Um esclarecimento sobre a real necessidade de realizar a reposição hormonal de testosterona no homem / A clarification on the real need for testosterone hormone replacement in men / Una aclaración sobre la necesidad real de sustituir la hormona testosterona en los hombres

O artigo é uma revisão sobre os aspectos relacionados ao envelhecimento masculino e necessidades de tratamentos, com ênfase no hipogonadismo tardio, baixa produção de testosterona e possível desenvolvimento do Distúrbio Androgênico do Envelhecimento Masculino (DAEM). O objetivo foi apresentar o DAEM e suas implicações sobre a qualidade de vida do paciente para promover e validar o tratamento, quando realmente for apropriado, para esse quadro clínico. Utilizou-se como a fonte de pesquisa Google Acadêmico, banco de dados Biblioteca Virtual em Saúde e do PubMed foram obtidos artigos com as aplicações dos seguintes filtros: 2010-2023 e descritores em saúde (andropausa, reposição hormonal, testosterona, DAEM, hipogonadismo e síndromes metabólicas). Os critérios de inclusão utilizados foram a disponibilidade integral dos artigos, ter os idiomas inglês e português, e abordar o tema da Doença Androgênica do Envelhecimento, todas as suas repercussões sobre a qualidade de vida do homem e, sobretudo, o seu tratamento. Para excluir artigos encontrados na busca, foram observadas obras que apenas tangenciam o tema e tinham enfoque em outros aspectos, como: estética e esporte. Após a aplicação do método, 14 trabalhos foram selecionados por estabelecerem grande relação com o tema. Esse distúrbio acarreta para o indivíduo um conjunto de sinais e sintomas capazes de comprometer sua qualidade de vida: disfunção erétil, baixa libido, obesidade, redução de massa magra ou sarcopenia, osteoporose e distúrbios do humor. O diagnóstico é feito clinicamente e através de exames laboratoriais de dosagem sérica de testosterona. Perante a confirmação diagnóstica e sem patologizar processos fisiológicos do envelhecimento, o tratamento indicado é a reposição de testosterona que tende a normalizar o quadro do idoso por amenizar ou finalizar os sinais e sintomas desse paciente, proporcionando-o uma terceira idade com qualidade de vida. Vale destacar que as disposições de formulações de testosterona são inúmeras: orais, transdérmicas, intramusculares ou injetáveis. A via de administração depende da situação individual de cada paciente e cada tipo de medicamento tem seus benefícios se comparado aos outros, seja por comparação entre efeitos colaterais, estabilidade de níveis séricos hormonais, custo e acesso. O DAEM precisa ser identificado e diagnosticado naqueles pacientes que necessitam de um tratamento por apresentar sinais e sintomas prejudiciais ao bem-estar. Para isso, a indústria farmacêutica disponibiliza uma gama de formas de administração de testosterona. Entretanto, é preciso ter clareza sobre a real necessidade de medicar um paciente.

The article is a review of aspects related to male aging and treatment needs, with an emphasis on late-onset hypogonadism, low testosterone production and the possible development of Androgenic Male Aging Disorder (AMAD). The aim was to present the AMAD and its implications for the patient's quality of life in order to promote and validate treatment, where appropriate, for this clinical condition. The search source used was Google Scholar, the Virtual Health Library database and PubMed, where articles were obtained using the following filters: 2010-2023 and health descriptors (andropause, hormone replacement, testosterone, AMAD, hypogonadism and metabolic syndromes). The inclusion criteria used were that the articles were available in full, that they were in English and Portuguese, and that they dealt with the subject of Androgenic Ageing Disorder, all its repercussions on men's quality of life and, above all, its treatment. To exclude articles found in the search, we looked at works that only touched on the subject and focused on other aspects, such as aesthetics and sport. After applying the method, 14 articles were selected because they were closely related to the topic. This disorder leads to a set of signs and symptoms that can compromise the individual's quality of life: erectile dysfunction, low libido, obesity, reduced lean mass or sarcopenia, osteoporosis and mood disorders. The diagnosis is made clinically and through laboratory tests of serum testosterone levels. Once the diagnosis has been confirmed and without pathologizing the physiological processes of ageing, the treatment indicated is testosterone replacement, which tends to normalize the condition of the elderly by easing or ending the signs and symptoms of the patient, providing them with a quality old age. It's worth noting that there are many different formulations of testosterone: oral, transdermal, intramuscular or injectable. The route of administration depends on the individual situation of each patient and each type of medication has its benefits compared to the others, whether it's a comparison of side effects, stability of serum hormone levels, cost and accessibility. AMAD needs to be identified and diagnosed in those patients who need treatment because they have signs and symptoms that are detrimental to their well-being. To this end, the pharmaceutical industry offers a range of forms of testosterone administration. However, it is necessary to be clear about the real need to medicate a patient.

El artículo es una revisión de los aspectos relacionados con el envejecimiento masculino y las necesidades de tratamiento, con énfasis en el hipogonadismo de inicio tardío, la baja producción de testosterona y el posible desarrollo del Trastorno Androgénico del Envejecimiento Masculino (TAME). El objetivo fue presentar el TAME y sus implicaciones en la calidad de vida del paciente, con el fin de promover y validar el tratamiento de esta condición clínica, cuando sea apropiado. La fuente de búsqueda utilizada fue Google Scholar, la base de datos de la Biblioteca Virtual de Salud y PubMed, donde se obtuvieron artículos utilizando los siguientes filtros: 2010-2023 y descriptores de salud (andropausia, reemplazo hormonal, testosterona, TAME, hipogonadismo y síndromes metabólicos). Los criterios de inclusión utilizados fueron que los artículos estuvieran disponibles en su totalidad, en inglés y portugués, y que abordaran el tema del Trastorno Androgénico del Envejecimiento, todas sus repercusiones en la calidad de vida de los hombres y, sobre todo, su tratamiento. Para excluir los artículos encontrados en la búsqueda, se consideraron los trabajos que sólo tocaban el tema y se centraban en otros aspectos, como la estética y el deporte. Tras aplicar el método, se seleccionaron 14 artículos por estar estrechamente relacionados con el tema. Este trastorno conlleva un conjunto de signos y síntomas que pueden comprometer la calidad de vida del individuo: disfunción eréctil, libido baja, obesidad, reducción de la masa magra o sarcopenia, osteoporosis y trastornos del estado de ánimo. El diagnóstico se realiza clínicamente y mediante pruebas de laboratorio de los niveles séricos de testosterona. Una vez confirmado el diagnóstico y sin patologizar los procesos fisiológicos del envejecimiento, el tratamiento indicado es el reemplazo de testosterona, que tiende a normalizar la condición del anciano, aliviando o terminando con sus signos y síntomas, proporcionándole una vejez con calidad de vida. Cabe destacar que existen diversas formulaciones de testosterona: oral, transdérmica, intramuscular o inyectable. La vía de administración depende de la situación individual de cada paciente y cada tipo de medicación tiene sus ventajas frente a las demás, ya sea en comparación con los efectos secundarios, la estabilidad de los niveles séricos de la hormona, el coste y la accesibilidad. Es necesario identificar y diagnosticar el TAME en aquellos pacientes que necesitan tratamiento porque presentan signos y síntomas perjudiciales para su bienestar. Para ello, la industria farmacéutica ofrece diversas formas de administración de testosterona. Sin embargo, es necesario tener clara la necesidad real de medicar a un paciente.

Encefalitis por dengue en Argentina / Dengue encephalitis in Argentina

Resumen El virus dengue es un virus endémico en Argentina que, si bien inicialmente se consideró que no era neu rotrópico, actualmente se reconoce que tiene neuroinva sión, condicionando así una prevalencia de manifesta ciones neurológicas de hasta el 15% entre los enfermos. Aun siendo considerados síntomas de gravedad, existe subdiagnóstico de encefalitis por dengue debido a su variada forma de presentación clínica. Las manifesta ciones neurológicas de la encefalitis por dengue pueden abarcar desde fiebre y cefalea hasta alteraciones del nivel de conciencia y convulsiones. Si bien el líquido cefalorraquídeo (LCR) puede hallarse normal en hasta un tercio de los casos, lo habitual es que presente aumento de concentración de proteínas y pleocitosis. En cuanto a los métodos de neuroimagen, los hallazgos suelen ser variados e inespecíficos, e incluso pueden ser normales hasta en 40-50% de los casos. Se presentan 3 casos de encefalitis por dengue diag nosticados en un hospital universitario de Buenos Ai res, Argentina, en donde la presentación clínica varió desde desorientación témporo-espacial hasta estatus convulsivo refractario con diferentes presentaciones en el LCR pero todos con PCR positivo para dengue y con neuroimágenes sin alteraciones.

Abstract Dengue virus is an endemic virus in Argentina that, although it was initially considered to be non-neuro tropic, it is currently recognized to be neuroinvasive; thus conditioning a prevalence of neurological mani festations of up to 15% among patients. Even being considered severe symptoms, there is underdiagnoses of dengue encephalitis due to its varied clinical presenta tion. Neurological manifestations of dengue encephalitis can range from fever and headache to altered levels of consciousness and seizures. Although the cerebrospinal fluid may be normal in up to a third of cases, it usually presents increased protein concentration and pleocyto sis. Regarding neuroimaging methods, the findings are usually varied and nonspecific, and can even be normal in up to 40-50% of cases. We present three cases of dengue encephalitis di agnosed in a university hospital in Buenos Aires, Ar gentina, where the clinical presentation varied from temporal-spatial disorientation to refractory convulsive status with different presentations in the cerebrospinal fluid but all with positive PCR for dengue in it and with normal neuroimaging.

Magnetic resonance imaging findings in acute febrile encephalopathy in children

Background: This prospective observational study aims to study magnetic resonance imaging (MRI) findings in the setting of acute febrile encephalopathy in children between 1 month to 18 year of age group.Methods: This study was conducted in patients of acute febrile encephalopathy admitted in pediatric intensive care unit (PICU) at tertiary care centre during January 2019 to December 2019 in age group one month to 18 years. 32 patients satisfied the inclusion criteria.Results: Of the 32 patients included in the study MRI was done in 28 patients. MRI brain was normal in 17 patients and abnormalities were found in 11 patients. Majority findings were cerebral enema and restricted diffusion 3 (10.5%). Other findings were T2 hyperintensity and FLAIR hyperintensity lesion in basal ganglia and thalami region 2 (7%), T2 and FLAIR hyperintensity hippocampal lesion in hippocampus 2 (7%), haemorrhagic lesion 1 (3.5%).Conclusions: Acute febrile encephalopathy is a life-threatening condition. It is important to identify the possible aetiology for directing specific treatment. Amongst others MRI is one modality that has the potential to identify possible aetiology. Paediatric intensive care physicians are not always updated regarding utility of MRI and its findings in acute febrile encephalopathy. The main reason being non-inclusion of this subject in curriculum. This study was intended to understand all the possible MRI findings in acute febrile encephalopathy, correlate it with clinical findings and ultimately aid in management of these cases.

Diagnostic accuracy of pocket-size lung ultrasound for etiological definition of pneumonia and surveillance of complications in children hospitalized: a prospective diagnostic cohort study

Background: Pneumonia, the leading infectious cause of death in children worldwide, often requires a chest radiograph (CXR) for diagnosis, involving radiation exposure. Point-of-Care Ultrasound (POCUS) offers a radiation-free alternative and, specifically the pocket-size variant, enhances convenience at the patient's bedside. While evidence supports ultrasound's accuracy in detecting community-acquired pneumonia (CAP) in children comparable to CXR, few studies have explored its ability to distinguish pneumonia etiology, especially utilizing pocket-size POCUS devices. Methods: In this prospective diagnostic cohort study conducted over a year in a tertiary pediatric referral center, we aim to assess the diagnostic accuracy of a pocket-size POCUS device compared to CXR for determining the etiology of CAP in pediatric patients (aged >6 months and <18 years). At least 76 participants diagnosed with CAP will undergo independent POCUS examinations at various intervals, complemented by CXRs when necessary, independently classified by a third investigator. The General Electrics Vscan AirTM®, featuring Bluetooth connectivity to smartphone/tablet, will be employed for POCUS. Data collection will include systematized POCUS and CXR descriptions, alongside sociodemographic, clinical, and therapeutic variables. Statistical analysis using SPSS® version 28 will evaluate the diagnostic accuracy of the POCUS device. Conclusions: This trial's outcomes hold significant promise in unveiling unknown data about the diagnostic accuracy of pocket-size POCUS for pediatric CAP etiological diagnosis. Utilizing a device meeting technical recommendations, featuring a dual-headed probe and Bluetooth connectivity, this study has the potential to bring innovation to clinical practice, improving patient care and creating scientific value. Trial Registration Number: NCT06296693.

Lineamientos técnicos para el control de las infecciones de transmisión sexual y hepatitis virales / Technical guidelines for the control of sexually transmitted infections and viral hepatitis

La prevención y el control de las infecciones de transmisión sexual (ITS) y hepatitis virales representan un desafío crucial en la agenda de la salud pública. Con el objetivo de reducir la incidencia y prevalencia de estas enfermedades, se establecen los siguientes lineamientos técnicos, delineando estrategias integrales de promoción, prevención y atención. Estos lineamientos definen las disposiciones técnicas necesarias para el control de las ITS y hepatitis virales, orientando las acciones del personal de salud en la promoción de la salud sexual, la identificación temprana de casos, el diagnóstico oportuno, el tratamiento adecuado y la atención integral de las personas afectadas a través de estrategias innovadoras y la provisión de servicios integrales de atención a la salud. Están diseñados para ser aplicados por el personal multidisciplinario en todos los establecimientos del Sistema Nacional Integrado de Salud (SNIS)

The prevention and control of sexually transmitted infections (STIs) and viral hepatitis represent a crucial challenge on the public health agenda. With the aim of reducing the incidence and prevalence of these diseases, the following technical guidelines are established, outlining comprehensive promotion, prevention and care strategies. These guidelines define the technical provisions necessary for the control of STIs and viral hepatitis, guiding the actions of health personnel in the promotion of sexual health, early identification of cases, timely diagnosis, adequate treatment and comprehensive care of affected people through innovative strategies and the provision of comprehensive health care services. They are designed to be applied by multidisciplinary staff in all establishments of the National Integrated Health System (SNIS)

Factores pronósticos de mortalidad a 30 días en neumonía por SARS-CoV-2 / Prognostic Factors for 30-day Mortality in SARS-CoV-2 Pneumonia

Introducción: SARS-CoV-2 ha causado millones de muertes a nivel global desde su primer caso reportado en China. En Guatemala existen pocos estudios que describan los factores pronósticos. Nuestro objetivo fue determinar los factores asociados de mortalidad a 30 días en pacientes con neumonía (Nm) por SARS-CoV-2 y construir un modelo predictor. Material y Métodos: Estudio retrospectivo en 144 sujetos en el Hospital Roosevelt de marzo a diciembre 2020 con criterios de Nm por SARS-CoV-2. Se revisó el expediente médico para datos clínicos y de laboratorio desde ingreso hasta alta hospitalaria o muerte. Resultados: Se evaluaron 105 hombres y 39 mujeres con media de edad 53 años. El 47% tenía comorbilidades como diabetes mellitus 2 e hipertensión arterial sistémica. Promedio de días de hospitalización: 13. Cuadros leves a moderados de Síndrome de Distrés Respiratorio Agudo (SDRA): 92%. Se indicó ventilación mecánica invasiva (VMI) a 46 pacientes. La mortalidad general fue 35%. Factores asociados a mortalidad a 30 días: edad ≥50 años, inicio de síntomas ≥7 días, SDRA severo, radio NL >4,4, recibir VMI, alteración en LDH y procalcitonina. Nuestro modelo mostró que los mejores predictores de mortalidad eran alteración en procalcitonina (OR: 4,45), recibir VMI (OR: 112) y días de estancia hospitalaria (OR: 1,12) con precisión de 91,5% y área bajo la curva de 94,4%. Conclusiones: Los factores pronósticos de mortalidad en pacientes guatemaltecos con Nm por SARS-CoV-2 son múltiples e incluyen rasgos demográficos, clínicos y serológicos; identificarlos y contar con un modelo pronóstico ayudará a brindar atención médica de precisión.

Introduction: SARS-CoV-2 has caused millions of deaths globally since its first case was reported in China. In Guatemala, few studies describe prognostic factors. Our objective was to determine the factors associated with 30 day mortality in patients with Pneumonia (Nm) due to SARS-CoV-2 and to build a predictor model. Material and Methods: Retrospective study in 144 subjects at Roosevelt Hospital from March to December 2020 with Nm criteria for SARS-CoV-2. The medical record was rviewed, obtaining clinical and laboratory data from admission to hospital discharge or death. Results: 105 men and 39 women with an average age of 53 years were evaluated. 47% had comorbidities, with type 2 diabetes mellitus and systemic arterial hypertension being common. The average number of days of hospitalization was 13. 92% had mild to moderate acute respiratory distress syndrome (ARDS). Invasive mechanical ventila-tion (IMV) was indicated for 46 patients. Overall mortality was 35%. The factors asso-ciated with 30-day mortality were age ≥50 years, the onset of symptoms ≥7 days, severe ARDS, N/L ratio >4.4, receiving IMV, alterations in LDH, and procalcitonin. Our model showed that the best predictors of mortality were altered procalcitonin (OR: 4.45), receiving IMV (OR: 112), and days of hospital stay (OR: 1.12) with precision of 91.5% and area under the curve of 94.4%. Conclusions: The prognostic factors of mortality in Guatemalan patients with Nm due to SARS-CoV-2 are multiple and include demographic, clinical and serological features; identifying them and having a prognostic model will help provide precision medical care.

Determinantes sociales de la salud y prevención de infecciones de transmisión sexual en estudiantes de una institución educativa del Perú / Social determinantsof health and prevention of sexually transmitted infections in students of an educational institution in Perú

Objetivo: Establecer la relación entre los determinantes sociales de la salud y prevención de infecciones de transmisión sexual en estudiantes de una Institución Educativa del Perú. Material y métodos: Estudio descriptivo, con enfoque cuantitativo, nivel correlacional y diseño no experimental, donde se contó con una muestra de 144 estudiantes, evaluados mediante un instrumento como el cuestionario estructurado, validado y con un nivel alto de confiabilidad. Resultados: Evidenciaron que la prevención de ITS mostró una relación significativa con las dimensiones biológico, estilo de vida y el sistema sanitario, donde el p valor alcanzado fue de 0,000, así como una correlación positiva media, donde los coeficientes obtenidos fueron 0,500, 0.485 y 0,434 respectivamente. Conclusiones: Predominó una relación significativa, así como una correlación positiva considerable entre las variables evaluadas, por lo mismo que se contó con un p valor de 0.000 y un coeficiente de 0,642 correspondientemente

Objective: To establish the relationship between the social determinants of health and the prevention of sexually transmitted infections in students of an educational institution in Peru. Material and method:descriptive study, with a quantitative approach, correlational level and non-experimental design, where there was a sample of 144 students, evaluated using an instrument such as the structured questionnaire, validated and with a high level of reliability. Results:Showed that STI prevention showed a significant relationship with the biological, lifestyle and health system dimensions, where the p value achieved was 0.000, as well as a mean positive correlation, where the coefficients obtained were 0.500, 0.485 and 0.434 respectively. Conclusions: A significant relationship predominated, as well as a considerable positive correlation between the variables evaluated, for the same reason that there was a p value of 0.000 and a coefficient of 0.642 respectively

Spontaneous Pneumoperitoneum: A Pathology Not Always Surgical. Presentation of Two Documented Cases in Patients in Association with SARS-CoV-2 Infection / Neumoperitoneo espontáneo: patología no siempre quirúrgica. Presentación de dos casos documentados en pacientes en asociación con infección por SARS-CoV-2

Abstract The finding of pneumoperitoneum has traditionally been a surgical emergency-indicative of gastrointestinal tract disruption requiring immediate surgical exploration; however, there are conditions involving non-surgical management. There were two cases of pneumoperitoneum in association with viral pneumonia (severe acute respiratory syndrome type 2 coronavirus [SARSCoV-2]) without a history of intestinal pneumatosis or another risk factor for spontaneous pneumoperitoneum that obtained a favorable outcome without surgical intervention. This is the second report of concurrent pneumoperitoneum and coronavirus disease of 2019 (COVID-19) in the literature. A brief review of this relationship and more recent data between pneumoperitoneum and the pathophysiological mechanism of SARS-CoV-2 was also included. This paper seeks to expand knowledge with these two cases to rethink, in part, the surgical dogma of pneumoperitoneum management and to lead the reader further from the pathophysiology point of view.

Resumen El hallazgo de neumoperitoneo ha sido tradicionalmente una urgencia quirúrgica indicativa de disrupción del tracto gastrointestinal que requiere exploración quirúrgica inmediata; sin embargo, existen condiciones que implican manejo no quirúrgico. Se presentan dos casos de neumoperitoneo en asociación con neumonía viral (coronavirus del síndrome respiratorio agudo grave de tipo 2 [SARS-CoV-2]) sin antecedentes de neumatosis intestinal ni otro factor de riesgo de neumoperitoneo espontáneo que obtuvieron un resultado favorable sin intervención quirúrgica. Este es el segundo informe de neumoperitoneo simultáneo y enfermedad por coronavirus de 2019 (COVID-19) en la literatura. También se incluye una breve revisión sobre esta relación y datos más recientes entre el neumoperitoneo y el mecanismo fisiopatológico del SARS-CoV-2. Este trabajo busca ampliar el conocimiento con estos dos casos para replantear, en parte, el dogma quirúrgico del manejo del neumoperitoneo y llevar al lector un poco más allá desde el punto de vista de la fisiopatología.

Antivirales de acción directa contra la hepatitis C: revisión narrativa / Direct acting antivirals against hepatitis C: Literature review

Desde los años ochenta se ha explorado el tratamiento para el virus de la hepatitis C, aunque en ese entonces los medicamentos disponibles eran poco toleradas y poco eficaces. En el 2011, la introducción de antivirales de acción directa transformó significativamente el curso de la enfermedad, logrando tasas de curación superiores al 90 % en los pacientes. Este avance ha permitido prevenir complicaciones futuras con efectos adversos mínimos. La presente revisión aborda la línea de tiempo del descubrimiento de los antivirales, su mecanismo de acción, sus indicaciones y potencial impacto en la salud pública.

Since the 1980s, the treatment of hepatitis C has been explored, although at that time, the available medications were poorly tolerated and ineffective. In 2011, the introduction of direct-acting antivirals significantly transformed the course of the disease, achieving cure rates of over 90% in patients. This advance has made it possible to prevent future complications with minimal adverse effects. This review addresses the timeline of the discovery of antivirals, their mechanism of action, and their impact on medicine.

A experiência francesa como ferramenta para eliminação das hepatites virais: o protagonismo da enfermagem / The french experience as a tool for eliminating viral hepatitis: the role of nursing / L'expérience française comme outil pour l'élimination des hépatites virales: le rôle des soins infirmiers

Objetivo: relatar a experiência do(a) enfermeiro(a) no cuidado das pessoas com hepatites virais em serviços de saúde da França. Métodos: trata-se de relato de experiência, que ocorreu por meio de estágio, em duas cidades francesas, por meio do Programa de Cooperação Técnica Brasil e França. Resultados: Acompanhou-se a realização de testes rápidos para hepatites B e C e para o HIV, realização da Carga Viral para hepatites B/C e para o diagnóstico etiológico da Clamídia e Gonorreia. O enfermeiro, realiza o exame de Elastografia para avaliar a fibrose hepática e a prescrição para o tratamento da hepatite C. Esses profissionais realizam estratégias para acolher e ofertar cuidado humanizado às populações que apresentam maior vulnerabilidade. Conclusão: A atuação do enfermeiro francês reflete inserções importantes na abordagem das hepatites, principalmente no cuidado às populações de maior vulnerabilidade, no seu cotidiano, com oferta de exames e de atenção humanizada e integral, suscitando reflexões para adaptação dessas estratégias no contexto brasileiro. A experiência do estágio favoreceu a aproximação entre os países, podendo contribuir em discussões conjuntas quanto a organização dos serviços de saúde e a atuação desse profissional em ambos os países, considerando a peculiaridade territorial, cultural e política. (AU)

Objective: to report the nurse's experience in caring for people with viral hepatitis in health services in France. Methods: this is an experience report, which took place through an internship, in two French cities, through the Brazil and France Technical Cooperation Program. Results: Rapid tests for hepatitis B and C and HIV were carried out, Viral Load testing for hepatitis B/C and the etiological diagnosis of Chlamydia and Gonorrhea were carried out. The nurse performs the Elastography exam to evaluate liver fibrosis and the prescription for the treatment of hepatitis C. These professionals carry out strategies to welcome and offer humanized care to populations that are most vulnerable. Conclusion: The French nurse's performance reflects important insertions in the approach to hepatitis, mainly in the care of the most vulnerable populations, in their daily lives, with the provision of exams and humanized and comprehensive care, prompting reflections on adapting these strategies in the Brazilian context. The internship experience favored rapprochement between the countries, being able to contribute to joint discussions regarding the organization of health services and the performance of this professional in both countries, considering the territorial, cultural and political peculiarities. (AU)

Objetivo: Relatar la experiencia del enfermero en el cuidado de personas con hepatitis viral en los servicios de salud en Francia. Métodos: Se trata de un relato de experiencia, que tuvo lugar a través de una pasantía, en dos ciudades francesas, a través del Programa de Cooperación Técnica Brasil y Francia. Resultados: Se realizaron pruebas rápidas de hepatitis B y C y VIH, pruebas de Carga Viral para hepatitis B/C y diagnóstico etiológico de Clamidia y Gonorrea. La enfermera realiza el examen de Elastografía para evaluar la fibrosis hepática y la prescripción para el tratamiento de la hepatitis C. Estos profesionales ejecutan estrategias para acoger y ofrecer atención humanizada a las poblaciones más vulnerables. Conclusion: La actuación de la enfermera francesa refleja inserciones importantes en el abordaje a las hepatitis, principalmente en la atención de las poblaciones más vulnerables, en su vida cotidiana, con la provisión de exámenes y atención humanizada e integral, suscitando reflexiones sobre la adaptación de estas estrategias en el contexto brasileño. La experiencia de la pasantía favoreció el acercamiento entre los países, pudiendo contribuir a discusiones conjuntas sobre la organización de los servicios de salud y el desempeño de este profesional en ambos países, considerando las particularidades territoriales, culturales y políticas. (AU)

A enfermagem e o letramento em saúde no contexto do hiv/aids, tuberculose, hepatites virais e infecções sexualmente transmissíveis / Nursing and health literacy in the context of hiv/aids, tuberculosis, viral hepatitis and sexually transmitted infections / Enfermería y alfabetización en salud en el contexto del vih/sida, tuberculosis, hepatitis viral e infecciones de transmisión sexual

Objetivo: identificar o Letramento em Saúde (LS), relacionados ao HIV/aids, à Tuberculose, às Hepatites Virais e às Infecções Sexualmente Transmissíveis (IST), na área de conhecimento da Enfermagem. Métodos: Pesquisa exploratória, descritiva, com base em materiais documentais, acerca do HIV/aids, tuberculose, hepatites virais e IST, no campo da Enfermagem, considerando as produções de dissertações e teses, até o ano de 2023. Resultados: Elencou-se 62 produções abordando o LS na área de conhecimento em Enfermagem, sendo a primeira em 2012. Após análise, identificou-se nove estudos: três teses (33,3%) e seis dissertações (66,7%), sendo, cinco (55,6%) de HIV/ Aids, um (11,1%) de tuberculose, um (11,1%) de hepatite C e dois (22,2%) de IST. Conclusão: As produções incipientes sobre LS no contexto do HIV/aids, tuberculose, hepatites virais e IST, bem como, na área de Enfermagem, requer o desenvolvimento de novas investigações, visto a proposta de eliminar essas doenças/ infecções como problema de saúde pública até 2030. Faz-se necessário compreender o LS dos indivíduos nessas áreas, como ferramenta para potencializar a atenção prestada, principalmente, no contexto da APS, considerando a atuação da enfermagem como estratégica para o planejamento e a oferta do cuidado e para a promoção do autocuidado. (AU)

Objective: to identify Health Literacy (HL), related to HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections (STIs), around nursing knowledge. Methods: This is an exploratory, descriptive research, based on documentary materials, about HIV/AIDS, tuberculosis, viral hepatitis and STIs, in the field of nursing, considering the production of dissertations and theses, until the year 2023. Results: 62 productions were listed addressing LS around knowledge in Nursing, the first being in 2012. After analysis, nine studies were identified: three theses (33.3%) and six dissertations (66.7%), five (55.6%) of HIV/AIDS, one (11.1%) of tuberculosis, one (11.1%) of hepatitis C and two (22.2%) of STIs. Conclusion: The incipient productions on LS in the context of HIV/AIDS, tuberculosis, viral hepatitis and STIs, as well as, around nursing, requires the development of new investigations, given the proposal to eliminate these diseases/infections as a public health problem by 2030. if necessary, understand the HL of individuals in these areas, as a tool to enhance the care provided, mainly in the context of PHC, considering nursing actions as strategic for planning and offering care and promoting self-care. (AU)

Objetivo: identificar la Alfabetización en Salud (AS), relacionada con VIH/SIDA, Tuberculosis, Hepatitis Virales e Infecciones de Transmisión Sexual (ITS), en el área de conocimiento de enfermería. Métodos: Se trata de una investigación exploratoria, descriptiva, basada en material documental, sobre VIH/SIDA, tuberculosis, hepatitis virales e ITS, en el campo de la enfermería, considerando la producción de disertaciones y tesis, hasta el año 2023. Resultados: 62 producciones. fueron listados abordando LS en el área de conocimiento en Enfermería, siendo el primero en 2012. Luego del análisis, se identificaron nueve estudios: tres tesis (33,3%) y seis disertaciones (66,7%), cinco (55,6%) sobre VIH/ SIDA, uno (11,1%) de tuberculosis, uno (11,1%) de hepatitis C y dos (22,2%) de ITS. Conclusión: Las incipientes producciones sobre LS en el contexto de VIH/SIDA, tuberculosis, hepatitis virales e ITS, así como así como, en el área de enfermería, requiere el desarrollo de nuevas investigaciones, ante la propuesta de eliminar estas enfermedades/infecciones como un problema de salud pública para el año 2030. De ser necesario, entender la AS de los individuos en estas áreas, como una herramienta. potenciar los cuidados prestados, principalmente en el contexto de la APS, considerando las acciones de enfermería como estratégicas para planificar y ofrecer cuidados y promover el autocuidado. (AU)

Fragilidades e potencialidades no ensino de estudantes de enfermagem sobre hepatites virais: sistematização da experiência / Weaknesses and potentialities in teaching nursing students about viral hepatitis: systematization of experience / Debilidades y potencialidades en la enseñanza de estudiantes de enfermería sobre hepatitis virales: sistematización de la experiencia

Objetivo: Narrar a sistematização da experiência de uma ação educativa com universitários da enfermagem sobre o cuidado às pessoas com hepatites virais. Métodos: Sistematização de experiência, de abordagem participativa, que envolveu uma ação educativa problematizadora com 12 estudantes de enfermagem. Os dados foram coletados por observação participante em diários de campo e atas de reuniões, a partir de encontros e discussões; e por preenchimento de questionário aplicado por plataforma lúdica. Os dados quantitativos foram analisados descritivamente e os qualitativos de forma exploratória por análise documental. Resultados: A participação ativa dos estudantes na idealização, o emprego do lúdico e a organização da atividade em módulos foram alguns potencializadores da aprendizagem sobre prevenção, transmissão, diagnóstico e tratamento das hepatites virais. Por outro lado, o excesso de temas abordados em um curto período, a condução de modo remoto e a sobrecarga com outras demandas da graduação foram alguns limitadores da experiência. Conclusão: O emprego de estratégias participativas foi instrumento potencial no ensino-aprendizagem, destacando-se a importância da problematização da realidade, de modo autônomo e emancipatório, para a transformação de saberes e práticas. Vislumbra-se que a estratégia educativa apresentada pode colaborar na qualificação profissional dos enfermeiros com vistas à eliminação das hepatites até 2030. (AU)

Objective: To narrate the systematization of the experience of an educational action with nursing students on the care of people with viral hepatitis. Methods: Systematization of experience, with a participatory approach, which involved a problematizing educational action with 12 nursing students. Data were collected through participant observation in field diaries and meeting minutes, based on meetings and discussions; and by completing a questionnaire administered via a playful platform. Quantitative data were analyzed descriptively and qualitative data were analyzed in an exploratory manner using documentary analysis. Results: The active participation of students in the idealization, the use of fun and the organization of the activity into modules were some of the learning enhancers about prevention, transmission, diagnosis and treatment of viral hepatitis. On the other hand, the excess of topics covered in a short period, the remote conduction and the overload with other graduation demands were some limitations of the experience. Conclusion: The use of participatory strategies was a potential instrument in teaching-learning, highlighting the importance of problematizing reality, in an autonomous and emancipatory way, for the transformation of knowledge and practices. It is envisaged that the educational strategy presented can contribute to the professional qualification of nurses with a view to eliminating viral hepatitis by 2030. (AU)

Objetivo: Narrar la sistematización de la experiencia de una acción educativa con estudiantes de enfermería sobre la atención a personas con hepatitis viral. Métodos: Sistematización de la experiencia, con enfoque participativo, que implicó una acción educativa problematizadora con 12 estudiantes de enfermería. Los datos fueron recolectados a través de la observación participante en diarios de campo y actas de reuniones, a partir de reuniones y discusiones; y completando un cuestionario administrado a través de una plataforma lúdica. Los datos cuantitativos se analizaron de forma descriptiva y los datos cualitativos se analizaron de forma exploratoria mediante análisis documental. Resultados: La participación activa de los estudiantes en la idealización, el uso de la diversión y la organización de la actividad en módulos fueron algunos de los potenciadores del aprendizaje sobre prevención, transmisión, diagnóstico y tratamiento de las hepatitis virales. Por otro lado, el exceso de temas tratados en un corto período, la conducción remota y la sobrecarga con otras exigencias de graduación fueron algunas limitaciones de la experiencia. Conclusión: El uso de estrategias participativas fue un instrumento potencial en la enseñanza-aprendizaje, destacando la importancia de problematizar la realidad, de manera autónoma y emancipadora, para la transformación de conocimientos y prácticas. Se prevé que la estrategia educativa presentada pueda contribuir a la calificación profesional de las enfermeras con miras a eliminar las hepatitis virales para 2030. (AU)

Eliminação das hepatites virais: o que a enfermagem brasileira pode contribuir? / Elimination of viral hepatitis: what can brazilian nursing contribute? / Eliminación de las hepatitis virales: ¿qué puede aportar la enfermería brasileña?

Objetivo: Refletir acerca das contribuições da enfermagem para a eliminação das hepatites virais no Sistema Único de Saúde. Métodos: Estudo reflexivo de abordagem qualitativa sustentado na prática do enfermeiro em sistemas de saúde organizado em três categorias. Resultados: Na categoria Ampliação do escopo de prática: percurso para fortalecer a atuação do enfermeiro na Rede de Atenção à Saúde, aborda-se atuação na agenda estratégica do Ministério da Saúde e do Conselho Federal de Enfermagem em prover condições para ampliação do acesso por meio da gestão, assistência, ensino e pesquisa. Na categoria Subsídios da gestão e coordenação do cuidado para guiar a prática do enfermeiro aborda-se a dimensão individual e familiar, profissional, organizacional, sistêmica e societária com reconhecimento da necessidade de ampliar a reflexão. Na categoria O enfermeiro na gestão de programas de enfrentamento às hepatites virais pontua-se aspectos intrínsecos construídos desde a formação com ênfase para a gestão e gerência, em uma dinâmica real de responsabilidade técnica em programas, serviços e equipes. Conclusão: A reflexão da contribuição do enfermeiro possui relação com a gestão e coordenação do cuidado, prática já estabelecida ao profissional, mas que requer diretrizes e investimento para às hepatites por meio da educação permanente. (AU)

Objective: To reflect on the contributions of nursing to the elimination of viral hepatitis in the Unified Health System. Methods: This was a reflexive study with a qualitative approach based on the practice of nursing in health systems, organized into three categories. Results: In the category Expansion of the scope of practice: path to strengthen the role of nurses in the Health Care Network, the strategic agenda of the Ministry of Health and the Federal Council of Nursing is addressed in providing conditions for expanding access through management, care, teaching and research. In the category subsidies of care management and coordination to guide nursing practice, the individual and family, professional, organizational, systemic and societal dimensions are addressed, with recognition of the need to broaden reflection. In the category Nurses in the management of programs to combat viral hepatitis, intrinsic aspects built since training are highlighted, with emphasis on management and management, in a real dynamic of technical responsibility in programs, services and teams. Conclusion: The reflection on the contribution of nurses is related to the management and coordination of care, a practice already established for professionals, but which requires guidelines and investment for hepatitis through continuing education. (AU)

Objetivo: Reflexionar sobre las contribuciones de la enfermería a la eliminación de las hepatitis virales en el Sistema Único de Salud. Métodos: Se trata de un estudio reflexivo con abordaje cualitativo basado en la práctica de enfermería en los sistemas de salud, organizado en tres categorías. Resultados: En la categoría Ampliación del ámbito de la práctica: camino para fortalecer el papel de los enfermeros en la Red de Atención a la Salud, se aborda la agenda estratégica del Ministerio de Salud y del Consejo Federal de Enfermería en la provisión de condiciones para ampliar el acceso a través de la gestión, el cuidado, la enseñanza y la investigación. En la categoría Subsidios de gestión y coordinación del cuidado para orientar la práctica de enfermería, se abordan las dimensiones individual y familiar, profesional, organizacional, sistémica y social, reconociendo la necesidad de ampliar la reflexión. En la categoría Enfermeras en la gestión de programas de combate a las hepatitis virales, se destacan aspectos intrínsecos construidos desde la formación, con énfasis en la gestión y gestión, en una dinámica real de responsabilidad técnica en programas, servicios y equipos. Conclusión: La reflexión sobre la contribución de los enfermeros se relaciona con la gestión y coordinación de los cuidados, una práctica ya establecida para los profesionales, pero que requiere directrices e inversión para la hepatitis a través de la educación continua. (AU)

Vacinas passado e futuro ­ Reflexões para discussão / The past and future of vaccines ­ Reflections for discussion

Neste artigo de opinião, apresento uma breve história do desenvolvimento de vacinas, comentando sobre as formas clássicas de produção de vacinas utilizando o próprio agente infeccioso. Em seguida, abordo as vacinas virais, discutindo seus benefícios e dificuldades e a questão dos sorotipos virais, bem como as vacinas bacterianas e seu relativo sucesso. Apresento nossos estudos sobre doença cardíaca reumática e o desenvolvimento de uma vacina contra infecções estreptocócicas. Também discuto plataformas vacinais, especialmente os sucessos alcançados com vacinas de vetores virais não replicantes e, acima de tudo, o grande êxito das vacinas de RNA mensageiro (mRNA). As vacinas de mRNA tornaram-se possíveis somente após os avanços obtidos com a substituição de nucleotídeos que reduziam a ação da imunidade inata. Serão todas as vacinas desenvolvidas a partir de mRNA no futuro? Em seguida, abordo a questão das vias de administração de vacinas, seja por via subcutânea, intradérmica, intramuscular ou nasal. Exponho dados do meu laboratório sobre o desenvolvimento de uma vacina de instilação nasal que induziu uma resposta de proteção da mucosa, prevenindo a infecção e, consequentemente, a transmissão do SARS-CoV-2. Posteriormente, discuto quais vacinas futuras poderiam ser desenvolvidas para além das doenças infecciosas agudas. Por fim, discuto as vantagens do desenvolvimento de vacinas seguras, eficazes e de uso múltiplo, bem como a forma de torná-las acessíveis à população mundial, promovendo a equidade em saúde.

In this opinion article, I provide a brief history of vaccine development, commenting on the classic ways of producing vaccines using the infectious agent itself. I address viral vaccines, discussing their benefits and challenges and the issue of viral serotypes, as well as bacterial vaccines and their relative success. I present our studies on rheumatic heart disease and the development of a vaccine against streptococcal infection. I also discuss vaccine platforms, highlighting the success achieved with non-replicating viral vector-based vaccines and, especially, with messenger RNA (mRNA) vaccines. mRNA vaccines only became possible after the advances provided by the replacement of nucleotides that reduced the action of the innate immune system. Will all vaccines be made from mRNA in the future? Then, I address the issue of vaccine administration routes, whether subcutaneously, intradermally, intramuscularly, or intranasal. I present data from my laboratory on the development of an intranasal vaccine that induced a protective mucosal response, preventing infection and, consequently, the transmission of SARSCoV- 2. I discuss which future vaccines could be developed beyond acute infectious diseases. Finally, I discuss the advantages of developing safe, effective, multiple-use vaccines and how to make them accessible worldwide by promoting health equity.

Identificación del alelo HLA B*57: 01 en una población militar, de Lima-Perú / Identification of the allele HLA B*57: 01 in a military population, from Lima-Peru

El alelo HLA B*57:01 es un marcador genético asociado con la hipersensibilidad al fármaco anti-retroviral abacavir (ABC) y su frecuencia en la población peruana todavía es desconocida. El objetivo fue identificar el alelo HLA B*57:01 en una población militar de Lima, Perú. Se reclutaron 43 personas viviendo con VIH (PVV) quienes aceptaron participar a través de un consentimiento informado. La detección del alelo HLA B*57:01 se realizó mediante RPC en tiempo real (RT-PCR). Asimismo, se determinó la carga viral (CV), el recuento de linfocitos CD4 y la genotipificación del VIH. Se identificaron dos casos positivos al alelo HLA B*57:01 (4,7%). Además, uno de ellos presentó múltiples mutaciones de resistencia a los anti-retrovirales (ARV), incluyendo ABC. Se demostró por primera vez en el Perú la presencia del alelo HLA B*57:01.

The HLA B*57:01 allele is a genetic marker associated with hypersensitivity to the antiretroviral Abacavir (ABC) and its frequency in the Peruvian population is still unknown. The objective was to identify the HLA B*57:01 allele in a military population from Lima, Peru. Forty three people living with HIV (PLWH) were recruited, who agreed to participate through informed consent. Detection of the HLA B*57:01 allele was performed by real-time PCR (RT-PCR). Likewise, viral load (VL), CD4 lymphocyte count and HIV genotyping were determined. Two cases positive for the HLA B*57:01 allele (4.7%) were identified. In addition, one of them had multiple resistance mutations to antiretrovirals (ARVs), including ABC. The presence of the HLA B*57:01 allele was demonstrated for the first time in Peru.

Follow-up of HIV patients during the Covid-19 pandemic in Callao region, Peru / Seguimiento de pacientes con VIH durante la pandemia de la Covid-19 en la región de Callao, Perú

SUMMARY The prompt diagnosis of HIV is a clue for starting anti-retroviral treatment (ART). Viral load determination and other immunologic parameters are essential for evaluating the prognosis and follow-up of these patients. Objective: To evaluate viral load and CD4 cell count determinations in HIV residents of Callao during the COVID-19 pandemic. Methods: a cohort study of 289 adult HIV patients living in Callao was implemented. The student's t-test was used to evaluate paired samples; a p-value<0.05 was considered statistically significant. Results: HIV patients who received ART had a reduction in viral load and an increase in CD4 counts. Conclusion: The management of HIV patients in Callao has been successful.

RESUMEN El diagnóstico del virus de la inmunodeficiencia humana (VIH) es clave para el inicio de la terapia antirretroviral (TAR). Los valores de carga viral (CV) y otros componentes inmunológicos son esenciales para el seguimiento y pronóstico de las personas con VIH. Objetivo: Evaluar el control de la carga viral y la carga linfocitaria en la población residente del Callao con diagnóstico confirmado de VIH, durante la pandemia de la Covid 19. Material y métodos: Estudio prospectivo, en el cual se evaluaron 289 adultos residentes de la región Callao, se realizaron mediciones confirmatorias y post tratamiento TAR. Para la diferencia de medias se calculó la prueba t de Student para muestras pareadas, considerando p<0,05 como estadísticamente significativo. Resultados: Las personas que recibieron TAR mostraron una disminución significativa de los valores de VL y un aumento de CD4+. Conclusión: El manejo y control de la enfermedad de la población infectada por VIH en el Callao ha sido exitoso.

Dengue en paciente de 32 días de vida. Reporte de un caso poco habitual / Dengue fever in a 32-day-old patient. A rare case report

El dengue es una enfermedad viral transmitida por la picadura del mosquito Aedes aegypti. El comportamiento del dengue en Argentina es epidémico; la mayoría de los casos se observan en los meses de mayor temperatura. Hasta la semana epidemiológica (SE) 20/2023, se registraron en Argentina 106 672 casos; se vieron afectadas 18 de las 24 provincias que conforman el país. Dentro de los principales grupos de riesgo, se incluyen los menores de 2 años. Reconocer los signos, síntomas e identificar los factores de riesgo es fundamental para el manejo de casos con mayor riesgo de gravedad. Presentamos el caso de una paciente de 32 días de vida que se internó por síndrome febril sin foco, con diagnósticos diferenciales de meningitis viral y sepsis, evolucionó con leucocitosis, plaquetopenia, hipoalbuminemia, asociado a exantema y edemas. Se llegó al diagnóstico de dengue por la clínica, epidemiologia e IgM positiva.

Dengue fever is a viral disease transmitted by the Aedes aegypti mosquitoes. In Argentina, dengue fever is an epidemic disease; most cases are reported during the hot months.Until epidemiological week (EW) 20/2023, 106 672 cases were reported across 18 of the 24 provinces of Argentina. Children younger than 2 years are among the main groups at risk. Recognizing signs and symptoms and identifying risk factors is fundamental for the management of cases at a higher risk of severity. Here we describe the case of a 32-day-old female patient who was hospitalized due to febrile syndrome without a source, who had a differential diagnosis of viral meningitis and sepsis and progressed to leukocytosis, thrombocytopenia, hypoalbuminemia in association with rash and edema. The diagnosis of dengue fever was established based on clinical, epidemiological, and positive IgM data.

Exposing Nipah virus: an epidemiological study of another thread in Kerala, South India

Bats spread the Nipah virus, which causes severe encephalitis and high mortality. Multiple reports have come from Malaysia, Bangladesh, Singapore, and India. Pteropus fruit bats are known to host the virus. The virus has caused four outbreaks in Kerala in the past quinquennium. Scholars believe the virus is indigenous to the state's bat population. Climate change, resource depletion, deforestation, natural terrain changes, farming, and industrialization all contribute to viral disease outbreaks. In this review, we will discuss the epidemiological background of the previous NiV outbreak. We will also examine the transmission method epidemic prevention and control strategies and possible causes of the outbreak. Four Nipah epidemics have occurred in Kerala in the past five years. Expert investigation suggests that the virus may be endemic in the state抯 bat population. Kerala, India, has many bat species. In 2018, research found viral infections in the local fruit bat population. Traditionally, people eat fresh toddy or sap from trees, which can be polluted by bats carrying the Nipah virus. Kerala's healthcare system also closely monitors unexplained fevers for Nipah virus infections. The World Health Organisation and Indian Council of Medical Research found that the entire state is susceptible to Nipah virus infections. The virus is a major cause of encephalitis outbreaks, which have high mortality rates, mostly in Indo-Bangladesh.

Docking Study of Licensed Non-Viral Drugs to Obtain Ebola Virus Inhibitors

Due to the power and high prevalence of infection and the lack of suitable medicine for the Ebola virus, research has been conducted on the discovery and introduction of anti-Ebola drugs. The purpose of the present study was to investigate the bioinformatic inhibition of Ebola virus entry and proliferation by licensed non-viral drugs. This research is a descriptive-analytical method and to carry out this investigation, first, the chemical structure of the compounds was drawn using ChemDraw Ultra 10.0 software, and then it was transferred to Hyperchem8 software to optimize the energy. Docking studies were carried out by AutoDock4.2 software and were analyzed in the final stage. The results obtained from the present study showed that the bonds involved in drug binding with receptors are hydrophobic, ?-?, hydrogen bonds, and cation-?. Among all studied compounds, the best docking results were related to chloroquine, diphenoxylate, and amodiaquine drugs. These three drugs with the most negative binding energy level had a greater tendency to bind to the amino acids of the binding site of GP and VP40 proteins. The weakest docking results were related to the two drugs erythromycin and dirithromycin, because the hydrophilicity of these two drugs is very high. In general, the presence of hydrophobic parts, optimal hydrogen bonds, and tertiary amine increases the anti-Ebola potency of drugs. Based on the results obtained from bioinformatics studies, all drugs show good inhibitory effects in the receptor binding site and can be considered effective inhibitors of Ebola virus entry and proliferation.

Viral Infection Prevention and Control Precautions

This review article mainly focused on the prevention and control precautions of viral disease which continue to cause considerable the morbidity and the mortality around the world. Prevention included: Primary preventions such as vaccination, pre- and post-exposure prophylaxis, reduction of viral exposure, hygiene/disinfection, screening of blood products, raising awareness/counseling and secondary prevention such as treatment of infected people, identification and counseling of infected people, and diagnosis of infected people. In control and precautions included avoiding sexual contact with HIV-infected individuals, avoiding drug abuse, screening of blood before transfusion, using condoms during sexual contact, avoiding contaminated syringe and needles, wash hands as needed, and maintain personal hygiene.