ABSTRACT
BACKGROUND The prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VOCs) has changed unevenly over time around the world. Although whole genome sequencing is the gold standard for virus characterisation, the discovery of alpha VOC causing spike gene target failure (SGTF) result, when tested using an reverse transcription real-time polymerase chain reaction (RT-qPCR) assay, has provided a simple tool for tracking the frequencies of variants. OBJECTIVES The aim of this study was to investigate if a multiplex RT-qPCR assay (BioM 4Plex VOC) could be used to detect SARS-CoV-2 and to perform a VOC screening test in a single reaction tube. Here, we present the multicentre study evaluating this assay. METHODS Twelve laboratories have participated in the multicentre study. The BioM 4Plex VOC was distributed to them with detailed instructions of how to perform the test. They were asked to test the BioM 4Plex VOC in parallel with their routine Commercial SARS-CoV-2 diagnostic assay. Additionally, they were requested to select SARS-CoV-2-positive samples with genome sequenced and lineage definition according to PANGO lineage classification. FINDINGS The BioM 4Plex VOC and commercial RT-PCR assay are equally effective in detecting SARS-CoV-2. Results revealed a specificity of 96.5-100% [95% confidence interval (CI)], a sensitivity of 99.8-100% (95% CI), and an accuracy of 99.8-100% (95% CI). A 99% concordance rate was found between results from the BioM 4Plex VOC and that from available genome sequencing data. MAIN CONCLUSIONS The BioM 4Plex VOC provides an effective solution to detect SARS-CoV-2 infections and screening for VOCs in a single reaction. It is a straightforward method to help us monitor the frequency and distribution of VOCs and develop strategies to better cope with the pandemics.
ABSTRACT
BACKGROUND The prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VOCs) has changed unevenly over time around the world. Although whole genome sequencing is the gold standard for virus characterisation, the discovery of alpha VOC causing spike gene target failure (SGTF) result, when tested using an reverse transcription real-time polymerase chain reaction (RT-qPCR) assay, has provided a simple tool for tracking the frequencies of variants. OBJECTIVES The aim of this study was to investigate if a multiplex RT-qPCR assay (BioM 4Plex VOC) could be used to detect SARS-CoV-2 and to perform a VOC screening test in a single reaction tube. Here, we present the multicentre study evaluating this assay. METHODS Twelve laboratories have participated in the multicentre study. The BioM 4Plex VOC was distributed to them with detailed instructions of how to perform the test. They were asked to test the BioM 4Plex VOC in parallel with their routine Commercial SARS-CoV-2 diagnostic assay. Additionally, they were requested to select SARS-CoV-2-positive samples with genome sequenced and lineage definition according to PANGO lineage classification. FINDINGS The BioM 4Plex VOC and commercial RT-PCR assay are equally effective in detecting SARS-CoV-2. Results revealed a specificity of 96.5-100% [95% confidence interval (CI)], a sensitivity of 99.8-100% (95% CI), and an accuracy of 99.8-100% (95% CI). A 99% concordance rate was found between results from the BioM 4Plex VOC and that from available genome sequencing data. MAIN CONCLUSIONS The BioM 4Plex VOC provides an effective solution to detect SARS-CoV-2 infections and screening for VOCs in a single reaction. It is a straightforward method to help us monitor the frequency and distribution of VOCs and develop strategies to better cope with the pandemics.
ABSTRACT
Se presentan dos casos clínicos de "criscross" de ramas pulmonares, una forma infrecuente de malformación del origen de estas arterias desde lados opuestos del tronco pulmonar y cuyos trayectos se cruzan en su camino hacia sus respectivos pulmones. De manera aislada es una condición benigna, sin consecuencias hemodinámicas y de buen pronóstico.
Two clinical cases of "crisscrossed" pulmonary arteries are presented. This is an unusual malformation in which arteries from opposite sides of the pulmonary trunk cross along their course towards their respective lungs. Usually, it is a benign condition when found as an isolated malformation, with no hemodynamic consequences and good prognosis.
ABSTRACT
RESUMEN En una minoría de pacientes con ileítis de Crohn (EC) de larga evolución, la recrudescencia de los síntomas puede representar una neoplasia ileal, con una clínica indistinguible de la enfermedad basal y por ende poco sospechada. Frecuentemente la patología tumoral se diagnostica en la pieza quirúrgica, tras una intervención por hemorragia u obstrucción intestinal. El objetivo de este trabajo es destacar la importancia de un diagnóstico diferencial ante una ileítis terminal en un paciente con EC con mala respuesta a tratamiento médico.
ABSTRACT In a minority of patients with long-standing Crohn's ileitis, the recrudescence of symptoms may represent a neoplasm involving the ileum that is clinically indistinguishable from the baseline disease and therefore poorly suspected. Tumors are often diagnosed in the surgical specimen, after an intervention due to bleeding or bowel obstruction. The aim of this study is to emphasize the importance of the differential diagnoses of terminal ileitis in a patient with CD with poor response to medical treatment.
Subject(s)
Humans , Female , Adult , Omentum/diagnostic imaging , Abdominal Pain/diagnosis , Pancreas , Appendicitis , Stomach Diseases , Cholecystitis , InfarctionABSTRACT
The Silent Child (Chris Overton, 2017), recibió el premio Oscar de la Academia al mejor cortometraje en su 90° edición, 2018. Además de sus méritos estéticos, tiene la virtud de incluir una multiplicidad de temas relativos al campo psicoeducativo, a la ética profesional y al Derecho a la Identidad. Para abordar esta complejidad se convocó a cuatro profesoras y tres tesistas de posgrado de la Universidad de Buenos Aires para que aportaran ideas desde sus respectivas especialidades. Este artículo es el resultado de esa interlocución, en su fase inicial a través de los escritos presentados por cada una de ellas. Se espera que en su carácter introductorio promueva nuevas indagaciones, contribuyendo a un pensamiento interdisciplinario en el ámbito de la salud y la educación.
The Silent Child (Chris Overton, 2017), received the Academy Award for best short film in its 90th edition, 2018. In addition to its aesthetic merits, it has the virtue of including a multiplicity of topics related to the psychoeducational field, to the professional ethics and the Right to Identity. To address this complexity, four professors and three postgraduate thesis students from the University of Buenos Aires were invited to contribute ideas from their respective specialties. This article is the result of this dialogue, in its initial phase through the writings presented by each of them. This introductory article is expected to promote new inquiries, contributing to interdisciplinary thinking in the field of health and education.
Subject(s)
Child, Preschool , Child , Parent-Child Relations , Persons With Hearing Impairments , Sign Language , Education of Hearing Disabled , Social Workers , Patient CareABSTRACT
Resumen: Introducción: la morbimortalidad permite evaluar la calidad asistencial, outcome y comparar diferentes centros asistenciales. Éste es el primer estudio de morbimortalidad en neurocirugía realizado en Uruguay. Objetivo: determinar la morbimortalidad global y específica en el Departamento de Neurocirugía del Hospital de Clínicas y la asociación entre complicación y morbimortalidad. Metodología: estudio observacional, descriptivo-analítico, longitudinal, retrospectivo de todos los pacientes >15 años que requirieron cirugía entre abril de 2017 y abril de 2019. Los datos se obtuvieron de historias clínicas y se analizaron las siguientes variables: edad, sexo, comorbilidad, clínica, diagnóstico, oportunidad quirúrgica, complicación, tipo de complicación, mortalidad, causa de mortalidad, outcome y tiempo quirúrgico. Resultados: 477 pacientes fueron intervenidos, 72 complicados. La mortalidad global fue 5,5% (26/477) y la morbilidad 15% (72/477). 36% de los pacientes complicados fallecieron (26/72). La patología vascular fue la morbilidad específica que más se complicó (20%, 14/69). La infección fue el tipo de complicación más frecuente (46%, 39/84). La propia evolución de la enfermedad y el terreno causó la muerte del 90% de los pacientes complicados operados de urgencia (19/21), siendo ésta última factor de riesgo independiente de fallecer (p=0,018). En coordinaciones, la causa de muerte estuvo vinculada al acto quirúrgico (80%). Hubo asociación entre patología vascular y morbimortalidad (p=0,015) y entre complicación isquémica y morbimortalidad (p=0,024). La presencia de hipertensión endocraneana (HEC) se asoció a un mal resultado (p=0,003). Conclusiones: los resultados muestran una buena calidad de atención comparado con otros centros. Aún existen aspectos a corregir para reducir la morbimortalidad.
Abstract: Introduction: morbidity and mortality rates allow for the evaluation of the quality of care and outcome and they also make it possible to compare different healthcare centers. This is the first morbidity and mortality study in neurosurgery carried out in Uruguay. Objective: to determine the global and specific morbidity and mortality rates in the Neurosurgery Department at the Clínicas University Hospital, and to determine if mortality and morbidity are associated to surgical complications. Method: retrospective, longitudinal, observational and descriptive analysis of all patients >15 years old that underwent a neurosurgical procedure between April 2017 and 2019. Data were obtained from patient medical records. The following variables were analyzed: age, sex, comorbidity, clinical data, diagnosis, opportunity of surgical procedure, complications, type of complication, mortality, cause of mortality, outcome and surgical time. Results: 477 patients underwent neurosurgical procedure, 72 of which were complicated surgeries. Overall mortality was 5.5% (26/477) and morbidity 15% (72/477). 36% of complicated patients died (26/72). Vascular pathology was the specific morbidity that complicated patients the most 20% (14/69). Infection was the most frequent type of complication 46% (39/84). The evolution of the disease itself and the terrain caused the death of 90% of complicated patients undergoing emergency surgery (19/21), being the latter an independent risk factor for death (p = 0.018). As to coordinated surgeries, the cause of death was associated to the surgical act (80%). Association was found between vascular pathology and morbidity and mortality (p = 0.015) and between ischemic complication and morbidity and mortality (p = 0.024). The presence of intracranial hypertension (IH) was associated with a bad outcome (p= 0.003). Conclusions: the results show a good quality of care compared to other centers. There are still aspects to correct to reduce morbidity and mortality rates.
Resumo: Introdução: a análise da morbimortalidade permite avaliar a qualidade do atendimento e dos resultados e comparar diferentes centros de saúde. Este é o primeiro estudo de morbimortalidade em neurocirurgia realizado no Uruguai. Objetivo: determinar a morbimortalidade global e específica no Departamento de Neurocirurgia do Hospital de Clínicas e a associação entre complicação e morbimortalidade. Metodologia: estudo observacional, descritivo-analítico, longitudinal, retrospectivo de todos os pacientes >15 anos que necessitaram de cirurgia entre abril de 2017 e 2019. Os dados foram obtidos dos prontuários dos pacientes e as variáveis analisadas foram: idade, sexo, comorbidade, aspectos clínicos, diagnóstico, oportunidade cirúrgica, complicação, tipo de complicação, mortalidade, causa da mortalidade, resultado e tempo cirúrgico. Resultados: 477 pacientes foram operados dos quais 72 apresentaram complicações. A mortalidade geral foi de 5,5% (26/477) e a morbidade de 15% (72/477). 36% dos pacientes com complicações morreram (26/72). A patologia vascular foi a causa específica de mortalidademorbidade específica mais freqüente 20% (14/69). A infecção foi o tipo de complicação mais freqüente 46% (39/84). A evolução da própria doença e do local da cirurgia ocasionou a morte de 90% dos pacientes com complicações submetidas a cirurgias de urgência (19/21), sendo este último fator de risco independente para óbito (p = 0,018). Nas cirurgias eletivas, a causa da morte esteve ligada ao ato cirúrgico (80%). Houve associação entre patologia vascular e morbimortalidade (p = 0,015) e entre complicação isquêmica e morbimortalidade (p = 0,024). A presença de hipertensão intracraniana (HEC) foi associada a um desfecho ruim (p = 0,003). Conclusões: os resultados mostram uma boa qualidade de atendimento em comparação com outros centros. Ainda há aspectos a serem corrigidos para reduzir a morbimortalidade.
Subject(s)
Indicators of Morbidity and Mortality , Hospitals, University , Neurosurgery/statistics & numerical data , Quality of Health CareABSTRACT
Resumen El síndrome inflamatorio multisistémico asociado a COVID-19 (SIM-COVID-19) es una complicación post-infecciosa descrita en niños y adolescentes con antecedente de exposición a SARS-CoV-2. Su potencial de evolución clínica grave, con compromiso hemodinámico y de falla de múltiples órganos lo convierten en una identidad que requiere de sospecha temprana, rápido diagnóstico y manejo adecuado, incluyendo terapia intensiva en la mayoría de los casos. Las siguientes recomendaciones recopilan información de la literatura científica, de la experiencia nacional en este año de pandemia y han sido consensuadas con expertos. Se presentan como guías de manejo de modo de facilitar el trabajo de equipos de salud a cargo de la atención pediátrica.
Abstract Multisystem inflammatory syndrome temporally associated with COVID-19 (MIS-C) is a post-infectious complication described in children and adolescents with previous exposure to SARS-CoV-2. Because of its potential to evolve to severe disease -including cardiovascular impairment and multiple organ failure it requires a prompt diagnosis and appropriate management, including intensive care for most cases. These guidelines compile recent information from scientific literature, from our local clinical experiences during the past pandemic year, and have been discussed by experts. The recommendations provided are meant to help the clinical work of health teams attending the pediatric population.
Subject(s)
Humans , Child , Adolescent , Systemic Inflammatory Response Syndrome/diagnosis , COVID-19/complications , Phenotype , Systemic Inflammatory Response Syndrome/therapy , Diagnosis, Differential , Pandemics , SARS-CoV-2ABSTRACT
ABSTRACT In response to the Zika epidemics in Brazil, the ZDC molecular assay (Bio-Manguinhos) was developed and registered at the Brazilian Regulatory Agency of Health Surveillance - ANVISA. The circulation of Zika (ZIKV) Dengue (DENV) and Chikungunya (CHIKV) viruses and their clinical similarities are challenges to correctly diagnose these viruses. The simultaneous detection of ZIKV, DENV and CHIKV is an important tool for diagnosis and surveillance. Here, we present the analytical and clinical performance evaluation of ZDC molecular assay (Bio-Manguinhos) at the public health laboratories three years after its registration at ANVISA. The clinical performance demonstrates the ZDC molecular assay (Bio-Manguinhos) has 100% sensitivity and 100% specificity to detect and discriminate ZIKV, CHIKV, and DENV from clinical plasma samples. The ZDC molecular assay (Bio-Manguinhos) results were highly reproducible and no cross-reactivity was seen during testing with a panel of other infectious agents. In conclusion, the ZDC molecular assay (Bio-Manguinhos) is an accurate and reliable tool to monitor Zika, dengue and chikungunya infections in countries like Brazil with simultaneous circulation of the three viruses.
Subject(s)
Humans , Zika Virus/genetics , Zika Virus Infection/diagnosis , Brazil , Chikungunya virus/genetics , Dengue/diagnosis , Dengue Virus/genetics , Chikungunya Fever/diagnosis , LaboratoriesABSTRACT
INTRODUCCION: El Síndrome Inflamatorio Pediátrico Multisistémico (PIMS) ha emergido como una nueva enfermedad en niños, secundaria a infección por SARSCoV-2. Se caracteriza por presentar compromiso multiorgánico con parámetros inflamatorios elevados y manifestaciones clínicas graves, siendo el corazón el órgano más severamente comprometido. OBJETIVO: Describir las características clínicas y de laboratorio de 23 pacientes con diagnóstico de PIMS con compromiso cardiovascular hospitalizados en un centro único. MÉTODO: Se efectuó un estudio retrospectivo analizando los hallazgos clínicos y de laboratorio junto a las manifestaciones cardiovasculares que presentaron estos pacientes. RESULTADOS: 23/29 pacientes con PIMS (78%) presentaron manifestaciones digestivas y mucocutáneas. Las manifestaciones cardiovasculares fueron: Síndrome Kawasaki y "Kawasaki like" sin compromiso coronario en 15/23 (65%) y con compromiso coronario en 3 (13%). Shock en 9 pacientes (39%), injuria miocárdica- miocarditis en 8 (35%) y derrame pericárdico en 13 (56%). Trastornos del ritmo cardíaco se observaron en 6 pacientes (26%). La terapia más utilizada fue inmunoglobulina y corticoides. 18 /23 requirieron manejo en unidades de intermedio y/o intensivo. Un 70% de los pacientes se recuperó del compromiso cardiovascular antes del alta. CONCLUSIÓN: El compromiso cardiovascular en PIMS es la complicación más frecuente de esta enfermedad, que se acompaña de manifestaciones inmunológicas y hematológicas graves lo que hace necesario un tratamiento multidisciplinario para un mejor manejo de estos pacientes.
INTRODUCTION: Pediatric Multisystemic Inflammatory Syndrome (PIMS) has emerged as a new disease in children, secondary to SARSCoV-2 infection. It is characterized by multi-organ involvement with elevated inflammatory parameters and severe clinical manifestations, the heart being the organ most severely involved. OBJETIVE: to describe the clinical and laboratory characteristics of 23 patients diagnosed with PIMS with cardiovascular involvement hospitalized in a single center. METHOD: We conducted a retrospective study in which we analyzed the clinical and laboratory findings along with the cardiovascular manifestations presented by these patients. Results: 23/29 patients with PIMS and cardiovascular involvement were selected, 78% had digestive and mucocutaneous manifestations. Cardiovascular manifestations consisted of KawasakiKawasaki like syndrome without coronary involvement in 15/23 (65%) and coronary involvement in 3 (13%). Nine patients developed shock (39%), 8 (35%) myocardial injury in and 13 (56%) pericardial effusion.. Heart rhythm disorders were observed in 6 patients (26%). The main therapy was immunoglobulin and corticosteroids. 18 /23 required management in intermediate and/or intensive care unit. 70% of patients recovered from cardiovascular involvement before discharge. CONCLUSION: Cardiovascular involvement in PIMS is the most frequent complication of this disease, but it is associated with severe immunological and hematological manifestations, which makes necessary a multidisciplinary treatment for a better management
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Cardiovascular Diseases/etiology , Cardiovascular Diseases/epidemiology , Systemic Inflammatory Response Syndrome/complications , COVID-19/complications , Coronary Aneurysm/etiology , Coronary Aneurysm/epidemiology , Echocardiography , Chile , Retrospective Studies , Age Distribution , SARS-CoV-2 , Heart Injuries/etiology , Heart Injuries/epidemiology , Hospitalization , Mucocutaneous Lymph Node Syndrome/etiology , Mucocutaneous Lymph Node Syndrome/epidemiologyABSTRACT
Resumen Introducción: La infección por virus SARS-CoV-2 responsable de la pandemia actual, es una entidad clínica y fisiopatológica nueva y en desarrollo, cuyo control aún es incierto mientras no contemos con una vacuna efectiva y de distribución universal. Descrita inicialmente como una enfermedad respiratoria mayoritariamente de adultos, los niños también pueden enfermar y se ha visto que en ellos las manifestaciones clínicas de enfermedad suelen diferir a las de los adultos expresándose como cuadros benignos en su mayoría. Si requieren hospitalización o algún tipo de asistencia, el cuadro se resuelve con tratamiento de soporte y sin complicaciones, mayoritariamente. Sin embargo, en el síndrome inflamatorio multisistémico asociado a COVID-19 (SIM-C) es de vital importancia la sospecha precoz y la derivación a un centro de alta complejidad para otorgar el soporte y tratamiento adecuado para lograr una buena y adecuada sobrevida. Objetivo: Describir el espectro clínico de enfermedad por virus SARS-CoV-2 en un centro de referencia pediátrico con la pandemia aún en desarrollo. Método: Se presenta la casuística de 537 pacientes con infección por SARS-CoV-2 atendidos entre marzo 1 y julio 15, 2020, con descripción de aquellos que fueran hospitalizados. Resultados: 127 (23%) de ellos fueron internados y de éstos 69% sintomáticos. Veintiséis pacientes (20%) de los hospitalizados presentaron SIM-C y sólo uno falleció por complicaciones de sus patologías de base.
Abstract Background: SARS-CoV-2 virus infection responsible for de pandemic in course, is a new clinical and physiopathological entity, whose control is still uncertain till we can provide an effective and universal vaccine. In the beginning it was described as a respiratory disease which affects mainly adults, children can have the disease too and in this group the disease can be different than the adult disease. Acute infection in children is mostly mild and when it requires hospital assistance it resolves with support therapy and without complications most of the time. However, in the Pediatric Inflammatory Multisystemic Syndrome is vital the early clinical suspect and refers to a tertiary center to bring support and properly treatment. Aim: To describe the clinical spectrum of SARS-CoV-2 virus disease in a pediatric referral center with the pandemic still in development. Method: A case series of 537 patients with SARS-CoV-2 infection treated between March 1 and July 15, 2020 is presented with a description of those who were hospitalized. Results: 127 (23%) of them were hospitalized and of these 69% were symptomatic. Twenty-six patients (20%) of those hospitalized presented PIMS, only one died for complications of his chronic diseases.
Subject(s)
Child , Humans , COVID-19/epidemiology , Hospitalization/statistics & numerical data , Chile/epidemiology , Pandemics , HospitalsABSTRACT
La enfermedad por coronavirus (COVID-19) se convirtió en una pandemia con implicaciones clínicas y emo-cionales, a veces invisibles para los gastroenterólogos. Aunque morir es parte de la vida, el riesgo para algunos médicos puede ser mayor. Específicamente, los gastroenterólogos nos vemos afectados por el temor a reiniciar nuestras consultas y procedimientos endoscópicos. En medio de un mar de información incluso con contradicciones entre diferentes expertos, seguir los lineamientos de las Asociaciones Colombianas del Aparato Digestivo podría ayudar a tranquilizar a los médicos y pacientes. Aunque las patologías seguirán apareciendo, el miedo de la población a contagiarse puede generar consecuencias como el retraso en el tratamiento de un cáncer de vías digestivas. El autocuidado físico mediante estrategias de protección y el cuidado emocional son clave para ayudar a nuestro sistema inmunológico. Adaptarnos a funcionar en medio de la pandemia por medio de la teleorientación en plataformas digitales es una forma creativa de disminuir la angustia colectiva.(AU)
COVID-19 is a pandemic with clinical and emotional implications, sometimes invisible to gastroenterologists. Although dying is part of life, the risk for some doctors may be greater. Specifically, gastroenterologists are affected by the fear of restarting medical check-ups and endoscopic procedures. Amid a sea of information even with contradictions between different experts following the guidelines of the Colombian Associations of the Digestive Tract could help reassure doctors and patients. Although the pathologies will continue to appear, the fear of the population to be infected can generate consequences such as delaying the treatment of digestive tract cancers. Physical self-care through protection strategies and the emotional care, are important to help our immune system. Adapting to function during the pandemic, using tele-orientation through digital platforms, is a creative way to reduce collective anxiety.(AU)
Subject(s)
Humans , Stress Disorders, Post-Traumatic/psychology , Mental Health , Coronavirus Infections/psychology , Gastroenterologists/psychology , TeleorientationABSTRACT
En el presente estudio se analizan las percepciones y expectativas que promueven la vinculación de los usuarios al tratamiento. Se trata de una investigación cualitativa, de cuño descriptivo e interpretativo que forma parte de una tesis doctoral realizada con 44 usuarios atendidos en cuatro Centros de Atención Psicosocial (CAPS) de un municipio de Rio Grande del Norte, Brasil. Los datos fueron obtenidos por entrevistas y grupos focales, sistematizados con el software QDA Miner LiteV1.4.3, aplicada la técnica de análisis temático y discutidos a partir de referencial teórico del campo de la salud mental. Los principales hallazgos apuntan a transformaciones positivas en sus vidas, el miedo de las internaciones, la concentración del cuidado en un único servicio y mantener la calidad de vida alcanzada. La investigación permitió identificar factores de protección para la efectiva vinculación de los usuarios a los CAPS.(AU)
This study analyses perceptions and expectations that promote treatment adherence. A descriptive-interpretive study was conducted as part of a doctoral thesis with 44 patients receiving treatment at four psychosocial care centers in a municipality in the State of Rio Grande do Norte, Brazil. Data was collected using interviews and focus groups. Thematic analysis was performed using the software QDA Miner Lite version 1.4.3 and frames of reference from the field of mental health. The findings show that positive transformations occurred in the patients, fear of being admitted to hospital, provision of various care options within the same service, and maintenance of quality of life gains. The study identified protective factors for effective adherence to treatment.(AU)
O objetivo deste estudo foi analisar as percepções e expectativas que favorecem a vinculação dos usuários ao tratamento. Trata-se de um estudo qualitativo, de caráter descritivo e interpretativo, cujos dados constituem um recorte de tese doutoral, realizado com 44 usuários atendidos em quatro Centros de Atenção Psicossocial (CAPS) de um município do Rio Grande do Norte, Brasil. Os dados foram coletados por entrevistas e grupos focais, sistematizados com o software QDA Miner LiteV 1.4.3, aplicados à técnica de análise temática e discutidos a partir de referenciais teóricos do campo da saúde mental. Os principais achados referem-se às transformações positivas em suas vidas, ao medo de ser internados, ao recebimento de várias opções de cuidado no mesmo serviço e à manutenção da qualidade de vida alcançada. A pesquisa permitiu identificar fatores de proteção para a efetiva vinculação dos usuários aos CAPS.(AU)
ABSTRACT
Este proyecto se propone:- Conceptualizar las relaciones entre los procesos psíquicos, las modalidades de producción simbólica y de aprendizaje en niños y adolescentes. - Conceptualizar las patologías de simbolización contemporáneas y -Proponer estrategias para la transformación de las dificultades subjetivas ligadas a la producción de conocimientos. Con tal fin se diseña un estudio organizado en dos ejes: a) a través del abordaje clínico de niños y adolescentes con problemas de aprendizaje y b) a través de talleres extracurriculares en la escuela. El análisis se focalizará en la conceptualización de las articulaciones entre la constitución narcisista, el proceso identificatorio y el aprendizaje, y sus transformaciones. Investigar esta temática permitirá conceptualizar el aprendizaje y sus problemáticas contemporáneas y diseñar estrategias de intervención tanto en la clínica como en el sistema educativo para favorecer el despliegue de procesos creativos críticos y reflexivos en la producción de conocimientos de niños y adolescentes.
This research proposes: To conceptualize the relationships between psychic processes, specific modalities of symbolic production and learning in children and adolescents. To conceptualize contemporary symbolization pathologies. To propose intervention strategies for transforming subjective difficulties linked to knowledge production. For that purpose, this research proposes a qualitative design in an exploratory and longitudinal outline. Therefore, this study is designed taking into account two differential axes: a) through the clinic approach of children and adolescents, and b) through extracurricular workshops. The analysis will be focused on producing conceptualizations about the links between narcissistic constitution, identificatory process and symbolization modalities involved in learning, and intervention strategies. On the one hand, researching this topic will allow conceptualizing learning and its contemporary problematics. On the other hand, it will enable to design intervention strategies in order to stimulate the subjective and symbolic development in knowledge production processes of children and adolescents.
Subject(s)
Psychology, Educational , Remedial Teaching , Child , AdolescentABSTRACT
ABSTRACT The Brazilian Public Health Service provides freely αPEG-IFN to treat patients infected with HCV. The primary goal of HCV therapy is the long-term elimination of HCV from the blood to reduce the risk of HCV associated complications and death. Patient viremia affects the treatment duration and response, thus influencing clinical decisions. We developed a high-throughput method to perform the quantification of RNA hepatitis C virus (HCV) virus load in plasma samples to monitor patients under treatment. The method is based on a duplex detection, in a one-step real-time RT-PCR assay and it has been validated according to the rules established by the official Brazilian regulatory agency (ANVISA). This new method was compared to a commercial kit (Cobas/Taqman HCV Test v2.0 - Roche), showing virus load results with significant correlation between them (p= 0,012) using commercial and clinical panels. In addition, 611 samples from patients treated with peguilated alfa-interferon (αPEG-IFN) from different regions of Brazil were analyzed. Our one-step real-time RT-PCR assay demonstrated good performance in viral load measurement and in treatment course monitoring, with acceptable sensitivity and specificity values.
Subject(s)
Humans , RNA, Viral/isolation & purification , Hepatitis C/virology , Hepacivirus/isolation & purification , Viral Load/methods , Real-Time Polymerase Chain Reaction/methods , Antiviral Agents/therapeutic use , Polyethylene Glycols/therapeutic use , Time Factors , Viremia , Recombinant Proteins/therapeutic use , Brazil , RNA, Viral/genetics , RNA, Viral/blood , Prospective Studies , Reproducibility of Results , Interferon-alpha/therapeutic use , Hepatitis C/drug therapy , Hepatitis C/blood , Hepacivirus/genetics , Genotyping Techniques , GenotypeABSTRACT
Los Centros de Atención Psicosocial fueron idealizados para reemplazar las prácticas asilares predominantes en los hospitales psiquiátricos. La evaluación de las prácticas realizadas en dichos servicios se torna fundamental para intentar dar garantías sobre la calidad del cuidado ofrecido a los usuarios y alcanzar los objetivos del movimiento de Reforma Psiquiátrica brasileña. Teniendo en cuenta estos aspectos, el objetivo es describir y analizar el tratamiento psicosocial ofrecido en cuatro Centros de Atención Psicosocial de una ciudad en el noreste de Brasil. Se trata de una investigación cualitativa de triangulación metodológica que utilizó el análisis documental de la legislación vigente y el análisis de contenido temático (Minayo, 2009) de las entrevistas realizadas con profesionales de los servicios, con la ayuda del software QDA MINER. Fue observado que los procesos de trabajo se apoyan en pilares asilares: atención centrada en el médico y prescripción psicofarmacológica, así como también la dificultad de los servicios en llevar a cabo actividades en el territorio y centradasen los derechos de los usuarios. Sobre el plan de cuidados se percibe un distanciamiento entre las prácticas diarias de los profesionales y las normativas postuladas.
Psychosocial Care Centers were developed as an alternative to the asylum model of mental health care predominant in psychiatric hospitals. The evaluation of service delivery is essential for ensuring quality of care and achieving the goals of the Brazilian psychiatric reform. In view of the above, this study aims to assess and describe the psychosocial treatment provided by four Psychosocial Care Centers in a municipality in the northeast of Brazil. The study used a qualitative research design and methodological triangulation based on documentary analysis of existing legislation and a thematic analysis (Minayo, 2009) of interviews conducted with managers of the centers with the aid of the software package QDA Miner. The findings show that the work processes in place in the centers investigated by this study are grounded in the asylum model of mental health care and a doctor-centered and psychopharmacological approach. This in turn hinders the services' capacity to plan activities focusing on users' rights. With respect to the therapeutic plan, the findings show that there is a gap between the daily practice of health professionals and the standards and regulations envisaged by the legislation.
Os Centros de Atenção Psicossocial foram idealizados para substituir as práticas asilares predominantes nos hospitais psiquiátricos. A avaliação das práticas realizadas nesses serviços tornou-se fundamental na tentativa de garantir a qualidade da assistência ofertada aos usuários e de alcançar as metas do movimento da Reforma Psiquiátrica brasileira. Considerando tais aspectos o objetivo é descrever e analisar o tratamento psicossocial oferecido em quatro centros de atenção psicossocial de um município do nordeste brasileiro. Trata-se de uma pesquisa qualitativa de triangulação metodológica que utilizou a análise documental da legislação vigente e a análise de conteúdo temático (Minayo, 2009) de entrevistas realizadas com profissionais dos serviços, com auxílio do software QDA MINER. Observaram-se processos de trabalho apoiados em pilares asilares: médico centrado e psicofarmacológico e dificuldade dos serviços em planejar ações desenvolvidas no território e focadas nos direitos dos usuários. No plano do cuidado foi percebido o distanciamento entre as práticas cotidianas dos profissionais e as normativas postuladas.
Subject(s)
Humans , Male , Female , Quality of Health Care/organization & administration , Hospitals, Psychiatric/organization & administration , Professional Practice , Psychiatry , Stress, Psychological/psychology , Health Services Administration , Mental Health , Public Health , Substance-Related Disorders/psychology , Alcohol-Related Disorders/psychology , Mental Disorders/psychology , Mental Health Services/organization & administrationSubject(s)
Cytotoxins , Terminal Care , Life Support Care , Terminally Ill , Neoplasms/drug therapy , Drug TherapyABSTRACT
Objective To present reflections on the type of research conducted on a treatment adherence among users of Public Mental Health System in Brazil and discuss the applicability of the concept of adherence to treatment in this context. Method Literature review in SciELO, LILACS, Cochrane Library and PubMed / MEDLINE using the Health Sciences Descriptors (DeCS) treatment, adhesion and “mental health” and the specific vocabulary of the Medical Subject Headings (MeSH) “patient compliance/psychologist” y “mental health”. They were included for review the complete texts and theses published between 2007-2012 in Portuguese, English and Spanish. Results 127 articles were recovered, 32 specifically related to mental health. Eight were excluded for duplicates and after reading the remaining 24 articles were selected for this study 10 conducted in the field of Mental Health in Brazil. No investigations have been identified with focus on adherence to psychosocial treatment offered in public mental health. Conclusions disregard of the mental health legislation and reinforce the asylum model of assistance.
Objetivo Apresentar reflexões sobre o tipo de pesquisa que são realizados sobre a adesão ao tratamento entre os usuários do Sistema de Saúde Mental Pública no Brasil e discutir a aplicabilidade do conceito de adesão ao tratamento neste contexto. Método Evisão da literatura nas bases SciELO, LILACS, Cochrane Library e PubMed/MEDLINE utilizando os descritores de Ciências da Saúde (DeCS) tratamento, adesão e “saúde mental” e o vocabulário específico do Medical Subject Headings (MeSH) “patient compliant/psychologist” e “mental health”. Foram inclusos para revisão os textos completos e as teses publicadas entre 2007-2012, em Português, Inglês e Espanhol. Resultados 127 artigos foram recuperados, 32 especificamente relacionados com a saúde mental. Oito duplicados foram excluídos, dos 24 restantes foram selecionados para este estudo os 10 realizados no campo da Saúde Mental no Brasil. Não se identificaram pesquisas com foco na adesão ao tratamento de perspectiva psicossocial oferecido na saúde mental pública. Conclusão As pesquisas analisadas desconsideram o contexto e a complexidade do tratamento oferecido, desconhecem a legislação de saúde mental em vigor e reforçam o modelo manicomial de assistência.
Objetivo Presentar reflexiones sobre el tipo de investigaciones realizadas en Brasil sobre la adhesión al tratamiento de los usuarios del Sistema Público de Salud Mental y discutir la aplicabilidad del concepto de adhesión al tratamiento en dicho contexto. Método Revisión bibliográfica en las bases SciELO, LILACS, Biblioteca Cochrane y PubMed/MEDLINE utilizando los descriptores de Ciencias de la Salud (DeCS) adhesión, tratamiento y “salud mental” y el vocabulario específico de Medical Subject Headings (MeSH) “patient compliance/psychologist” y “mental health”. Se incluyeron los textos completos y las tesis publicadas entre 2007-2012, en portugués, inglés y español. Resultados F1eron recuperados 127 artículos, 32 específicamente de la salud mental. Se excluyeron los 8 duplicados y de los 24 restantes fueron seleccionados para el presente trabajo los 10 realizados en Brasil. No se identificaron enfoques sobre la adhesión al tratamiento de perspectiva psicosocial ofrecido en la red pública de salud mental. Conclusión Las investigaciones analizadas desconsideran el contexto y la complejidad del tratamiento ofrecido desconociendo la legislación en salud mental vigente y reforzando el modelo de atención asilar.
Subject(s)
Mental Health , Concept Formation , Treatment Adherence and Compliance , BrazilABSTRACT
Introduccion: Los aneurismas y divertículos cardíacos congénitos constituyen malformaciones poco frecuentes y generalmente comprometen el ventrículo izquierdo. Pueden presentarse en forma asintomática, causar embolización, arritmia, insuficiencia cardíaca, rotura o muerte súbita. La ecocardiografía Doppler color realiza el diagnóstico y detecta malformaciones asociadas. La terapia puede ser médica o quirúrgica dependiendo de la presentación clínica y de los hallazgos en cada paciente. Método: Estudio retrospectivo de 5 pacientes durante un período de diez años, uno con divertículo, cuatro con aneurismas, en los cuales se analizó sexo, edad, motivo de consulta, sintomatología, hallazgos al examen físico, malformaciones extracardíacas o cardíacas asociadas. La ecocardiografía confirmó el diagnóstico y analizó la localización, efecto sobre la función cardíaca y presencia de complicaciones. Se estudió el tipo de tratamiento elegido como terapia antiplaquetaria, antiarrítmica o quirúrgica, además del seguimiento. Resultados: De un total de 5 pacientes, tres eran hombres, la mediana de edad al diagnóstico fue de 13 meses; dos de diagnóstico antenatal. Soplo cardíaco (3/5) fue el principal hecho que motivó el estudio. La ubicación más frecuente fue en el ventrículo izquierdo y la malformación cardíaca asociada la comunicación interventricular (2 pacientes). La terapia elegida fue médica en todos los pacientes con aspirina y en un caso se agregó atenolol por taquicardia ventricular no sostenida. Ningún paciente falleció. Conclusion: Constituye la primera publicación sobre esta patología en nuestro país; si bien es una serie pequeña, aporta aspectos clínicos, diagnósticos y de seguimiento que ayudan a sospechar esta rara malformación en el paciente pediátrico.
Introduction: Congenital cardiac aneurysms and diverticula are rare cardiac malformations which mainly affects the left ventricle. Clinically, most are asymptomatic or may cause systemic embolization, arrhyth-mia, heart failure, ventricular wall rupture or sudden cardiac death. Doppler echocardiography establishes the diagnosis and can detect associated malformations. Treatment may be medical or surgical, depending on findings. Patients and Methods: Retrospective study of 5 patients followed for ten years. One patient presented with a diverticulum and four with aneurysms. We analyzed sex, age at diagnosis, symptoms, physical examination, and associated cardiac and extracardiac malformations. Echocardiography confirmed the diagnosis and established location, cardiac function, and presence of complications. We analyzed the treatments used: antiplatelet, anti-arrhythmic or surgical therapy, and follow up. Results: Three were males, the median age at diagnosis was 13 months; in two patients the diagnosis was made before birth. Heart murmur in 3 of 5 patients was the main presenting finding. The most frequent location was the left ventricle and the associated cardiac malformation was ventricular septal defect in 2 patients. All patients were treated with aspirin. One patient with non-sustained ventricular tachycardia received ateno-lol. There were no deaths. Conclusion: This is the first report of this disease in our country. Although it is a small series it provides important clinical aspects for the diagnosis, treatment and follow-up that help us suspect this rare malformation in pediatric patients.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Diverticulum/congenital , Diverticulum/diagnostic imaging , Heart Aneurysm/congenital , Heart Aneurysm/diagnostic imaging , Abnormalities, Multiple , Diverticulum/therapy , Echocardiography, Doppler , Follow-Up Studies , Heart Aneurysm/therapy , Radiography, Thoracic , Retrospective StudiesABSTRACT
Este artículo desarrolla los principales ejes del Proyecto de Desarrollo Tecnológico y Social (P002), "Procesos de simbolización y uso de nuevas tecnologías: estrategias de complejización del pensamiento en niños y adolescentes socialmente vulnerables" dirigido por la Dra. Patricia Álvarez. El mismo se encuentra en su segundo año de desarrollo y al iniciar se propuso abordar el uso de nuevas tecnologías con niños y adolescentes en situación de vulnerabilidad social con el objeto de favorecer el despliegue de experiencias subjetivas enriquecedoras, dinámicas y creativas capaces de potenciar los procesos de aprendizaje, entendiendo a los mismos como producción simbólica. Se explicitan en primer lugar los antecedentes sobre los que se asienta el proyecto y las referencias teóricas fundamentales sobre las que se erige la propuesta investigativa. En segundo lugar se postulan los objetivos propuestos y la metodología que se desarrolla. Finalmente se consideran las expectativas de resultados y el impacto favorable del proyecto.
This article develops the main axes of Project Technological and Social Development (P002), " Processes of symbolization and use of new technologies: strategies complexity of thought in children and adolescents, socially vulnerable " directed by Dr. Patricia Alvarez. The same is in its second year of development and start set out to address the use of new technologies in children and adolescents in situations of social vulnerability in order to facilitate the deployment of subjective experiences enriching, dynamic and creative processes capable of enhancing learning, understanding them as symbolic production. Background on the project and fundamental theoretical references on which stands the research proposal is based are explained first. Secondly the objectives and methodology to develop postulated. Finally we consider the expected results and the favorable impact of the project.