Perfil clínico, farmacoterapêutico e laboratorial de pacientes internados com insuficiência cardíaca aguda / Clinical, pharmacotherapeutic and laboratory profile of hospitalized patients with acute heart failure / Perfil clínico, farmacoterapéutico y de laboratorio de los pacientes hospitalizados com insuficiência cardíaca aguda

A insuficiência cardíaca aguda (ICA) é uma das causas mais comuns de internação hospitalar, associada a um alto risco de mortalidade. O tratamento atual é principalmente sintomático, sendo os exames laboratoriais realizados, a fim de complementar a avaliação clínica no diagnóstico e auxiliar no estabelecimento do perfil de risco admissional e prognóstico. Este estudo teve como objetivo caracterizar o perfil clínico, farmacoterapêutico e laboratorial de pacientes internados com insuficiência cardíaca aguda em hospital referência regional. Trata-se de um estudo transversal retrospectivo, descritivo, de abordagem quantitativa. Os participantes do estudo foram aqueles com alta médica por ICA pela classificação Internacional de Doenças (CID-10), admitidos na sala de emergência. Excluindo-se a participação de pacientes com tempo de internação inferior a 24 horas, menores de 18 anos. Para análise estatística foi usado o programa SPSS versão 21.0. Quanto ao perfil farmacoterapêutico, os medicamentos mais frequentes foram os que atuam no aparelho cardiovascular e aparelho digestivo e metabolismo, sendo a furosemida o fármaco mais frequente. A análise entre as alterações laboratoriais e a escala de ADHERE, revelou diferença estatística significativa entre os pacientes com risco baixo e risco intermediário/alto nos valores de hemoglobina (p=0,005), TGO (p=0,001), creatinina (p=0,000), ureia (p=0,000), potássio (p=0,004), TTPA (p=0,004) e RNI (p=0,021). Concluiu-se que os medicamentos frequentemente corresponderam ao tratamento recomendado no manejo inicial de pacientes com ICA. O risco de mortalidade intra-hospitalar intermediário/alto de acordo com a escala de ADHERE estavam associados com alterações laboratoriais dos pacientes com ICA.

Acute heart failure (AHF) is one of the most common causes of hospitalization, associated with a high risk of mortality. The current treatment is mainly symptomatic, and laboratory tests are carried out in order to complement the clinical evaluation in the diagnosis and help in establishing the admission and prognostic risk profile. This study aimed to characterize the clinical, pharmacotherapeutic and laboratory profile of patients hospitalized with acute heart failure in a regional reference hospital. This is a retrospective, descriptive, cross-sectional study with a quantitative approach. Study participants were those discharged due to AHF according to the International Classification of Diseases (ICD-10), admitted to the emergency room. Excluding the participation of patients with hospitalization time of less than 24 hours, under 18 years old. For statistical analysis, SPSS version 21.0 was used. As for the pharmacotherapeutic profile, the most frequent drugs were those that act on the cardiovascular and digestive systems and metabolism, with furosemide being the most frequent drug. The analysis between laboratory changes and the ADHERE scale revealed a statistically significant difference between patients at low risk and intermediate/high risk in hemoglobin (p=0.005), TGO (p=0.001), creatinine (p=0.000) values, urea (p=0.000), potassium (p=0.004), APTT (p=0.004) and INR (p=0.021). It was concluded that the medications often corresponded to the recommended treatment in the initial management of patients with AHF. Intermediate/high risk of in-hospital mortality according to the ADHERE scale were associated with laboratory alterations in patients with AHF.

La insuficiencia cardiaca aguda (ICA) es una de las causas más frecuentes de hospitalización, asociada a un alto riesgo de mortalidad. El tratamiento actual es principalmente sintomático y se realizan pruebas de laboratorio para complementar la evaluación clínica en el diagnóstico y ayudar a establecer el perfil de riesgo de ingreso y pronóstico. Este estudio tuvo como objetivo caracterizar el perfil clínico, farmacoterapéutico y de laboratorio de pacientes hospitalizados con insuficiencia cardíaca aguda en un hospital regional de referencia. Se trata de un estudio retrospectivo, descriptivo, transversal con enfoque cuantitativo. Los participantes del estudio fueron los dados de alta por ICA según la Clasificación Internacional de Enfermedades (CIE-10), ingresados en urgencias. Se excluye la participación de pacientes con tiempo de hospitalización menor a 24 horas, menores de 18 años. Para el análisis estadístico se utilizó SPSS versión 21.0. En cuanto al perfil farmacoterapéutico, los fármacos más frecuentes fueron los que actúan sobre los sistemas cardiovascular, digestivo y el metabolismo, siendo la furosemida el fármaco más frecuente. El análisis entre los cambios de laboratorio y la escala ADHERE reveló una diferencia estadísticamente significativa entre los pacientes de riesgo bajo e intermedio/alto en los valores de hemoglobina (p=0,005), TGO (p=0,001), creatinina (p=0,000), urea (p =0,000), potasio (p=0,004), APTT (p=0,004) e INR (p=0,021). Se concluyó que los medicamentos correspondían muchas veces al tratamiento recomendado en el manejo inicial de pacientes con ICA. El riesgo intermedio/alto de mortalidad hospitalaria según la escala ADHERE se asoció con alteraciones de laboratorio en pacientes con ICA.

Rare Presentation of Primary Hyperparathyroidism in a Young Woman.

Even though primary hyperparathyroidism (PHPT) is a common endocrine disorder, due to better and more regular screening, the usual presentation is only seen in less than 15% of cases of PHPT. The authors present the case of a young female patient with a previous medical history of depression and nephrolithiasis, with one year of bone pain, that had become progressively worse and disabling. In the initial work-up, several lytic bone lesions and moderate hypercalcemia were found, leading to admission of the patient in the Internal Medicine ward for investigation and treatment. The ensuing investigation revealed PHPT due to hyperfunctioning parathyroid adenoma. The patient underwent a parathyroidectomy and at the follow-up assessment two months after discharge, she reported no symptoms and a computer tomography scan showed regression of the lytic lesions. This case is a reminder that severe symptomatic PHPT, a rare form in developed countries nowadays, still exists, and even though it is a medical condition, collaboration with surgical specialties is necessary to ensure the best possible treatment and prognosis.

Breast Tuberculosis: A Case Report.

Breast tuberculosis (BTB) is a rare manifestation of tuberculosis (TB), and it is more common in countries with a high incidence of TB. We describe a case of a 36-year-old Angolan woman, who had a history of breast reduction surgery, presenting with right breast enlargement, pain, purulent discharge through multiple skin openings, fever, and abdominal pain, progressively worsening in the past year. She had already undergone several surgical drainages and six months of treatment with ciprofloxacin, with no improvement. Breast ultrasound and MRI were performed, which revealed a large fluid collection, with several small abscesses and surrounding adenopathies, complicated by multiple fistulae. The fluid was drained through needle aspiration, which was found to be sterile for bacteria, mycobacteria, and fungi. A lymph node biopsy showed necrosis without granulomas, and the biopsy culture was positive for Mycobacterium tuberculosis (Mt). This case shows how a rare manifestation can simulate bacterial breast abscesses or cancer, and hence a high index of suspicion is necessary to reach the correct diagnosis and ensure appropriate treatment delivery in these patients.

Oleothorax: A Historic Chest Radiograph Finding.

Even though tuberculosis (TB) is an extremely old disease, proper effective treatment for the condition became available only around 1944, with the discovery of streptomycin's effect on Mycobacterium tuberculosis. Until then, surgical approaches had been among some of the treatments employed, which were dropped with the progressive development of antimycobacterial agents. We present a case of an 83-year-old woman, with a history of pulmonary tuberculosis (PT) at the age of 15 years, presenting with a seven-day history of cough, dark sputum, dyspnea, and pleuritic chest pain. She was submitted to a chest radiograph. The exam revealed a large oval calcified mass on the left apex, compatible with oleothorax. Oleothorax should be included in the differential diagnosis of large calcified thoracic masses in older patients.

Sex-biased admixture and assortative mating shape genetic variation and influence demographic inference in admixed Cabo Verdeans.

Genetic data can provide insights into population history, but first, we must understand the patterns that complex histories leave in genomes. Here, we consider the admixed human population of Cabo Verde to understand the patterns of genetic variation left by social and demographic processes. First settled in the late 1400s, Cabo Verdeans are admixed descendants of Portuguese colonizers and enslaved West African people. We consider Cabo Verde's well-studied historical record alongside genome-wide SNP data from 563 individuals from 4 regions within the archipelago. We use genetic ancestry to test for patterns of nonrandom mating and sex-specific gene flow, and we examine the consequences of these processes for common demographic inference methods and genetic patterns. Notably, multiple population genetic tools that assume random mating underestimate the timing of admixture, but incorporating nonrandom mating produces estimates more consistent with historical records. We consider how admixture interrupts common summaries of genomic variation such as runs of homozygosity. While summaries of runs of homozygosity may be difficult to interpret in admixed populations, differentiating runs of homozygosity by length class shows that runs of homozygosity reflect historical differences between the islands in their contributions from the source populations and postadmixture population dynamics. Finally, we find higher African ancestry on the X chromosome than on the autosomes, consistent with an excess of European males and African females contributing to the gene pool. Considering these genomic insights into population history in the context of Cabo Verde's historical record, we can identify how assumptions in genetic models impact inference of population history more broadly.

Study of the Etiology of Acute Respiratory Infections in Children Under 5 Years at the Dr. Agostinho Neto Hospital, Praia, Santiago Island, Cabo Verde.

Background: Acute respiratory infections are one of the major causes of morbidity and mortality in children under 5 years in developing countries and are a challenge for the health system of these countries. In Cabo Verde, despite the lack of recent studies, data indicate that it affects thousands of children, being the fourth leading cause of infant mortality in 2013. The aim of this study was to identify and describe the etiological agents associated with acute respiratory tract infections in children under 5 years old, and their associated risk factors, such as clinical symptoms or socio-demographic characteristics. Methods: Naso-pharyngeal samples were collected from children under 5 years attending at Dr. Agostinho Neto Hospital (Praia, Santiago Island, Cabo Verde) with suspected ARI at different time-points during 2019. Samples were analyzed using FilmArray® Respiratory Panel v. 2.0 Plus to identify etiological agents of ARI. A questionnaire with socio-demographic information was also collected for each participant. Data analyses were carried out using the IBM SPSS version 25 (IBM Corporation, Armonk, NY) and R 3.5.1 statistical software. Results: A total of 129 naso-pharyngeal samples were included in the study. Seventeen different etiologic agents of respiratory infections were identified. HRV/EV was the most frequent agent detected, followed by FluA H3 and RSV. Coinfection with two or more pathogens was detected in up to 20% of positive samples. The results were analyzed in terms of age-group, sex, period of the year and other social and demographic factors. Conclusion: Viruses are the main causative agents of ARI in children <5 years attending at the pediatrics service at the Dr. Agostinho Neto Hospital in Praia city, Santiago Island, Cabo Verde. Some factors are described in this study as statistically associated with the presence of an infectious agent, such as having one or more children sharing the bedroom with an adult and the presence of some clinical symptoms. The data addresses the need for studies on respiratory tract infections in Cabo Verde.

Genetic Characterization of a New HIV-1 Sub-Subtype A in Cabo Verde, Denominated A8.

Previous molecular characterization of Human immunodeficiency virus (HIV-1) samples from Cabo Verde pointed out a vast HIV-1 pol diversity, with several subtypes and recombinant forms, being 5.2% classified as AU-pol. Thus, the aim of the present study was to improve the characterization of these AU sequences. The genomic DNA of seven HIV-1 AU pol-infected individuals were submitted to four overlapping nested-PCR fragments aiming to compose the full-length HIV-1 genome. The final classification was based on phylogenetic trees that were generated using the maximum likelihood and bootscan analysis. The genetic distances were calculated using Mega 7.0 software. Complete genome amplification was possible for two samples, and partial genomes were obtained for the other five. These two samples grouped together with a high support value, in a separate branch from the other sub-subtypes A and CRF26_A5U. No recombination was verified at bootscan, leading to the classification of a new sub-subtype A. The intragroup genetic distance from the new sub-subtype A at a complete genome was 5.2%, and the intergroup genetic varied from 8.1% to 19.0% in the analyzed fragments. Our study describes a new HIV-1 sub-subtype A and highlights the importance of continued molecular surveillance studies, mainly in countries with high HIV molecular diversity.

Whole-genome analysis uncovers loss of blaZ associated with carriage isolates belonging to methicillin-resistant Staphylococcus aureus (MRSA) clone ST5-VI in Cape Verde.

OBJECTIVES: Surveillance studies for Staphylococcus aureus carriage are a primary tool to survey the prevalence of methicillin-resistant S. aureus (MRSA) in the general population, patients and healthcare workers. We have previously reported S. aureus carriage in various African countries, including Cape Verde. METHODS: Whole-genome sequences of 106 S. aureus isolates from Cape Verde were determined. RESULTS: Staphylococcus aureus carriage isolates in Cape Verde show high genetic variability, with the detection of 27 sequence types (STs) and three primary genetic clusters associated with ST152, ST15 and ST5. One transmission event with less than eight core-genome single nucleotide polymorphisms (cgSNP) differences was detected among the ST5-VI MRSA lineage. Genetic analysis confirmed the phenotypic resistance and allowed the identification of six independent events of plasmid or transposon loss associated with the deletion of blaZ in nine isolates. In the four ST5 MRSA isolates, loss of the blaZ plasmid coincided with the acquisition of SCCmec type VI and an unusual penicillin phenotype with a minimum inhibitory concentration (MIC) at the breakpoint, indicating an adaptation trend in this endemic lineage. Similar events of blaZ plasmid loss, with concomitant acquisition SCCmec elements, were detected among ST5 isolates from different geographical origins. CONCLUSION: Overall, the genome data allowed to place isolates in a phylogenetic context and to identify different blaZ gene deletions associated with plasmid or transposon loss. Genomic analysis unveiled adaptation and evolution trends, namely among emerging MRSA lineages in the country, which deserve additional consideration in the design of future infection control protocols.

Human pegivirus 1 in Cabo Verde: prevalence and genotypic distribution among HIV-infected individuals.

Human pegivirus 1 (HPgV-1) belongs to the genus Pegivirus, family Flaviviridae, and until now has been considered a non-pathogenic agent, despite being considered a risk factor for non-Hodgkin lymphoma. However, a beneficial impact of HPgV-1 on HIV disease progression has been extensively reported. Given the high prevalence of HIV in sub-Saharan Africa and the scarcity of epidemiological data for many countries of West Africa, we conducted the first study of HPgV-1 in HIV-infected individuals from Cabo Verde. To obtain new data regarding prevalence and genetic diversity of HPgV-1 in Africa, serum samples from 102 HIV-infected Cabo Verdeans were tested for the presence of viral RNA, and the circulating genotypes were identified by sequencing of the 5' untranslated region. HPgV-1 RNA was detected in 19.6% (20/102) of the samples. In 72.2% (13/18) of the samples, the virus was identified as genotype 2 (11/13 subtype 2a and 2/13 subtype 2b), and in 27.8% (5/18), it was identified as genotype 1. The estimated substitution rate of HPgV-1 genotype 2 was 5.76 × 10-4, and Bayesian analysis indicated the existence of inner clusters within subtypes 2a and 2b. The prevalence of HPgV-1 viremia in Cabo Verde agrees with that reported previously in Africa. Genotypes 1 and 2 cocirculate, with genotype 2 being more common, and HIV/HPgV-1 coinfection was not associated with higher CD4 T cell counts in the studied population. This finding contributes for the expansion of the pegivirus research agenda in African countries.

Avaliação da cognição de um grupo de idosos institucionalizados de uma região do norte de Portugal / Cognition assessment of a group of institutionalized aged from a northern region of Portugal / Evaluación cognitiva de un grupo de ancianos institucionalizados de una región del norte de Portugal

Resumo Contexto: Envelhecer compreende um conjunto de alterações, nomeadamente cognitivas; existindo uma linha muito ténue entre as mudanças esperadas para esta etapa da vida e as alterações de cariz patológico. Cerca de 80% das pessoas com défice cognitivo desenvolvem demência, pelo que, é fundamental intervir para retardar o aparecimento desta síndrome. O primeiro passo para a intervenção é a avaliação do perfil cognitivo destas pessoas. Objetivos: Identificar o perfil cognitivo de um grupo de idosos de uma região do Norte de Portugal; e identificar a relação entre as variáveis sociodemográficas e o perfil cognitivo de um grupo de idosos de uma região do Norte de Portugal. Métodos: Estudo quantitativo, transversal, descritivo-correlacional de corte. A amostra foram idosos institucionalizados (n = 37) com capacidade para responder a um questionário composto por questões sociodemográficas e pelo Montreal Cognitive Assessment (MoCA), versão portuguesa. A colheita de dados decorreu entre Novembro de 2017 e Fevereiro de 2018, sendo cumpridos todos os pressupostos éticos da investigação com humanos. Resultados: Os participantes eram maioritariamente mulheres (67,6%), com média de idade de 82 anos, viúvas e com mais de 4 anos de escolaridade. A pontuação obtida no MOCA variou entre 6 e 24 pontos, verificando-se correlação entre o score global e as variáveis sexo e idade. Todos os participantes apresentaram défices maioritariamente na linguagem e na abstração. Conclusões: Evidenciou-se uma maior prevalência de défices cognitivos na população mais velha, sendo clara a importância de avaliar e intervir na cognição destas pessoas, objetivando a manutenção/regressão dos défices e prevenindo a evolução para quadros demenciais. Pela proximidade a esta população, os enfermeiros, nomeadamente os especialistas em saúde mental e psiquiatria, são agentes privilegiados para a intervenção nesta área, através da implementação de programas de estimulação geral da cognição.

Abstract Background: Aging comprises a set of changes, namely cognitive. There is a very thin line between the expected changes for this stage of life and the pathological changes. About 80% of people with cognitive impairment develop dementia, so it is essential to intervene to delay the onset of this syndrome. The first step for the intervention is the assessment of the cognitive profile of these people. Aim: To identify the cognitive features of a group of aged from a region of northern Portugal; and to identify the relationship between sociodemographic variables and cognitive features of a group of elderly people from a northern region of Portugal. Methods: Quantitative, cross-sectional and descriptive-correlational study. The sample consisted of institutionalized aged (n = 37) capable of answering a questionnaire composed of sociodemographic questions and the Montreal Cognitive Assessment (MoCA), Portuguese version. Data collection took place between November 2017 and February 2018, and all ethical assumptions for human research were met. Results: The participants were mostly women (67.6%), with an average age of 82 years, widows and with more than 4 years of schooling. The MOCA score ranged from 6 to 24 points, with a correlation between the overall score and the gender and age variables. All participants presented deficits mostly in language and abstraction. Conclusions: The results confirm the higher prevalence of cognitive deficits in the older population, being clear the importance of evaluating and intervening in the cognition of these people, aiming at the maintenance / regression of the deficits and preventing the evolution to dementia. Due to the proximity to this population, nurses, namely specialists in mental health and psychiatry, are privileged agents for intervention in this area, through the implementation of general cognition stimulation programs.

Resumen Contexto: El envejecimiento comprende un conjunto de cambios, a saber, cognitivos; Hay una línea muy delgada entre los cambios esperados en esta fase de la vida y los cambios patológicos. Alrededor del 80% de las personas con deterioro cognitivo desarrollan demencia, por lo que es esencial intervenir para retrasar la aparición de este síndrome. El primer paso para la intervención es la evaluación del perfil cognitivo de estas personas. Objetivo(s): Identificar las características cognitivas de un grupo de ancianos de una región del norte de Portugal; e identificar la relación entre las variables sociodemográficas y las características cognitivas de un grupo de ancianos de una región del norte de Portugal. Metodología: Estudio cuantitativo, transversal y descriptivo-correlacional de corte. La muestra consistió en ancianos institucionalizados (n = 37), capaces de responder un cuestionario compuesto por preguntas sociodemográficas y la Evaluación Cognitiva de Montreal (MoCA), versión portuguesa. La recopilación de datos tuvo lugar entre noviembre de 2017 y febrero de 2018, y se cumplieron todos los supuestos éticos para la investigación en humanos. Resultados: Los participantes eran en su mayoría mujeres (67,6%), con una edad promedio de 82 años, viudas y con más de 4 años de estudio. El puntaje MOCA varió de 6 a 24 puntos, con una correlación entre el puntaje general y las variables de género y edad. Todos los participantes presentaron déficits principalmente en lenguaje y abstracción. Conclusiones: Los resultados confirman la mayor prevalencia de déficits cognitivos en la población de edad avanzada, dejando en claro la importancia de evaluar e intervenir en la cognición de estas personas, apuntando al mantenimiento / regresión de los déficits y evitando la evolución a la demencia. Debido a la proximidad a esta población, las enfermeras, es decir, especialistas en salud mental y psiquiatría, son agentes privilegiados para la intervención en esta área, a través de la implementación de programas generales de estimulación cognitiva.

Nutritional Counseling Protocol for Colorectal Cancer Patients after Surgery Improves Outcome.

Incidences of colorectal cancer (CRC) have continued to grow. Surgery is the main treatment and the only curative factor is nutritional status, which has an enormous influence on postoperative evolution. This study proposes a protocol for nutritional intervention beginning preoperatively and lasting up to three months postoperatively. Twenty patients with confirmed diagnosis of colon adenocarcinoma who underwent resection surgery were included. Anthropometric and food intake data-assessed through two 24-hour recalls, one weekday and one weekend-were collected at baseline, one month postoperative (PO), and three months PO. Anthropometric evaluation showed a decrease in the first month PO in weight, BMI, Hand grip strength, and arm circumference (P < 0.05), but these parameters recovered after 3 mo, PO and concomitant with the increase in protein and dietary fiber intake. In addition, collateral symptoms, such as abdominal distension, abdominal pain, and post prandial fullness, decreased between baseline and three months postoperative (P < 0.05). The nutritional counseling protocol for patients undergoing surgery due to CRC was positive in the recovery of nutritional status and improve of symptoms.

Phosphorus and suspended matter retention in mangroves affected by shrimp farm effluents in NE Brazil.

This study compares two mangroves with different land uses in the Jaguaribe River estuary, harboring large shrimp farms, and in the more pristine Pacotí River estuary. Normalized Difference Vegetation Index (NDVI) was used to compare the overall health of the forests. Measures of suspended matter (TSS), total (TP), particulate (PartP) and soluble reactive phosphorus (SRP) in the inflow and outflow waters of tidal channels draining the mangroves were performed during tidal cycles. NDVI varied from 0.65 in the Jaguaribe estuary to 0.85 in the Pacotí, suggesting the impact of shrimp farm effluents on mangrove canopy cover. The shrimp farm influenced site showed 10 times larger absolute ∑P (TP + PartP + SRP) = 1.2-5.2 kg.hr-1) flux than the pristine site (∑P = 0.22 kg.hr-1). Tidal balances showed smaller retentions of the total influx: 28-54%; 44-45%; 38-65% and 8-53% for TSS; TP; SRP; and PartP respectively, in the shrimp farm influenced site to over 93% of the total tidal input of TSS and all P fractions in the pristine mangrove. This suggests that mangrove phosphorus accumulation is decreased in the forest with lower NDVI and limits mangrove's potential as a natural barrier to the nutrient transport to adjacent estuarine and coastal waters.

Forensic nursing practice - What do the students know anyway?

BACKGROUND: Forensic Nursing emerges as a new nursing practice, combining scientific and technical nursing knowledge with Forensic Science principles. OBJECTIVES: To evaluate the level of knowledge about the Forensic Nursing Practices in the 4th year students of the Nursing Degree. METHODOLOGY: A cross sectional analysis study conducted with a sample of 240 students. The Knowledge Questionnaire over Forensics Nursing Practices (KQFNP) was applied in a survey. RESULTS: The level of knowledge of the students of the 4th year of the Degree in Nursing was good (52.1%), sufficient (21.3%) and insufficient (26.7%), according with scale scored defined, with the existence of deficits essentially at the level of crucial aspects of the preservation of vestiges. CONCLUSION: The evidence emphasizes the need of investment in the training of the students over forensic nursing practices. So, basic knowledge of forensic nursing is a critical concept to be included in core curriculum of a four-year nursing degree program.

A five-year retrospective study shows increasing rates of antimicrobial drug resistance in Cabo Verde for both Staphylococcus aureus and Escherichia coli.

OBJECTIVES: Data on baseline drug resistance important in informing future antimicrobial stewardship programs. So far, no data on the antimicrobial drug resistance of clinical isolates available for the African archipelago of Cabo Verde. METHODS: We performed a retrospective analysis over years (2013-17) of the drug susceptibility profiles of clinical isolates in the two main hospitals of Cabo Verde. For Escherichia coli and Staphylococcus aureus, representing 47% and 26% of all clinical isolates, the antimicrobial drug resistance profile was reported for six representative drugs. RESULTS: For E. coli we detected an increase in resistance to ampicillin, amoxicillin/clavulanic acid, ceftriaxone, ciprofloxacin and trimethoprim-and for S. aureus to methicillin, erythromycin and trimethoprim-sulfamethoxazole. This increase in both the most commonly isolated bacterial pathogens is alarm as it might compromise empirical treatment in a setting with limited access to laboratory testing. CONCLUSIONS: When compared to the published low resistance rates in carriage isolates, the more alarming situation in clinical isolates for S. aureus might encourage antimicrobial stewardship programs to reduce in hospital settings, possibly as part of the Cabo Verdean national plan against antimicrobial drug resistance.

Automedicação: comportamento de um grupo de estudantes de saúde no ensino superior / Self-medication: behavior of a group of health students in higher education

Introduction: In developed countries, self-medication has become a common practice, especially where over-the-counter medication is possible. Self-medication is considered one of the main public health problems. Aim: To characterize the profile of a group of students in health higher education, in relation to self-medication during their academic career. Methods: Cross-sectional descriptive exploratory study, framed in the quantitative paradigm. 285 students from the Nursing Degree and Physiotherapy Degree courses, a stratified sample, from a private Higher School of Health in northern Portugal, participated. A structured questionnaire was used to gather the necessary information for the study, the data collection period was from October to December 2017. Data analysis was performed using the Statistical Package for Social Sciences (SPSS - version 24), using descriptive statistics techniques (univariate and bivariate). Results and Discussion: Participated predominantly female students, with an average age of 21 years. They resort to self-medication, and on their own initiative. The most commonly used drugs were analgesics and anti-inflammatory drugs, which were consumed for short periods. The results obtained with the study are in line with others developed in the area. Conclusions: Students self-medicate and base their decision making with knowledge in pharmacology. These results are important for the population where the study was conducted. It is suggested to approach non-pharmacological interventions to treat pain cause that stood out for self-medication

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Nível de e-literacia em saúde em alunos do ensino secundário privado / Level of e-literacy in health in private secondary school students

Introduction: e-literacy in health is related to the use of Internet or other electronic means related to the dissemination or visualization of information about health and / or health services. Objectives: To describe the level of e-literacy in health, in a group of students of a private high school, in the North of Portugal; to relate the level of e-literacy in health with sociodemographic data; to relate the level of e-literacy in health with the contextual variables of the students. Method: Descriptive, correlational and transversal quantitative study. 102 students from the science and technology course of a private high school in the north of Portugal participated. A questionnaire was applied consisting of 3 groups: group I sociodemographic variables; group II consisted of contextual variables and group III constituted by the "eHEALS - eHealth Literacy Scale" scale. Results: Students presented positive levels of e-Literacy in health. They know how to use the Internet to find health information and recognize its usefulness and importance, but did not have confidence in the information obtained when making deci-sions on health. Conclusion: Students present positive levels of e-literacy in health but need guidance to the sources of consultation in order to rely on the information accessed for health project management

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Principais problemas éticos nos cuidados de saúde primários / Major ethical problems in primary health care

Introduction: Identifying the ethical problems experienced in Primary Health Care leads us to the importance of reflection on them being essential for a humanizing care culture. Aim: To describe the main ethical problems in the daily life of health professionals in Primary Health Care. Methods: Integrative Literature Review, conducted between October / December 2016. The following databases were used: Medline, Scielo, UCP Institutional Repository and RCAAP. Inclusion criteria were: primary studies that met the study objectives and studies under 10 years. We found 200 studies. 97 were excluded for not meeting the study objectives, 24 because they were not from primary sources, 45 because they were not fully presented, and 34 because they were older than 10 years. They incorporated the integrative review 5 articles. Results and Discussion: It was noticed that the main ethical problems identified can be distributed in 3 groups: ethical problems in relations with users and families; ethical problems in team relations and ethical problems in health system relations. It has been noted that as the number of years of experience increases, ethical problems become more supported and sustained. It was found that there are differences in the identification of ethical problems between nurses and doctors working in Primary Health Care. Conclusions: All studies present ethical issues in relationships with clients and family members; interprofessional relations and relations with the health system. In addition, it was found that ethical problems are influenced by length of service and profession

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Abordagem na sala de emergência: dotação adequada de recursos de enfermagem / Emergency room approach: safe nursing staffing / Enfoque en la sala de urgencias: dotación adecuada de los recursos de enfermería

Enquadramento: O prognóstico da pessoa em situação crítica na sala de emergência depende da eficácia da atuação da equipa que a assiste. Objetivos: Perceber e justificar a necessidade de alocar um enfermeiro que tenha como função a abordagem em exclusivo a clientes da sala de emergência num hospital da região de Lisboa e Vale do Tejo com um serviço de urgência polivalente. Metodologia: Estudo retrospetivo, descritivo, exploratório, quantitativo. 3185 clientes críticos, recolha de informação por grelha de observação. Análise estatística foi realizada com o software IBM SPSS Statistics, versão 25.0. Recorreu-se ao teste de Kruskal-Wallis e Qui-quadrado. Resultados: No ano de 2017, na sala de emergência admitiram-se em média 9 clientes por dia, os cuidados diretos prestados exigiram em média 45,4 minutos, 65% foram admitidos na unidade de internamento médico-cirúrgico do serviço de urgência ou na área de observação clínica do mesmo serviço. Conclusão: Emerge a necessidade de garantir dotação adequada aquando da prestação de cuidados à pessoa em situação crítica, sendo necessário um enfermeiro para funções exclusivas à sala de emergência.

Background: The prognosis of the critically ill person in the emergency room depends on the effective performance of the health team in operation. Objectives: To understand and justify the need to allocate a nurse who works exclusively in the assistance to patients in the emergency room of a hospital in the Great Lisbon and Tagus Valley region with multipurpose emergency service. Methodology: Retrospective, descriptive, exploratory, and quantitative study, with a sample of 3185 critically ill patients. Data collection through observation grid. Statistical analysis was performed using the IBM SPSS Statistics software, version 25.0. The Kruskal-Wallis test and chi-square test were used. Results: In 2017, an average of 9 patients per day were admitted in the emergency room. The direct care delivered lasted, on average, 45.4 minutes, 65% were admitted to the surgical admission unit service or the area of clinical observation of the emergency department. Conclusion: It is crucial to ensure safe staffing in care delivery to the critically ill person, being necessary a nurse working exclusively in the emergency room.

Marco contextual: El pronóstico de la persona en una situación crítica en la sala de urgencias depende de la eficacia del equipo que la asiste. Objetivos: Comprender y justificar la necesidad de asignar un enfermero cuya función sea atender exclusivamente a los pacientes de la sala de urgencias de un hospital de la región de Lisboa y Valle del Tajo con un servicio de urgencias polivalente. Metodología: Estudio retrospectivo, descriptivo, exploratorio y cuantitativo. 3185 pacientes críticos, recopilación de información mediante una parilla de observación. El análisis estadístico se realizó con el programa IBM SPSS Statistics, versión 25.0. Se utilizó la prueba de Kruskal-Wallis y la de ji al cuadrado. Resultados: En 2017, se admitió una media de 9 pacientes por día en la sala de urgencias, la atención directa prestada exigió un promedio de 45,4 minutos, el 65% fue admitido en la unidad de internamiento médico-quirúrgico del servicio de urgencias o en el área de observación clínica del mismo servicio. Conclusión: Es necesario garantizar una dotación adecuada cuando se atiende a la persona en una situación crítica, y es necesario un enfermero para las funciones exclusivas de la sala de urgencias.

Correction to: Tracking cognitive impairment in multiple sclerosis using the Brain on Track test: a validation study.

The above article was published online with an error in author name's affiliations. Affiliation 8 has to be added to Maria Pia Amato and has to be deleted from Vitor Tedim.

Tracking cognitive impairment in multiple sclerosis using the Brain on Track test: a validation study.

BACKGROUND: The accurate and regular monitoring cognitive performance in multiple sclerosis (MS) patients is critical to develop new prevention and management strategies for cognitive impairment (CI). The Brain on Track (BoT) test is a self-administered web-based tool developed for cognitive screening and monitoring. The objective of this study was to validate the use of the BoT in MS, by assessing its ability to distinguish between MS patients and matched controls, as well as detect CI among MS patients, by analysing its correlation with standard cognitive tests and its reliability and learning effects in repeatable use. METHODS: The BoT was applied in 30 patients with MS consecutively selected and 30 age- and education-matched controls, first in a hospital clinic, under supervision, and then 1 week later from home. After these first two trials, MS patients repeated the test from home every 4 weeks for 3 months. A standard neuropsychological battery was also applied to MS patients at baseline. RESULTS: The Cronbach's alpha was 0.89. Test scores were significantly different between MS patients and controls (Cohen's d = 0.87; p < 0.01). Among MS patients, scores were significantly lower in those with CI documented in the standard neuropsychological battery than in their cognitively preserved counterparts (Cohen's d = 2.0; p < 0.001). The BoT scores presented a good correlation with standard neuropsychological tests, particularly for information processing speed. Regarding test-retest reliability, 10/11 subtests presented two-way mixed single intraclass consistency correlation coefficients > 0.70. CONCLUSION: The BoT showed good neuropsychological parameters in MS patients, endorsing the use of self-administered computerized tests in this setting.