Patients with Spondylodiscitis following Chemoradiotherapy for Head and Neck Cancer in a Portuguese Cancer Hospital: A Case Report.

Introduction: Head and neck cancer is an umbrella term for tumor manifestations across the head and neck regions, including the oral cavity, pharynx (including the naso, oro, and hypopharynx), larynx, and sinuses. Treatment options for head and neck cancer include surgery, radiation therapy, chemotherapy, and immunotherapy, with specific treatment plans depending upon individual tumor location and staging, together with overall patient health status. Furthermore, definitive chemoradiotherapy (CRT) has emerged as a highly effective therapeutic option for locoregional advanced head and neck squamous cell cancer. However, such therapy has also been linked to the development of spondylodiscitis. Spondylodiscitis consists of an infection starting at the vertebral endplates and spreading into the intervertebral discs, typically manifesting in adults. Case Presentation and Conclusion: This case report describes our clinical team's experience in managing three separate cases of spondylodiscitis following CRT for head and neck tumors that presented at our clinic for diagnosis and treatment in order to identify predisposing factors that underlie the link between CRT and spondylodiscitis.

Measurement of perineal tears as an additional tool for laceration assessment during vaginal birth.

INTRODUCTION: Spontaneous lacerations at vaginal birth are everyday events, but their classification and management still challenge midwifery care. This study aims to measure and describe first-degree and second-degree perineal lacerations resulting from vaginal birth, describe their repair, and the education provided for care. METHODS: A descriptive study was conducted in a public maternity hospital in São Paulo, Brazil, with 87 parturients. Data were collected between October 2017 and June 2018 using a structured instrument containing obstetric variables and a description of lacerations. The obstetricians and nurse midwives assisted with births, determining the degree of laceration and intervention, and the researchers measured and reported them. RESULTS: The majority of parturients (82.7%) had lacerations only in the anterior region, 8% had them in the posterior region, and 9.2% in both regions. The lacerations were classified as first-degree (78.1%) or second-degree (21.8%). Among the 32 nulliparous parturients, 27.6% had first-degree lacerations, and 9.2% had second-degree. Of the 55 multiparous parturients, 50.6% had first-degree, and 12.6% had second-degree. Among the lacerations assessed as first-degree, 25% had deeper tissue layers compromised in addition to the skin and mucosa. There were 180 lacerations, with an average length of 33.1 mm, depth of 19.8 mm, and width of 23.8 mm. Half of the parturients did not receive guidance on laceration care. There was no association between parity and size, number, location, or degree classification of lacerations. CONCLUSIONS: This study provides a broad description of the characteristics of perineal lacerations and presents measurement techniques as a complementary resource for evaluating lacerations.

An unusual cardiac involvement in mixed connective tissue disease / Una afección cardíaca poco común en la enfermedad mixta del tejido conjuntivo

Mixed connective tissue disease is an autoimmune disorder with overlapping features of systemic lupus erythematosus, systemic sclerosis and polymyositis. Cardiac involvement is common, being pericarditis the most frequent manifestation, as also pulmonary hypertension. The authors present a case of a woman with one year of symptoms of polyarthritis and myalgia with gradual muscle weakness and weight loss, with severe impaired mobility in the last months. The initial evaluation showed an inflammatory systemic condition with an infiltrative pattern in echocardiogram, with pulmonary hypertension, that was confirmed by cardiac magnetic resonance. After an extensive study, where infiltrative cardiomyopathies were a differential diagnosis, the patient meet criteria to mixed connective disease with signs of pulmonary hypertension and an atypical cardiac involvement. Immunosuppressive treatment and rehabilitation were initiated and one year after the patient remains asymptomatic without any limitations. (AU)

La enfermedad mixta del tejido conectivo es un trastorno autoinmune con características superpuestas de lupus eritematoso sistémico, esclerosis sistémica y polimiositis. La afectación cardiaca es común, siendo la pericarditis la manifestación más frecuente, al igual que la hipertensión pulmonar. Los autores presentan el caso de una mujer con un año de síntomas de poliartritis y mialgia con debilidad muscular gradual y pérdida de peso, con grave deterioro de la movilidad en los últimos meses. La evaluación inicial mostró un cuadro inflamatorio sistémico con patrón infiltrativo en ecocardiograma, con hipertensión pulmonar, que se confirmó por resonancia magnética cardiaca. Tras un amplio estudio, en el que las miocardiopatías infiltrativas constituyeron un diagnóstico diferencial, la paciente cumplía criterios de conectivopatía mixta con signos de hipertensión pulmonar y una afectación cardiaca atípica. Se inició tratamiento inmunosupresor y rehabilitación y un año después la paciente permanece asintomática sin limitaciones. (AU)

A Comparison of Dobutamine, Norepinephrine, Vasopressin, and Hetastarch for the Treatment of Isoflurane-Induced Hypotension in Healthy, Normovolemic Dogs.

Isoflurane is a commonly used inhalation anesthetic in species undergoing veterinary care that induces hypotension, impacting organ perfusion, making it imperative to minimize its occurrence or identify effective strategies for treating it. This study evaluated and compared the hemodynamic effects of DOB, NEP, VAS, and HES in twelve isoflurane-anesthetized Beagle dogs. The order of the first three treatments was randomized. HES was administered last. Data were collected before treatments (baseline) and after 10 min of a sustained MAP of <45 mmHg induced by a high end-tidal isoflurane concentration (T0). Once treatment was initiated and the target MAP was achieved (65 to 80 mmHg) or the maximum dose reached, data were collected after 15 min of stabilization (T1) and 15 min after (T2). A 15 min washout period with a MAP of ≥65 mmHg was allowed between treatments. The intravenous dosage regimens started and were increased by 50% every five minutes until the target MAP or maximum dose was reached. The dosages were as follows: DOB, 5-15 µg/kg/min; NEP, 0.1-2 µg/kg/min; VAS, 0.5-5 mU/kg/min; and HET, 6% 1-20 mL/kg/min. DOB improved CO, DO2, and VO2, but reduced SVR. VAS elevated SVR, but decreased CO, DO2, and VO2. HES minimally changed BP and mildly augmented CO, DO2, and VO2. These treatments failed to reach the target MAP. NEP increased the arterial BP, CO, MPAP, and PAWP, but reduced HR. Norepinephrine infusion at 0.44 ± 0.19 µg/kg/min was the most efficient therapy for correcting isoflurane-induced hypotension.

Compromised Mitotic Fidelity in Human Pluripotent Stem Cells.

Human pluripotent stem cells (PSCs), which include both embryonic and induced pluripotent stem cells, are widely used in fundamental and applied biomedical research. They have been instrumental for better understanding development and cell differentiation processes, disease origin and progression and can aid in the discovery of new drugs. PSCs also hold great potential in regenerative medicine to treat or diminish the effects of certain debilitating diseases, such as degenerative disorders. However, some concerns have recently been raised over their safety for use in regenerative medicine. One of the major concerns is the fact that PSCs are prone to errors in passing the correct number of chromosomes to daughter cells, resulting in aneuploid cells. Aneuploidy, characterised by an imbalance in chromosome number, elicits the upregulation of different stress pathways that are deleterious to cell homeostasis, impair proper embryo development and potentiate cancer development. In this review, we will summarize known molecular mechanisms recently revealed to impair mitotic fidelity in human PSCs and the consequences of the decreased mitotic fidelity of these cells. We will finish with speculative views on how the physiological characteristics of PSCs can affect the mitotic machinery and how their suboptimal mitotic fidelity may be circumvented.

Do different protocols affect the success rate or bond strength of glass-ceramics repaired with composite resin? A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Intraoral repair techniques prevent unnecessary replacement of ceramic restorations, thereby increasing the survival rate. However, adhesion between ceramics and the composite resin is challenging and how different protocols influence adhesion is unclear. PURPOSE: The purpose of this systematic review and meta-analysis was to analyze the influence of different protocols on repairing glass-ceramic surfaces with composite resins. MATERIAL AND METHODS: PubMed, Scopus, ISI Web of Science, and Embase electronic databases were searched to select studies comparing bond strength values or survival rates of glass-ceramic repaired with composite resins using different surface treatment protocols. No publication year or language restriction was applied. Data sets were extracted from all included studies, and the mean differences calculated. A 95% confidence interval was calculated by using the random effect model (Rev Man 5.4). RESULTS: The search identified 5037 studies, and 165 were assessed for eligibility. Finally, 123 in vitro studies were included in the systematic review and 48 in the meta-analysis. Considering different glass-ceramics, bond strength tests, and aged or not aged specimens, 37 meta-analyses found the effect of repair protocols: only adhesive, silane plus adhesive alone or preceded by hydrofluoric (HF) acid, airborne-particle abrasion (APA) with Al2O3 particles, silica-coated APA (SCAPA), diamond rotary instrument (DRI), and laser irradiation (LI). CONCLUSIONS: For feldspathic porcelain, HF acid, APA, SCAPA, or DRI improved the repair micromechanical retention; applying silane is essential to HF-conditioned surfaces but the use of adhesive is optional when silane is applied. Results for leucite and lithium disilicate were inconclusive in terms of suggesting a treatment other than HF acid plus silane and adhesive applications.

Evaluation of Electrical Cardiometry for Measuring Cardiac Output and Derived Hemodynamic Variables in Comparison with Lithium Dilution in Anesthetized Dogs.

Numerous cardiac output (CO) technologies were developed to replace the 'gold standard' pulmonary artery thermodilution due to its invasiveness and the risks associated with it. Minimally invasive lithium dilution (LiD) shows excellent agreement with thermodilution and can be used as a reference standard in animals. This study evaluated CO via noninvasive electrical cardiometry (EC) and acquired hemodynamic variables against CO measured using LiD in six healthy, anesthetized dogs administered different treatments (dobutamine, esmolol, phenylephrine, and high-dose isoflurane) impacting CO values. These treatments were chosen to cause drastic variations in CO, so that fair comparisons between EC and LiD across a wide range of CO values (low, intermediate, and high) could be made. Statistical analysis included linear regression, Bland-Altman plots, Lin's concordance correlation coefficient (ρc), and polar plots. Values of p < 0.05 represented significance. Good agreement was observed between EC and LiD, but consistent underestimation was noted when the CO values were high. The good trending ability, ρc of 0.88, and low percentage error of ±31% signified EC's favorable performance. Other EC-acquired variables successfully tracked changes in CO measured using LiD. EC may be a pivotal hemodynamic tool for continuously monitoring circulatory changes, as well as guiding and treating cardiovascular anesthetic complications in clinical settings.

Assessment and comparison of microcirculation and macrocirculation in horses undergoing emergency exploratory celiotomy versus elective surgical procedures.

OBJECTIVE: To assess oral buccal microcirculation by hand-held videomicroscopy in horses during colic surgery, comparing microcirculation values with macrocirculatory parameters and with those of healthy elective surgical horses. STUDY DESIGN: Clinical prospective study. ANIMALS: Client-owned horses (nine in the colic group; 11 in the elective group). METHODS: In the colic group, buccal mucosal side stream dark-field microscopy (DFM) videos, cardiac output (CO), mean arterial pressure (MAP), and lactate were obtained at three timepoints under general anesthesia (30, 90, and 150 min after induction). Video analysis was used to determine total vessel density, proportion of perfused vessels, perfused vessel density, and heterogeneity index. Dark-field microscopy videos, MAP, and lactate were obtained at a single timepoint under general anesthesia (45 min after induction) in the elective group. RESULTS: There were no differences in microcirculatory parameters between colic and elective horses, nor was there a difference across timepoints in the colic group. There was a weak negative correlation between microvascular parameters and CO (rho = -0.23). CONCLUSION: The colic group did not have decreased microcirculation in comparison with the healthy elective group. Dark-field microscopy did not correlate well with macrocirculatory parameters in the colic group. IMPACT: Dark-field microscopy may not be a sensitive enough indicator to detect differences in microcirculation between colic and elective groups. The lack of difference in microcirculation may be due to sample size, probe location, or variation in disease severity.

Agreement of cardiac output measurements by esophageal Doppler and transesophageal echocardiography with intermittent pulmonary artery thermodilution during pharmacologic manipulation of hemodynamics in anesthetized dogs.

OBJECTIVE: To compare cardiac output (CO) measurements by transesophageal echocardiography (TEECO) and esophageal Doppler monitor (EDMCO) with pulmonary artery thermodilution (PATDCO) in anesthetized dogs subjected to pharmacological interventions. The effect of treatments on EDM-derived indexes was also investigated. ANIMALS: 6 healthy male dogs (10.8 ± 0.7 kg). METHODS: Dogs were anesthetized with propofol and isoflurane, mechanically ventilated, and monitored with invasive mean arterial pressure (MAP), end-tidal isoflurane concentration (ETISO), PATDCO, TEECO, EDMCO, and EDM-derived indexes. Four treatments were administered to all dogs by randomization. Baseline data were collected before each treatment: (1) dobutamine infusion; (2) esmolol infusion; (3) phenylephrine infusion; and (4) ETISO > 3%. Data were collected after 10-minute stabilization and after 30 minutes of washout between treatments. Statistical tests were pairwise t test, Bland-Altman analysis, Lin's concordance correlation (ρc), and polar plot analysis with P < .05 set as significance. RESULTS: The mean ± SD relative bias (limits of agreement) for TEECO was 0.35 ± 25.2% (-49.1% to 49.8%) and for EDMCO was -27.2 ± 22.5% (-71.4% to 17%) versus PATDCO. The percent error for TEECO and EDMCO was 27.6% and 44.1%, respectively. The ρc value was 0.82 for TEECO and 0.66 for EDMCO. TEECO and EDMCO showed good trending ability. EDM-derived indexes displayed significant changes specific to the drug administered (P < .001). CLINICAL RELEVANCE: For minimally invasive CO monitoring, TEE may provide more favorable performance than EDM in clinical settings; however, EDM-derived indexes yield valuable hemodynamic information that reliably follows trends in CO, thus supporting critical decision-making in canine patients.

Pharmacokinetics and pharmacodynamics of intramuscular dexmedetomidine in dogs.

OBJECTIVE: To determine the pharmacokinetics and pharmacodynamics of dexmedetomidine after IM administration in dogs. ANIMALS: 6 healthy adult purpose-bred dogs (3 males, 3 females) with a mean ± SD body weight of 25.2 ± 1.8 kg. PROCEDURES: Each dog received 10 µg/kg dexmedetomidine, IM. Heart rate and respiratory rate were counted via cardiac auscultation and visual assessment of chest excursions. Sedation was assessed utilizing 2 sedation scoring systems. Plasma concentrations were determined using ultra performance liquid chromatography-mass spectrometry. Plasma concentrations versus time data after IM dexmedetomidine were analyzed using noncompartmental analysis for extravascular administration. RESULTS: Over the first 2 hours following IM injection of dexmedetomidine, plasma concentrations fluctuated in each dog. The geometric mean (range) maximum plasma concentration was 109.2 (22.4 to 211.5) ng/mL occurring at 20.5 (5 to 75) minutes, and the mean half-life was 25.5 (11.5 to 41.5) minutes. Heart rate was significantly lower than baseline from 30 minutes to 2 hours postdexmedetomidine administration, and respiratory rate was significantly lower than baseline from 45 minutes to 1.75 hours. Dogs were significantly more sedated from 30 minutes to 1.5 hours postdexmedetomidine administration. Median time to onset of sedation was 7.5 minutes (range, 2 to 10 minutes), and median time to peak sedation was 30 minutes (range, 15 to 60 minutes). CLINICAL RELEVANCE: Variations in plasma concentrations occurred in all dogs for the 2 hours postinjection of dexmedetomidine at 10 µg/kg, IM. This was likely due to alterations in absorption due to dexmedetomidine-induced local vasoconstriction. Despite variable plasma concentrations, all dogs were sedated following IM dexmedetomidine administration.

Legal action for access to resources inefficiently made available in health care systems in Brazil: a case study on obstructive sleep apnea.

OBJECTIVE: Obstructive sleep apnea (OSA) is a highly prevalent chronic disease, associated with morbidity and mortality. Although effective treatment for OSA is commercially available, their provision is not guaranteed by lines of care throughout Brazil, making legal action necessary. This study aimed at presenting data related to the volume of legal proceedings regarding the access to diagnosis and treatment of OSA in Brazil. METHODS: This was a descriptive study of national scope, evaluating the period between January of 2016 and December of 2020. The number of lawsuits was analyzed according to the object of the demand (diagnosis or treatment). Projections of total expenses were carried out according to the number of lawsuits. RESULTS: We identified 1,462 legal proceedings (17.6% and 82.4% related to diagnosis and treatment, respectively). The projection of expenditure for OSA diagnosis in the public and private spheres were R$575,227 and R$188,002, respectively. The projection of expenditure for OSA treatment in the public and private spheres were R$2,656,696 and R$253,050, respectively. There was a reduction in the number of lawsuits between 2017 and 2019. CONCLUSIONS: Legal action as a strategy for accessing diagnostic and therapeutic resources related to OSA is a recurrent practice, resulting in inefficiency and inequity. The reduction in the number of lawsuits between 2017 and 2019 might be explained by the expansion of local health care policies or by barriers in the journey of patients with OSA, such as difficulties in being referred to specialized health care and low availability of diagnostic resources.

Microglial depletion exacerbates motor impairment and dopaminergic neuron loss in a 6-OHDA model of Parkinson's disease.

6-hydroxydopamine (6-OHDA) is a common neurotoxin used to induce Parkinson's disease (PD) in mice, exerting neurotoxic effects through the production of reactive oxygen species and microglial activation. However, the role of microglia in PD is still not clear, with contradictory reports showing neuroprotection or exacerbation of neuronal death. Microglial depletion aggravates motor coordination impairments and reduces tyrosine hydroxylase positive neurons in the substantia nigra pars compacta. Moreover, MeCP2 and Adora1 genes expression were downregulated, suggesting they may be involved in the neurodegenerative process. This study highlights that microglia plays a protective role in dopaminergic neuron survival during the initial phase of PD, and the investigation of the mechanisms of this effect in future studies will help elucidate the pathophysiology of PD.

Molecular profile of patients with myelofibrosis: a 10-year experience.

OBJECTIVE: To analyze the karyotype test and myeloid panel with next-generation sequencing findings in patients with myelofibrosis, and to compare transplant characteristics in patients referred for bone marrow transplantation. METHODS: Retrospective, single-center study with patients diagnosed with myelofibrosis treated at Hospital Israelita Albert Einstein between 2010 and 2020. RESULTS: A total of 104 patients with myelofibrosis were examined. Patients who had not been submitted to tests in our service were excluded. The final sample comprised 69 patients. Of these 69, 56 were submitted to karyotyping and 22 to myeloid panel with next-generation sequencing. Karyotype was normal in 60% of the patients and altered in 40%. The prevalence of high-risk molecular mutations was higher in patients referred for bone marrow transplantation (100% versus 50%). The median follow-up of transplant patients was 2.4 years and the overall survival at 2 years was 80% (95%CI: 62-100%). CONCLUSION: The molecular analysis enables estimating the patient's risk and thus instituting more aggressive treatment such as bone marrow transplant for patients at higher risk, being a relevant tool to guide therapy. Given the significance of molecular analysis for therapeutic decision-making in myelofibrosis, collection and disclosure of data on the prevalence of cytogenetic changes and findings of next-generation sequencing in affected patients is important.

Evaluation of urinary cysteinyl leukotrienes as biomarkers of severity and putative therapeutic targets in COVID-19 patients.

BACKGROUND: Cysteinyl leukotrienes (CysLT) are potent inflammation-promoting mediators, but remain scarcely explored in COVID-19. We evaluated urinary CysLT (U-CysLT) relationship with disease severity and their usefulness for prognostication in hospitalized COVID-19 patients. The impact on U-CysLT of veno-venous extracorporeal membrane oxygenation (VV-ECMO) and of comorbidities such as hypertension and obesity was also assessed. METHODS: Blood and spot urine were collected in "severe" (n = 26), "critically ill" (n = 17) and "critically ill on VV-ECMO" (n = 17) patients with COVID-19 at days 1-2 (admission), 3-4, 5-8 and weekly thereafter, and in controls (n = 23) at a single time point. U-CysLT were measured by ELISA. Routine markers, prognostic scores and outcomes were also evaluated. RESULTS: U-CysLT did not differ between groups at admission, but significantly increased along hospitalization only in critical groups, being markedly higher in VV-ECMO patients, especially in hypertensives. U-CysLT values during the first week were positively associated with ICU and total hospital length of stay in critical groups and showed acceptable area under curve (AUC) for prediction of 30-day mortality (AUC: 0.734, p = 0.001) among all patients. CONCLUSIONS: U-CysLT increase during hospitalization in critical COVID-19 patients, especially in hypertensives on VV-ECMO. U-CysLT association with severe outcomes suggests their usefulness for prognostication and as therapeutic targets.

Risk of anesthesia-related complications in draft horses: a retrospective, single-center analysis.

OBJECTIVE: To report anesthetic-related complications and determine risks associated with anesthesia in draft horses. STUDY DESIGN: Retrospective study. ANIMALS: A total of 401 anesthetic records for draft horse breeds that underwent general anesthesia from January 2010 through December 2020 were reviewed; horses euthanized during general anesthesia were excluded. METHODS: Demographics, perioperative drugs used, procedure type and duration, time to extubation, number of attempts to stand, use of sling in recovery and perioperative morbidity and mortality were investigated. Morbidity and mortality statistical evaluation included univariable logistic regression analysis and ordinal regression analysis. RESULTS: American Society of Anesthesiologists (ASA) status I-II, ASA III-V and total mortality rate for all cases was 0.69% (2/288), 6.19% (7/113) and 2.24% (9/401), respectively, with Belgian horses being overrepresented (6/9). Cardiac arrest occurred in six out of nine horses that died without euthanasia, and five out of six of these horses underwent colic surgery. Factors associated with increased mortality risk included ASA status of III-V, increased body weight, emergency status and horses presenting for colic. Hypotension, hypercarbia and hypoxemia occurred in 56% (224/401), 46% (186/401) and 14% (58/401) of horses, respectively. During recovery from anesthesia, lighter horses and horses undergoing shorter anesthetic procedures were more likely to be successful on the first or second attempt to stand and were less likely to require a sling in recovery. CONCLUSIONS AND CLINICAL RELEVANCE: Draft horses undergoing general anesthesia had a higher mortality rate than previously reported for all types and breeds of horses.

Diversity, Equity, and Inclusion in the United States Emergency Medical Services Workforce: A Scoping Review.

OBJECTIVE: Emergency medical services (EMS) workforce demographics in the United States do not reflect the diversity of the population served. Despite some efforts by professional organizations to create a more representative workforce, little has changed in the last decade. This scoping review aims to summarize existing literature on the demographic composition, recruitment, retention, and workplace experience of underrepresented groups within EMS. METHODS: Peer-reviewed studies were obtained from a search of PubMed, CINAHL, Web of Science, ProQuest Thesis and Dissertations, and non-peer-reviewed ("gray") literature from 1960 to present. Abstracts and included full-text articles were screened by two independent reviewers trained on inclusion/exclusion criteria. Studies were included if they pertained to the demographics, training, hiring, retention, promotion, compensation, or workplace experience of underrepresented groups in United States EMS by race, ethnicity, sexual orientation, or gender. Studies of non-EMS fire department activities were excluded. Disputes were resolved by two authors. A single reviewer screened the gray literature. Data extraction was performed using a standardized electronic form. Results were summarized qualitatively. RESULTS: We identified 87 relevant full-text articles from the peer-reviewed literature and 250 items of gray literature. Primary themes emerging from peer-reviewed literature included workplace experience (n = 48), demographics (n = 12), workforce entry and exit (n = 8), education and testing (n = 7), compensation and benefits (n = 5), and leadership, mentorship, and promotion (n = 4). Most articles focused on sex/gender comparisons (65/87, 75%), followed by race/ethnicity comparisons (42/87, 48%). Few articles examined sexual orientation (3/87, 3%). One study focused on telecommunicators and three included EMS physicians. Most studies (n = 60, 69%) were published in the last decade. In the gray literature, media articles (216/250, 86%) demonstrated significant industry discourse surrounding these primary themes. CONCLUSIONS: Existing EMS workforce research demonstrates continued underrepresentation of women and nonwhite personnel. Additionally, these studies raise concerns for pervasive negative workplace experiences including sexual harassment and factors that negatively affect recruitment and retention, including bias in candidate testing, a gender pay gap, and unequal promotion opportunities. Additional research is needed to elucidate recruitment and retention program efficacy, the demographic composition of EMS leadership, and the prevalence of racial harassment and discrimination in this workforce.

Cuidado fragmentado: resposta da Rede de Cuidados à Pessoa com Deficiência para crianças com Síndrome Congênita do Zika Vírus / Fragmented care: the response of the Persons with Disabilities Care Network to children with Congenital Zika Syndrome / Cuidado fragmentado: respuesta de la Red de Cuidados de la Persona con Discapacidad para niños con Síndrome Congénito del Zika Virus

Resumo O objetivo da pesquisa foi analisar a organização e estrutura que a Rede de Cuidados à Pessoa com Deficiência (RCPD) oferece às crianças com Síndrome Congênita do Zika Vírus (SCZV) na Região de Saúde de Salvador (BA). Trata-se de uma pesquisa qualitativa que cotejou Itinerários Terapêuticos, das crianças com SCZV com a percepção, de gestores e profissionais da RCPD, sobre o funcionamento da rede. Ainda que existam concordâncias entre entrevistados, há problemas evidenciados somente pelas cuidadoras. Não existem mecanismos de regulação assistencial definidos entre os serviços da RCPD, levando as cuidadoras a navegarem pelo sistema de forma desgovernada em busca de assistência. A fragmentação do cuidado revelada impede o cuidado continuado e coordenado entre os diferentes serviços de saúde, resultando em intervenções pontuais. A SCZV coloca a proposta de RCPD em xeque, uma vez que há pouca congruência entre as trajetórias percorridas e a política nacional instituída.(AU)

Abstract The aim of this study was to analyze the organization and structure that the Persons with Disabilities Care Network (RCPD) offers children with Congenital Zika Syndrome (CZS) in the Salvador Health Region (BA). We conducted a qualitative study to investigate the experiences of the children's caregivers based on therapeutic itineraries and the perceptions of RCPD managers and professionals. Despite general agreement between the interviewees, only the caregivers highlighted problems. There are no health care regulation defined among the RCPD services, meaning that caregivers had to browse the system aimlessly to search for care. The fragmentation of care revealed by the findings prevents the provision of continuous care coordinated between the different health services, resulting in ad hoc care interventions. CZS highlights the limitations of the RCPD, demonstrating the incongruence between practice and national policy.(AU)

Resumen Analizar la organización y estructura que la Red de Cuidados de la Persona con Discapacidad (RCPD) ofrece a los niños con Síndrome Congénito del Zika Virus (SCZV) en la Región de Salud de Salvador (Estado de Bahia). Investigación cualitativa que compara la experiencia de las cuidadoras de los niños con SCZV por medio de Itinerarios Terapéuticos y la percepción de gestores y profesionales de la RCPD. Aunque existen concordancias entre entrevistados, hay problemas que solamente son puestos en evidencia por las cuidadoras. No hay mecanismos de reglamentación asistencial definidos entre los servicios de la RCPD, haciendo que las cuidadoras naveguen por el sistema de manera desgobernada en busca de asistencia. La fragmentación del cuidado revelada impide el cuidado continuado y coordinado entre los diferentes servicios de salud, resultando en intervenciones puntuales. El SCZV pone en jaque la propuesta de RCPD puesto que hay poca congruencia entre las trayectorias recorridas y la política nacional instituida.(AU)

O lugar das práticas artístico-culturais na constituição da negritude para negros/as de pele clara / El lugar de las prácticas artístico-culturales en la constitución de la negritud para negros/as de piel clara / The place of artistic-cultural practices in the constitution of blackness for light-skinned black people

Resumo Este artigo tem como objetivo compreender o processo de identificação e pertencimento racial de pessoas negras de pele clara mediante análise das expressões artístico-culturais e os efeitos subjetivos para sua racialização. Optamos por analisar aqui as expressões artístico-culturais trazidas pelos/as participantes e os efeitos subjetivos no constituir-se como negro/a. A imersão em práticas artístico-culturais, expressas por meio de múltiplas dimensões da linguagem pelo corpo performático, pode impulsionar a identidade negra positiva, construindo imagens identificatórias que estimulam outras narrativas sobre si, seu corpo e sua negritude. Dentre as expressões artístico-culturais trazidas pelos/as participantes destacam-se o Sopapo poético, o slam e o rap, que são formas de aquilombamento por meio de escrevivências, dos corpoemas, das oralituras e das atrevivências. Podemos concluir que as produções estéticas de negritude são fundamentais para o processo de tornar-se negro.

Resumen Este artículo tiene como objetivo comprender el proceso de identificación y pertenencia racial de personas negras de piel clara mediante el análisis de expresiones artístico-culturales y los efectos subjetivos en su racialización. Optamos por analizar aquí las expresiones artístico-culturales aportadas por los/as participantes y los efectos subjetivos en la construcción de su identidad como negro/a. La inmersión en prácticas artístico-culturales, expresadas a través de múltiples dimensiones del lenguaje en el cuerpo performativo, puede impulsar una identidad negra positiva, construyendo imágenes identificatorias que estimulan otras narrativas sobre uno mismo, su cuerpo y su negritud. Entre las expresiones artístico-culturales aportadas por los/as participantes, destacan el Sopapo poético, el slam y el rap, que son formas de comunidad a través de la escrevivencias, los corpoemas, la oralidad y las experiencias audaces. Podemos concluir que las producciones estéticas de la negritud son fundamentales para el proceso de convertirse en negro/a.

Abstract This article aims to understand the process of racial identification and belonging of light-skinned Black individuals through the analysis of artistic-cultural expressions and their subjective effects on their racialization. We chose to examine here the artistic-cultural expressions brought by the participants and the subjective effects on their self-identification as Black. Immersion in artistic-cultural practices, expressed through multiple dimensions of language in the performative body, can promote positive Black identity by constructing identifying images that stimulate other narratives about oneself, one's body, and one's blackness. Among the artistic-cultural expressions brought by the participants, the poetic Sopapo, Slam, and rap stand out as forms of aquilombamento through escrevivências, corpoemas, oralitura, and atrevivências. We can conclude that the aesthetic productions of blackness are essential to the process of becoming Black.

Características sociodemográficas, laborais, de saúde relacionadas a pacientes submetidos à telenfermagem em estomaterapia / Sociodemographic, employment and health characteristics related to patients submitted to telemonitoring in a stomatherapy clinic / Características sociodemográficas, laborales y de salud relacionadas con los pacientes sometidos a teleenfermería en una clínica de estomaterapia

Objetivo: identificar as características sociodemográficas, laborais de saúde de pessoas submetidas à telenfermagem em uma clínica de estomaterapia. Método: pesquisa quantitativa, descritiva, transversal e de caráter documental, realizada em uma instituição pública de saúde no município do Rio de Janeiro. Resultados: usuários com idade entre 50 e 60 anos (34,79%); pardos (61,96%); homens (55,44%); moradores do município do Rio de Janeiro (69,56%); trabalham sob regime celetista (32,39%); se ausentaram do trabalho ao menos uma vez nos últimos 12 meses (40,85%); não trabalham à noite (81,63%); 18,37% possuem trabalho noturno, 55,85% não descansam ou dormem, e justificam o não descanso noturno pelas altas demandas laborais. Possuem doença crônica (79,75%); são hipertensos (60,31%); não apresentam doença como consequência do trabalho (53,96%). Conclusão: evidenciou-se a necessidade de um maior aprofundamento de práticas de atenção à saúde considerando o impacto das características individuais no processo saúde doença

Objective: to identify the sociodemographic and occupational health characteristics of people undergoing telenursing in a stomatherapy clinic. Method: quantitative, descriptive, cross-sectional and documentary research, carried out in a public health institution in the city of Rio de Janeiro. Results: users aged between 50 and 60 years (34.79%); browns (61.96%); men (55.44%); residents of the city of Rio de Janeiro (69.56%); work under a CLT regime (32.39%); were absent from work at least once in the last 12 months (40.85%); do not work at night (81.63%); 18.37% work at night, 55.85% do not rest or sleep, and they justify the lack of night rest due to the high work demands. They have a chronic disease (79.75%); are hypertensive (60.31%); do not have disease as a result of work (53.96%). Conclusion: the need for a deeper understanding of health care practices was evidenced, considering the impact of individual characteristics on the health-disease process

Objetivo: identificar las características sociodemográficas y de salud ocupacional de personas en teleenfermería en una clínica de estomaterapia. Método: investigación cuantitativa, descriptiva, transversal y documental, realizada en una institución de salud pública de la ciudad de Río de Janeiro. Resultados: usuarios con edad entre 50 y 60 años (34,79%); marrones (61,96%); hombres (55,44%); residentes de la ciudad de Río de Janeiro (69,56%); trabajar en régimen CLT (32,39%); se ausentó del trabajo al menos una vez en los últimos 12 meses (40,85%); no trabaja de noche (81,63%); El 18,37% trabaja de noche, el 55,85% no descansa ni duerme, y justifican la falta de descanso nocturno por las altas exigencias laborales. Tienen una enfermedad crónica (79,75%); son hipertensos (60,31%); no tienen enfermedad como consecuencia del trabajo (53,96%). Conclusión: se evidenció la necesidad de una mayor profundidad de las prácticas de atención a la salud, considerando el impacto de las características individuales en el proceso salud-enfermedad