Baby Date: a mobile application for teaching nursing care to newborns in primary care.

OBJECTIVE: to develop and validate a mobile application for teaching undergraduates about the first nursing visit to a newborn in primary care. METHOD: methodological study with an Instructional Design framework; content drawn up from scientific documents on caring for newborns and their families, supported by the results of an integrative review on the subject. The Integrated Development Environment Android Studio 4.0.1 tool and the IntelliJ IDEA platform were used to build the digital technology. Experts validated content and students evaluated navigability. RESULTS: the final version of the mobile application contains 67 screens grouped into 12 sections with random access. The device is presented on the introductory screen; this is followed by content on the physical examination, neonatal screening, nutrition, oral health, the vaccination calendar, growth, development, danger signs, and accident prevention; at the end, there is a fact sheet and references. Audiovisual resources (texts, images, and videos) complement the application; experts presented a Content Validity Index (CVI) = 1.00; for nursing students all the items had a CVI = 1.00; only the item "layout and presentation" had a CVI = 0.95. CONCLUSION: the digital technology received a satisfactory evaluation from experts and students. It is innovative in child health care, with the potential to be used in the teaching-learning process of nursing students. BACKGROUND: (1) The mobile application provides content for newborn care in primary care. (2) The mobile application directs the nurse's consultation through evidence of care. (3) The mobile application can be used offline, offering knowledge at any time and place. (4) Navigation does not require a specific order, which gives the user freedom. (5) The mobile application promotes quality care in the first consultation with the newborn in primary care.

Hypocoagulability in severe yellow fever infection is associated with bleeding: results from a cohort study.

Background: Severe yellow fever infection (YFI) may be complicated by a hemorrhagic diathesis. However, the hemostasis profile of YFI has rarely been reported. Objectives: The aim of this study was to characterize the hemostatic features of YFI by using a rotational thromboelastometry (ROTEM). Methods: We evaluated clinical, laboratory, and ROTEM parameters in adults with severe YFI and their correlation with hemostatic variables according to bleeding and death. Results: A total of 35 patients were included (median age, 49 years). ROTEM was performed in 22 patients, of whom 21 (96%) presented bleeding and 4 (18%) died. All patients who died had major bleeding. Patients who died presented prolonged clotting time (CT; median, 2326 seconds; IQR, 1898-2986 seconds) and reduced alpha angle (median, 12°; IQR, 12°-15°) in comparison with patients who had minor (median CT, 644 seconds; IQR, 552-845 seconds and alpha angle, 47°; IQR, 28°-65°) and major (median CT, 719 seconds; IQR, 368-1114 seconds and alpha angle, 43°; IQR, 32°-64°) bleeding who survived. In patients who had bleeding, CT showed a strong negative correlation with factor (F)V (r = -.68), FIX (r = -.84), and FX (r = -.63) as well as alpha angle showed a strong negative correlation with FIX (r = -.92). In patients who died, the correlations were even stronger. A total of 19/21 (90%) patients presented hypocoagulability assessed by ROTEM. Conclusion: Hypocoagulabitity is the hallmark of the bleeding diathesis of severe YFI. Abnormal CT and alpha angle associated with death and could be used as potential predictors of adverse outcome in severe YFI.

Índice de massa corporal e desfechos clínicos: um estudo retrospectivo durante a pandemia de Covid-19 / Body mass index and clinical outcomes: a retrospective study in Covid-19 / Índice de masa corporal y resultado clínico: un estudio retrospectivo durante la pandemia de Covid-19

A COVID-19 é uma doença respiratória aguda provocada pela infecção do vírus SARS-CoV-2, que pode causar uma grave insuficiência respiratória hipoxêmica, complicações e mortes, principalmente na população com condições crônicas de saúde. Os mecanismos pelos quais a obesidade pode aumentar a gravidade da COVID-19 incluem mecanismos físicos, inflamação crônica e uma função imunológica prejudicada. Além disso, o índice de massa corporal elevado é um fator de risco para várias condições médicas que têm sido sugeridas para aumentar o risco de gravidade da COVID-19. Objetivo: analisar a associação entre o índice de massa corporal e desfechos clínicos dos casos confirmados de COVID-19. Metodologia: Estudo transversal, com coleta de dados de prontuários, conduzido de março de 2020 a dezembro 2021. Foram analisados os registros de prontuários, exames bioquímicos e de imagem de pacientes internados com COVID-19 em três hospitais da cidade de Francisco Beltrão (PR). As variáveis analisadas foram o diagnóstico nutricional, idade, sexo, necessidade de internação em UTI, comorbidades, dias de hospitalização, complicações, exames laboratoriais e desfecho. Os critérios para inclusão no estudo foram, pacientes hospitalizados com diagnóstico para COVID-19, com presença de diagnóstico nutricional relatado. Resultados: No ano de 2020 foram analisados 292 prontuários e no ano de 2021 foram 860 prontuários. Destes, somente 413 possuíam diagnóstico nutricional, sendo assim incluídos no presente estudo. Foram classificados como peso normal 78 (18,9%), com sobrepeso 153 (37%)e como obeso 182 (44,1%) participantes. A maior prevalência de obesidade foi encontrada no sexo feminino (52,5%), portadores de diabetes (27,6%), pacientes com estado geral comprometido (67,9%), que apresentaram complicações pulmonares (54,5%) e arritmias (23%). A média de idade encontrada em pacientes com obesidade foi mais jovem (55,54) em comparação com os classificados com sobrepeso (59,08) e normal (62,51). Observou-se que quanto maior o IMC menor foram os valores encontrados para idade (rho = -0,190), leucócitos (rho = -0,109), ureia (rho = -0,145) e D-dímero (rho = -0,155). Conclusão: Este estudo fornece evidências de que o sobrepeso e/ou obesidade então associadas a um pior quadro clínico durante a internação dos pacientes com COVID-19. Em relação a frequência de óbito, não houve diferença estatística em relação ao diagnóstico nutricional.

COVID-19 is an acute respiratory disease caused by SARS-CoV-2 virus infection, which can cause severe hypoxemic respiratory failure, complications, and deaths, especially in the population with chronic health conditions. The mechanisms by which obesity may increase the severity of COVID-19 include physical mechanisms, chronic inflammation, and impaired immune function. In addition, high body mass index is a risk factor for several medical conditions that have been suggested to increase the risk of COVID-19 severity. Objective: to analyze the association between body mass index and clinical outcomes of confirmed cases of COVID-19. Methodology: Cross-sectional study, with data collection from medical records, conducted from March 2020 to December 2021. The records of medical records, biochemical and imaging tests of patients hospitalized with COVID-19 in three hospitals in the city of Francisco Beltrão (PR) were analyzed. The variables analyzed were nutritional diagnosis, age, gender, need for ICU admission, comorbidities, days of hospitalization, complications, laboratory tests and outcome. The inclusion criteria for the study were, hospitalized patients with diagnosis for COVID-19, with presence of nutritional diagnosis reported. Results: In the year 2020, 292 medical records were analyzed and in the year 2021 there were 860 medical records. Of these, only 413 had nutritional diagnosis, thus being included in this study. Were classified as normal weight 78 (18.9%), overweight 153 (37%), and obese 182 (44.1%) participants. The highest prevalence of obesity was found in females (52.5%), patients with diabetes (27.6%), patients with impaired general condition (67.9%), who presented pulmonary complications (54.5%) and arrhythmias (23%). The mean age found in obese patients was younger (55.54) compared to those classified as overweight (59.08) and normal (62.51). It was observed that the higher the BMI the lower were the values found for age (rho = -0.190), leukocytes (rho = -0.109), urea (rho = -0.145) and D-dimer (rho = -0.155). Conclusion: This study provides evidence that overweight and/or obesity then associated with a worse clinical picture during hospitalization of patients with COVID-19. Regarding the frequency of death, there was no statistical difference in relation to nutritional diagnosis.

COVID-19 es una enfermedad respiratoria aguda causada por la infección por el virus SARS-CoV-2, que puede provocar insuficiencia respiratoria hipoxémica grave, complicaciones y muertes, especialmente en poblaciones con enfermedades crónicas. Los mecanismos por los cuales la obesidad puede aumentar la gravedad de la COVID-19 incluyen mecanismos físicos, inflamación crónica y función inmune deteriorada. Además, un índice de masa corporal alto es un factor de riesgo para varias afecciones médicas que, según se ha sugerido, aumentan el riesgo de gravedad del COVID-19. Objetivo: analizar la asociación entre el índice de masa corporal y los resultados clínicos de casos confirmados de COVID-19. Metodología: Estudio transversal, con recolección de datos de historias clínicas, realizado de marzo de 2020 a diciembre de 2021. Se analizaron historias clínicas, exámenes bioquímicos y de imagen de pacientes hospitalizados con COVID-19 en tres hospitales de la ciudad de Francisco Beltrão (PR). Las variables analizadas fueron diagnóstico nutricional, edad, sexo, necesidad de ingreso a UCI, comorbilidades, días de internación, complicaciones, exámenes de laboratorio y evolución. Los criterios de inclusión en el estudio fueron pacientes hospitalizados con diagnóstico de COVID-19, con presencia de diagnóstico nutricional informado. Resultados: En 2020 se analizaron 292 historias clínicas y en 2021 se analizaron 860 historias clínicas. De ellos, sólo 413 tenían diagnóstico nutricional, por lo que fueron incluidos en el presente estudio. 78 (18,9%) participantes fueron clasificados como normopeso, 153 (37%) como sobrepeso y 182 (44,1%) como obesidad. La mayor prevalencia de obesidad se encontró en el sexo femenino (52,5%), pacientes con diabetes (27,6%), pacientes con estado general comprometido (67,9%), quienes presentaron complicaciones pulmonares (54,5%) y arritmias (23%). La edad promedio encontrada en los pacientes con obesidad fue menor (55,54) en comparación con los clasificados como con sobrepeso (59,08) y normales (62,51). Se observó que a mayor IMC, menores son los valores encontrados para edad (rho = -0,190), leucocitos (rho = -0,109), urea (rho = -0,145) y dímero D (rho = -0,155). Conclusión: Este estudio proporciona evidencia de que el sobrepeso y/u obesidad se asocia con una peor condición clínica durante la hospitalización de pacientes con COVID-19. En cuanto a la frecuencia de muerte, no hubo diferencia estadística en relación al diagnóstico nutricional.

Baby Date: a mobile application for teaching nursing care to newborns in primary care / Baby Date: aplicación móvil instructora de consulta de enfermería al recién nacido en atención básica / Baby Date: aplicación móvil instructora de consulta de enfermería al recién nacido en atención básica

Objective: to develop and validate a mobile application for teaching undergraduates about the first nursing visit to a newborn in primary care. Method: methodological study with an Instructional Design framework; content drawn up from scientific documents on caring for newborns and their families, supported by the results of an integrative review on the subject. The Integrated Development Environment Android Studio 4.0.1 tool and the IntelliJ IDEA platform were used to build the digital technology. Experts validated content and students evaluated navigability. Results: the final version of the mobile application contains 67 screens grouped into 12 sections with random access. The device is presented on the introductory screen; this is followed by content on the physical examination, neonatal screening, nutrition, oral health, the vaccination calendar, growth, development, danger signs, and accident prevention; at the end, there is a fact sheet and references. Audiovisual resources (texts, images, and videos) complement the application; experts presented a Content Validity Index (CVI) = 1.00; for nursing students all the items had a CVI = 1.00; only the item "layout and presentation" had a CVI = 0.95. Conclusion: the digital technology received a satisfactory evaluation from experts and students. It is innovative in child health care, with the potential to be used in the teaching-learning process of nursing students.

Objetivo: desarrollar y validar aplicación móvil para instrucción de estudiantes sobre la primera consulta de Enfermería al recién nacido en atención básica. Método: estudio metodológico con referencial Diseño Instruccional; contenido elaborado partiendo de documentos científicos sobre atención al recién nacido y su familia, respaldado en resultados de revisión integrativa del tema. Fueron utilizadas la herramienta Integrated Development Environment Android Studio 4.0.1 y la plataforma IntelliJ IDEA para construir la tecnología digital. Expertos validaron contenido, y estudiantes evaluaron navegabilidad. Resultados: la versión final de la aplicación móvil incluye 67 pantallas agrupadas en 12 secciones de acceso aleatorio. El dispositivo es presentado en la pantalla introductora, a continuación, se muestra contenido referente al examen físico, cribado neonatal, alimentación, salud bucal, calendario de vacunación, crecimiento, desarrollo, señales de riesgo, prevención de accidentes; al final, ficha técnica y referencias. Recursos audiovisuales (textos, imágenes y videos) complementan la aplicación; para expertos, Índice de Validez de Contenido (IVC)=1,00; y para estudiantes de Enfermería, todos los ítems presentaron IVC=1,00; solo el ítem " layout y presentación" obtuvo IVC=0,95. Conclusión: la tecnología digital fue evaluada satisfactoriamente por expertos y estudiantes; es innovadora en el área de salud del niño, con potencial uso en el proceso de enseñanza-aprendizaje de los estudiantes de Enfermería.

Objetivo: desenvolver e validar aplicativo móvel para o ensino de graduandos sobre a primeira consulta de Enfermagem ao recém-nascido na atenção básica. Método: estudo metodológico com referencial Design Instrucional; conteúdo elaborado a partir de documentos científicos acerca do cuidado ao recém-nascido e sua família, apoiado em resultados de revisão integrativa sobre o tema. A ferramenta Integrated Development Environment Android Studio 4.0.1 e a plataforma IntelliJ IDEA foram utilizadas para a construção da tecnologia digital. Experts validaram conteúdo e alunos avaliaram navegabilidade. Resultados: a versão final do aplicativo móvel contém 67 telas agrupadas em 12 seções com acesso aleatório. O dispositivo é apresentado na tela introdutória; na sequência, tem-se conteúdo referente ao exame físico, triagem neonatal, alimentação, saúde bucal, calendário vacinal, crescimento, desenvolvimento, sinais de perigo, prevenção de acidentes; ao final, ficha técnica e referências. Recursos audiovisuais (textos, imagens e vídeos) complementam o aplicativo; para experts Índice de Validade de Conteúdo (IVC)=1,00; para estudantes de Enfermagem, todos os itens apresentaram IVC=1,00; somente o item " layout e apresentação" obteve IVC=0,95. Conclusão: a tecnologia digital obteve avaliação satisfatória entre experts e estudantes; é inovadora para a área da saúde da criança, com potencial para uso no processo de ensino-aprendizagem dos estudantes de Enfermagem.

Excess weight increases the risk of sarcopenia in patients with multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) is an autoimmune neurodegenerative disease. Nutritional status influences the course of the disease, however, its relationship with sarcopenia needs further investigation. The aim of the study was to identify patients with sarcopenia and assess its association with nutritional status and the clinical course of the disease. METHODS: The study assessed 110 patients submitted to evaluation of sociodemographic characteristics, level of physical activity, nutritional status, and presence of sarcopenia. The clinical course of the disease, age at onset, disease duration, disease-modifying therapy, and expanded scale of disability status (EDSS) were investigated. RESULTS: Mean age was 37.17 (SD = 10.60) years, disease duration was 6.29 years (SD = 4.65), with a predominance of female gender (80.90 %), relapsing-remitting clinical form (RRMS) (89.10 %) and mild level of disability (EDSS median = 1.92). The group had excess weight (53.6 %) according to body mass index (BMI) and abdominal fat accumulation measured by waist circumference (WC) (53.6 %). High percentage of fat mass ( % FM) was observed in 54.5 % and 38.2 % of the patients according to bioimpedance (BIA) and ultrasound (US), respectively. It was observed that 15.5 % were at risk for sarcopenia, which was associated with excess weight, and high % FM (p<0.05). CONCLUSION: These findings highlight the importance of including nutritional status indicators, and sarcopenia assessment in the care of patients with MS.

Gestational hypertension as a factor associated with chronic kidney disease: the importance of obstetric history of women undergoing hemodialysis / Hipertensão gestacional como fator associado à doença renal crônica: a importância do histórico obstétrico de mulheres submetidas à hemodiálise

ABSTRACT Introduction: Pregnancy-related complications may impact women's reproductive cycle and health through their lives. The objective of this study was to evaluate the sociodemographic, clinical, and obstetric history of women undergoing hemodialysis. Methods: We performed a cross-sectional study in a specialized health facility with four hemodialysis units. Sociodemographic characteristics, clinical and personal history, obstetric and perinatal results of women with pregnancies before hemodialysis were evaluated. Prevalence, bivariate, and logistic regression analyses were performed. Results: We included 208 (87.76%) women. Hypertension was the main cause of chronic kidney disease (CKD) (128 women). Rates of adverse perinatal outcomes, including prematurity, low birth weight, miscarriage, fetal death, and neonatal death, were 19.3%, 14.5%, 25.5%, 12.1%, and 5.3%, respectively. Hypertensive syndromes during pregnancy occurred in 37.0% of women, with 12.5% reporting preeclampsia and 1.4% reporting eclampsia. Up to 1 year after birth, 45.2% of women reported hypertension. Hemodialysis due to hypertension was associated with a history of hypertension during pregnancy (OR 2.33, CI 1.27 - 4.24), gestational hypertension (2.41, CI 3.30 - 4.45), and hypertension up to one year after birth (OR 1.98, CI 1.11 - 3.51). Logistic regression showed that gestational hypertension was independently associated with CKD due to hypertension (aOR 2.76, CI 1.45 - 5.24). Conclusion: Women undergoing hemodialysis due to hypertension were more likely to have gestational hypertension or hypertension up to one year after birth. To delay end-stage renal disease, it is necessary to identify women at risk of kidney failure according to their reproductive history.

RESUMO Introdução: Complicações relacionadas à gestação podem afetar o ciclo reprodutivo e a saúde das mulheres ao longo de suas vidas. Este estudo visou avaliar histórico sociodemográfico, clínico e obstétrico de mulheres em hemodiálise. Métodos: Realizamos estudo transversal em unidade de saúde especializada com quatro unidades de hemodiálise. Avaliou-se características sociodemográficas, histórico clínico e pessoal, resultados obstétricos e perinatais de mulheres com gestações anteriores à hemodiálise. Foram realizadas análises de prevalência, bivariadas e regressão logística. Resultados: Incluímos 208 (87,76%) mulheres. Hipertensão foi a principal causa de doença renal crônica (DRC) (128 mulheres). Taxas de desfechos perinatais adversos, incluindo prematuridade, baixo peso ao nascer, aborto espontâneo, óbito fetal e neonatal, foram de 19,3%, 14,5%, 25,5%, 12,1% e 5,3%, respectivamente. Síndromes hipertensivas durante a gestação ocorreram em 37,0% das mulheres, com 12,5% relatando pré-eclâmpsia e 1,4% relatando eclampsia. Até 1 ano após o parto, 45,2% das mulheres relataram hipertensão. Hemodiálise devido à hipertensão foi associada ao histórico de hipertensão na gestação (OR 2,33; IC 1,27 - 4,24), hipertensão gestacional (2,41; IC 3,30 - 4,45), e hipertensão até um ano após o parto (OR 1,98; IC 1,11 - 3,51). A regressão logística mostrou que hipertensão gestacional foi independentemente associada à DRC devido à hipertensão (ORa 2,76; IC 1,45 - 5,24). Conclusão: Mulheres submetidas à hemodiálise por hipertensão foram mais propensas a apresentar hipertensão gestacional ou hipertensão até um ano após o parto. Para retardar a doença renal em estágio terminal, deve-se identificar mulheres em risco de insuficiência renal de acordo com sua história reprodutiva.

Particle size and storage length affect fermentation and ruminal degradation of rehydrated corn grain silage.

Particle size and storage time are factors that can affect the fermentation quality and digestibility of rehydrated corn grain silage (RCS). The objective of this study was to evaluate the effect of particle size and storage time on chemical and microbiological characteristics, aerobic stability, and ruminal degradability of RCS. Corn grains were ground to pass through either a 3 mm (fine) or 9 mm (coarse) screen, rehydrated to 44.3% moisture and ensiled in 200 L polyethylene buckets. Samples were taken before and after ensiling at 10, 30, 90 and 200 days of storage to assess microbial counts, fermentation end products, and DM ruminal degradability. DM degradation was evaluated with incubation times of 0 (bag wash), 3, 6 and 48 h in 3 rumen-cannulated cows. The effective ruminal degradation (ERD) was calculated based on soluble fraction (A), degradable fraction (B) and passage rate (kp) defined as 7.0%/h: A + B [kd/(kd + kp)]. Aerobic stability was evaluated in silages after 200 days of storage, and pH and temperature were analysed up to 240 h of aerobic exposure. At 90 and 200 d of storage, fine RCS resulted in lower crude protein and greater NH3-N concentrations than coarse RCS. Coarsely ground RCS had a lower temperature at the beginning of storage than finely ground corn. Finely ground RCS had greater yeast counts and ethanol concentrations than coarsely ground RCS during storage time. Fine RCS was more susceptible to aerobic deterioration, reaching maximum temperature and pH values faster than coarse RCS. DM ruminal degradability increased over the storage time. The particle size of the rehydrated corn grain silage did not affect the kd values after 90 d of storage, while for the ERD, a long fermentation time was necessary (200 d). Considering the fermentation characteristics and the kinetics of ruminal DM degradation, fine grinding is recommended for short storage periods and coarse grinding may be a strategy to increase the rate of grinding when the storage period is greater than 200 d.

Deficiency of coagulation factors is associated with the bleeding diathesis of severe yellow fever.

Yellow fever (YF) is an acute tropical infectious disease caused by an arbovirus and can manifest as a classic hemorrhagic fever. The mechanism of the bleeding diathesis in YF is not well understood. We assessed clinical and laboratory data (including a panel of coagulation tests) from 46 patients with moderate (M) and severe (S) YF admitted to a local hospital between January 2018 and April 2018. Among 46 patients, 34 had SYF of whom 12 (35%) patients died. A total of 21 (45%) patients developed some type of bleeding manifestation and 15 (32%) presented severe bleeding. Patients with SYF had more severe thrombocytopenia (p = 0.001); prolonged activated partial thromboplastin time (aPTT) and thrombin time (TT) (p = 0.03 and p = 0.005, respectively); reduced plasma levels of coagulation factor (F) II (p < 0.01), FIX (p = 0.01), and FX (p = 0.04); and D-dimer levels almost 10 times higher (p < 0.01) when compared with patients with MYF. Patients who died had more bleeding (p = 0.03), more major bleeding (p = 0.03), prolonged international normalized ratio (INR) and aPTT (p = 0.003 and p = 0.002, respectively), as well as lower activity of FII (p = 0.02), FV (p = 0.001), FVII (p = 0.005), FIX (p = 0.01), and protein C (p = 0.01) than the ones who survived. FVIII levels were either normal or increased in all patients studied. Our results suggest that the bleeding diathesis of SYF is associated with the deficiency of coagulation factors produced by the liver. Prolonged INR and aPTT and reduced FII, FV, FVII, FIX, and protein C were associated with death.

Gestational hypertension as a factor associated with chronic kidney disease: the importance of obstetric history of women undergoing hemodialysis.

INTRODUCTION: Pregnancy-related complications may impact women's reproductive cycle and health through their lives. The objective of this study was to evaluate the sociodemographic, clinical, and obstetric history of women undergoing hemodialysis. METHODS: We performed a cross-sectional study in a specialized health facility with four hemodialysis units. Sociodemographic characteristics, clinical and personal history, obstetric and perinatal results of women with pregnancies before hemodialysis were evaluated. Prevalence, bivariate, and logistic regression analyses were performed. RESULTS: We included 208 (87.76%) women. Hypertension was the main cause of chronic kidney disease (CKD) (128 women). Rates of adverse perinatal outcomes, including prematurity, low birth weight, miscarriage, fetal death, and neonatal death, were 19.3%, 14.5%, 25.5%, 12.1%, and 5.3%, respectively. Hypertensive syndromes during pregnancy occurred in 37.0% of women, with 12.5% reporting preeclampsia and 1.4% reporting eclampsia. Up to 1 year after birth, 45.2% of women reported hypertension. Hemodialysis due to hypertension was associated with a history of hypertension during pregnancy (OR 2.33, CI 1.27 - 4.24), gestational hypertension (2.41, CI 3.30 - 4.45), and hypertension up to one year after birth (OR 1.98, CI 1.11 - 3.51). Logistic regression showed that gestational hypertension was independently associated with CKD due to hypertension (aOR 2.76, CI 1.45 - 5.24). CONCLUSION: Women undergoing hemodialysis due to hypertension were more likely to have gestational hypertension or hypertension up to one year after birth. To delay end-stage renal disease, it is necessary to identify women at risk of kidney failure according to their reproductive history.

Impacts of COVID-19 on Neuropsychomotor Development From the Perspective of the International Classification of Functioning, Disability and Health in a Case Series of Children Aged 4 to 24 Months Assessed in Land and Aquatic Settings.

Mitigation measures the pandemic caused by the coronavirus disease 2019 (COVID-19) can change neuropsychomotor development (NPMD), diminishing adaptation, learning, and physical and cognitive development skills. Biopsychosocial screening in this scenario requires specific physical therapy assessment for each intervention setting, with validated scales. Hence, the objective of this study was to analyze the consequences of the COVID-19 pandemic on NPMD based on a case series in 4-to-24-month-old children assessed on land and in water. Case series descriptive study, based on physical therapy assessments with the Alberta Infant Motor Scale (AIMS), Developmental Screening Test (Denver II), and Adaptation of the Aquatic Functional Assessment Scale for Babies (AFAS-BABY©). AIMS classified 8 children as typical NPMD and 5 as suspect NPMD, while Denver II classified 10 children as typical NPMD, 3 as questionable NPMD, and 2 as delayed NPMD. AFAS-BABY© created a qualitative profile, relating it to the land assessments. Thus, the consequences of the COVID-19 pandemic on NPMD were analyzed based on a case series in 4-to-24-month-old children assessed on land and in water.

Functional disability and associated factors in older adults seen at a primary health care unit / Incapacidade funcional e fatores associados em idosos atendidos na atenção primária

OBJECTIVES: To assess functional disability and associated factors in older patients cared for at a large Brazilian urban area. METHODS: This is a cross-sectional study performed at a primary health care unit in the city of São Paulo, Brazil. Participants were selected via probabilistic sampling of 400 older individuals. We used a sociodemographic and health questionnaire along with instruments for assessing fear of falling (FES-I), cognitive function (MMSE), and depression symptoms (GDS-15). For dependent variables, we used instruments for assessing basic activities (BADL; Katz) and instrumental activities of daily living (IADL; Lawton). Factors associated with functional disability were analyzed via logistic regression models. RESULTS: The mean age of participants was 75.23 (SD = 8.53); 63.20% were female, 27.00% were dependent in BADL and 39.25%, in IADL. Older individuals with better cognitive function and who had not been hospitalized in the previous year were less prone to functional disabilities. Factors such as older age, more depression symptoms, and greater fear of falling were more linked to disabilities in BADL. Factors such as older age, female sex, and greater fear of falling were more linked to disabilities in IADL. CONCLUSIONS: The prevalence of disability in BADL and IADL in the studied sample was high. Modifiable and non-modifiable factors were associated with functional disability. These results may help primary health care professionals understand the risk factors for functional disability in the older population

OBJETIVOS: Avaliar a incapacidade funcional e fatores associados em pacientes idosos atendidos em um grande centro urbano brasileiro. METODOLOGIA: Estudo transversal realizado em uma Unidade Básica de Saúde na cidade de São Paulo, Brasil. A seleção dos participantes foi por meio de amostragem probabilística de 400 indivíduos idosos. Foi utilizado um questionário sociodemográfico, de saúde e instrumentos para avaliar medo de queda (FES-I), status cognitivo (MEEM) e sintomas depressivos (GDS-15). Para as variáveis dependentes, utilizou-se os instrumentos para avaliar as atividades básicas (ABVD; Katz) e atividades instrumentais de vida diária (Lawton; AIVD). Os fatores associados à incapacidade funcional foram analisados por meio de modelos de regressão logística. RESULTADOS: A média de idade dos participantes foi de 75,23 (DP = 8,53), 63,20% eram do sexo feminino, 27,00% eram dependentes para ABVD e 39,25% para as AIVD. Indivíduos idosos com melhor status cognitivo e que não estiveram internados no último ano eram menos propensos às incapacidades funcionais. Fatores como ter mais idade, mais sintomas depressivos e mais medo de queda eram mais propensos às incapacidades das ABVD. Fatores como ter mais idade, ser do sexo feminino e mais medo de queda foram mais propensos às incapacidades das AIVD. CONCLUSÕES: A prevalência de incapacidade para ABVD e AIVD na amostra estudada foi alta. Fatores modificáveis e não modificáveis foram associados à incapacidade funcional. Esses resultados podem ajudar os profissionais da atenção primária à saúde a entenderem os fatores de risco de incapacidade funcional na população mais velha

Theoretical Investigation of Regiodivergent Addition of Anilines and Phenolates to p-Benzoquinone Ring.

Two different products were obtained by the regiodivergent reaction of benzoquinone derivatives with phenolates and anilines: 3-aryloxybenzoquinone and 2-phenylamino-3-bromobenzoquinone. Calculated density functional theory free energies of reaction values corroborate the experimental observation of the formation of the substitution product in the reaction with phenolates in acetonitrile and the product of addition/oxidation for the reaction with aniline in water. Calculated charges and Fukui functions are similar for C2 and C3 atoms, indicating an equal possibility to suffer a nucleophilic attack. The calculated energy barriers for nucleophilic attack steps indicated that the first steps of the substitution with phenolates and addition/oxidation with anilines are faster, which justifies the formation of the respective products. The natural bond order analysis for the transition states revealed that there is a strong interaction between lone pairs of N and O atoms and the πC2C3 * for the O → C2 and N → C3 attacks and a weak interaction for the O → C3 and N → C2 attacks, which also agrees with experimental observations.

Foliar Application of Salicylic Acid to Mitigate Water Stress in Tomato.

Salicylic acid (SA) is an important plant regulator reported as a mitigator of water deficit in plants, however without a recommendation for use in field conditions. Thus, this research aims to validate the use of SA under field conditions in regions with low water availability. For that, we evaluated CO2 assimilation (A), stomatal conductance (gs), transpiration (E), water use efficiency (WUE), and carboxylation efficiency (A/Ci) at 15, 30, and 45 days of continuous stress water deficit, as well as the application of salicylic acid (0.0; 0.5; 1.0; 1.5; 2.0 mM) in tomato plants subjected to continuous water deficit (45 days), in two years (2019 and 2020). The water deficit reduced the A, gs, E and A/Ci, while the foliar application of SA increased these parameters in all evaluated times, resulting in similar or even higher values than in plants without water deficit. Water deficit caused floral abortion in tomato plants, without the application of SA, reducing the number of fruit production. In contrast, plants that received about 1.3 mM of SA increased A and A/Ci and translocated the photo-assimilates, mainly to flowers and fruits, reducing floral abortion and increasing fruit production. Thus, foliar application of SA was efficient in mitigating the deleterious effects of water deficit in tomato plants regarding the gas exchange and fruit production.

SCID and Other Inborn Errors of Immunity with Low TRECs - the Brazilian Experience.

Severe combined immunodeficiency, SCID, is a pediatric emergency that represents the most critical group of inborn errors of immunity (IEI). Affected infants present with early onset life-threatening infections due to absent or non-functional T cells. Without early diagnosis and curative treatment, most die in early infancy. As most affected infants appear healthy at birth, newborn screening (NBS) is essential to identify and treat patients before the onset of symptoms. Here, we report 47 Brazilian patients investigated between 2009 and 2020 for SCID due to either a positive family history and/or clinical impression and low TRECs. Based on clinical presentation, laboratory finding, and genetic information, 24 patients were diagnosed as typical SCID, 14 as leaky SCID, and 6 as Omenn syndrome; 2 patients had non-SCID IEI, and 1 remained undefined. Disease onset median age was 2 months, but at the time of diagnosis and treatment, median ages were 6.5 and 11.5 months, respectively, revealing considerable delay which affected negatively treatment success. While overall survival was 51.1%, only 66.7% (30/45) lived long enough to undergo hematopoietic stem-cell transplantation, which was successful in 70% of cases. Forty-three of 47 (91.5%) patients underwent genetic testing, with a 65.1% success rate. Even though our patients did not come from the NBS programs, the diagnosis of SCID improved in Brazil during the pilot programs, likely due to improved medical education. However, we estimate that at least 80% of SCID cases are still missed. NBS-SCID started to be universally implemented in the city of São Paulo in May 2021, and it is our hope that other cities will follow, leading to early diagnosis and higher survival of SCID patients in Brazil.

Administração do extrato de garcinia brasiliensis e modulação do ambiente tumoral em modelo de carcinogênese pulmonar / Administration of garcinia brasiliensis extract and modulation of the tumor environment in a model of pulmonary carcinogenesis / Administración de extracto de garcinia brasiliensis y modulación del ambiente tumoral en un modelo de carcinogénesis pulmonar

Introdução: O benzopireno é um dos principais hidrocarbonetos aromáticos policíclicos presentes no ambiente e com alta capacidade carcinogênica, sendo, portanto, usado em modelos in vivo de carcinogênese pulmonar. Investigações têm mostrado o envolvimento dos mastócitos na modulação do ambiente tumoral e que os fármacos anti-inflamatórios podem reduzir a incidência de câncer de pulmão. Entre as possibilidades terapêuticas estão os fitoterápicos. O extrato de Garcinia brasiliensis, conhecido popularmente como bacupari, mostra propriedades anti-inflamatórias e antitumorais, mas ainda pouco estudado em modelos animais. Objetivos: Avaliar os efeitos da administração do extrato alcoólico de G. brasiliensis em modelo de carcinogênese induzida por benzopireno. Material e Método: O extrato bruto foi obtido por percolação com o uso de 20 g das folhas secas e trituradas de G. brasiliensis e 100 ml de etanol a 70%, por 24h. Ratos Wistar foram divididos em 3 grupos, um controle sem indução ou tratamento, um induzido pelo benzopireno (100 mg/kg, diluído em DMSO e administrado intraperitonealmente, uma única aplicação) e um grupo tratado por gavagem (1 ml) com extrato de bacupari a 4% (3x/semana, por 7 semanas, a partir da 15o semana da indução. Os animais de todos os grupos foram eutanasiados após 21 semanas para coleta dos pulmões que foram processados para análises histopatológicas (HE) e histoquímicas (Azul de Toluidina e Azul de Alcian Safranina) para quantificação dos mastócitos. Resultados: Os resultados das análises histopatológicas mostraram desorganização do parênquima pulmonar, aumento de tecido linfático associado aos brônquios, grande influxo de células inflamatórias e regiões de displasia. Pela coloração de azul de toluidina os mastócitos foram identificados na forma intacta e desgranulada (em processo de ativação). Na coloração conjunta Azul de Alcian e Safranina, os mastócitos corados em azul representam as fases iniciais do processo de maturação, enquanto os corados em vermelho estão maduros. A quantificações evidenciaram maior quantidade de mastócitos desgranulados, azul de Alcian e mistos (corados pelo Azul de Alcian e Safranina) nos grupos tratados com o extrato. Conclusão: Os dados indicam que o ambiente tumoral nos animais tratados mostra maior modulação dos mastócitos, com mais células jovens e ativadas. Mais análises serão realizadas para verificar se a ativação dos mastócitos promovida pelo tratamento com o extrato ocorre para contenção ou promoção do processo tumoral.(AU)

Introduction: Benzopyrene is one of the main polycyclic aromatic hydrocarbons present in the environment and with a high carcinogenic capacity, being, therefore, used in in vivo models of lung carcinogenesis. Investigations have shown the involvement of mast cells in modulating the tumor environment and that anti-inflammatory drugs can reduce the incidence of lung cancer. Among the therapeutic possibilities are herbal medicines. Garcinia brasiliensis extract, popularly known as bacupari, shows anti-inflammatory and antitumor properties, but still little studied in animal models. Objectives: To evaluate the effects of the administration of the alcoholic extract of G. brasiliensis in a model of carcinogenesis induced by benzopyrene. Material and Methods: The crude extract was obtained by percolation using 20 g of dried and crushed leaves of G. brasiliensis and 100 ml of 70% ethanol for 24 hours. Wistar rats were divided into 3 groups, a control without induction or treatment, one induced by benzopyrene (100 mg/kg, diluted in DMSO and administered intraperitoneally, a single application) and a group treated by gavage (1 ml) with bacupari extract. at 4%...(AU)

Introducción: El benzopireno es uno de los principales hidrocarburos aromáticos policíclicos presentes en el ambiente y tiene una elevada capacidad carcinogénica, por lo que se utiliza en modelos in vivo de carcinogénesis pulmonar. Las investigaciones han demostrado la implicación de los mastocitos en la modulación del entorno tumoral y que los fármacos antiinflamatorios pueden reducir la incidencia del cáncer de pulmón. Entre las posibilidades terapéuticas están las fitoterapias. El extracto de Garcinia brasiliensis, conocido popularmente como bacupari, muestra propiedades antiinflamatorias y antitumorales, pero todavía está sido poco estudiado en modelos animales. Objetivos: Evaluar los efectos de la administración del extracto alcohólico de G. brasiliensis en el modelo de carcinogénesis inducido por el benzopireno. Material y métodos: El extracto crudo se obtuvo por percolación utilizando 20 g de hojas de G. brasiliensis secas y trituradas y 100 ml de etanol al 70%, durante 24h. Las ratas Wistar fueran divididas en 3 grupos, uno de control sin inducción ni tratamiento, otro inducido por benzopireno (100 mg/kg, diluido en DMSO y administrado por vía intraperitoneal, una sola aplicación) y un grupo tratado por gavage (1ml) con extracto de bacupari 4% (3x/semana, durante 7 semanas, desde la 15ª semana de inducción). Los animales de todos los grupos fueron eutanasiados después de 21 semanas para recoger los pulmones que se procesaron para los análisis histopatológicos (HE) e histoquímicos (azul de toluidina y azul de safranina) para la cuantificación de los mastocitos. Resultados: Los resultados de los análisis histopatológicos mostraron desorganización del parénquima pulmonar, aumento del tejido linfoide asociado a los bronquios, gran afluencia de células inflamatorias y regiones de displasia. Mediante la tinción con azul de toluidina, los mastocitos se identificaron como intactos y degranulados (en proceso de activación). En la tinción conjunta de azul Alcian y Safranina, los mastocitos teñidos de azul representan las fases iniciales del proceso de maduración, mientras que los teñidos de rojo son maduros. La cuantificación mostró una mayor cantidad de mastocitos degranulados, azul Alcian y mixtos (teñidos con azul Alcian-Safranin) en los grupos tratados con el extracto. Conclusión: Los datos indican que el entorno del tumor en los animales tratados muestra una mayor modulación de los mastocitos, con más células jóvenes y activadas. Se llevarán a cabo más análisis para verificar si la activación de los mastocitos promovida por el tratamiento con el extracto se produce para contener o promover el proceso tumoral.(AU)

Panorama nacional da adesão ao pré-natal: série histórica de 2009 a 2018 / Panorama nacional de adhesión a la atención prenatal: serie histórica de 2009 a 2018 / National panorama of adherence to prenatal care: historical series from 2009 a 2018

Objetivo: analisar o panorama nacional da adesão pré-natal enquanto maior ou igual a sete consultas, segundo características sociodemográficas das mães de nascidos vivos entre os anos de 2009 e 2018. Método: estudo ecológico, descritivo, de séries temporais, efetuado na plataforma Sistema de Informação de Nascidos Vivos do Brasil. Resultados: foram registrados 29.189.619 nascidos vivos, com predominância nas regiões sudeste e nordeste. O perfil epidemiológico da adesão a sete consultas ou mais é composto por mulheres brancas e pardas, cujas faixas etárias foram entre 30 e 39 e 40 ou mais anos, casadas ou em união estável, com 12 anos ou mais de estudo. Conclusões: predominou mais consultas de pré-natal em mulheres jovens, casadas, não negras, com 11 anos de estudo. Percebeu-se maior tendência de realização de sete ou mais consultas durante o período.(AU)

Objective: analyze the national panorama of prenatal adherence as greater than or equal to seven consultations according to sociodemographic characteristics of mothers of live births between the years 2009 and 2018. Method: ecological, descriptive study of time series, carried out on the Live Birth Information in Brazil. Result: 29,189,619 live births were registered, predominantly in the southeast and northeast regions. The epidemiological profile of adherence to seven consultations or more is composed of white and brown women, whose age groups between 30 and 39 and 40 or more years, married or in a stable relationship, with 12 years or more of study. Conclusions: there was a predominance of prenatal consultations among young, married, non-black women, with 11 years of schooling. There was a greater tendency to carry out seven or more consultations during the period.(AU)

Objetivo: analizar el panorama nacional de adherencia prenatal como mayor o igual a siete consultas según características sociodemográficas de madres de nacidos vivos entre los años 2009 y 2018. Método: estudio ecológico, descriptivo, de series de tiempo, realizado sobre el Sistema de Información de nacidos vivos en Brasil. Resultado: se registraron 29.189.619 nacidos vivos, con predominio en las regiones sureste y noreste. El perfil epidemiológico de adherencia a siete consultas o más está compuesto por mujeres blancas y morenas, cuyos grupos de edad entre 30-39 y 40 o más años, casadas o en relación estable, con doce años o más de estudio. Conclusiones: predominó la consulta prenatal entre mujeres jóvenes, casadas, no negras, con 11 años de escolaridad. Hubo una mayor tendencia a realizar siete o más consultas durante el período.(AU)

Atuação do Enfermeiro em Cuidados Paliativos na Atenção Primária à Saúde: Revisão Integrativa / Nursing Work in Palliative Care in Primary Health Care: Integration Review / Actuación del Enfermero en Cuidados Paliativos en la Atención Primaria a la Salud: Revisión Integrativa

Introdução: A atuação da enfermagem ao indivíduo em cuidados paliativos (CP) na Atenção Primária à Saúde (APS) visa a promover a qualidade de vida dos indivíduos e da sua família como garantia da assistência integral, para um cuidado humanizado e digno, melhorando a maneira de enfrentar a doença e minimizando o sofrimento. Objetivo: Analisar e sintetizar a produção científica relacionada à assistência do enfermeiro ao indivíduo em CP nas APS. Método: Revisão integrativa da literatura realizada nas bases de dados Literatura Latino- -Americana e do Caribe em Ciências da Saúde (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE) via PubMed, Base de Dados de Enfermagem (BDENF) e Scientific Electronic Library Online (SciELO), utilizando os descritores: Palliative Care, Nursing e Primary Health Care. Resultados: Foram analisados 17 artigos após seleção sistemática, sintetizados em um quadro com seus principais resultados e agrupados em três categorias: capacitação em CP: uma barreira para atuação do enfermeiro na APS; percepções, experiências e práticas dos enfermeiros nos CP; o papel do enfermeiro na equipe multiprofissional de CP. Conclusão: Notou-se que os enfermeiros possuíam conhecimento superficial acerca dos CP na APS, evidenciando a necessidade de educação continuada para promover a sua atuação em CP. Ademais, estudos com maior rigor metodológico com o foco no enfermeiro como agente disseminador da prática são necessários

Introduction: The role of nursing professionals in palliative care (PC) in Primary Health Care (PHC) aims to promote the quality of life of individuals and their families as a guarantee of comprehensive humanized and dignified care, improving the way to cope with the disease and minimizing suffering. Objective: To analyze and synthesize the scientific production related to the nurse's assistance to the individual in PC in PHC. Method: Integrative literature review carried out in the databases of Latin American and Caribbean Health Sciences Literature (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE) by PubMed, Nursing Database (BDENF) and Scientific Electronic Library Online (SciELO), using the following descriptors: Palliative Care, Nursing and Primary Health Care. Results: 17 articles were analyzed after a systematic selection summarized in a table with their main results and grouped into three categories: training in PC: a barrier for nurses to work in PHC; perceptions, experiences, and practices of nurses regarding PC; the role of nurses in the multiprofessional PC team. Conclusion: It was noticed that nurses had superficial knowledge about PC in PHC, demonstrating the need for continuing education to promote their role in PC. Furthermore, thorough methodological studies targeted to the nurse as agent disseminating the practice are neededodológicos más rigurosos, con foco en lo enfermero como agente divulgador de la práctica

Introducción: El rol de los profesionales de enfermería en los cuidados paliativos (CP) en la Atención Primaria de Salud (APS) tiene como objetivo promover la calidad de vida de las personas y sus familias como garantía de una atención integral, humanizada y digna, mejorando la forma de afrontar la enfermedad y minimizando sufrimiento. Objetivo: Analizar y sintetizar la producción científica relacionada con la asistencia del enfermero al individuo en CP en APS. Método: Revisión integradora de la literatura realizada en las bases de datos de Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), Medical Literature Analysis and Retrieval Sistem Online (MEDLINE) a través de PubMed, Banco de Datos de Enfermería (BDENF) y Scientific Electronic Library Online (SciELO), utilizando los descriptores: Palliative Care, Nursing y Primary Health Care. Resultados: Se analizaron 17 artículos después de una selección sistemática, resumidos en una tabla con sus principales resultados y agrupados en tres categorías: capacitación en CP: barrera para el trabajo de enfermería en APS; percepciones, experiencias y prácticas de enfermeros en CP; el papel de los enefermeros en el equipo multiprofesional de CP. Conclusión: Se observó que los enfermeros tenían conocimientos superficiales sobre CP en la APS, evidenciando la necesidad de una educación continua para promover su actuación en CP. Además, se necesitan estudios metodológicos más rigurosos, con foco en lo enfermero como agente divulgador de la práctica

World experiences in preceptorship in medical undergraduate education: an integrative review / Experiências mundiais em preceptoria na graduação médica: uma revisão integrativa

Abstract: Introduction: The preceptor, as the physician who facilitates the teaching-learning process in practice settings, is essential for in service-training in the undergraduate medical school. The importance of these professionals in the training of new physicians highlights the need to understand the preceptorship activity from a medical education perspective. Objective: To verify, in the scientific literature, global experiences in preceptorship in the undergraduate medical school. Method: Integrative literature review using standardized descriptors in the following databases: LILACS - Latin American and Caribbean Literature in Health Sciences, MEDLINE - Online System for Analysis and Recovery of Medical Literature and SciELO - Scientific Electronic Library Online, between 2009 to 2019. Analysis of the articles was carried out using the thematic category technique. Results: The search in the databases resulted in 274 studies, of which 23 were analyzed and discussed in full. Detailing of the global experiences in preceptorship was systematized into two categories: intrinsic and extrinsic aspects for the exercise of preceptorship and educational strategies used by the preceptor. Conclusions: The analysis of the articles indicates the importance of the students' actions together with preceptors for the acquisition of professional skills. A critical factor for the success of monitoring students in professional practice is the preceptor's ability to assume the role of educator, in order to see the students in their uniqueness and in their integral development. Therefore, the significance of the preceptors' qualifications becomes more evident.

Resumo: Introdução: O preceptor, como médico que facilita o processo ensino-aprendizagem nos cenários de prática, é essencial para o ensino em serviço na graduação em Medicina. A importância desses profissionais na formação de novos médicos expõe a necessidade de compreender a atividade de preceptoria na perspectiva da educação médica. Objetivo: Este estudo teve como objetivo verificar, na literatura científica, as experiências mundiais em preceptoria na graduação em Medicina. Método: Trata-se de revisão integrativa da literatura a partir de descritores padronizados nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE) e Scientific Electronic Library Online (SciELO), entre 2009 e 2019. A análise dos artigos foi realizada por meio da técnica de categoria temática. Resultado: A busca nas bases de dados resultou em 274 estudos, dos quais 23 foram analisados e discutidos na íntegra. O detalhamento das experiências mundiais em preceptoria foi sistematizado em duas categorias: aspectos intrínsecos e extrínsecos para o exercício da preceptoria e estratégias educacionais utilizadas pelo preceptor. Conclusão: A análise dos artigos indica a importância da atuação dos estudantes em conjunto com os preceptores para aquisição de competências profissionais. Um fator crítico para o sucesso do acompanhamento de estudantes na prática profissional é a capacidade do preceptor em assumir o papel de educador, de modo a enxergar o estudante na sua singularidade e no desenvolvimento integral. Dessa forma, fica mais evidente a relevância da qualificação dos preceptores.