,Programa de Psiquiatria Transcultural da Universidade de São Paulo) and on theoretical foundations in the field of cultural psychiatry. Objective: To highlight the importance of teaching cultural psychiatry for the training of psychiatry residents. Results: Brazilian psychiatry, throughout its history, was marked by the incorporation of knowledge from developed countries with little concern for the Brazilian reality. The teaching of cultural aspects, in the psychiatric field, makes it possible to reactivate the importance of Brazilian reality and specificity for the teaching of residents. Conclusion: The central thesis of this essay is that the teaching of cultural psychiatry is a form of decolonization of teaching, insofar as it makes psychiatrists more apt to face the different clinical scenarios in a diverse country full of contradictions such as Brazil.

The influence of pesticides on the corrosion of a Roman bowl excavated in Kent, UK.

We analysed corrosion from a copper bowl dating from the Roman period (43-410 AD) found in a farm in Kent, UK. Despite its relatively good condition, the interior and exterior surface of the object had areas of deterioration containing green and brown-coloured corrosion which were sampled for characterization by a multi-analytical protocol. Basic copper chlorides atacamite and paratacamite were identified in the context of mineral phases along with chlorobenzenes in the green corrosion. Chlorobenzenes are common soil contaminants in rural areas from the use of pesticides, many of which were banned more than 50 years ago. Here we show that their presence is associated with accelerated corrosion, and this provides a threat to the preservation of archaeological metal objects in the ground.

Ex-vivo mucolytic and anti-inflammatory activity of BromAc in tracheal aspirates from COVID-19.

COVID-19 is a lethal disease caused by the pandemic SARS-CoV-2, which continues to be a public health threat. COVID-19 is principally a respiratory disease and is often associated with sputum retention and cytokine storm, for which there are limited therapeutic options. In this regard, we evaluated the use of BromAc®, a combination of Bromelain and Acetylcysteine (NAC). Both drugs present mucolytic effect and have been studied to treat COVID-19. Therefore, we sought to examine the mucolytic and anti-inflammatory effect of BromAc® in tracheal aspirate samples from critically ill COVID-19 patients requiring mechanical ventilation. METHOD: Tracheal aspirate samples from COVID-19 patients were collected following next of kin consent and mucolysis, rheometry and cytokine analysis using Luminex kit was performed. RESULTS: BromAc® displayed a robust mucolytic effect in a dose dependent manner on COVID-19 sputum ex vivo. BromAc® showed anti-inflammatory activity, reducing the action of cytokine storm, chemokines including MIP-1alpha, CXCL8, MIP-1b, MCP-1 and IP-10, and regulatory cytokines IL-5, IL-10, IL-13 IL-1Ra and total reduction for IL-9 compared to NAC alone and control. BromAc® acted on IL-6, demonstrating a reduction in G-CSF and VEGF-D at concentrations of 125 and 250 µg. CONCLUSION: These results indicate robust mucolytic and anti-inflammatory effect of BromAc® ex vivo in tracheal aspirates from critically ill COVID-19 patients, indicating its potential to be further assessed as pharmacological treatment for COVID-19.

Accuracy of delirium risk factors in adult intensive care unit patients.

OBJECTIVE: To assess the accuracy measurements for predisposing and precipitating Risk Factors for delirium in an adult Intensive Care Unit. METHOD: Cohort, prospective study with patients over 18 who had been hospitalized for over 24 hours and were able to communicate. The patients were assessed once a day until the onset of delirium or permanence in the Intensive Care Unit. Instruments were employed to track delirium, characterize the sample, and identify the risk factors. Descriptive statistics was employed for sample characterization and accuracy tests for risk factors. RESULTS: The included patients amounted to 102, 31 of which presented delirium. The predisposing predictive risk factors were hypoalbuminemia, American Society of Anesthesiology over three, severity, altered tissue perfusion, dehydration, and being a male, whereas precipitating predictive factors were physical restraint, infection, pharmacological agent, polypharmacy, anemia, altered renal function, dehydration, invasive devices, altered tissue perfusion and altered quality and quantity of sleep. CONCLUSION: An accurate identification of predisposing and precipitating risk factors may contribute to planning preventive measures against delirium.

The first evidence of pituitary gland tumor in ground sloth Valgipes bucklandi Lund, 1839.

Bone diseases are commonly found in the fossil record, especially in mammals of the Pleistocene megafauna, which exhibit signs of overload in the articulations. However, pathologies that affect soft tissues are not usually reported, even due to the nature of fossilization that rarely preserves such materials. In paleoneurological research using CT scan and three-dimensional reconstructions of Pleistocene sloths, an anomaly is discovered in the space that houses the pituitary gland, the sella turcica. The tomographic analysis of a Valgipes bucklandi skull revealed a great enlargement at the sella turcica, at the medial region in the body of the basisphenoid bone. The images delimit an enlarged dorsal-ventral projection, measuring approximately 15 mm height, at the tridimensional reconstructed endocranium. Taphonomic processes, such as the action of necrophagous agents, were discarded due to the shape and conditions of the structure, which also showed signs of bone remodeling. Thus, it is possible to affirm that a paleopathological process altered the size of the pituitary gland of the specimen MCT 3993-M, being probably a pituitary tumor.