Spiro-Acridine Compound as a Pteridine Reductase 1 Inhibitor: in silico Target Fishing and in†vitro Studies.

Among the many neglected tropical diseases, leishmaniasis ranks second in mortality rate and prevalence. In a previous study, acridine derivatives were synthesized and tested for their antileishmanial activity against L. chagasi. The most active compound identified in that study (1) showed a single digit IC50 value against the parasite (1.10 µg/mL), but its macromolecular target remained unknown. Aiming to overcome this limitation, this work exploited inverse virtual screening to identify compound 1's putative molecular mechanism of action. In vitro assays confirmed that compound 1 binds to Leishmania chagasi pteridine reductase 1 (LcPTR1), with moderate affinity (Kd=33,1 µM), according to differential scanning fluorimetry assay. Molecular dynamics simulations confirm the stability of LcPTR1-compound 1 complex, supporting a competitive mechanism of action. Therefore, the workflow presented in this work successfully identified PTR1 as a macromolecular target for compound 1, allowing the designing of novel potent antileishmanial compounds.

Disseminated Mycobacterium bovis Infection: A Rare Complication of Bacillus Calmette-Guérin Immunotherapy.

Intravesical instillation of bacillus Calmette-Guérin (BCG) is a crucial adjunctive therapy in the treatment of bladder carcinoma. Its systemic complications are rare but include disseminated Mycobacterium bovis (M. bovis) infections, the diagnosis of which is a challenging task that requires keen clinical awareness. We report the case of an adult male treated with BCG who presented with fever, nonspecific constitutional symptoms, hepatic cytolysis, and cholestasis. After a detailed workup, the diagnosis was made of disseminated M. bovis infection with hepatic, pulmonary, renal, and ureteral involvement. Prompt anti-tuberculosis treatment resulted in clinical and analytical improvement. This case highlights the importance of early recognition of this serious complication in patients with BCG exposure, as well as the difficulty in confirming the diagnosis for proper treatment.

Relational Continuity of Chronic Patients with Primary and Secondary Care Doctors: A Study of Public Healthcare Networks of Six Latin American Countries.

Despite relational continuity (RC) with the doctor being key to care quality for chronic patients, particularly in fragmented healthcare systems, like many in Latin America (LA), little is known about RC and its attributes, particularly regarding specialists. Aim: We aim to analyse chronic patients' perceptions of RC with primary (PC) and secondary (SC) care doctors, and record changes between 2015 and 2017 in the public healthcare networks of six LA countries. An analysis of two cross-sectional studies applying the CCAENA questionnaire to chronic patients (N = 4881) was conducted in Argentina, Brazil, Chile, Colombia, Mexico, and Uruguay. The dependent variables of RC with PC and SC doctors were: consistency, trust, effective communication, and synthetic indexes based on RC attributes. Descriptive and multivariate analyses were performed. Although the RC index was high in 2015, especially in PC in all countries, and at both levels in Argentina and Uruguay, low perceived consistency of PC and SC doctors in Colombia and Chile and of SC doctors in Mexico revealed important areas for improvement. In 2017 the RC index of SC doctors increased in Chile and Mexico, while SC doctors' consistency in Colombia decreased. This study reveals important gaps in achieving RC with doctors, particularly in SC, which requires further structural and organisational reforms.

Effects of Metacontingencies on Cooperative Behavior: A Systematic Replication Using Innovative Procedures during Isolation.

The study replicated research on metacontingencies that used a chessboard simulating a simplified chess game, in a completely online environment, with participants in their homes. Dyads of participants had to work together moving two knights in L-shape. Each trial ended when the knights met in adjacent squares. The squares where the knights should meet (aggregate product [AP]) varied in two conditions, using an ABAB design. In conditions A, knights should meet anywhere on the chessboard, and there was no consequence. In conditions B, the matrix of reinforceable squares was gradually reduced in four phases and knights' encounters were followed by different messages when correct or incorrect (cultural consequences). In group 1, five dyads were allowed to communicate. In group 2, dyads had no access to video call. Results of group 1 corroborate the findings of the original studies that showed a decrease in APs variability from conditions A to B, when communication was allowed. Group 2 showed similar results, therefore extending to the setting that not allowed communication. The online platform XadrezWeb, developed for this study, was an important tool to program the interlocked behavior contingencies and collect data during social isolation.

Do Body Mass Index Levels Correlate with Tinnitus Among Teachers?

Abstract Introduction Working conditions can contribute to the development of lifestylerelated diseases among teachers, including obesity and tinnitus. Describing tinnitus in relation to characteristics and comorbidities can help the treatment and prognosis of teachers affected by this symptom. Objective To verify a possible association between tinnitus complaint and body mass index (BMI) in teachers. Methods Cross-sectional study with a sample of teachers who responded to the Visual Analog Scale (VAS) and to the Tinnitus Handicap Inventory (THI). The BMI (kg/m2) was calculated based on self-reported body weight (in kilograms) divided by height (in meters squared). Nonparametric statistics were applied adopting a significance level < 0.05 Results A total of 83 teachers were assessed, with a mean age 48 ± 9.7 years old; 63.9% (n= 53) were females; 44.6% were eutrophic (n = 37), and 16.9% (n = 14) were obese. Of the total, 19.3% (n = 16) reported tinnitus. No differences were found between the groups and BMI (p > 0.05), although there was a significant difference between the Tinnitus and No Tinnitus groups for age (p < 0.001). The chi-squared test showed an association between age group and tinnitus (p < 0.028); those with tinnitus were in the 49 to 65 years old age group. In addition, there was a moderate correlation between tinnitus parameters (VAS; THI-Functional; THI-Total) and BMI. Conclusion There was a moderate correlation between tinnitus parameters and BMI indicating that, as the BMI increased, so did the impact of tinnitus in the lives of the teachers. Body mass index should be considered a factor in tinnitus assessment and rehabilitation process.

Do Body Mass Index Levels Correlate with Tinnitus Among Teachers?

Introduction Working conditions can contribute to the development of lifestyle-related diseases among teachers, including obesity and tinnitus. Describing tinnitus in relation to characteristics and comorbidities can help the treatment and prognosis of teachers affected by this symptom. Objective To verify a possible association between tinnitus complaint and body mass index (BMI) in teachers. Methods Cross-sectional study with a sample of teachers who responded to the Visual Analog Scale (VAS) and to the Tinnitus Handicap Inventory (THI). The BMI (kg/m2) was calculated based on self-reported body weight (in kilograms) divided by height (in meters squared). Nonparametric statistics were applied adopting a significance level < 0.05 Results A total of 83 teachers were assessed, with a mean age 48 ± 9.7 years old; 63.9% ( n = 53) were females; 44.6% were eutrophic ( n = 37), and 16.9% ( n = 14) were obese. Of the total, 19.3% ( n = 16) reported tinnitus. No differences were found between the groups and BMI ( p > 0.05), although there was a significant difference between the Tinnitus and No Tinnitus groups for age ( p < 0.001). The chi-squared test showed an association between age group and tinnitus ( p < 0.028); those with tinnitus were in the 49 to 65 years old age group. In addition, there was a moderate correlation between tinnitus parameters (VAS; THI-Functional; THI-Total) and BMI. Conclusion There was a moderate correlation between tinnitus parameters and BMI indicating that, as the BMI increased, so did the impact of tinnitus in the lives of the teachers. Body mass index should be considered a factor in tinnitus assessment and rehabilitation process.

Evaluating the effectiveness of care coordination interventions designed and implemented through a participatory action research process: Lessons learned from a quasi-experimental study in public healthcare networks in Latin America.

BACKGROUND: Despite increasing recommendations for health professionals to participate in intervention design and implementation to effect changes in clinical practice, little is known about this strategy's effectiveness. This study analyses the effectiveness of interventions designed and implemented through participatory action research (PAR) processes in healthcare networks of Brazil, Chile, Colombia, Mexico and Uruguay to improve clinical coordination across care levels, and offers recommendations for future research. METHODS: The study was quasi-experimental. Two comparable networks, one intervention (IN) and one control (CN), were selected in each country. Baseline (2015) and evaluation (2017) surveys of a sample of primary and secondary care doctors (174 doctors/network/year) were conducted using the COORDENA® questionnaire. Most of the interventions chosen were based on joint meetings, promoting cross-level clinical agreement and communication for patient follow-up. Outcome variables were: a) intermediate: interactional and organizational factors; b) distal: experience of cross-level clinical information coordination, of clinical management coordination and general perception of coordination between levels. Poisson regression models were estimated. RESULTS: A statistically significant increase in some of the interactional factors (intermediate outcomes) -knowing each other personally and mutual trust- was observed in Brazil and Chile INs; and in some organizational factors -institutional support- in Colombia and Mexico. Compared to CNs in 2017, INs of Brazil, Chile, Colombia and Mexico showed significant differences in some factors. In distal outcomes, care consistency items improved in Brazil, Colombia and Uruguay INs; and patient follow-up improved in Chile and Mexico. General perception of clinical coordination increased in Brazil, Colombia and Mexico INs. Compared to CNs in 2017, only Brazil showed significant differences. CONCLUSIONS: Although more research is needed, results show that PAR-based interventions improved some outcomes regarding clinical coordination at network level, with differences between countries. However, a PAR process is, by definition, slow and gradual, and longer implementation periods are needed to achieve greater penetration and quantifiable changes. The participatory and flexible nature of interventions developed through PAR processes poses methodological challenges (such as defining outcomes or allocating individuals to different groups in advance), and requires a comprehensive mixed-methods approach that simultaneously evaluates effectiveness and the implementation process to better understand its outcomes.

Assessing the impact of clinical coordination interventions on the continuity of care for patients with chronic conditions: participatory action research in five Latin American countries.

Although fragmentation in the provision of services is considered an obstacle to effective health care, there is scant evidence on the impact of interventions to improve care coordination between primary care and secondary care in terms of continuity of care-i.e. from the patient perspective-particularly in Latin America (LA). Within the framework of the Equity-LA II project, interventions to improve coordination across care levels were implemented in five Latin American countries (Brazil, Chile, Colombia, Mexico and Uruguay) through a participatory action research (PAR) process. This paper analyses the impact of these PAR interventions on the cross-level continuity of care of chronic patients in public healthcare networks. A quasi-experimental study was performed with measurements based on two surveys of a sample of patients with chronic conditions (392 per network; 800 per country). Both the baseline (2015) and evaluation (2017) surveys were conducted using the CCAENA questionnaire. In each country, two comparable public healthcare networks were selected, one intervention and one control. Outcomes were cross-level continuity of information and clinical management continuity. Descriptive analyses were conducted, and Poisson regression models with robust variance were fitted to estimate changes. With differences between countries, the results showed improvements in cross-level continuity of clinical information (transfer of clinical information) and clinical management continuity (care coherence). These results are consistent with those of previous studies on the effectiveness of the interventions implemented in each country in improving care coordination in Brazil, Chile and Colombia. Differences between countries are probably related to particular contextual factors and events that occurred during the implementation process. This supports the notion that certain context and process factors are needed to improve continuity of care. The results provide evidence that, although the interventions were designed to enhance care coordination and aimed at health professionals, patients report improvements in continuity of care.

Introdução alimentar: cartilha de orientações aos pais / Food introduction: guidebook for parents

Vocês estão recebendo a cartilha introdução alimentar, para orienta-los quanto a escolha adequada dos alimentos complementares ao aleitamento materno, para bebês a partir dos seis meses. Essa fase é muito importante para a formação dos hábitos saudáveis, é nesse momento que a criança passa a conhecer a infinidade de sabores que a acompanharão por toda a vida. Visando melhorar a qualidade de vida de nossas crianças, apresentamos esta cartilha que tem como objetivo, orientar os pais, familiares e cuidadores, quanto as escolhas alimentares mais saudáveis, garantindo assim, crescimento e desenvolvimento adequados às crianças.

Primary Biliary Cholangitis: A Case of Underdiagnosis.

Primary biliary cholangitis is a rare autoimmune cholestatic disease with a variable clinical course. Its etiopathogenesis has not been completely clarified. It predominantly affects women and often progresses to liver cirrhosis. It may be asymptomatic or symptomatic with hepatic or extrahepatic manifestations. If its diagnosis and treatment are made early, the progression to cirrhosis and liver failure can be prevented. We describe a clinical case of a 63-year-old woman, with no history of hepatotoxic drugs, who presented an analytical pattern of cytocholestasis with more than one decade of evolution.

The thinking and acting of health professionals on the coordination between the assistance levels of the health care network. / O pensar e o agir de profissionais de saúde sobre a coordenação entre os níveis assistenciais da rede de atenção à saúde.

The study aims to understand the thinking and acting of health professionals about the coordination between levels of care. Qualitative research from an international multicenter study Equity-LA II. Audios were retrieved from eleven interviews of doctors/nurses of two levels of care in Recife, 2014. A content analysis of the theoretical framework of coordination was performed in the light of the hermeneutic approach. Most professionals knew the duties of coordination, without identifying its execution. The primary care physician was not recognized as responsible for the clinic, nor for his role by the specialist physician, while the primary care physician resented it. Failures in the use/completion of reference/counter-reference mechanisms and organizational barriers emerged. The unavailability for the "conversation game" and "fusionality" was evidenced in the lack of recognition of authority in the authoritative character of the primary care physician by that of the specialized, feeling of less value for that and technicist and specialized posture in everyone's practice. The coordination in on professionals' view revealed the "there-to-be-understood" condition that needs to be launched in the "game of comprehension" to build dialogical practices focused on integral care.

O estudo objetiva compreender o pensar e o agir dos profissionais de saúde sobre a coordenação entre níveis assistenciais. Pesquisa qualitativa oriunda de estudo multicêntrico internacional Equity-LA II. Reescutaram-se áudios de onze entrevistas de médicos/enfermeiras de dois níveis assistenciais no Recife, 2014. Realizou-se análise de conteúdo do referencial teórico da coordenação à luz da abordagem hermenêutica. A maioria dos profissionais conhecia as atribuições da coordenação, sem identificar sua execução. O médico da atenção primária não foi reconhecido como responsável clínico, nem quanto ao seu papel pelo médico da atenção especializada, enquanto o da atenção primária ressentia-se. Emergiram falhas no uso/preenchimento dos mecanismos de referência/contrarreferência e entraves organizacionais. A indisponibilidade para o "jogo da conversação" e "fusionalidade" evidenciou-se no não reconhecimento da autoridade no caráter autoritativo do médico da atenção primária pelo da especializada, sentimento de menos valia daquele e postura tecnicista e especializada na práxis de todos. A coordenação no olhar dos profissionais revelou a condição "aí-a-ser-compreendido" carecendo se lançar no "jogo da compreensão" para construir práticas dialógicas voltadas ao cuidado integral.

O pensar e o agir de profissionais de saúde sobre a coordenação entre os níveis assistenciais da rede de atenção à saúde / The thinking and acting of health professionals on the coordination between the assistance levels of the health care network

Resumo O estudo objetiva compreender o pensar e o agir dos profissionais de saúde sobre a coordenação entre níveis assistenciais. Pesquisa qualitativa oriunda de estudo multicêntrico internacional Equity-LA II. Reescutaram-se áudios de onze entrevistas de médicos/enfermeiras de dois níveis assistenciais no Recife, 2014. Realizou-se análise de conteúdo do referencial teórico da coordenação à luz da abordagem hermenêutica. A maioria dos profissionais conhecia as atribuições da coordenação, sem identificar sua execução. O médico da atenção primária não foi reconhecido como responsável clínico, nem quanto ao seu papel pelo médico da atenção especializada, enquanto o da atenção primária ressentia-se. Emergiram falhas no uso/preenchimento dos mecanismos de referência/contrarreferência e entraves organizacionais. A indisponibilidade para o "jogo da conversação" e "fusionalidade" evidenciou-se no não reconhecimento da autoridade no caráter autoritativo do médico da atenção primária pelo da especializada, sentimento de menos valia daquele e postura tecnicista e especializada na práxis de todos. A coordenação no olhar dos profissionais revelou a condição "aí-a-ser-compreendido" carecendo se lançar no "jogo da compreensão" para construir práticas dialógicas voltadas ao cuidado integral.

Abstract The study aims to understand the thinking and acting of health professionals about the coordination between levels of care. Qualitative research from an international multicenter study Equity-LA II. Audios were retrieved from eleven interviews of doctors/nurses of two levels of care in Recife, 2014. A content analysis of the theoretical framework of coordination was performed in the light of the hermeneutic approach. Most professionals knew the duties of coordination, without identifying its execution. The primary care physician was not recognized as responsible for the clinic, nor for his role by the specialist physician, while the primary care physician resented it. Failures in the use/completion of reference/counter-reference mechanisms and organizational barriers emerged. The unavailability for the "conversation game" and "fusionality" was evidenced in the lack of recognition of authority in the authoritative character of the primary care physician by that of the specialized, feeling of less value for that and technicist and specialized posture in everyone's practice. The coordination in on professionals' view revealed the "there-to-be-understood" condition that needs to be launched in the "game of comprehension" to build dialogical practices focused on integral care.

Synthesis and biological evaluation of thiazolidinedione derivatives with high ligand efficiency to P. aeruginosa PhzS.

The thiazolidinone ring is found in compounds that have widespan biology activity and there is mechanism-based evidence that compounds bearing this moiety inhibit P. aeruginosa PhzS (PaPzhS), a key enzyme in the biosynthesis of the virulence factor named pyocyanin. Ten novel thiazolidinone derivatives were synthesised and screened against PaPhzS, using two orthogonal assays. The biological results provided by these and 28 other compounds, whose synthesis had been described, suggest that the dihydroquinazoline ring, found in the previous hit (A- Kd = 18 µM and LE = 0.20), is not required for PaPzhS inhibition, but unsubstituted nitrogen at the thiazolidinone ring is. The molecular simplification approach, pursued in this work, afforded an optimised lead compound (13- 5-(2,4-dimethoxyphenyl)thiazolidine-2,4-dione) with 10-fold improvement in affinity (Kd= 1.68 µM) and more than 100% increase in LE (0.45), which follows the same inhibition mode as the original hit compound (competitive to NADH).Executive summaryPhzS is a key enzyme in the pyocyanin biosynthesis pathway in P. aeruginosa.Orthogonal assays (TSA and FITC) show that fragment-like thiazolidinedione derivatives bind to PaPhzS with one-digit micromolar affinity.Fragment-like thiazolidinedione derivatives bind to the cofactor (NADH) binding site in PaPhzS.The molecular simplification optimised the ligand efficiency and affinity of the lead compound.

COVID-19-related Multisystem Inflammatory Syndrome in a Young Adult.

INTRODUCTION: A condition called multisystem inflammatory syndrome in children (MIS-C), related to past SARS-CoV-2 infection, has been described in a series of cases. There is a growing body of evidence suggesting a similar entity in adults (MIS-A). We report a case of a young adult with a hyperinflammatory systemic syndrome with end-organ lesions and a recent SARS-CoV-2 infection. METHODS AND PROCEDURES: The patient developed end-organ lesions in the respiratory, cardiovascular, digestive, haematological and mucocutaneous systems. A wide diagnostic work-up did not find any specific aetiology (autoimmunity, neoplastic or infectious). There was evidence of past SARS-CoV-2 infection with positive autoimmune titres (positive IgG). A presumptive diagnosis of MIS-A was made and treatment with corticosteroids was introduced with improvement. DISCUSSION: COVID-19-related multisystem inflammatory syndrome in adults is still an unknown entity with no diagnostic criteria or treatment guidelines. Much of what is known is inferred from what we already know about MIS-C. There have been several reported cases with severity ranging from mild to severe. The mechanisms behind this condition are still largely unknown. More evidence is needed to establish diagnosis and treatment. LEARNING POINTS: COVID-19-related multisystem inflammatory syndrome in adults is a new entity with few case reports.Awareness is important for early diagnosis and treatment.

[Communicational relations between healthcare professionals and their influence on coordination of care]. / As relações comunicacionais entre os profissionais de saúde e sua influência na coordenação da atenção.

The study aims to understand the influence of communicational relations among healthcare professionals in the coordination of care between levels. This is a qualitative study with data from the international multicenter study Equity-LA II, with dialectic hermeneutics as the theoretical reference. The authors listened to the audios from 15 interviews with professionals (7 physicians from primary care and 5 from specialized care, and 3 institutional supporters from primary care) in a municipal network in the Agreste region of the state of Pernambuco, Brazil, in 2016. The mixed categories were submitted to content analysis. The analysis revealed a lack of recognition, by nearly all of the professionals, of primary care as the organizational backbone for care, and the perception of coordination revealed obstacles related to disconnects in establishing dialogical relations. Knowledge of the physician's role in primary care is incomplete, and its praxis is viewed with distrust by specialists, while the reciprocal is not true. There was a visibly non-dialogical interpersonal relationship, based on asymmetric relations reflected in the specialist's authoritarian stance and that of inferiority of primary care physicians. The basis for the communicative action relates to pretensions of validity rather than of power, which is external to language, and impedes the discussion of reasons and arguments. There was little disposition for dialogue and reciprocal recognition between the parties involved, with interdiction of a communicative situation in which there is symmetry of participation. The results revealed communicational weaknesses, thus requiring strategies that allow achieving communicative understanding among the professionals and promoting satisfactory patient follow-up between levels of care.

O estudo objetiva compreender a influência das relações comunicacionais entre os profissionais da rede de atenção à saúde na coordenação entre níveis assistenciais. Estudo qualitativo com dados de pesquisa multicêntrica internacional Equity-LA II, utilizando o referencial teórico da hermenêutica dialética. Escutaram-se áudios de 15 entrevistas a profissionais (7 médicos da atenção primária e 5 da atenção especializada e de 3 apoiadores institucionais da atenção primária) de uma rede municipal no agreste pernambucano, Brasil, em 2016. As categorias mistas foram submetidas à análise de conteúdo. Revelou-se o não reconhecimento da atenção primária como ordenadora do cuidado por quase todos os profissionais e a percepção sobre a coordenação do cuidado desvelou obstáculos relacionados aos desencontros em estabelecer relações dialógicas. O saber sobre o papel do médico da atenção primária é incompleto e sua práxis vista com desconfiança por especialistas, a recíproca não ocorrendo. Percebeu-se uma relação interpessoal não dialógica, pautada na relação assimétrica refletida na postura autoritária do especialista e de inferioridade dos médicos da atenção primária. A base do agir comunicativo refere-se às pretensões de validade e não de poder, que é externo à linguagem, e impossibilita a discussão de razões e argumentos. Evidenciou-se pouca disponibilidade ao diálogo e ao reconhecimento recíproco entre os envolvidos, com interdição da situação comunicativa, em que há simetria de participação. Os resultados revelaram fragilidades comunicacionais, sendo necessárias estratégias que permitam o alcance do entendimento comunicativo entre os profissionais, promovendo o seguimento satisfatório entre níveis assistenciais.

El objetivo del estudio fue comprender la influencia de las relaciones comunicacionales entre los profesionales de la red de atención a la salud en la coordinación entre niveles asistenciales. Estudio cualitativo con datos de investigación multicéntrica internacional Equity-LA II, utilizando el marco referencial teórico de la hermenéutica dialéctica. Se escucharon audios de 15 entrevistas a profesionales (7 médicos de la atención primaria y 5 de la atención especializada, y 3 profesionales de la atención primaria), en una red municipal en zona rural pernambucana, Brasil, en 2016. Las categorías mixtas se sometieron al análisis de contenido. Se reveló el no reconocimiento de la atención primaria como ordenadora del cuidado por casi todos los profesionales, y la percepción sobre la coordinación del cuidado desveló obstáculos relacionados con los desencuentros para establecer relaciones dialógicas. El saber sobre el papel del médico de la atención primaria es incompleto y su praxis vista con desconfianza por especialistas, lo que no sucede recíprocamente. Se percibió una relación interpersonal no dialógica, pautada en la relación asimétrica, reflejada en la postura autoritaria del especialista y de inferioridad de los médicos de la atención primaria. La base de la actuación comunicativa se refiere a las pretensiones de validez y no de poder, que es externo al lenguaje, e imposibilita la discusión de razones y argumentos. Se evidenció la poca disponibilidad para el diálogo y reconocimiento recíproco entre los implicados, con prohibición de situaciones comunicativas donde existe simetría de participación. Los resultados revelaron fragilidades comunicacionales, siendo necesarias estrategias que permitan el alcance del entendimiento comunicativo entre los profesionales, promoviendo el seguimiento satisfactorio entre niveles asistenciales.

Manual com orientações para pacientes: cirurgias cardíacas com pós operatório imediato em UTI / Manual with guidelines for patients: cardiac surgeries with immediate postoperative period in the ICU

Preparamos este manual para que você fique por dentro de tudo que vai acontecer durante seu tratamento. Aqui você encontrará as rotinas e os cuidados necessários antes, durante e após a sua cirurgia, com todas as informações para passar por esse momento com tranquilidade. Fique atento aos documentos e exames necessários. Caso tenha alguma dúvida, entre em contato com o hospital!

Manual de orientações gerais e recomendações para otimizar o retorno às atividades após a alta hospitalar / Manual of general guidelines and recommendations to optimize the return to activities after hospital discharge

Esse manual foi desenvolvido com muito empenho e dedicação com o objetivo de dar orientações e sugerir recomendações para o retorno gradual e seguro do paciente às suas atividades de vida diária e rotina laboral após a alta hospitalar. Esperamos que o leitor compreenda a importância dessas orientações e recomendações, visando uma melhor qualidade de vida e evitar complicações e reinternações no futuro.

Atendimento odontológico em pacientes com covid-19 em Unidades de Terapia Intensiva / Dental care in patients with covid-19 in Intensive Care Units

Este manual é uma produção científica da Residência Multiprofissional em Saúde, com área de Concentração em Terapia Intensiva Adulto, da Secretaria Estadual de Saúde do Maranhão. O principal objetivo é orientar a equipe multiprofissional acerca dos cuidados necessários com a saúde bucal dos pacientes em Unidade de Terapia Intensiva, e discorrer sobre o Atendimento Odontológico em UTI em tempos de pandemia da Covid-19.

Manual de monitorização do volume prescrito e infundido em terapia nutricional enteral / Manual for monitoring the volume prescribed and infused in enteral nutritional therapy

Esse Manual foi elaborado com a intenção de orientá-lo, quanto a importância do controle do prescrito e infundido na terapia nutricional enteral. Contém informações bem simples e seguras e que abrange toda a equipe multiprofissional.