Imatinib-induced dermatomyositis sine dermatitis - a rare case report.

Idiopathic Inflammatory Myopathies are rare conditions with several heterogeneous disease subtypes. They can range from limited muscle or skin involvement to severe, systemic, life-threatening disease. Although the etiology is unknown, some evidence suggests a role for external agents, particularly drugs. Herein, we present a case of a 71-year-old woman with chronic myeloid leukemia who developed imatinib-induced dermatomyositis sine dermatitis. The presentation was predominantly muscular, characterized by proximal muscle weakness and myalgia of the lower limbs, with positive anti-Mi2a antibodies. Spontaneous recovery was observed after drug discontinuation, without the need for immunosuppressive therapy. This is the first confirmed description of an imatinib-induced dermatomyositis sine dermatitis. It reflects the importance of a high awareness from rheumatologists and hematologists to accurately anticipate and identify similar situations.

Assignment of individual structures from intermetalloid nickel gallium cluster ensembles.

Poorly selective mixed-metal cluster synthesis and separation yield reaction solutions of inseparable intermetalloid cluster mixtures, which are often discarded. High-resolution mass spectrometry, however, can provide precise compositional data of such product mixtures. Structure assignments can be achieved by advanced computational screening and consideration of the complete structural space. Here, we experimentally verify structure and composition of a whole cluster ensemble by combining a set of spectroscopic techniques. Our study case are the very similar nickel/gallium clusters of M12, M13 and M14 core composition Ni6+xGa6+y (x + y ≤ 2). The rationalization of structure, bonding and reactivity is built upon the organometallic superatom cluster [Ni6Ga6](Cp*)6 = [Ga6](NiCp*)6 (1; Cp* = C5Me5). The structural conclusions are validated by reactivity tests using carbon monoxide, which selectively binds to Ni sites, whereas (triisopropylsilyl)acetylene selectively binds to Ga sites.

Severe infections in Portuguese patients with rheumatoid arthritis under biologic treatment - a multicenter, nationwide study (SIPPRA-B Study).

INTRODUCTION: Despite years of experience with biological disease modifying anti-rheumatic drugs (bDMARD) in rheumatoid arthritis (RA), little is known about differences in infectious risk among bDMARDs. The aim of this study was to assess the incidence and type of infections in RA patients on bDMARDs and to determine possible predictors. METHODS: A retrospective multicenter cohort study that included patients registered in the Rheumatic Diseases Portuguese Registry (Reuma.pt) with RA, and exposed to at least one bDMARD until April 2021. RA patients under bDMARD and with at least one episode of severe infection (SI), defined as infection that requires hospitalization, use of parenteral antibiotics or that resulted in death, were compared to patients with no report of SI. Demographic and clinical data at baseline and at the time of each SI were collected to establish comparisons between different groups of bDMARDs. Comparisons between different bDMARDs were assessed and logistic regression was performed to identify predictors of SI. RESULTS: We included 3394 patients, 2833 (83.5%) female, with a mean age at RA diagnosis of 45.5±13.7 years. SI was diagnosed in 142 of the 3394 patients evaluated (4.2%), totaling 151 episodes of SI. At baseline, patients with SI had a significantly higher proportion of prior orthopedic surgery, asthma, interstitial lung disease, chronic kidney disease and corticosteroid use, higher mean age and longer median disease duration at first bDMARD. Nine patients died (6.0%). Ninety-two SI (60.9%) occurred with the first bDMARD, the majority leading to discontinuation of the bDMARD within 6 months (n=75, 49.7%), while 65 (43.0%) restarted the same bDMARD and 11 (7.3%) switched to another bDMARD (6 of them to a different mechanism of action). In the multivariate analysis, we found that chronic kidney disease, asthma, infliximab, corticosteroid use, interstitial lung disease, previous orthopedic surgery, higher Health Assessment Questionnaire and DAS284V-ESR are independent predictors of SI. CONCLUSION: This study described the incidence and types of SI among Portuguese RA patients on biologics, identifying several predictors of SI, both globally and with different bDMARDs. Physicians should be aware of the real-word infectious risk in RA patients on bDMARDs when making treatment decisions.

Metodologias ativas na Atenção Primária à Saúde e Estratégia Saúde da Família: revisão de escopo / Active methodologies in Primary Health Care and Family Health Strategy: scoping review

Introdução: Conduziu-se uma revisão de escopo voltada à identificação de estudos realizados no contexto da Atenção Primária à Saúde ou Estratégia Saúde da Família cujo desenvolvimento envolvera o emprego de ao menos uma forma de Metodologia Ativa. Desenvolvimento: A busca ocorrera em março de 2022 e considerou o emprego de 18 estratégias distintas que deveriam compor a seção Título dos manuscritos. Foram recuperados sete manuscritos, envolvendo cenários de graduação, estágio, residência, preceptoria e avaliação curricular envolvendo sete estratégias ativas de ensino-aprendizagem. Conclusão: A ausência da avaliação dos impactos decorrentes do emprego das estratégias ativas representa lacunas envolvendo processos pedagógicos eficientes voltado à formação de profissionais da saúde.

Introduction: A scope review was conducted aimed at identifying studies realized in the context of Primary Health Care or Family Health Strategy whose development involved the use of at least one form of Active Methodology. Development: The search took place in March 2022 and considered the use of 18 different strategies that should compose the Title section of the manuscripts. Seven manuscripts were retrieved, involving graduation, internship, residency, preceptorship and curriculum evaluation scenarios involving seven active teaching-learning strategies. Conclusion: The absence of an assessment of the impacts resulting from the useof active strategies represents gaps involving efficient pedagogical processes aimed at training health professionals.

Fatores associados ao estresse de pais em Unidade de Terapia Intensiva Neonatal / Factores asociados al estrés de padres en Unidad de Cuidados Intensivos Neonatales / Factors associated with parental stress in a Neonatal Intensive Care Unit

Resumo Objetivo Analisar os fatores associados ao estresse de pais de recém-nascidos internados em Unidade de Terapia Intensiva Neonatal. Métodos Estudo transversal desenvolvido com 204 pais presentes em uma Unidade de Terapia Intensiva Neonatal do estado do Rio Grande do Sul. Para a coleta dos dados, utilizaram-se um instrumento de caracterização dos participantes e a versão brasileira da Parental Stress Scale: Neonatal Intensive Care Unit. Os dados foram analisados por meio do teste de Mann-Whitney e Kruskal-Wallis. Resultados As variáveis sociodemográficas que se mostraram associadas a maiores níveis de estresse foram sexo, experiência anterior com unidade neonatal, escolaridade e religião. E as variáveis clínicas dos recém-nascidos foram unidade de internação, terapêuticas respiratória e intravenosa e procedimento cirúrgico prévio. Conclusão Os participantes do sexo feminino, que não possuíam experiência prévia com unidade neonatal, com maior escolaridade e religião apresentaram maiores níveis de estresse bem como os que tinham os filhos internados na unidade de alto risco, com suporte respiratório, uso de dois dispositivos intravenosos e com história prévia de procedimento cirúrgico.

Resumen Objetivo Analizar los factores asociados al estrés de padres de recién nacidos internados en Unidad de Cuidados Intensivos Neonatales. Métodos Estudio transversal realizado con 204 padres presentes en una Unidad de Cuidados Intensivos Neonatales del estado de Rio Grande do Sul. Para la recopilación de datos, se utilizó un instrumento de caracterización de los participantes y la versión brasileña de la Parental Stress Scale: Neonatal Intensive Care Unit. Los datos fueron analizados mediante la prueba de Mann-Whitney y Kruskal-Wallis. Resultados Las variables sociodemográficas que demostraron estar asociadas a mayores niveles de estrés fueron sexo, experiencia anterior en unidad neonatal, escolaridad y religión. Y las variables clínicas de los recién nacidos fueron unidad de internación, terapia respiratoria e intravenosa y procedimiento quirúrgico previo. Conclusión Los participantes de sexo femenino, que no tenían experiencia previa en unidad neonatal, con mayor escolaridad y religión presentaron mayores niveles de estrés, así como los que tenían hijos internados en unidades de alto riesgo, con soporte respiratorio, uso de dos dispositivos intravenosos y con historia previa de procedimiento quirúrgico.

Abstract Objective To analyze the stress-related factors of parents of newborns hospitalized in a Neonatal Intensive Care Unit. Methods This is a cross-sectional study developed with 204 parents present in a Neonatal Intensive Care Unit in the state of Rio Grande do Sul. For data collection, we used an instrument to characterize participants and the Brazilian version of the Parental Stress Scale: Neonatal Intensive Care Unit. Data were analyzed using the Mann-Whitney and Kruskal-Wallis tests. Results The sociodemographic variables that were associated with higher levels of stress were sex, previous experience with neonatal unit, education and religion. And the clinical variables of newborns were hospitalization unit, respiratory and intravenous therapies and previous surgical procedure. Conclusion Female participants, who had no previous experience with a neonatal unit, with higher education and religion, had higher levels of stress, as well as those who had their children hospitalized in the high-risk unit, with respiratory support, use of two intravenous devices and with previous history of surgical procedure.

Fish fauna of the São Francisco River Interbasin Water Transfer reservoirs / Ictiofauna dos reservatórios do Projeto de Integração do Rio São Francisco

Abstract Artificial impoundments are frequently built to mitigate the water scarcity in the drylands such as the Caatinga region in Brazil. The São Francisco Interbasin Water Transfer (SF-IWT) megaproject implemented many artificial reservoirs for that purpose. A checklist of fish species from the SF-IWT reservoirs is provided based on samples from eight years of monitoring. The collections were conducted semiannually at 28 reservoirs divided into three groups: the East Axis, North Axis, and Agreste Branch. The SF-IWT reservoirs presented a total of 47 species, 46 were recorded in the North Axis, 27 in the East Axis, and only seven in the Agreste Branch. Characids and cichlids represented most of the species. The three analyzed groups of reservoirs presented distinct communities and the reservoirs' age, richness and abundance were relevant variables responsible for fish composition. The SF-IWT reservoirs present a diverse and heterogeneous ichthyofauna, typical of lentic environments. The main colonizers of the SF-IWT reservoirs were fish from the São Francisco donor basin, invasive species anthropically released in those sites, and eventual species from the surrounding receiving basins. As the accumulation curves suggested, a continuous effort could reveal additional species, patterns in long-term colonization, and contribute to data on the reservoirs' future stabilization phase. Since invasive species were present in most reservoirs, along with donor-basin native species with potential to disperse to the receiving basins, a continuous and detailed monitoring is key for management planning and possible impacts assessment.

Resumo Barramentos artificiais são comumente construídos para mitigar a escassez hídrica em áreas semiáridas como a região da Caatinga brasileira. O Projeto de Integração do Rio São Francisco (PISF) com Bacias Hidrográficas do Nordeste Setentrional implementou muitos reservatórios artificiais com este propósito. Uma lista de espécies de peixes dos reservatórios do PISF foi obtida após amostragens realizadas em oito anos de monitoramento. As campanhas foram realizadas semestralmente em 28 reservatórios divididos em três grupos: Eixo Leste, Eixo Norte e Ramal do Agreste. Os reservatórios amostrados apresentaram um total de 47 espécies, 46 delas foram registradas no Eixo Norte, 27 no Eixo Leste e apenas sete no Ramal do Agreste. Characidae e Cichlidae foram as famílias mais representativas. Os três grupos de reservatórios analisados apresentaram comunidades distintas e a idade, a riqueza e a abundância de cada reservatório foram as variáveis que mais influenciaram a composição das espécies de peixes. Os reservatórios do PISF apresentaram uma ictiofauna diversa e heterogênea, característica de ambientes lênticos. Os principais colonizadores dos reservatórios do PISF foram peixes da bacia doadora do São Francisco, espécies invasoras antropicamente liberadas nesses locais e eventuais espécies das bacias receptoras do entorno. De acordo com o resultado das curvas de acúmulo, um esforço contínuo poderia revelar espécies adicionais, padrões na colonização em longo prazo e contribuir com dados para a fase futura de estabilização dos reservatórios. Visto que espécies invasoras estiveram presentes em quase todos os reservatórios, juntamente com espécies nativas da bacia doadora com potencial de dispersão para as bacias receptoras, um monitoramento continuo e detalhado é essencial para o planejamento de manejo e avaliação de impactos.

Influence of the ethical climate on workers' health among healthcare professionals: a systematic review / Influencia del clima ético en la salud del trabajador entre los profesionales de la salud: una revisión sistemática / Influência do clima ético na saúde do trabalhador entre profissionais de saúde: revisão sistemática

ABSTRACT Objective: To evaluate the influence of the ethical climate on workers' health among healthcare professionals. Method: Systematic review and meta-analysis conducted in MEDLINE/PubMed, EMBASE, SciVerse Scopus (Elsevier), Cumulative Index to Nursing and Allied Health Literature and Web of Science. Trained reviewers performed the selection, data extraction, and assessment of methodological quality. Meta-analysis was applied for data synthesis. Results: Among the 2644 studies, 20 were included for analysis, in which three (15.0%) articles were classified as high quality (score ≥ 80%), while 17 (85.0%) were classified as regular (score 50-79%). There was a moderate negative correlation between the ethical climate and overall moral distress (r=-0.43; 95%CI -0.50; -0.36) and the frequency of moral distress (r=-0.36; 95%CI -0.45; -0.25), as well as the positive and strong correlation between ethical climate and job satisfaction (r=0.71; 95%CI 0.39-0.88). Conclusion: The negative and positive perception of the ethical climate among healthcare professionals, respectively, influenced the increase in moral distress and job satisfaction.

RESUMEN Objetivo: Evaluar la influencia del clima ético en la salud de los trabajadores entre los profesionales de la salud. Método: Revisión sistemática y metanálisis utilizando MEDLINE/PubMed, EMBASE, SciVerse Scopus (Elsevier), Cumulative Index to Nursing and Allied Health Literature y Web of Science. La selección, la extracción de datos y la evaluación de la calidad metodológica fueron realizadas por revisores capacitados. Se aplicó metanálisis para la síntesis de datos. Resultados: Entre 2644 estudios, 20 fueron incluidos para el análisis, en el que tres (15,0%) artículos fueron clasificados como de alta calidad (puntuación ≥ 80%), mientras que 17 (85,0%) fueron clasificados como regulares (puntuación 50-79%). Ocurrió correlación negativa y moderada entre el clima ético y el sufrimiento moral general (r=-0,45; IC95% -0,52; -0,38) y la frecuencia del sufrimiento moral (r=- 0,32; IC 95% -0,45; -0,18), así como una correlación positiva y fuerte entre el clima ético y la satisfacción laboral (r=0,71; IC 95% 0,39-0, 88). Conclusión: La percepción negativa y positiva del clima ético entre los profesionales de la salud, respectivamente, influyeron en el aumento del malestar moral y la satisfacción laboral.

RESUMO Objetivo: Avaliar a influência do clima ético na saúde do trabalhador entre os profissionais de saúde. Método: Revisão sistemática nas bases MEDLINE/PubMed, EMBASE, SciVerse Scopus (Elsevier), Cumulative Index to Nursing and Allied Health Literature e Web of Science. A seleção, a extração dos dados e a avaliação da qualidade metodológica foram realizadas por revisores capacitados. Aplicou-se a meta-análise para a síntese dos dados. Resultados: Dentre os 2644 estudos, foram incluídos 20 para análise, em que três (15,0%) artigos foram classificados como de alta qualidade (pontuação ≥ 80%), enquanto 17 (85,0%) foram classificados como regulares (pontuação 50-79%). Houve correlação negativa e moderada entre o clima ético e o sofrimento moral geral (r=-0,43; IC95% -0,50; -0,36) e a frequência de sofrimento moral (r=-0,36; IC95% -0,45; -0,25), bem como a correlação positiva e forte entre o clima ético e a satisfação no trabalho (r=0,71; IC95% 0,39-0,88). Conclusão: A percepção negativa e positiva do clima ético entre os profissionais de saúde, respectivamente, influenciou no aumento do sofrimento moral e na satisfação no trabalho.

Supervised and semi-supervised training of deep convolutional neural networks for gastric landmark detection.

This work focuses on detection of upper gas-trointestinal (GI) landmarks, which are important anatomical areas of the upper GI tract digestive system that should be photodocumented during endoscopy to guarantee a complete examination. The aim of this work consisted in testing new automatic algorithms, specifically based on convolutional neural network (CNN) systems, able to detect upper GI landmarks, that can help to avoid the presence of blind spots during esophagogastroduodenoscopy. We tested pre-trained CNN architectures, such as the ResNet-50 and VGG-16, in conjunction with different training approaches, including the use of class weights, batch normalization, dropout, and data augmentation. The ResNet-50 model trained with class weights was the best performing CNN, achieving an accuracy of 71.79% and a Mathews Correlation Coefficient (MCC) of 65.06%. The combination of supervised and unsupervised learning was also explored to increase classification performance. In particular, convolutional autoencoder architectures trained with unlabeled GI images were used to extract representative features. Such features were then concatenated with those extracted by the pre-trained ResNet-50 architecture. This approach achieved a classification accuracy of 72.45% and an MCC of 65.08%. Clinical relevance- Esophagogastroduodenoscopy (EGD) photodocumentation is essential to guarantee that all areas of the upper GI system are examined avoiding blind spots. This work has the objective to help the EGD photodocumentation monitorization by testing new CNN-based systems able to detect EGD landmarks.

Consumo de tabaco y alcohol y comportamientos de salud entre estudiantes de enfermería / O consumo de tabaco e álcool e os comportamentos de saúde em estudantes de enfermagen / Tobacco and alcohol consumption and health behaviors among nursing students

Objective: To evaluate the association between attitudes, health behaviors, and the use of tobacco and alcohol among nursing students. Materials and method: Exploratory, descriptive and cross-sectional study conducted with 182 undergraduate nursing students in the countryside of São Paulo, Brazil. Sociodemographic Information Form, Alcohol Use Disorders Identification Test ­ C (AUDIT-C), Fagerström Test for Nicotine Dependence (FTND), Attitudes and Health Behaviors Questionnaire (AHBQ), and Patient Health Questionnaire ­ 2 (PHQ-2) were applied. Results: More than half of the students showed appropriate health behaviors and positive attitudes. Approximately 50% of the participants had consumed alcoholic beverages in the last month. Experimental use of illicit drugs and smoking were also observed. In addition, students who reported excessive alcohol use presented a deficit in self-care. Conclusions: The precariousness in health attitudes and behaviors identified in this study was associated with various patterns of psychoactive substance use. Thus, the results indicate the need for interventions aimed at promoting well-being and a healthy lifestyle in the university environment.

Objetivo: evaluar la asociación entre las actitudes, los comportamientos de salud y el uso de tabaco y alcohol entre un grupo de estudiantes de enfermería. Materiales y método: estudio exploratorio, descriptivo y transversal realizado con 182 estudiantes de pregrado en enfermería en São Paulo, Brasil. Se aplicaron los siguientes instrumentos: Formulario de Información Sociodemográfica, Prueba de Identificación de Trastornos Derivados del Consumo de Alcohol ­ C (AUDIT-C), Test de Fagerström para Adicción a la Nicotina (FTND), Cuestionario sobre Actitudes y Conductas de Salud (CACS) y Cuestionario de Salud del Paciente ­ 2 (PHQ-2). Resultados: más de la mitad de los estudiantes mostraron comportamientos de salud apropiados y actitudes positivas. Aproximadamente 50 % de los participantes había consumido bebidas alcohólicas en el último mes. También se observó el uso experimental de drogas ilícitas y tabaco. Además, los estudiantes que reportaron el consumo excesivo de alcohol presentaron un déficit en el autocuidado. Conclusiones: la precariedad en las actitudes y los comportamientos de salud identificados en este estudio fue asociada con diversos patrones de uso de sustancias psicoactivas. Los resultados señalan la necesidad de intervenciones destinadas a promover el bienestar y un estilo de vida saludable en el ámbito universitario.

Objetivo: avaliar a associação entre as atitudes, os comportamentos de saúde e o uso de tabaco e álcool num grupo de estudantes de enfermagen. Materiais e método: estudo exploratório, descritivo e transversal realizado com 182 estudantes de graduação em enfermagem em São Paulo, Brasil. Foram aplicados os seguintes instrumentos: Formulário de Informação Sociodemográfica, Teste de Identificação de Transtornos Derivados do Consumo de Álcool-C (AUDIT-C), Teste de Fagerström para a Dependência de Nicotina (FTND), Questionário sobre Atitudes e Condutas de Saúde (CACS) e Questionário de Saúde do Paciente-2 (PHQ-2). Resultados: mais da metade dos estudantes mostraram comportamentos de saúde apropriados e atitudes positivas. Aproximadamente 50 % dos participantes tinham consumido bebidas alcoólicas no último mês. Também foi observado o uso experimental de drogas ilícitas e tabaco. Além disso, os estudantes que relataram o consumo excessivo de álcool apresentaram um déficit no autocuidado. Conclusões: a precariedade nas atitudes e comportamentos de saúde identificados neste estudo foi associada com diversos padrões de uso de substâncias psicoativas. Os resultados indicam a necessidade de intervenções destinadas a promover o bem-estar e um estilo de vida saudável no contexto universitário.

Prostate Cancer Aggressiveness Prediction Using CT Images.

Prostate Cancer (PCa) is mostly asymptomatic at an early stage and often painless requiring active surveillance screening. Transrectal Ultrasound Guided Biopsy (TRUS) is the principal method to diagnose PCa following a histological examination by observing cell pattern irregularities and assigning the Gleason Score (GS) according to the recommended guidelines. This procedure presents sampling errors and, being invasive may cause complications to the patients. External Beam Radiotherapy Treatment (EBRT) is presented as curative option for localised and locally advanced disease, as a palliative option for metastatic low-volume disease or after prostatectomy for prostate bed and pelvic nodes salvage. In the EBRT worflow a Computed Tomography (CT) scan is performed as the basis for dose calculations and volume delineations. In this work, we evaluated the use of data-characterization algorithms (radiomics) from CT images for PCa aggressiveness assessment. The fundamental motivation relies on the wide availability of CT images and the need to provide tools to assess EBRT effectiveness. We used Pyradiomics and Local Image Features Extraction (LIFEx) to extract features and search for a radiomic signature within CT images. Finnaly, when applying Principal Component Analysis (PCA) to the features, we were able to show promising results.

Potential Therapeutic Effects of the Neural Stem Cell-Targeting Antibody Nilo1 in Patient-Derived Glioblastoma Stem Cells.

Glioblastoma (GBM) is the most devastating and least treatable brain tumor with median survival <15 months and extremely high recurrence rates. Promising results of immune checkpoint blockade obtained from pre-clinical studies in mice did not translate to clinic, and new strategies are urgently needed, particularly those targeting GBM stem cells (GSCs) that are held responsible for drug resistance and tumor recurrence. Patient-derived GSC cultures are critical for finding effective brain tumor therapies. Here, we investigated the ability of the recently described monoclonal antibody Nilo1 to specifically recognize GSCs isolated from GBM surgical samples. We employed five patient-derived GSC cultures with different stemness marker expression and differentiation potential, able to recapitulate original tumors when xenotransplanted in vivo. To answer whether Nilo1 has any functional effects in patient-derived GSCs lines, we treated the cells with Nilo1 in vitro and analyzed cell proliferation, cell cycle, apoptosis, sphere formation, as well as the expression of stem vs. differentiation markers. All tested GSCs stained positively for Nilo1, and the ability of Nilo1 to recognize GSCs strongly relied on their stem-like phenotype. Our results showed that a subset of patient-derived GSCs were sensitive to Nilo1 treatment. In three GSC lines Nilo1 triggered differentiation accompanied by the induction of p21. Most strikingly, in one GSC line Nilo1 completely abrogated self-renewal and led to Bax-associated apoptosis. Our data suggest that Nilo1 targets a molecule functionally relevant for stemness maintenance and pinpoint Nilo1 as a novel antibody-based therapeutical strategy to be used either alone or in combination with cytotoxic drugs for GSC targeting. Further pre-clinical studies are needed to validate the effectiveness of GSC-specific Nilo1 targeting in vivo.

Mapping of spatiotemporal distribution of Tibraca limbativentris Stal (Hem.: Pentatomidae) in flooded rice crop in Southern Brazil

ABSTRACT The rice stem bug, Tibraca limbativentris Stal (Hem.: Pentatomidae), is one of the main insect pests in Brazilian rice crops. Knowledge of its spatiotemporal distribution can support the development of an effective sampling system and improve IPM strategies. This study aimed to map the spatiotemporal distribution of rice stem bug in flooded rice crop in Southern Brazil. Flooded rice crop was scouted for two seasons to estimate insect densities. Four occurrence categories were observed: no insect, only adults, only nymphs, and both phases. The relationship between phenological stages and insect categories was established. Interpolation (mapping) of occurrence categories of T. limbativentris was performed by multiquadric equations. In two seasons during the rice cycle, the results indicate that rice stem bug "adults" were the most abundant category until the mid-vegetative phase of the rice; "nymphs" were the most abundant from the end of vegetative phase; "adults + nymphs" occurred from the beginning of reproductive phase; there were no rice stem bugs in more than 66% of the area, as they were most concentrated near the edge of the crop. The information presented here provides further knowledge about T. limbativentris spatiotemporal dynamics that can be applied to improve IPM strategies, such as developing sampling plans and localized control measures at the edge of rice fields.

Sofrimento moral e satisfação profissional: qual a sua relação no trabalho do enfermeiro? / Sufrimiento moral y satisfacción profesional: ¿cuál su relación en el trabajo del enfermero? / Moral distress and work satisfaction: what is their relation in nursing work?

RESUMO Objetivo Verificar relações entre sofrimento moral e satisfação profissional no trabalho de enfermeiros no contexto hospitalar. Método Estudo transversal, realizado em um hospital universitário com enfermeiros por meio da aplicação de questionário sociodemográfico, Índice de Satisfação Profissional e Moral Distress Scale - Versão Brasileira. Para a análise, empregaram-se a estatística descritiva e a correlação de Spearman. Resultados Participaram do estudo 141 enfermeiros. A "autonomia" foi o componente de maior satisfação profissional, aparecendo fragilizada nas questões de maior intensidade de sofrimento moral. Seguiram-se à autonomia a "interação" e "remuneração" como componentes de satisfação; e "falta de competência na equipe" e "condições de trabalho insuficientes" como de maior intensidade e frequência de sofrimento moral, respectivamente. Conclusão As aproximações entre esses dois constructos denotaram relações inversas entre eles, principalmente ao passo que a autonomia, componente de maior satisfação, também se configura num desencadeador de sofrimento moral quando insuficientemente exercida. Considera-se a necessidade de fortalecimento dos ambientes de trabalho da enfermagem para uma atuação ética e satisfatória.

RESUMEN Objetivo Verificar las relaciones entre sufrimiento moral y satisfacción en el trabajo de enfermeros en el marco hospitalario. Método Estudio transversal, realizado en un hospital universitario con enfermeros mediante la aplicación de cuestionario sociodemográfico, Índice de Satisfacción Profesional y Moral Distress Scale - Versión Brasileña. Para el análisis, se emplearon la estadística descriptiva y la correlación de Spearman. Resultados Participaron en el estudio 141 enfermeros. La "autonomía" fue el componente de mayor satisfacción profesional, apareciendo fragilizada en los temas de mayor intensidad de sufrimiento moral. Se siguieron a la autonomía la "interacción" y la "remuneración" como componentes de satisfacción; y la "ausencia de competencia en el equipo" y "condiciones laborales insuficientes" como de mayor intensidad y frecuencia de sufrimiento moral, respectivamente. Conclusión Las aproximaciones entre ambos constructos denotaron relaciones notablemente inversas entre ellos, mientras que la autonomía, componente de mayor satisfacción, también se configura como un desencadenador de sufrimiento moral cuando insuficientemente ejercitada. Se considera la necesidad de fortalecimiento de los ambientes laborales de la enfermería para una actuación ética y satisfactoria.

ABSTRACT Objective To verify relations between moral distress and work satisfaction in nursing work in the hospital context. Method A cross-sectional study carried out in a university hospital with nurses by applying a sociodemographic questionnaire, the "Index of Work Satisfaction" and the Brazilian Version of the "Moral Distress Scale". Descriptive statistics and Spearman's correlation were used for the analysis. Results 141 nurses participated in the study. "Autonomy" was the component of greater work satisfaction, appearing as fragile in the greater intensity issues of moral distress. Autonomy was followed by "interaction" and "remuneration" as components of satisfaction, and "lack of competence in the team" and "insufficient working conditions" as having greater intensity and frequency of moral distress, respectively. Conclusion Comparing these two constructs denoted inverse relationships between them, especially while autonomy, a component of greater satisfaction, also appears as a trigger of moral distress when insufficiently exercised. Thus, it is considered necessary to strengthen nursing work environments for ethical and satisfactory performance.

Stress in Parents of Newborns in a Neonatal Intensive Care Unit / Estrés en padres de recién nacidos en una Unidad de Terapia Intensiva Neonatal / Estresse em pais de recém-nascidos em uma Unidade de Terapia Intensiva Neonatal

Abstract Objective: To identify the level of stress and the most stressful situations for the parents of newborns hospitalized in a Neonatal Intensive Care Unit. Methods: A descriptive study, with a quantitative approach, performed with parents of newborns admitted to the Neonatal Intensive Care Unit. For the data collection, the Brazilian version of the Parental Stress Scale: Neonatal Intensive Care Unit (PSS: NICU) was used. The analysis was performed using descriptive statistics. Results: The change in the role of mother/father was the subscale in which the highest level of stress was obtained (mean=3.49) and the items considered more stressful in this subscale were "Separated from my baby" (mean=4.00) and "Feeling helpless and unable to protect my baby from pain and painful procedures" (mean=3.78). Conclusion: Hospitalization of a child in a neonatal unit is a stressful experience for parents and there are situations that trigger higher levels of stress.

Resumen Objetivo: Identificar el nivel de estrés y las situaciones más estresantes para los padres de recién nacidos internados en una Unidad de Terapia Intensiva Neonatal. Método: Estudio descriptivo, con abordaje cuantitativo, realizado con padres/madres de recién nacidos internados en Unidad de Terapia Intensiva Neonatal. Para la recolección de los datos, se utilizó la versión brasileña de la Parental Stress Scale: Neonatal Intensive Care Unit (PSS: NICU). El análisis fue realizado por medio de la estadística descriptiva. Resultados: La alteración en el papel de madre/padre fue la subescala en que se obtuvo el mayor nivel de estrés (promedio=3,49) y los ítems considerados más estresantes en esta subescala fueron "Estar separada(o) de mi bebé" (promedio=4,00) y "Sentirse desamparada y incapaz de proteger a mi bebé del dolor y de los procedimientos dolorosos" (promedio=3,78). Conclusión: La hospitalización de un hijo en unidad neonatal es una experiencia estresante para los padres y hay situaciones que desencadenan niveles más elevados de estrés.

Resumo Objetivo: Identificar o nível de estresse e as situações mais estressantes para os pais de recém-nascidos internados em uma Unidade de Terapia Intensiva Neonatal. Método: Estudo descritivo, com abordagem quantitativa, realizado com pais/mães de recém-nascidos internados em Unidade de Terapia Intensiva Neonatal. Para a coleta dos dados, utilizou-se a versão brasileira da Parental Stress Scale: Neonatal Intensive Care Unit (PSS: NICU). A análise foi realizada por meio da estatística descritiva. Resultados: A alteração no papel de mãe/pai foi a subescala em que se obteve o maior nível de estresse (média=3,49) e os itens considerados mais estressantes nessa subescala foram "Estar separada(o) do meu bebê" (média=4,00) e "Sentir-se desamparada(o) e incapaz de proteger o meu bebê da dor e de procedimentos dolorosos" (média=3,78). Conclusão: A hospitalização de um filho em unidade neonatal é uma experiência estressante para os pais e existem situações que desencadeiam estresse em níveis mais elevados.

Acessibilidade ao pré-natal e fatores de risco nas parturientes do Hospital do Servidor Público Municipal de São Paulo / Access to pre-natal and risk factors in parturing women at the Hospital do Servidor Público Municipal de São Paulo

• Resumo Foi realizado análise de prontuários das parturientes a termo do Hospital do Servidor Público Municipal de São Paulo (HSPM) durante o ano de 2017, contabilizado e avaliado o número de consultas de pré-natal durante toda a gestação baseado no consenso estabelecido pela Organização Mundial de Saúde (OMS) de no mínimo oito encontros de pré-natal ao qual reduz o risco de morbidade materna e perinatal. A partir do número de consultas, as parturientes foram subdivididas por idade, raça, quantidade gestacional e se a assistência ao pré-natal foi feita no Hospital do Servidor e descentralizados (Funcionárias) ou externamente (Munícipes/SUS). O número total de parturientes foi de 997, destas 331 apresentaram menos de oito consultas de pré-natal no momento do parto, o que corresponde a 33,1% de todos os partos a termo do HSPM. A partir destes dados obteve-se a conclusão de que as pacientes provenientes do Sistema Único de Saúde (SUS), multigestas, maiores de 18 anos, amarelas e indígenas apresentam riscos maiores à não acessibilidade ao pré-natal e portanto, necessitam de intervenções para a melhoria à acessibilidade. Palavras chaves: pré-natal, acessibilidade, primigesta, multigesta, raça, idade, Sistema Único de Saúde.

Satisfação profissional de trabalhadores de enfermagem de um serviço de hemato-oncologia / Professional satisfaction of nursing workers from a service of hematology-oncology

Objetivo: avaliar o nível de satisfação profissional de trabalhadores de enfermagem de um serviço de hematooncologia. Métodos: estudo transversal, realizado com 46 trabalhadores de enfermagem de um serviço de hemato-oncologia. Utilizou-se questionário com dados sociodemográficos, laborais e o instrumento Índice de Satisfação Profissional. Para análise dos dados foi utilizada estatística descritiva. Resultados: o nível de satisfação profissional encontrado foi de 11,17, considerado baixo. O componente mais importante entre os trabalhadores no que se refere à satisfação profissional foi a interação (2,96), seguida da autonomia (2,93), e o menos importante foi o status profissional (1,62). Conclusão: observou-se baixo índice de satisfação profissional dos trabalhadores de enfermagem do serviço de hemato-oncologia. Os componentes interação e autonomia foram considerados os mais importantes para a satisfação profissional. (AU)

Emergency Nightmares - Rupture of Type III Thoracoabdominal Aneurysm.

Introduction The rupture of thoracoabdominal aneurysms (rTAA) represents one of the major challenges to the vascular surgeon. Recent developments in the endovascular armamentarium and the high mortality from open surgery make endovascular treatment an attractive option. Devices to be used in an emergency environment should be "off-the-shelf" and include, among others, EVAR snorkel/chimney and branched endoprosthesis (T-branch, Cook®). METHODS: We describe the case of a 70-year-old patient who was admitted to the emergency room due continuous low back pain with 3 days of evolution. RESULTS: The tomographic computer angiography showed a type III thoracoabdominal aneurysm, with a transverse maximum diameter of 75x81mm in the infrarenal aorta and an exuberant hematoma in the left retroperitoneum, but no active extravasation of the contrast was observed (Figure 1). There was still marked tortuosity and moderate iliac calcification. It was decided to place a branched endoprosthesis (34 mm diameter at the top and 18 mm at the bottom). The branched endoprosthesis was extra-corporeally oriented, and introduced through a right femoral approach. The final position was verified with the digital subtraction angiography in anteroposterior incidence, ensuring that the distal border of each branch was 1.5 to 2 cm above the target vessel and that the stent marks presented the desired position. After the endoprosthesis was opened, the branches are catheterized by the left axillary access, however, it was verified that the endoprosthesis had an antero-posteriorly inverted implantation. It was possible to catheterize the superior mesenteric artery and the left renal artery (celiac trunk occlusion was documented intraoperatively); occlusion of the remaining endoprosthesis branches was performed with an Amplatzer. The patient evolved with multiorgan dysfunction and died at 24 hours post-operatively. CONCLUSION: Implantation of an off-the-shelf branched endoprosthesis requires specific anatomical criteria such as aortic diameter> 25mm to allow catheterization of the vessels, the possibility of incorporating each target vessel at a 90o angle in relation to each branch and visceral arteries with a diameter between 4 and 8 mm. Anatomy review is important to understand the lengths and positions of the branches. It should be borne in mind that it is possible that the device might have to be rotated during implantation to better align the marks and that both incidences (anteroposterior and profile) may be useful in confirming the position, something that should be thoroughly pursued to safeguard a correct implantation regardless of the initial stent position in your delivery system.

Qualidade de vida e capacidade funcional em pacientes com úlcera arterial / Quality of life and functional ability in patients with arterial ulcers

Resumo Objetivo: Avaliar a Qualidade de Vida (QV) e a capacidade funcional em pacientes com Doença Arterial Periférica (DAP) e Úlceras Arteriais (UA). Metodologia: Estudo clínico descritivo e transversal, realizado no Sul de Minas Gerais, Brasil. Sessenta pacientes adultos alocados em três grupos -grupo DAP com UA, grupo DAP sem UA e grupo controle, sem DAP e sem UA- foram entrevistados, utilizando-se os questionários Health Assessment Questionnaire (HAQ) e o Short Form-36 Health Survey (SF-36) para medir a capacidade funcional e a QV, respectivamente. Para a comparação entre os grupos, foi utilizado o teste de Kruskal-Wallis. Resultados: Quarenta e dois participantes (70%) são mulheres e a idade média foi de 63 anos. Os pacientes com DAP, com ou sem UA, apresentaram incapacidade funcional significativamente maior que pacientes sem DAP (p < 0,01) nos componentes relacionados a deambulação, uso de utensílios domésticos, higiene e apreensão/sustentação de objetos. Os pacientes com DAP, com ou sem lesões, apresentaram SF-36 escores significativamente mais baixos -menor QV- nos domínios Capacidade funcional, Aspectos físicos, Dor corporal, Vitalidade, Aspectos sociais e Aspecto emocional do SF-36 em relação ao grupo controle (p < 0,001). Também foram observadas diferenças significativas (p < 0,001) entre o grupo controle e o grupo com DAP e UA nos domínios Estado geral de saúde e Saúde mental. Conclusão: Os pacientes com DAP, com ou sem úlcera, apresentaram redução na capacidade de realização de algumas atividades cotidianas, além de baixos níveis de QV quando comparados aos pacientes sem a doença.

Objetivo: Evaluar la Calidad de Vida (CV) y la capacidad funcional en pacientes con Enfermedad Arterial Periférica ( EAP) y Úlceras Arteriales (UA). Metodología: Estudio clínico descriptivo y transversal, realizado en el sur de Minas Gerais, Brasil. Sesenta pacientes adultos asignados en tres grupos -grupo EAP con UA, grupo EAP sin UA y grupo de control sin EAP y UA- fueron entrevistados, para lo cual se hizo uso de las escalas Health Assessment Questionnaire (HAQ) y el Short Form-36 Health Survey (SF-36) que evalúan la capacidad física y la calidad de vida, respectivamente. Para las comparaciones entre los grupos, se utilizó la prueba de Kruskal-Wallis. Resultados: Cuarenta y dos participantes (70%) son mujeres y la edad media fue de 63 años. Los pacientes con EAP, con o sin UA, presentaron limitación funcional significativamente mayor que los pacientes sin PAD (p < 0,01) en componentes relacionados con el andar, el uso de utensilios domésticos, la higiene y el alcance/agarre de objetos. Los pacientes con PAD, con o sin lesiones, tenían puntuaciones significativamente más bajas de SF-36 -CV inferior- en las dimensiones Función física, Rol físico, Dolor corporal, Vitalidad, Función social y Rol emocional en comparación con los pacientes del grupo control (p < 0,001). También se observaron diferencias significativas entre el grupo control y el grupo con EAP y au en las dimensiones Salud general y Salud mental. Conclusión: Los pacientes con EAP, con o sin úlcera, mostraron dificultad para realizar algunas actividades cotidianas, así como baja calidad de vida en comparación con los pacientes sin la enfermedad.

Objective: To assess Quality of Life (QOL) and functional ability in patients with Peripheral Arterial Disease (PAD) and Arterial Ulcers (AUS). Methodology: Descriptive and cross-sectional clinical study, conducted in Southern Minas Gerais, Brazil. Sixty adult patients allocated in three groups -group PAD with aus, group PAD without aus, and control group, without both PAD and aus- were interviewed using the scales Health Assessment Questionnaire (HAQ) and Short Form-36 Health Survey (SF-36), which assess physical disability and quality of live, respectively. The Krus-kal-Wallis test was used in order to compare the groups. Results: Forty-two participants (70%) are women, and the mean age was 63 years old. Patients with PAD, with or without aus, had significantly greater disability than patients without PAD (p < 0.01) on components related to walking, use of household utensils, hygiene, and reach/grip of objects. Patients with PAD, with or without lesions, reported significantly lower SF-36 scores -lower QOL- on Physical functioning, Role physical, Bodily pain, Vitality, Social functioning, and Role emotional domains, in comparison to patients from the control group (p < 0.001). Significant differences were also observed between the control group and the group with PAD and aus on the General health and Mental health domains. Conclusion: Patients with PAD, with or without AUS, reported difficulty in performing some activities of daily living and impaired QOL in comparison to patients without the disease.