Ten Issues for Updating in Community-Acquired Pneumonia: An Expert Review.

Community-acquired pneumonia represents the third-highest cause of mortality in industrialized countries and the first due to infection. Although guidelines for the approach to this infection model are widely implemented in international health schemes, information continually emerges that generates controversy or requires updating its management. This paper reviews the most important issues in the approach to this process, such as an aetiologic update using new molecular platforms or imaging techniques, including the diagnostic stewardship in different clinical settings. It also reviews both the Intensive Care Unit admission criteria and those of clinical stability to discharge. An update in antibiotic, in oxygen, or steroidal therapy is presented. It also analyzes the management out-of-hospital in CAP requiring hospitalization, the main factors for readmission, and an approach to therapeutic failure or rescue. Finally, the main strategies for prevention and vaccination in both immunocompetent and immunocompromised hosts are reviewed.

Critical appraisal beyond clinical guidelines for intraabdominal candidiasis.

BACKGROUND: Regardless of the available antifungals, intraabdominal candidiasis (IAC) mortality continues to be high and represents a challenge for clinicians. MAIN BODY: This opinion paper discusses alternative antifungal options for treating IAC. This clinical entity should be addressed separately from candidemia due to the peculiarity of the required penetration of antifungals into the peritoneal cavity. Intraabdominal concentrations may be further restricted in critically ill patients where pathophysiological facts alter normal drug distribution. Echinocandins are recommended as first-line treatment in guidelines for invasive candidiasis. However, considering published data, our pharmacodynamic analysis suggests the required increase of doses, postulated by some authors, to attain adequate pharmacokinetic (PK) levels in peritoneal fluid. Given the limited evidence in the literature on PK/PD-based treatments of IAC, an algorithm is proposed to guide antifungal treatment. Liposomal amphotericin B is advocated as first-line therapy in patients with sepsis/septic shock presenting candidemia or endophthalmitis, or with prior exposure to echinocandins and/or fluconazole, or with infections by Candida glabrata. Other situations and alternatives, such as new compounds or combination therapy, are also analysed. CONCLUSION: There is a critical need for more robust clinical trials, studies examining patient heterogeneity and surveillance of antifungal resistance to enhance patient care and optimise treatment outcomes. Such evidence will help refine the existing guidelines and contribute to a more personalised and effective approach to treating this serious medical condition. Meanwhile, it is suggested to broaden the consideration of other options, such as liposomal amphotericin B, as first-line treatment until the results of the fungogram are available and antifungal stewardship could be implemented to prevent the development of resistance.

A Qualitative Analysis of Treatment Patterns for Mild and Severe Molar Hypomineralization in Permanent Teeth: A Systematic Review.

Purpose: Using a systematic review to answer the following question: What are the treatment patterns for mild and severe molar hypomineralization in permanent teeth? Methods: Electronic searches were conducted to identify randomized clinical trials (RCT) that related treatment to molar hypomineralization- (MH) affected permanent molars in children from five to 16 years old. Data extraction and risk of bias evaluation, using the Cochrane risk of bias tool, were performed for all included studies. Studies were selected according to PICOS criteria. RCTs relating mild and severe MH to treatments on permanent molars were included. Studies analyzing clinical techniques, whether single or any association of tech- niques for restorative and desensitizing treatments, were included. Studies involving another disease or comparing different types of enamel defects related to trauma and hereditary were excluded. The certainty of the evidence was evaluated using the GRADE approach. Results: The electronic search was performed on MEDLINE via PubMed, Embase, Cochrane Library, and Grey literature up to May 9, 2022. Of the 5,201 studies initially identified, 88 were fully assessed and 14 RCTs were included. A total of 2,399 interventions were analyzed in 576 patients. Certainty of evidence was found to be of low quality for the outcomes remineralization, structural integrity maintenance, and decay prevention, and very low quality for hypersensitivity decrease and retention. Conclusions: Mild molar hypomineralization needs remineralization, desensitization, sealants, and close follow-up. Severe MH requires restoration both to treat hypersensitivity and reconstruct the affected teeth. Yellow-brown defects have a poor prognosis.

Influência do Percentual de Ítrio nas Propriedades da Zircônia Monolítica: Revisão de Literatura / INFLUENCE OF YTRIO PERCENTAGE ON MONOLITHIC ZIRCONIA PROPERTIES: LITERATURE REVIEW

A principal desvantagem da zircônia convencional é sua alta opacidade. Dependendo de diversas condições, especialmente o conteúdo do estabilizador ítrio, é possível contornar essa questão. Em vista disso, várias gerações de zircônia estabilizada com ítrio foram desenvolvidas buscando aliar a robustez da zircônia com a estética das facetas em porcelana. O presente trabalho teve como objetivo realizar uma análise a respeito de como o aumento ou a redução do percentual de ítrio na composição das zircônias monolíticas podem influenciar em suas propriedades, sobretudo no que tange à translucidez. Este estudo foi executado através de uma revisão nas bases de dados SciELO, PubMed e Google Scholar, com artigos publicados entre 2013 e 2021.Desse modo, concluiu-se que o maior teor de Y2O3 tendeu a aumentar a quantidade de fase cúbica isotrópica presente e reduzir a quantidade de fase tetragonal birrefringente no ZrO2, juntamente com uma minimização da dispersão de luz por fases secundárias, levando ao aumento da translucidez e resistência ao envelhecimento. À medida que o óxido de ítrio aumenta, os tamanhos dos grãos de zircônia tendem a aumentar também. A tenacidade e a resistência à fratura podem ser consideravelmente sacrificadas.

Current Positioning against Severe Infections Due to Klebsiella pneumoniae in Hospitalized Adults.

Infections due to Klebsiella pneumoniae have been increasing in intensive care units (ICUs) in the last decade. Such infections pose a serious problem, especially when antimicrobial resistance is present. We created a task force of experts, including specialists in intensive care medicine, anaesthesia, microbiology and infectious diseases, selected on the basis of their varied experience in the field of nosocomial infections, who conducted a comprehensive review of the recently published literature on the management of carbapenemase-producing Enterobacterales (CPE) infections in the intensive care setting from 2012 to 2022 to summarize the best available treatment. The group established priorities regarding management, based on both the risk of developing infections caused by K. pneumoniae and the risk of poor outcome. Moreover, we reviewed and updated the most important clinical entities and the new antibiotic treatments recently developed. After analysis of the priorities outlined, this group of experts established a series of recommendations and designed a management algorithm.

Plasma-induced nanoparticle aggregation for stratifying COVID-19 patients according to disease severity.

Stratifying patients according to disease severity has been a major hurdle during the COVID-19 pandemic. This usually requires evaluating the levels of several biomarkers, which may be cumbersome when rapid decisions are required. In this manuscript we show that a single nanoparticle aggregation test can be used to distinguish patients that require intensive care from those that have already been discharged from the intensive care unit (ICU). It consists of diluting a platelet-free plasma sample and then adding gold nanoparticles. The nanoparticles aggregate to a larger extent when the samples are obtained from a patient in the ICU. This changes the color of the colloidal suspension, which can be evaluated by measuring the pixel intensity of a photograph. Although the exact factor or combination of factors behind the different aggregation behavior is unknown, control experiments demonstrate that the presence of proteins in the samples is crucial for the test to work. Principal component analysis demonstrates that the test result is highly correlated to biomarkers of prognosis and inflammation that are commonly used to evaluate the severity of COVID-19 patients. The results shown here pave the way to develop nanoparticle aggregation assays that classify COVID-19 patients according to disease severity, which could be useful to de-escalate care safely and make a better use of hospital resources.

Micro- and nanosensors for detecting blood pathogens and biomarkers at different points of sepsis care.

Severe infections can cause a dysregulated response leading to organ dysfunction known as sepsis. Sepsis can be lethal if not identified and treated right away. This requires measuring biomarkers and pathogens rapidly at the different points where sepsis care is provided. Current commercial approaches for sepsis diagnosis are not fast, sensitive, and/or specific enough for meeting this medical challenge. In this article, we review recent advances in the development of diagnostic tools for sepsis management based on micro- and nanostructured materials. We start with a brief introduction to the most popular biomarkers for sepsis diagnosis (lactate, procalcitonin, cytokines, C-reactive protein, and other emerging protein and non-protein biomarkers including miRNAs and cell-based assays) and methods for detecting bacteremia. We then highlight the role of nano- and microstructured materials in developing biosensors for detecting them taking into consideration the particular needs of every point of sepsis care (e.g., ultrafast detection of multiple protein biomarkers for diagnosing in triage, emergency room, ward, and intensive care unit; quantitative detection to de-escalate treatment; ultrasensitive and culture-independent detection of blood pathogens for personalized antimicrobial therapies; robust, portable, and web-connected biomarker tests outside the hospital). We conclude with an overview of the most utilized nano- and microstructured materials used thus far for solving issues related to sepsis diagnosis and point to new challenges for future development.

Fabrication and characterization of low-shrinkage dental composites containing montmorillonite nanoclay.

Dental composites are aesthetic materials widely used in Dentistry for replacing hard dental tissues lost due to caries or traumas. The aim of this study was to fabricate low-shrinkage dental composite charged with nanoclay fillers (montmorillonite Cloisite®-MMT) and evaluate their cytotoxicity and physicomechanical properties. Four dental composites were produced from the same organic matrix: Bis-GMA/TEGDMA (30 wt.%). The filler system was constituted of BaSi, SiO2, and MMT in the following concentrations (wt.%): 93.8/6.2/0, 89.1/5.9/5, 86.7/5.8/7.5, and 84.4/5.6/10 (E0: 0; E5: 5%; E7.5: 7.5%; E10: 10% of MMT nanoclays). The following properties were tested: in vitro cytotoxicity, flexural strength, elastic modulus, volumetric shrinkage, water sorption, water solubility, and hygroscopic expansion. Scanning electron microscopy was used to characterize composites' topography. Data were analyzed by one-way ANOVA and Tukey's HSD post hoc test (p < 0.05). MMT nanoclays did not affect the cytotoxicity. E5 and E7.5 groups showed a significant decrease in polymerization shrinkage while maintained the overall physicomechanical properties. The inclusion of 5 and 7.5 wt.% of MMT nanoclays allowed the fabrication of dental composites with low cytotoxicity and low polymerization shrinkage, without jeopardizing the overall behaviour of their physicomechanical properties (flexural strength, elastic modulus, water sorption, water solubility, and hygroscopic expansion). These aspects suggest that the usage of MMT nanoclays could be an effective strategy to formulate new dental composites with clinical applicability.

Career commitment and career entrenchment among Primary Health Care workers / Compromiso y afianzamiento con la carrera del personal de la Atención Primaria de Salud / Comprometimento e entrincheiramento com a carreira em trabalhadores da Atenção Primária à Saúde

ABSTRACT Objective: Assess levels of career commitment and career entrenchment among Primary Health Care workers. Methods: This Cross-sectional study addressed 393 workers using the Brazilian versions of the Career Commitment Measure (CCM) and Career Entrenchment Measure (CEM). Results: Levels of Career commitment [75.5-77.5] were higher (p<0.001) than Career Entrenchment [66.7-69.2]. Identity levels [82.7-85.5] were higher (p<0.001) than Investment levels [60.4-65.0]. Career resilience levels [75.1-79.2] were higher (p<0.001) than Emotional costs [69.0-72.1]. Planning levels [64.2-67.1] were lower (p<0.001) than levels of limitedness of career alternatives [68.1-71.0]. Conclusion: The highest scores were obtained in Career commitment, showing the workers' identification and positive relationship with their careers, that is, these workers remain in Primary Health Care services because they identify themselves with their professions.

RESUMEN Objetivo: Evaluar los niveles de compromiso y afianzamiento con la carrera del personal de la Atención Primaria de Salud. Métodos: Se trata de un estudio transversal, realizado entre 393 trabajadores, en el que se utilizaron las versiones brasileras de las Escalas de Compromiso con la Carrera (ECC) y de Afianzamiento con la Carrera (EEC). Resultados: Los niveles de Compromiso [75,5 - 77,5] eran superiores (p<0,001) a los de Afianzamiento [66,7 - 69,2]. Los niveles de Identidad [82,7 - 85,5] eran superiores (p<0,001) a los de Inversión [60,4 - 65,0]. Los niveles de Resiliencia con la carrera [75,1 - 79,2] eran superiores (p<0,001) a los de Costo emocional [69,0 - 72,1]. Los niveles de Planificación [64,2 - 67,1] eran inferiores (p<0,001) a los de Limitación de alternativas [68,1 - 71,0]. Conclusión: Predominó el vínculo de compromiso con la carrera, lo que demuestra una identificación y relación positiva de los trabajadores con la misma y permanecen en la Atención Primaria de Salud porque se identifican con la profesión.

RESUMO Objetivo: Avaliar os níveis de comprometimento e entrincheiramento com a carreira de trabalhadores da Atenção Primária à Saúde. Métodos: Estudo transversal com 393 trabalhadores, utilizando as versões brasileiras das Escalas de Comprometimento com a Carreira (ECC) e de Entrincheiramento na Carreira (EEC). Resultados: Os níveis de Comprometimento [75,5 - 77,5] foram superiores (p<0,001) aos de Entrincheiramento [66,7 - 69,2]. Os níveis de Identidade [82,7 - 85,5] foram superiores (p<0,001) aos níveis de Investimentos [60,4 - 65,0]. Os níveis de Resiliência com a carreira [75,1 - 79,2] foram superiores (p<0,001) aos níveis de Custos emocionais com a carreira [69,0 - 72,1]. Os níveis de Planejamento [64,2 - 67,1] foram inferiores (p<0,001) aos níveis de Limitação de alternativas [68,1 - 71,0]. Conclusão: Predominou o vínculo de comprometimento com a carreira, evidenciando identificação e relação positiva dos trabalhadores com a carreira, os quais permanecem na Atenção Primária à Saúde porque se identificam com a profissão.

Occupational stress and work engagement among military police officers. / Estresse ocupacional e engajamento no trabalho entre policiais militares.

This paper investigates the levels of occupational stress and work engagement among military police officers. This cross-sectional, descriptive, and analytical study was conducted with 268 police officers from the 3rd Military Police Battalion of Paraná state. We observed significant levels of occupational stress in 125 (46.7%) police officers. The main stressors were lack of career growth prospects (3.7; ±1.3); inadequate training (3.4; ±1.2); discrimination/favoritism in the work environment (3.1; ±1.4); long working hours (3.0; ±1.4); distribution of tasks (2.7; ±1.1); control type (2.7; ±1.1); gaps in disclosing information about organizational decisions (2.7; ±1.2); low valuation (2.7; ±1.2). Levels of work engagement ranged from 3.8 [medium] to 4.1 [high]. The correlation between occupational stress and work engagement was low for the dimensions of Absorption (r: -.284; p<0.001) and Overall Score (r: -0.393; p<0.001) and moderate for the dimensions Vigor (r: -0.422; p<0.001) and Dedication (r: -0.414; p<0.001). We concluded that an important number of police officers had shown occupational stress. However, they displayed good levels of work engagement and are enthusiastic, inspired, and proud of their work.

Este artigo investiga os níveis de estresse ocupacional e engajamento no trabalho entre policiais militares. Estudo transversal, descritivo e analítico, com 268 policiais do 3º Batalhão de Polícia Militar do estado do Paraná. Observou-se níveis importantes de estresse ocupacional em 125 (46,7%) policiais. Os principais estressores foram: falta de perspectivas de crescimento na carreira (3,7; ±1,3); deficiência nos treinamentos (3,4; ±1,2); presença de discriminação/favoritismo no ambiente de trabalho (3,1; ±1,4); longas jornadas de trabalho (3,0; ±1,4); forma de distribuição das tarefas (2,7; ±1,1); tipo de controle (2,7; ±1,1); deficiência na divulgação de informações sobre decisões organizacionais (2,7; ±1,2); baixa valorização (2,7;±1,2). Os níveis de engajamento no trabalho variaram de 3,8 [médio] a 4,1 [alto]. A correlação entre estresse ocupacional e engajamento no trabalho foi baixa para as dimensões 'Absorção' (r: -0,284; p<0,001) e 'Escore geral' (r: -0,393; p<0,001) e moderada para as dimensões 'Vigor' (r: -0,422; p<0,001) e 'Dedicação' (r: -0,414; p<0,001). Concluiu-se que há um importante número de policiais com estresse ocupacional que, no entanto, apresentam bons níveis de engajamento no trabalho e mostram-se entusiasmados, inspirados e orgulhosos com o seu trabalho.

Estresse ocupacional e engajamento no trabalho entre policiais militares / Occupational stress and work engagement among military police officers

Resumo Este artigo investiga os níveis de estresse ocupacional e engajamento no trabalho entre policiais militares. Estudo transversal, descritivo e analítico, com 268 policiais do 3º Batalhão de Polícia Militar do estado do Paraná. Observou-se níveis importantes de estresse ocupacional em 125 (46,7%) policiais. Os principais estressores foram: falta de perspectivas de crescimento na carreira (3,7; ±1,3); deficiência nos treinamentos (3,4; ±1,2); presença de discriminação/favoritismo no ambiente de trabalho (3,1; ±1,4); longas jornadas de trabalho (3,0; ±1,4); forma de distribuição das tarefas (2,7; ±1,1); tipo de controle (2,7; ±1,1); deficiência na divulgação de informações sobre decisões organizacionais (2,7; ±1,2); baixa valorização (2,7;±1,2). Os níveis de engajamento no trabalho variaram de 3,8 [médio] a 4,1 [alto]. A correlação entre estresse ocupacional e engajamento no trabalho foi baixa para as dimensões 'Absorção' (r: -0,284; p<0,001) e 'Escore geral' (r: -0,393; p<0,001) e moderada para as dimensões 'Vigor' (r: -0,422; p<0,001) e 'Dedicação' (r: -0,414; p<0,001). Concluiu-se que há um importante número de policiais com estresse ocupacional que, no entanto, apresentam bons níveis de engajamento no trabalho e mostram-se entusiasmados, inspirados e orgulhosos com o seu trabalho.

Abstract This paper investigates the levels of occupational stress and work engagement among military police officers. This cross-sectional, descriptive, and analytical study was conducted with 268 police officers from the 3rd Military Police Battalion of Paraná state. We observed significant levels of occupational stress in 125 (46.7%) police officers. The main stressors were lack of career growth prospects (3.7; ±1.3); inadequate training (3.4; ±1.2); discrimination/favoritism in the work environment (3.1; ±1.4); long working hours (3.0; ±1.4); distribution of tasks (2.7; ±1.1); control type (2.7; ±1.1); gaps in disclosing information about organizational decisions (2.7; ±1.2); low valuation (2.7; ±1.2). Levels of work engagement ranged from 3.8 [medium] to 4.1 [high]. The correlation between occupational stress and work engagement was low for the dimensions of Absorption (r: -.284; p<0.001) and Overall Score (r: -0.393; p<0.001) and moderate for the dimensions Vigor (r: -0.422; p<0.001) and Dedication (r: -0.414; p<0.001). We concluded that an important number of police officers had shown occupational stress. However, they displayed good levels of work engagement and are enthusiastic, inspired, and proud of their work.

Análise do engajamento no trabalho em agentes comunitários de saúde no período pré-pandêmico / Analysis of work engagement in community health agents in the pre-pandemic period / Análisis del compromiso laboral entre los trabajadores de salud comunitarios en el período prepandémico

RESUMO Objetivo: avaliar os níveis de engajamento no trabalho em agentes comunitários de saúde, no período pré-pandêmico. Método:estudo transversal, realizado em 2017, com 85 agentes comunitários de saúde, utilizando-se a Utrecht Work Engagement Scale (UWES), composta por dezessete itens de autoavaliação e três dimensões: vigor, dedicação e absorção. Os escores foram calculados conforme modelo estatístico proposto no Manual Preliminar UWES. Resultados: os níveis de engajamento no trabalho variaramde 3,3 a 3,5, classificados como médios. Profissionais que nunca pensaram em desistir da profissão e aqueles que se referiram satisfeitos com a profissão apresentaram escores altos nas dimensões Vigor (4,6±1,1 e 4,1±1,3) e Dedicação (4,2±1,2 e 4,1±1,2). Conclusão:os resultados evidenciaram a presença de situações de risco que podem interferir no desempenho laboral dos agentes comunitários de saúde. Ao quantificar os níveis de vigor, dedicação e absorção, o engajamento no trabalho torna-se um constructo importante para a avaliação das relações laborais dos profissionais com o trabalho, reforçando a necessidade e a importância de implementação de ações de valorização profissional.

ABSTRACT Objective: to evaluate the levels of work engagement among community health workers in the pre-pandemic period.Method: cross-sectional study conducted in 2017 with 85 community health workers, using the Utrecht Work Engagement Scale (UWES), composed of seventeen self-assessment items and three dimensions: vigor, dedication, and absorption. The scores were calculated according to the statistical model proposed in the UWES Preliminary Manual.Results: the levels of work engagement ranged from 3.3 to 3.5, classified as average. Professionals who never thought of giving up their profession and those who reported being satisfied with their profession showed high scores in the dimensions Vigor (4.6±1.1 and 4.1±1.3) and Dedication (4.2±1.2 and 4.1±1.2). Conclusion: the results showed the presence of risk situations that can interfere with the work performance of community health agents. By quantifying the levels of vigor, dedication, and absorption, work engagement becomes an important construct for the evaluation of the professionals' labor relations with work, reinforcing the need and importance of implementing professional valorization actions.

RESUMEN Objetivo:avaliar los niveles de compromiso laboral de los trabajadores de salud comunitarios en el período prepandémico. Método:estudio transversal, realizado en 2017, con 85 trabajadores de salud comunitarios, utilizando la Escala de Compromiso Laboral de Utrecht (UWES), que consta de diecisiete ítems de autoevaluación y tres dimensiones: vigor, dedicación y absorción. Los puntajes se calcularon de acuerdo con el modelo estadístico propuesto en el Manual Preliminar de UWES. Resultados:los niveles de engagement en el trabajo oscilaron entre 3,3 y 3,5, clasificado como medio. Los profesionales que nunca pensaron en dejar la profesión y los que informaron estar satisfechos con la profesión obtuvieron puntuaciones altas en las dimensiones Vigor (4,6 ± 1,1 y 4,1 ±1,3) y Dedicación (4,2 ± 1,2 y 4,1 ± 1,2). Conclusión:los resultados mostraron la presencia de situaciones de riesgo que pueden interferir con el desempeño laboral de los trabajadores comunitarios de salud. Al cuantificar los niveles de vigor, dedicacióny absorción, el engagement en el trabajo se convierte en un constructo importante para la valoración de las relaciones laborales del profesional con el trabajo, reforzando la necesidad e importancia de implementar acciones de desarrollo profesional.

Colorimetric Detection of Sepsis-Derived Hyperdegranulation with Plasmonic Nanosensors.

Hyperdegranulation of neutrophilic granulocytes is a common finding in sepsis that directly contributes to the heightened immune response leading to organ dysfunction. Currently, cell degranulation is detected by flow cytometry, which requires large infrastructure that is not always available at the point of care. Here, we propose a plasmonic assay for detecting the degranulation status of septic cells colorimetrically. It is based on triggering the aggregation of gold nanoparticles with cationic granule proteins. Cells from septic patients contain fewer granules and therefore release less cationic proteins than healthy cells. This results in red-colored assays than can be easily detected by eye. The assay can selectively detect cationic granule proteins even in the presence of an excess of unrelated proteins, which is key to detect degranulation with high specificity. Coupling this signal generation mechanism with a magnetic purification step enabled the identification of septic cells with the same performance as flow cytometry. This makes the proposed method a promising alternative for diagnosing sepsis in decentralized healthcare schemes.

Career commitment and career entrenchment among Primary Health Care workers.

OBJECTIVE: Assess levels of career commitment and career entrenchment among Primary Health Care workers. METHODS: This Cross-sectional study addressed 393 workers using the Brazilian versions of the Career Commitment Measure (CCM) and Career Entrenchment Measure (CEM). RESULTS: Levels of Career commitment [75.5-77.5] were higher (p<0.001) than Career Entrenchment [66.7-69.2]. Identity levels [82.7-85.5] were higher (p<0.001) than Investment levels [60.4-65.0]. Career resilience levels [75.1-79.2] were higher (p<0.001) than Emotional costs [69.0-72.1]. Planning levels [64.2-67.1] were lower (p<0.001) than levels of limitedness of career alternatives [68.1-71.0]. CONCLUSION: The highest scores were obtained in Career commitment, showing the workers' identification and positive relationship with their careers, that is, these workers remain in Primary Health Care services because they identify themselves with their professions.

Optimized detection of lung IL-6 via enzymatic liquefaction of low respiratory tract samples: application for managing ventilated patients.

Lung IL-6 is a promising biomarker for predicting respiratory failure during pulmonary infections. This biomarker is found in respiratory samples which need to be liquefied prior to analysis. Traditional liquefying methods use reducing agents such as dithiothreitol (DTT). However, DTT impairs immunodetection and does not liquefy highly viscous samples. We propose an enzymatic method that liquefies samples by means of generating O2 bubbles with endogenous catalase. Low respiratory tract specimens from 48 mechanically ventilated patients (38 with SARS-CoV-2 infection) were treated with DTT or with the enzymatic method. We used turbidimetry to compare the liquefaction degree and IL-6 was quantified with ELISA. Finally, we used AUC-ROC, time-to-event and principal component analysis to evaluate the association between respiratory compromise or local inflammation and IL-6 determined with both methods. Enzymatically treated samples were better liquefied than those reduced by DTT, which resulted in higher ELISA signals. Lung IL-6 levels obtained with the enzymatic procedure were negatively correlated with the oxygenation index (PaO2/FiO2) and the time of mechanical ventilation. The proposed enzymatic liquefaction method improves the sensitivity for lung IL-6 detection in respiratory samples, which increases its predictive power as a biomarker for evaluating respiratory compliance.

Nanoparticle transfer biosensors for the non-invasive detection of SARS-CoV-2 antigens trapped in surgical face masks.

Detecting SARS-CoV-2 antigens in respiratory tract samples has become a widespread method for screening new SARS-CoV-2 infections. This requires a nasopharyngeal swab performed by a trained healthcare worker, which puts strain on saturated healthcare services. In this manuscript we describe a new approach for non-invasive COVID-19 diagnosis. It consists of using mobile biosensors for detecting viral antigens trapped in surgical face masks worn by patients. The biosensors are made of filter paper containing a nanoparticle reservoir. The nanoparticles transfer from the biosensor to the mask on contact, where they generate colorimetric signals that are quantified with a smartphone app. Sample collection requires wearing a surgical mask for 30 min, and the total assay time is shorter than 10 min. When tested in a cohort of 27 patients with mild or no symptoms, an area under the receiving operating curve (AUROC) of 0.99 was obtained (96.2 % sensitivity and 100 % specificity). Serial measurements revealed a high sensitivity and specificity when masks were worn up to 6 days after diagnosis. Surgical face masks are inexpensive and widely available, which makes this approach easy to implement anywhere. The excellent sensitivity, even when tested with asymptomatic patient samples, along with the mobile detection scheme and non-invasive sampling procedure, makes this biosensor design ideal for mass screening.

Immunodetection of Lung IgG and IgM Antibodies against SARS-CoV-2 via Enzymatic Liquefaction of Respiratory Samples from COVID-19 Patients.

Lung-secreted IgG and IgM antibodies are valuable biomarkers for monitoring the local immune response against respiratory infections. These biomarkers are found in lower airway secretions that need to be liquefied prior to analysis. Traditional methods for sample liquefaction rely on reducing disulfide bonds, which may damage the structure of the biomarkers and hamper their immunodetection. Here, we propose an alternative enzymatic method that uses O2 bubbles generated by endogenous catalase enzymes in order to liquefy respiratory samples. The proposed method is more efficient for liquefying medium- and high-viscosity samples and does not fragment the antibodies. This prevents damage to antigen recognition domains and recognition sites for secondary antibodies that can decrease the signal of immunodetection techniques. The suitability of the enzymatic method for detecting antibodies in respiratory samples is demonstrated by detecting anti-SARS-CoV-2 IgG and IgM to viral N-protein with gold standard ELISA in bronchial aspirate specimens from a multicenter cohort of 44 COVID-19 patients. The enzymatic detection sharply increases the sensitivity toward IgG and IgM detection compared to the traditional approach based on liquefying samples with dithiothreitol. This improved performance could reveal new mechanisms of the early local immune response against respiratory infections that may have gone unnoticed with current sample treatment methods.

Paper biosensors for detecting elevated IL-6 levels in blood and respiratory samples from COVID-19 patients.

Decentralizing COVID-19 care reduces contagions and affords a better use of hospital resources. We introduce biosensors aimed at detecting severe cases of COVID-19 in decentralized healthcare settings. They consist of a paper immunosensor interfaced with a smartphone. The immunosensors have been designed to generate intense colorimetric signals when the sample contains ultralow concentrations of IL-6, which has been proposed as a prognosis biomarker of COVID-19. This is achieved by combining a paper-based signal amplification mechanism with polymer-filled reservoirs for dispensing antibody-decorated nanoparticles and a bespoken app for color quantification. With this design we achieved a low limit of detection (LOD) of 10-3 pg mL-1 and semi-quantitative measurements in a wide dynamic range between 10-3 and 102 pg mL-1 in PBS. The assay time is under 10 min. The low LOD allowed us to dilute blood samples and detect IL-6 with an LOD of 1.3 pg mL-1 and a dynamic range up to 102 pg mL-1. Following this protocol, we were able to stratify COVID-19 patients according to different blood levels of IL-6. We also report on the detection of IL-6 in respiratory samples (bronchial aspirate, BAS) from COVID-19 patients. The test could be easily adapted to detect other cytokines such as TNF-α and IL-8 by changing the antibodies decorating the nanoparticles accordingly. The ability of detecting cytokines in blood and respiratory samples paves the way for monitoring local inflammation in the lungs as well as systemic inflammation levels in the body.

Estresse ocupacional, work engagement e estratégias de enfrentamento em Agentes Comunitários de Saúde / Occupational stress, work engagement and coping strategies in Community Health Workers

RESUMO Objetivo avaliar os níveis de estresse ocupacional, work engagement e estratégias de enfrentamento em agentes comunitários de saúde. Métodos estudo transversal com 133 Agentes Comunitários de Saúde. Foram utilizados um questionário com variáveis socioeconômicas e profissionais, a Escala de Estresse no Trabalho, a Utrecht Work Engagement Scale e a Escala Modos de Enfrentamento de Problemas. Resultados o escore médio do estresse ocupacional foi 2,7. Os níveis de work engagement foram altos para dedicação (4,0), vigor (4,3) e escore geral (4,0). Destacaram-se os modos de enfrentamento Focalizados no Problema (3,9;±0,6) e Baseados na busca de práticas religiosas e pensamento fantasioso (3,4;±0,7). Conclusão há um percentual elevado de profissionais com estresse ocupacional importante. Os níveis de work engagement foram médios para a absorção e altos para dedicação, vigor e escore geral. As estratégias de enfrentamento estão voltadas para a focalização na resolução do problema, práticas religiosas e pensamentos fantasiosos de caráter positivo.

ABSTRACT Objectives to evaluate the levels of occupational stress, work engagement, and coping strategies among community health workers. Methods cross-sectional study with 133 Community Health Workers. We used a questionnaire with socioeconomic and professional variables, the Work Stress Scale, the Utrecht Work Engagement Scale, and the Coping Modes Scale. Results The mean occupational stress score was 2.7. Work engagement levels were high for dedication (4.0), vigor (4.3), and overall score (4.0). Problem-focused coping modes (3.9; ±0.6) and based on religious practices and fantasy thinking (3.4; ±0.7) stood out. Conclusion there is a high percentage of professionals with significant occupational stress. The levels of work engagement were medium for absorption and high for dedication, vigor, and overall score. The coping strategies are focused on problem solving, religious practices and fanciful thoughts of positive character.