High prevalence of dengue, Zika, and chikungunya viruses in blood donors during a dengue outbreak and an endemic period in Colombia.

Objective: Arboviruses pose a challenge in ensuring the supply of pathogen-free blood components because they are not routinely screened in blood banks, and blood components from infected asymptomatic donors could be transfused. This study aimed to detect and characterize arboviral infections in Colombian blood donors. Methods: In a cross-sectional study, the prevalence of dengue (DENV), Zika (ZIKV), and chikungunya (CHIKV) viruses and co-infections of blood donors were compared between an epidemic period (November 2019-February 2020, n = 462) and an endemic period (November 2021-August 2022, n = 1,119). Viral RNA from each donor serum was purified, and the viruses were detected using a previously standardized multiplex hemi-nested RT-PCR protocol. Subsequently, donors who tested positive were surveyed 15 days after the detection of the virus to identify clinical characteristics related to the arboviral infection. The prevalences of each virus were presented as percentages and compared between epidemic and endemic periods. Results: Significantly higher prevalences were found in the epidemic period compared with the endemic period for DENV (14.5 vs. 1.9%), ZIKV (7.8 vs. 0.3%), CHIKV (8 vs. 3.3%), and co-infections (4.3 vs. 0.2%). The survey response rate of positive donors in the two periods was 83/175 (47%). In total, 57% of the donors surveyed were asymptomatic. Symptomatic donors most frequently reported headache (31%), malaise (13%), arthralgia (10%), and fever/chills (8%). Conclusion: The prevalence observed in epidemic and endemic periods was higher than that reported in other studies in the Americas. The high proportion of asymptomatic cases found, in addition to the mild and nonspecific manifestations among the symptomatic, may limit the effectiveness of the donor selection criteria used to mitigate the risk of transfusion-transmitted arboviruses.

Investigating SARS-CoV-2 Incidence and Morbidity in Ponce, Puerto Rico: Protocol and Baseline Results From a Community Cohort Study.

BACKGROUND: A better understanding of SARS-CoV-2 infection risk among Hispanic and Latino populations and in low-resource settings in the United States is needed to inform control efforts and strategies to improve health equity. Puerto Rico has a high poverty rate and other population characteristics associated with increased vulnerability to COVID-19, and there are limited data to date to determine community incidence. OBJECTIVE: This study describes the protocol and baseline seroprevalence of SARS-CoV-2 in a prospective community-based cohort study (COPA COVID-19 [COCOVID] study) to investigate SARS-CoV-2 infection incidence and morbidity in Ponce, Puerto Rico. METHODS: In June 2020, we implemented the COCOVID study within the Communities Organized to Prevent Arboviruses project platform among residents of 15 communities in Ponce, Puerto Rico, aged 1 year or older. Weekly, participants answered questionnaires on acute symptoms and preventive behaviors and provided anterior nasal swab samples for SARS-CoV-2 polymerase chain reaction testing; additional anterior nasal swabs were collected for expedited polymerase chain reaction testing from participants that reported 1 or more COVID-19-like symptoms. At enrollment and every 6 months during follow-up, participants answered more comprehensive questionnaires and provided venous blood samples for multiantigen SARS-CoV-2 immunoglobulin G antibody testing (an indicator of seroprevalence). Weekly follow-up activities concluded in April 2022 and 6-month follow-up visits concluded in August 2022. Primary study outcome measures include SARS-CoV-2 infection incidence and seroprevalence, relative risk of SARS-CoV-2 infection by participant characteristics, SARS-CoV-2 household attack rate, and COVID-19 illness characteristics and outcomes. In this study, we describe the characteristics of COCOVID participants overall and by SARS-CoV-2 seroprevalence status at baseline. RESULTS: We enrolled a total of 1030 participants from 388 households. Relative to the general populations of Ponce and Puerto Rico, our cohort overrepresented middle-income households, employed and middle-aged adults, and older children (P<.001). Almost all participants (1021/1025, 99.61%) identified as Latino/a, 17.07% (175/1025) had annual household incomes less than US $10,000, and 45.66% (463/1014) reported 1 or more chronic medical conditions. Baseline SARS-CoV-2 seroprevalence was low (16/1030, 1.55%) overall and increased significantly with later study enrollment time (P=.003). CONCLUSIONS: The COCOVID study will provide a valuable opportunity to better estimate the burden of SARS-CoV-2 and associated risk factors in a primarily Hispanic or Latino population, assess the limitations of surveillance, and inform mitigation measures in Puerto Rico and other similar populations. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/53837.

Zoledronic Acid Abrogates Restraint Stress-Induced Macrophage Infiltration, PDGF-AA Expression, and Ovarian Cancer Growth.

Multiple studies suggest that chronic stress accelerates the growth of existing tumors by activating the sympathetic nervous system. Data suggest that sustained adrenergic signaling can induce tumor growth, secretion of pro-inflammatory cytokines, and macrophage infiltration. Our goal was to study the role of adrenergic-stimulated macrophages in ovarian cancer biology. Cytokine arrays were used to assess the effect of adrenergic stimulation in pro-tumoral cytokine networks. An orthotopic model of ovarian cancer was used to assess the in vivo effect of daily restraint stress on tumor growth and adrenergic-induced macrophages. Cytokine analyses showed that adrenergic stimulation modulated pro-inflammatory cytokine secretion in a SKOV3ip1 ovarian cancer cell/U937 macrophage co-culture system. Among these, platelet-derived growth factor AA (PDGF-AA), epithelial cell-derived neutrophil-activating peptide (ENA-78), Angiogenin, vascular endothelial growth factor (VEGF), granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin-5 (IL-5), Lipocalin-2, macrophage migration inhibitory factor (MIF), and transferrin receptor (TfR) were upregulated. Enriched biological processes included cytokine-mediated signaling pathways and positive regulation of cell proliferation. In addition, daily restraint stress increased ovarian cancer growth, infiltration of CD68+ macrophages, and expression of PDGF-AA in orthotopic models of ovarian cancer (SKOV3ip1 and HeyT30), while zoledronic acid, a macrophage-depleting agent, abrogated this effect. Furthermore, in ovarian cancer patients, high PDGFA expression correlated with worse outcomes. Here, it is shown that the adrenergic regulation of macrophages and PDGFA might play a role in ovarian cancer progression.

Sustained Adrenergic Signaling Promotes Intratumoral Innervation through BDNF Induction.

Mounting clinical and preclinical evidence supports a key role for sustained adrenergic signaling in the tumor microenvironment as a driver of tumor growth and progression. However, the mechanisms by which adrenergic neurotransmitters are delivered to the tumor microenvironment are not well understood. Here we present evidence for a feed-forward loop whereby adrenergic signaling leads to increased tumoral innervation. In response to catecholamines, tumor cells produced brain-derived neurotrophic factor (BDNF) in an ADRB3/cAMP/Epac/JNK-dependent manner. Elevated BDNF levels in the tumor microenvironment increased innervation by signaling through host neurotrophic receptor tyrosine kinase 2 receptors. In patients with cancer, high tumor nerve counts were significantly associated with increased BDNF and norepinephrine levels and decreased overall survival. Collectively, these data describe a novel pathway for tumor innervation, with resultant biological and clinical implications.Significance: Sustained adrenergic signaling promotes tumor growth and metastasis through BDNF-mediated tumoral innervation. Cancer Res; 78(12); 3233-42. ©2018 AACR.

Enhancement of herpes simplex virus (HSV) infection by seminal plasma and semen amyloids implicates a new target for the prevention of HSV infection.

Human herpesviruses cause different infectious diseases, resulting in world-wide health problems. Sexual transmission is a major route for the spread of both herpes simplex virus-1 (HSV-1) and -2. Semen plays an important role in carrying the viral particle that invades the vaginal or rectal mucosa and, thereby, initiates viral replication. Previously, we demonstrated that the amyloid fibrils semenogelin (SEM) and semen-derived enhancer of viral infection (SEVI), and seminal plasma (SP) augment cytomegalovirus infection (Tang et al., J. Virol 2013). Whether SEM or SEVI amyloids or SP could also enhance other herpesvirus infections has not been examined. In this study, we found that the two amyloids as well as SP strongly enhance both HSV-1 and -2 infections in cell culture. Along with SP, SEM and SEVI amyloids enhanced viral entry and increased infection rates by more than 10-fold, as assessed by flow cytometry assay and fluorescence microscopy. Viral replication was increased by about 50- to 100-fold. Moreover, viral growth curve assays showed that SEM and SEVI amyloids, as well as SP, sped up the kinetics of HSV replication such that the virus reached its replicative peak more quickly. The interactions of SEM, SEVI, and SP with HSVs are direct. Furthermore, we discovered that the enhancing effects of SP, SEM, and SEVI can be significantly reduced by heparin, a sulfated polysaccharide with an anionic charge. It is probable that heparin abrogates said enhancing effects by interfering with the interaction of the viral particle and the amyloids, which interaction results in the binding of the viral particles and both SEM and SEVI.

Nuevos retos en la protección de la vida y salud de las mujeres / New challenges in protecting women's life and health

Background: One of the UN Sustainable Development Goals is to reduce maternal mortality. Objective: To determine knowledge, attitudes and practices of health professionals regarding abortion. Design: Cross-sectional type of survey. Methods: During 2017, the Ecuadorian Federation of Gynecology and Obstetrics Society FESGO applied a survey to 132 health professionals to determine their knowledge, attitudes and practices regarding abortion. Results: We identified more nonpunishable abortion causes than those the law recognizes. The most frequent of these were rape (21%) and congenital malformations (13%). 83% of respondents agreed that law should allow ending a pregnancy if the woman's life were at risk and 46% if her health was at risk. 61% of them agreed if the fetus had a congenital malformation. In addition, 46% agreed if it was the product of rape of a disabled woman, 40% if it was the product of rape, and 28%, if it was product of an incest. In case of a disabled woman pregnant because of rape, 57% would give information on options for pregnancy interruption, and 26% would give information on the legal frame that allows pregnancy interruption. However, 23% would lie by saying that the country's legal frame does not allow pregnancy interruption. Conclusions: The survey reflects a wider perception on non-punishable abortion causatives than what the law recognizes. Nevertheless, 23% would indicate that the country's legal frame does not allow pregnancy interruption, contradicting the legal regulation that protects the woman's right to abortion access to protect her health and life. Barriers against the women's right to decide on her health persist.

Introducción. Uno de los Objetivos de Desarrollo Sostenible es reducir la mortalidad materna. Objetivo. Valorar los conocimientos, actitudes y prácticas de profesionales de la salud en relación con el aborto. Diseño. Estudio transversal tipo encuesta. Métodos. En el año 2017, FESGO aplicó una encuesta a 132 profesionales de la salud, para valorar sus conocimientos, actitudes y prácticas en relación con el aborto. Resultados. La encuesta reflejó una percepción más amplia de causales de aborto no punible que las que la ley reconoce, destacando la violación en 21% y las malformaciones congénitas en 13%. El 83% estaría de acuerdo que la ley permita la interrupción de un embarazo frente al riesgo para la vida de la mujer, 46% frente al riesgo de salud; 61% por malformaciones congénitas fetales, 46% en caso de violación a una mujer con discapacidad y 40% en la violación en general; 28%, en casos de incesto. En caso de una mujer con discapacidad embarazada por violación, el 57% señaló que le daría información sobre las opciones de interrupción. El 26% le daría información sobre el marco legal que le permite la interrupción del embarazo. Pero, el 23% le indicaría que el marco legal del país no permite la interrupción. Conclusiones. La encuesta refleja una percepción más amplia de causales de aborto no punible que las que la ley reconoce. Un 23% indicaría que el marco legal del país no permite la interrupción del embarazo, contradiciendo la norma legal que protege el derecho de esa mujer a acceder a un aborto para proteger su salud y su vida. Persisten barreras para garantizar el derecho de las mujeres a decidir sobre su salud.

Experimental study on the efficiency and safety of the manual hyperinflation maneuver as a secretion clearance technique.

OBJECTIVE: To evaluate, in a lung model simulating a mechanically ventilated patient, the efficiency and safety of the manual hyperinflation (MH) maneuver as a means of removing pulmonary secretions. METHODS: Eight respiratory therapists (RTs) were asked to use a self-inflating manual resuscitator on a lung model to perform MH as if to remove secretions, under two conditions: as routinely applied during their clinical practice; and after receiving verbal instructions based on expert recommendations. In both conditions, three clinical scenarios were simulated: normal lung function, restrictive lung disease, and obstructive lung disease. RESULTS: Before instruction, it was common for an RT to compress the resuscitator bag two times, in rapid succession. Proximal pressure (Pprox) was higher before instruction than after. However, alveolar pressure (Palv) never exceeded 42.5 cmH2O (median, 16.1; interquartile range [IQR], 11.7-24.5), despite Pprox values as high as 96.6 cmH2O (median, 36.7; IQR, 22.9-49.4). The tidal volume (VT) generated was relatively low (median, 640 mL; IQR, 505-735), and peak inspiratory flow (PIF) often exceeded peak expiratory flow (PEF), the median values being 1.37 L/s (IQR, 0.99-1.90) and 1.01 L/s (IQR, 0.55-1.28), respectively. A PIF/PEF ratio < 0.9 (which theoretically favors mucus migration toward the central airways) was achieved in only 16.7% of the maneuvers. CONCLUSIONS: Under the conditions tested, MH produced safe Palv levels despite high Pprox. However, the MH maneuver was often performed in a way that did not favor secretion removal (PIF exceeding PEF), even after instruction. The unfavorable PIF/ PEF ratio was attributable to overly rapid inflations and low VT.

Evaluation of manual resuscitators used in ICUs in Brazil.

OBJECTIVE: To evaluate the performance of manual resuscitators (MRs) used in Brazil in accordance with international standards. METHODS: Using a respiratory system simulator, four volunteer physiotherapists employed eight MRs (five produced in Brazil and three produced abroad), which were tested for inspiratory and expiratory resistance of the patient valve; functioning of the pressure-limiting valve; and tidal volume (VT) generated when the one-handed and two-handed techniques were used. The tests were performed and analyzed in accordance with the American Society for Testing and Materials (ASTM) F920-93 criteria. RESULTS: Expiratory resistance was greater than 6 cmH2O . L-1 . s-1 in only one MR. The pressure-limiting valve, a feature of five of the MRs, opened at low pressures (< 17 cmH2O), and the maximal pressure was 32.0-55.9 cmH2O. Mean VT varied greatly among the MRs tested. The mean VT values generated with the one-handed technique were lower than the 600 mL recommended by the ASTM. In the situations studied, mean VT was generally lower from the Brazilian-made MRs that had a pressure-limiting valve. CONCLUSIONS: The resistances imposed by the patient valve met the ASTM criteria in all but one of the MRs tested. The pressure-limiting valves of the Brazilian-made MRs usually opened at low pressures, providing lower VT values in the situations studied, especially when the one-handed technique was used, suggesting that both hands should be used and that the pressure-limiting valve should be closed whenever possible.

Métodos de conservación para actinobacterias con actividad solubilizadora de fósforo / Preservation methods for actinobacterias with phosphate solubilizing activity

El objetivo de esta investigación fue evaluar diferentes métodos de conservación para actinobacterias solubilizadoras de fósforo debido a la poca información de métodos específicos reportados para estos microorganismos. Los métodos de conservación se evaluaron a 3 diferentes periodos de tiempo; largo, mediano y corto plazo, usando métodos de congelación y liofilización; arcilla, sílica, arena y transferencia periódica, respectivamente. Para ello se usaron 15 aislamientos de 3 localidades diferentes (La Vega, Maní y Tota) y un banco de referencia de la Unidad de Investigaciones Agropecuarias de la Pontificia Universidad Javeriana. Se prepararon todos los inóculos en solución salina al 0,85% (p/v) y se ajustaron a una concentración de 10(8) cel/mL, seguido a ello se inocularon los viales de cada método de conservación con sus respectivos crioprotectantes, glicerol 20% (v/v), 30% (v/v) para congelación y skim milk 18% (p/v) para liofilización. Los métodos a mediano plazo se ejecutaron de igual manera, el inóculo se agregó a 10 perlas de arcilla, 10 g de arena y 5 g de sílica, posteriormente se almacenaron a 4 °C. El método de corto plazo se evaluó en agar avena (15 g/L). La evaluación se realizó mediante recuento directo en cámara de Neubauer por la técnica de azul de tripán, además de la caracterización macroscópica y microscópica de cada aislamiento en transferencia periódica. Se estableció que la actividad solubilizadora de fósforo se mantuvo más estable en los métodos de glicerol 30 % (p/v) y liofilización según el análisis estadístico.

The aim of this research was to evaluate different methods of preservation for actinobacteria with phosphate solubilization activity due to there are a few specific methods reported for these organisms. The methods were evaluated at three different time periods; long, medium and short-term and employing methods as cryopreservation and dry-freezing; clay, silica and sand; and periodically plating, respectively. Therefore 15 isolates from 3 different locations (La Vega, Maní and Tota) and a bank reference from Livestock Research Unit of the Pontificia Universidad Javeriana were used. All inocula were prepared in 0.85% saline solution (w/v) which were adjusted to a concentration of 10(8) cells/mL, followed each vial was inoculated with their respective storage cryoprotectants , glycerol 20% (v/v), 30% (v/v) to freeze and 18% skim milk (w/v) for dry-freezing. Medium-term methods were performed similarly; the inoculum was added to 10 clay beads, 10 g of sand and 5 g of silica and then stored at 4 °C. The short-term method was evaluated in oatmeal agar (15 g/L). The evaluation was performed by direct counting in a Neubauer chamberusing trypan blue staining technique, in addition to macroscopic and microscopic characterization of each isolate in periodic plating. It was established that the phosphorus solubilizing activity was more stable in glycerol 30% (w/v) and lyophilization for statistical analysis.

Importância do autoconhecimento dos grupos sanguíneos (ABO e Rh) de alunos de Tangará da Serra-MT / Importance of self-knowledge of ABO and Rh blood-groups of students in Tangará da Serra-MT

Os sistemas ABO e Rh são importantes do ponto de vista das transfusões sanguíneas, o que os tornam muito utilizados nas seleções de doadores. O autoconhecimento dos grupos sanguíneos ABO e Rh entre os estudantes vem sendo incentivado, com o intuito de promover um maior esclarecimento com relação à captação de doadores de sangue. Sendo assim, esse estudo tem como objetivo avaliar o autoconhecimento dos alunos da Escola Estadual 13 de Maio -Tangará da Serra-MT sobre os grupos sanguíneos ABO e Rh e transmitir aos alunos os fundamentos do sistema sanguíneo através de palestras, além de incentivar a prática da doação de sangue e a conscientização da importância da captação de doadores. Para isso, foram aplicados questionários fechados a 120 alunos da 1ª série do ensino médio (04 questões). Os dados foram avaliados estaticamente por frequência relativa. Em seguida, foram oferecidas palestras teórico-práticas e incentivada a doação de sangue. Dos avaliados, mais de 90% tinham entre 15-16 anos e apenas 27% sabiam a qual grupo sanguíneo pertenciam, dos quais apenas 48% pertenciam ao grupo sanguíneo O+, não tendo sido observado indivíduos do grupo AB. Sendo assim, foi possível concluir que poucos jovens têm conhecimento sobre o seu tipo sanguíneo e que a população tangaraense tende a ser predominantemente composta por indivíduos O+, enquanto que poucos indivíduos seriam tangaraenses de tipo sanguíneo AB. Esse trabalho comprova também a necessidade de se realizar mais trabalhos nesse assunto, principalmente com o enfoque na doação sanguínea.

The ABO and Rh systems are important to blood transfusions, thus they have been used to select donors. The self-knowledge about blood groups ABO and Rh of young students has been encouraged in order to elucidate explanations on blood donors. Thus, this study aims to evaluate the self-knowledge of the students from the ?State School 13 de Maio? in Tangará da Serra-MT regarding the ABO and Rh blood groups, as well as elucidate the subject through lectures, and encourage blood donation practice and its importance. Questionnaires were applied to 120 students of the 1st grade of high school (04 questions). Data were statistically assessed by relative frequency. Then, lectures were offered to encourage blood donation. Based on the results, 90% of students were 15-16 years old, but only 27% knew their own blood group, and 48% belonged to the group O+; there was no individuals on AB group.Thus, we concluded that few students known about blood type and the population of Tangará da Serra-MT may be predominantly O+ blood type individuals, while the AB group was considered as less predominant in the region. This research demonstrates the need of more studies regarding this subject, mainly focusing blood donation.

Benefícios do CPAP na apneia obstrutiva do sono: relato de caso / Benefits of CPAP in obstructive sleep apnea: case report

O aparelho CPAP (continuous positive airway pressure) nasal � indicado para pacientes com s�ndrome da apneia obstrutiva do sono - SOAP. Sabe-se que diversos eventos patol�gicos respirat�rios que caracterizam a SOAP ocorrem durante a noite e s�o definidos como: apneia obstrutiva, apneia central, hipopneia, os quais, quando presentes, afetam diretamente a qualidade de vida da pessoa. Sendo assim, o objetivo desse estudo foi relatar o caso de um paciente com SAOS e apresentar os benef�cios do tratamento com CPAP. Para isso, foi eleg�vel paciente do sexo masculino, 42 anos, com diagn�stico de SAOS, em uso de CPAP nasal, residente na cidade de Tangar� da Serra- MT. A avalia��o constou de polissonografia e question�rios de qualidade do sono (�ndice de Qualidade do Sono de Pittsburgh) e propor��o de sonol�ncia (Escala de Sonol�ncia de Epworth) pr� e p�s-uso do aparelho do CPAP (3 meses). Foi poss�vel constar melhora cl�nica do paciente em rela��o � hipersonia diurna e a qualidade do sono, com elimina��o das apneias e as hipopneias, o que interferiu diretamente na qualidade de vida do paciente. Desta forma, foi poss�vel comprovar que a utiliza��o do CPAP foi eficiente no tratamento da Apneia Obstrutiva do Sono.

Nasal CPAP (continuous positive airway pressure) is indicated for patients with the obstructive sleep apnea syndrome (SOAP). It is know that many pathological respiratory diseases that characterize SOAP occurs during the night and it could be define as obstructive apnea, central apnea and hypopnea, which may affect life quality. The aim of this study is relate one case report of a patient with SAOS, as well as to report CPAP benefits. For this, a male patient, 42 years old, resident in Tangar� da Serra, MT, in use of nasal CPAP presented diagnosis of SAOS. The evaluation consisted of polysomnography exam and questionnaires of sleep quality (Index of Quality of the Sleep of Pittsburgh) and ratio of sleepiness (Sleepiness Epworth Scale) before and after CPAP use (3 months). There was improvement in relation to diurnal hypersomnia and sleep quality, with elimination of apneas and hypopneas. Thus, it was possible to prove the efficacy of CPAP in the treatment of Obstructive Sleep Apnea.

Estudo experimental sobre a eficiência e segurança da manobra de hiperinsuflação manual como técnica de remoção de secreção / Experimental study on the efficiency and safety of the manual hyperinflation maneuver as a secretion clearance technique

OBJETIVO: Avaliar, em um modelo pulmonar simulando um paciente sob ventilação mecânica, a eficiência e a segurança da manobra de hiperinsuflação manual (HM) com o intuito de remover secreção pulmonar. MÉTODOS: Oito fisioterapeutas utilizaram um ressuscitador manual autoinflável para realizar HM com o objetivo de remover secreções, em duas condições: conforme rotineiramente aplicada durante sua prática clínica, e após receberem instruções verbais baseadas em recomendações de especialistas. Três cenários clínicos foram simulados: função pulmonar normal, doença pulmonar restritiva e doença pulmonar obstrutiva. RESULTADOS: Antes da instrução, o uso de duas compressões sequenciais do ressuscitador era comum, e a pressão proximal (Pprox) foi mais alta em relação à obtida após a instrução. Entretanto, a pressão alveolar (Palv) nunca excedeu 42,5 cmH2O (mediana, 16,1; intervalo interquartil [IQ], 11,7-24,5), mesmo com valores de Pprox de até 96,6 cmH2O (mediana, 36,7; IQ, 22,9-49,4). O volume corrente (VC) gerado foi relativamente pequeno (mediana, 640 mL; IQ, 505-735) e o pico de fluxo inspiratório (PFI) geralmente excedeu o pico de fluxo expiratório (PFE): 1,37 L/s (IQ, 0,99-1,90) e 1,01 L/s (IQ, 0,55-1,28), respectivamente. Uma relação PFI/PFE < 0,9 (que teoricamente favorece a migração do muco em direção às vias aéreas centrais) foi obtida em somente 16,7% das manobras. CONCLUSÕES: Nas condições testadas, a HM gerou valores seguros de Palv mesmo com altas Pprox. Entretanto, a HM foi comumente realizada de um modo que não favorecia a remoção de secreção (PFI excedendo PFE) mesmo após a instrução. A relação PFI/PFE desfavorável foi explicada pelas insuflações rápidas e o baixo VC.

OBJECTIVE: To evaluate, in a lung model simulating a mechanically ventilated patient, the efficiency and safety of the manual hyperinflation (MH) maneuver as a means of removing pulmonary secretions. METHODS: Eight respiratory therapists (RTs) were asked to use a self-inflating manual resuscitator on a lung model to perform MH as if to remove secretions, under two conditions: as routinely applied during their clinical practice; and after receiving verbal instructions based on expert recommendations. In both conditions, three clinical scenarios were simulated: normal lung function, restrictive lung disease, and obstructive lung disease. RESULTS: Before instruction, it was common for an RT to compress the resuscitator bag two times, in rapid succession. Proximal pressure (Pprox) was higher before instruction than after. However, alveolar pressure (Palv) never exceeded 42.5 cmH2O (median, 16.1; interquartile range [IQR], 11.7-24.5), despite Pprox values as high as 96.6 cmH2O (median, 36.7; IQR, 22.9-49.4). The tidal volume (VT) generated was relatively low (median, 640 mL; IQR, 505-735), and peak inspiratory flow (PIF) often exceeded peak expiratory flow (PEF), the median values being 1.37 L/s (IQR, 0.99-1.90) and 1.01 L/s (IQR, 0.55-1.28), respectively. A PIF/PEF ratio < 0.9 (which theoretically favors mucus migration toward the central airways) was achieved in only 16.7% of the maneuvers. CONCLUSIONS: Under the conditions tested, MH produced safe Palv levels despite high Pprox. However, the MH maneuver was often performed in a way that did not favor secretion removal (PIF exceeding PEF), even after instruction. The unfavorable PIF/ PEF ratio was attributable to overly rapid inflations and low V T.

Evaluation of manual resuscitators used in ICUs in Brazil / Avaliação de reanimadores manuais utilizados em UTIs brasileiras

OBJECTIVE: To evaluate the performance of manual resuscitators (MRs) used in Brazil in accordance with international standards. METHODS: Using a respiratory system simulator, four volunteer physiotherapists employed eight MRs (five produced in Brazil and three produced abroad), which were tested for inspiratory and expiratory resistance of the patient valve; functioning of the pressure-limiting valve; and tidal volume (VT) generated when the one-handed and two-handed techniques were used. The tests were performed and analyzed in accordance with the American Society for Testing and Materials (ASTM) F920-93 criteria. RESULTS: Expiratory resistance was greater than 6 cmH2O . L−1 . s−1 in only one MR. The pressure-limiting valve, a feature of five of the MRs, opened at low pressures (< 17 cmH2O), and the maximal pressure was 32.0-55.9 cmH2O. Mean VT varied greatly among the MRs tested. The mean VT values generated with the one-handed technique were lower than the 600 mL recommended by the ASTM. In the situations studied, mean VT was generally lower from the Brazilian-made MRs that had a pressure-limiting valve. CONCLUSIONS: The resistances imposed by the patient valve met the ASTM criteria in all but one of the MRs tested. The pressure-limiting valves of the Brazilian-made MRs usually opened at low pressures, providing lower VT values in the situations studied, especially when the one-handed technique was used, suggesting that both hands should be used and that the pressure-limiting valve should be closed whenever possible. .

OBJETIVO: Avaliar o desempenho de reanimadores manuais (RMs) utilizados no Brasil conforme critérios definidos por uma norma internacional. MÉTODOS: Utilizando um simulador do sistema respiratório, oito RMs manuais (cinco produzidos no Brasil e três importados) foram avaliados em relação a resistência inspiratória e expiratória da válvula para o paciente; funcionamento da válvula limitadora de pressão; e volume corrente (VT) gerado por quatro fisioterapeutas voluntários, utilizando uma ou duas mãos. Para a realização e análise dos testes, foram utilizados critérios sugeridos pela norma da American Society for Testing and Materials (ASTM) F920-93. RESULTADOS: A resistência expiratória foi superior a 6 cmH2O . L−1 . s−1 em apenas um dos RMs testados. A válvula limitadora de pressão, presente em cinco RMs, abriu em baixas pressões (< 17 cmH2O), e a pressão máxima variou de 32,0-55,9 cmH2O. Houve grande variação da média de VT obtido pelos diferentes RMs. Os valores médios de VT utilizando uma mão foram inferiores ao sugerido pela ASTM (600 mL). O VT médio, nas situações estudadas, foi geralmente menor nos RMs nacionais com válvula limitadora de pressão. CONCLUSÕES: As resistências impostas pela válvula do paciente estão de acordo com os critérios da ASTM, com exceção de um RM. As válvulas limitadoras de pressão dos RMs nacionais geralmente abrem em baixas pressões, determinando o fornecimento de um menor VT nas situações estudadas, principalmente com o uso de uma mão, o que sugere que a ventilação deva ser feita com as duas mãos e a válvula limitadora de pressão deva ser fechada sempre que possível. .

Caracterización de la depresión en jóvenes universitarios / Caracterization of depression in university youngsters

Esta investigación tuvo como objetivo describir las características de la depresión en jóvenes universitarios. A partir del trabajo clínico y psicoeducativo con esta población se identificaron aspectos específicos de los jóvenes que fueron asociados al trastorno depresivo

Análisis de la implementación de la técnica REIKI en niños con comportamiento negativo que asisten a la consulta odontopediátrica por primera vez / REIKI technique implementation in children with negative behaviour to the first time dental pediatric consultation

El propósito de este estudio fue evaluar la eficacia de la técnica REIKI, que es una técnica de sanación a través de la imposición de manos mediante la canalización de energía que pasa por el cuerpo físico y áurico del terapeuta quien la transfiere a otro individuo, en el control de la ansiedad de niños que asisten a la consulta odontológica comparada con la técnica convencional Diga, Muestre y Haga modificada por la clínica Odontológica Infantil de Bogotá (COIB). De 150 niños con edades que oscilan entre 2 - 5 años y que asistían a la casa Vecinal San Antonio, se escogieron 20 niños teniendo en cuenta que se encontrarán en las categorías de comportamiento negativo según Frank. Se les realizaron procedimientos odontológicos tales como: Diagnóstico, conteo de dientes, control de placa, profilaxis y Aplicación de Flúor, tanto para el grupo Reiki como para el diga, Muestre y Haga. Con el fin de lograr un juicio de valor objetivo sus comportamientos se grabaron en video y se evitó que los niños supieran la evaluación a la cual estaban siendo sometidos. Para la clasificación de los menores se contó con la participación de un odontólogo, de un sicólogo y un padre de familia a los cuales se les dio instrucción para llenar la tabla de recolección de datos, diseñada para realizar una evaluación cada 3 minutos desde el ingreso del niño a la recepción hasta el final de los procedimientos. Estas personas calificaron a los infantes a partir del video con las imágenes de su comportamiento. Los resultados fueron evaluados tomando en cuenta el comportamiento del niño durante la consulta, registrando estos en una tabla; los puntajes obtenidos en las secciones se promediaron y se analizaron aplicando la prueba U de Mann Withney, en donde se encontró que no existe diferencia significativa de comportamiento entre los dos métodos, indicando que la técnica Reiki, siendo una técnica nueva en el campo de la odontología se puede utilizar como terapia complementaria para el control del comportamiento del niño durante la consulta odontológica, sin ser ésta una técnica invasiva que atente contra la integridad del niño, de fácil aprendizaje, corto tiempo de aplicación y resultados eficaces.