Development of a mobile application for vancomycin dosing calculation: A useful tool for the rational use of antimicrobials.

Background: Mobile applications (app) provide many benefits for healthcare professionals, making them a useful support clinical decision system. Objectives: To describe the development of a mobile app, CalcVAN, to calculate vancomycin dosage regimens for adult and pediatric patients. Methods: This study is a technological production research to develop a mobile app through the rapid prototyping type for the Android system in the Brazilian context. The mobile app structure was developed in four steps: 1) conception, including the needs assessment, the target audience, the literature search, and the definition of contents; 2) prototype planning, including the definition of topics and writing of modules, the selection of media, and the layout; 3) production of the mobile app, including the selection of multimedia tools, the navigation structure, and planning of environment configuration; and 4) make the mobile app available. Results: The CalcVAN has six screens, containing the vancomycin dosing calculator for adult and pediatric patients based on weight and estimated creatinine clearance parameters. Moreover, the mobile app is free and can be used without internet connection. Conclusions: A free mobile app was developed to calculate vancomycin dosage regimens for inpatients. This tool assists to optimize the vancomycin dosing, contributing to the antimicrobial stewardship.

The Diagnosis as a Guide for a Life Trajectory: An Autobiographical Case Report.

In surgical procedures in the pediatric population, the doctor-patient relationship becomes more complex, extending to the doctor-patient-family relationship. This case report presents my perspective as a pediatric patient with the diagnosis and surgical excision of a cervical lymphangioma and later a hemangioma, demonstrating the impacts and repercussions on my life trajectory. The quality of medical services depends on the relationship between professionals and the user. Thus, medical care can no longer be organized considering only the effectiveness. It is the doctor's responsibility to understand and manage his attitudes so that all patients have individualized care worthy of a life trajectory with resilience. By doing this, who knows, maybe we are generating a great stream of future doctors who can better understand their patients?

Plano municipal de contingência de Monte Santo do Tocantins /TO: Novo Coronavírus (Covid-19) / Municipal contingency plan of Monte Santo do Tocantins / TO: Novo Coronavirus (Covid-19)

Orienta na campanha para ações de combate ao Coronavírus (Covid-19) no município de Monte Santo do Tocantins. Apresenta quais as definições de casos de infecção humana pelo COVID-19. Orientações de como notificar ao Centro de Informações Estratégicas de Vigilância em Saúde (CIEVS). Quais os períodos de incubação da doença. Fatores sobre a transmissão e tratamento. Investigação epidemiológica. Quais atribuições da Vigilância em Saúde. Orientações para a coleta de amostras no Laboratório Central de Saúde Pública do Tocantins (LACEN-TO) bem como a técnica de coleta de Swabde nasofaringe e orofaringe (swabs combinados), o acondicionamento, transporte e envio das amostras. Traz as recomendações para a coleta de amostras em situação de óbito. Mostra as medidas de prevenção e controle Precauções padrão, as medidas de isolamento. Transporte do paciente. Como se dá a Limpeza e desinfecção de superfícies.

He guides in the campaign for actions to combat the Coronavirus (Covid-19) in the municipality of Monte Santo do Tocantins. It presents the definitions of cases of human infection by COVID-19. Guidelines on how to notify the Health Surveillance Strategic Information Center (CIEVS). What are the disease incubation periods. Factors about transmission and treatment. Epidemiological investigation. Which attributions of Health Surveillance. Guidelines for the collection of samples at the Central Laboratory of Public Health of Tocantins (LACEN-TO) as well as the technique of collecting Swabde nasopharynx and oropharynx (combined swabs), packaging, transport and sending of samples . It provides recommendations for the collection of samples in situations of death. Shows prevention and control measures Standard precautions, isolation measures. Transporting the patient. How to clean and disinfect surfaces.

Orienta en la campaña de acciones para combatir el Coronavirus (Covid-19) en el municipio de Monte Santo do Tocantins. Presenta las definiciones de casos de infección humana por COVID-19. Directrices sobre cómo notificar al Centro de Información Estratégica de Vigilancia Sanitaria (CIEVS). Cuáles son los períodos de incubación de la enfermedad. Factores de transmisión y tratamiento. Investigación epidemiológica. Qué atribuciones de la Vigilancia Sanitaria. Lineamientos para la recolección de muestras en el Laboratorio Central de Salud Pública de Tocantins (LACEN-TO) así como la técnica de recolección de Swabde nasofaringe y orofaringe (hisopos combinados), el empaque, transporte y envío de las muestras . Proporciona recomendaciones para la recolección de muestras en situaciones de muerte. Muestra medidas de prevención y control Precauciones estándar, medidas de aislamiento. Transporte del paciente. Cómo limpiar y desinfectar superficies.

Il guide dans la campagne d'actions de lutte contre le Coronavirus (Covid-19) dans la municipalité de Monte Santo do Tocantins. Il présente les définitions des cas d'infection humaine par COVID-19. Lignes directrices sur la manière de notifier le Centre d'information stratégique de surveillance sanitaire (CIEVS). Quelles sont les périodes d'incubation de la maladie. Facteurs de transmission et de traitement. Enquête épidémiologique. Quelles attributions de la Surveillance de la Santé. Directives pour le prélèvement d'échantillons au Laboratoire Central de Santé Publique de Tocantins (LACEN-TO) ainsi que la technique de prélèvement de Swabde nasopharynx et oropharynx (écouvillons combinés), l'emballage, le transport et l'envoi des échantillons . Il fournit des recommandations pour le prélèvement d'échantillons en cas de décès. Affiche les mesures de prévention et de contrôle. Transport du patient. Comment nettoyer et désinfecter les surfaces.

Prevalence of early loss of primary molar and its impact in schoolchildren's quality of life.

BACKGROUND: Evidence regarding the impact of premature loss of primary molars on oral health-related quality of life (OHRQoL) is lacking. AIM: To evaluate the prevalence of premature loss of primary molars in schoolchildren and its impact on OHRQoL. DESIGN: We randomly selected 667 children aged 8-9 years enrolled in public and private schools from Aracaju (Brazil). The presence of untreated dental caries and early loss of primary molars were recorded, and its impacts on OHRQoL evaluated using Child Perceptions Questionnaire (CPQ8-10 ). Influence of some variables on tooth loss and OHRQoL was assessed by multilevel Poisson's regression analysis (P < 0.05). RESULTS: The prevalence for early tooth loss was 65.4% (95% confidence interval 51.1%-77.3%). Children with untreated dental caries and attending public schools presented higher prevalence of early tooth loss. Moreover, early loss of primary molars provoked negative impact on OHRQoL considering total score of CPQ8-10 and domains "oral symptoms," "functional limitations" and "emotional well-being." Children presenting early teeth loss presented significantly higher scores of CPQ8-10 , as well as females and children with dental caries in other teeth. CONCLUSIONS: The prevalence of early loss of primary molars is high, and it impacts the OHRQoL of children aged 8-9 years.

The hypothalamus at the crossroads of psychopathology and neurosurgery.

The neurosurgical endeavor to treat psychiatric patients may have been part of human history since its beginning. The modern era of psychosurgery can be traced to the heroic attempts of Gottlieb Burckhardt and Egas Moniz to alleviate mental symptoms through the ablation of restricted areas of the frontal lobes in patients with disabling psychiatric illnesses. Thanks to the adaptation of the stereotactic frame to human patients, the ablation of large volumes of brain tissue has been practically abandoned in favor of controlled interventions with discrete targets. Consonant with the role of the hypothalamus in the mediation of the most fundamental approach-avoidance behaviors, some hypothalamic nuclei and regions, in particular, have been selected as targets for the treatment of aggressiveness (posterior hypothalamus), pathological obesity (lateral or ventromedial nuclei), sexual deviations (ventromedial nucleus), and drug dependence (ventromedial nucleus). Some recent improvements in outcomes may have been due to the use of stereotactically guided deep brain stimulation and the change of therapeutic focus from categorical diagnoses (such as schizophrenia) to dimensional symptoms (such as aggressiveness), which are nonspecific in terms of formal diagnosis. However, agreement has never been reached on 2 related issues: 1) the choice of target, based on individual diagnoses; and 2) reliable prediction of outcomes related to individual targets. Despite the lingering controversies on such critical aspects, the experience of the past decades should pave the way for advances in the field. The current failure of pharmacological treatments in a considerable proportion of patients with chronic disabling mental disorders is reminiscent of the state of affairs that prevailed in the years before the early psychosurgical attempts. This article reviews the functional organization of the hypothalamus, the effects of ablation and stimulation of discrete hypothalamic regions, and the stereotactic targets that have most often been used in the treatment of psychopathological and behavioral symptoms; finally, the implications of current and past experience are presented from the perspective of how this fund of knowledge may usefully contribute to the future of hypothalamic psychosurgery.

Increased nuchal traslucency in normal karyotype fetuses.

Nuchal traslucency (NT) measurement between 11 and 14 weeks' gestation is a reliable marker for chromosomal abnormalities, including trisomy 21. However, even if conventional karyotyping is normal, increased NT is a predictive value of adverse pregnancy outcome, because it is associated with several fetal malformations, congenital heart defects, genetic syndromes, intrauterine death and miscarriages; the majority of these structural anomalies are undetectable before birth. The risk is proportional to the nuchal translucency thickness, in fact it statistically increases after measurement reaching 3.5 mm or more. However, when these chromosomally normal fetuses with an enlarged NT survive, even if a detailed ultrasound examination and echocardiography fail to reveal any abnormalities, their uneventful outcome and postnatal developmental delay will be not statistically increased when compared to the general population. These parents should be confidently reassured that the residual chance of structural anomalies and abnormal neurodevelopment may not be higher than in the general population.

Maternal weight gain during pregnancy and neonatal birth weight: a review of the literature.

Obesity has become a serious global public health issue and has consequences for nearly all areas of medicine. Within obstetrics, obesity not only has direct implications for the health of a pregnancy but also impacts on the weight of the child in infancy and beyond. As such, maternal weight may influence the prevalence and severity of obesity in future generations. Pregnancy has been identified as a key time to target a weight control or weight loss strategy to help curb the rapidly growing obesity epidemic. This study reviews the current evidence for interventions to promote weight control or weight loss in women around the time of pregnancy. Studies have shown positive correlations between both maternal pre-pregnancy weight and gestational weight gain with the birth weight of the infant and associated health risks, so interventions have been put to clinical trials at both time points. Many women are concerned about the health of their babies during pregnancy and are in frequent contact with their healthcare providers, pregnancy may be an especially powerful "teachable moment" for the promotion of healthy eating and physical activity behaviors among women.

Fetal growth restriction: current perspectives.

Intrauterine growth restriction is one of the most common and complex problems in modern obstetrics. The cut off value mainly used for defining an IUGR is at the 10th percentile. There are many evidence demonstrating that the adverse perinatal outcome are mainly confined to infants below the 5th or 3th percentile. The mains causes for the onset of IUGR can be divided into three categories: maternal, fetal and placental. Aim of this study is to obtain a review from which speculate useful indication in clinical practice. Evidence from randomized controlled trials finds few interventions beneficial in preventing or treating IUGR.

Fetal cardiac function during the first trimester of pregnancy.

Chromosomally normal first trimester fetuses with an increased nuchal translucency measurement have an elevated risk of congenital heart defect (CHD). so there is an increased demand for imaging the fetal heart during the first and early second trimesters of pregnancy.Echocardiographic and anatomical correlations in firsttrimester fetuses show that by 11 weeks' gestation, the position of the fetal heart within the chest is similar to that in later gestation, and the spatial relation of the great arteries and their relative sizes are similar to those on second-trimester scans by 12 weeks' gestation.In the first trimester during the heart analysis it's possible value: anatomic structure (size, rate), hemodynamic development through analysis of these waveforms and flow patterns (inflow and outflow waveforms of the diastolic filling and the systolic ejection) and modification during the first trimester.

Treatment of gestational diabetes: oral hypoglycemic agents or insulin?

Our report aims to verify whether perinatal maternal glycemic control in gestational diabetes can only be achieved with insulin or with oral hypoglycaemic agents. Then we want to evaluate the efficacy and safety of oral hypoglycemic agents in the treatment of gestational diabetes and then to compare these results with those associated with the use of insulin.

Antiphospholipid Syndrome during pregnancy: the state of the art.

Obstetric complications are the hallmark of antiphospholipid syndrome. Recurrent miscarriage, early delivery, oligohydramnios, prematurity, intrauterine growth restriction, fetal distress, fetal or neonatal thrombosis, pre-eclampsia/eclampsia, HELLP syndrome, arterial or venous thrombosis and placental insufficiency are the most severe APS-related complication for pregnant women. Antiphospholipid antibodies promote activation of endothelial cells, monocytes and platelets, causing an overproduction of tissue factor and thromboxane A2. Complement activation might have a central pathogenetic role. These factors, associated with the typical changes in the hemostatic system during normal pregnancy, result in a hypercoagulable state. This is responsible of thrombosis that is presumed to provoke many of the pregnancy complications associated with APS. Obstetric care is based on combined medical-obstetric high-risk management and treatment with the association between aspirin and heparin. This review aims to deter- mine the current state of the art of APS by investigating the knowledge achievements of recent years, to provide the most appropriate diagnostic and therapeutic management for pregnant women suffering from this syndrome.

Biochemical markers for prediction of preclampsia: review of the literature.

Preeclampsia (PE) is one of the most common diseases worldwide, complicating ~5% of all pregnancies.Although no major progress has been achieved in the treatment of PE, our ability to identify women at highrisk has increased considerably during the past decade.The early identification of patients with an increased risk for preeclampsia is therefore one of the most important goals in obstetrics. Today, several markers may offer the potential to be used, most likely in a combinatory analysis, as predictors or diagnostic tools. We present here the current knowledge on the biology of preeclampsia and review several biochemical markers which may be used to monitor preeclampsia in a future, that, we hope, is not to distant from today.

Efeito do leite humano na cicatrização de feridas abertas em ratos / Human Milk Result on the healing of wounds produced in rats

OBJETIVO: verificar o efeito do leite humano cru congelado e cru resfriado na cicatrização de feridas abertas em ratos. MÉTODO: utilizaram-se 45 ratos, machos, adultos, distribuídos em 3 grupos, com 15 animais cada: o Grupo Controle, tratado com solução salina a 0,9%; o Grupo Cru Resfriado, tratado com Leite Humano Resfriado; o Grupo Cru Congelado, tratado com Leite Humano Cru Congelado. Em cada grupo, foifeito uso tópico de 0,1ml de cada substância correspondente ao grupo em estudo, 3 vezes ao dia, na região dorso-costalis de cada animal. A avaliação da lesão foi realizada no 7º, 14º e 21º dia de pós-operatório, no qual foi determinado o tamanho da lesão, presença ou não de pelos ao redor da ferida operatória, dos respectivos grupos. RESULTADOS: os grupos tratados com leites nesta amostra obtiveram resultados estatisticamente significantes, quando comparado com o tratado com solução salina a 0,9% no período agudo de cicatrização. CONCLUSÃO: as feridas cutâneas abertas na região dorso costal de ratos tratadas com leite humano cru congelado e o leite cru resfriado utilizado nesta pesquisa, quando comparado às tratadas com solução salina a 0,9% apresentaram resultados, estatisticamente significativos, comparado ao grupo controle no período agudo de cicatrização.

OBJETIVE: check out the frozen and the cold human milk effect on tlze healing of wounds produced in rats. METHOD: it was used 60 males; adults rats divided in 3 groups, witlz 15 animals each one. The Control Group, treated with a quantity of 0,9% of sodium clzloride; The Cold Raw Group, which Cold Human Milk was used; The Frozen Raw Group, treated witlz Frozen Raw Human Milk. 1n each group, it was tested, under the skin, the usage of eaclz corresponding substance to the group studied, 3 times a day, on the dorsocostalis region of each animal.The assessments of the injury was done in the 7th, 14th and 21th post-operatorion day, which the size, presence or not of four around the wound operated of each group was determined. RESULTS: the Kinds of milk used in this experience reach a meaningful statically result when compared to that one used with sodium chloride at 0,9 %. CONCLUSION: the coetaneous wounds made on the dorsocostalis region of treated rats with cold raw human milk and the frozen raw human milk used in this experiment, when compared to those with saline solution, show statically meaningful results, although it had always presented a higher percentage as compared to the control group.