Brazilian consensus recommendations on the diagnosis and treatment of autoimmune encephalitis in the adult and pediatric populations.

BACKGROUND: Autoimmune encephalitis (AIE) is a group of inflammatory diseases characterized by the presence of antibodies against neuronal and glial antigens, leading to subacute psychiatric symptoms, memory complaints, and movement disorders. The patients are predominantly young, and delays in treatment are associated with worse prognosis. OBJECTIVE: With the support of the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, ABN) and the Brazilian Society of Child Neurology (Sociedade Brasileira de Neurologia Infantil, SBNI), a consensus on the diagnosis and treatment of AIE in Brazil was developed using the Delphi method. METHODS: A total of 25 panelists, including adult and child neurologists, participated in the study. RESULTS: The panelists agreed that patients fulfilling criteria for possible AIE should be screened for antineuronal antibodies in the serum and cerebrospinal fluid (CSF) using the tissue-based assay (TBA) and cell-based assay (CBA) techniques. Children should also be screened for anti-myelin oligodendrocyte glucoprotein antibodies (anti-MOG). Treatment should be started within the first 4 weeks of symptoms. The first-line option is methylprednisolone plus intravenous immunoglobulin (IVIG) or plasmapheresis, the second-line includes rituximab and/or cyclophosphamide, while third-line treatment options are bortezomib and tocilizumab. Most seizures in AIE are symptomatic, and antiseizure medications may be weaned after the acute stage. In anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis, the panelists have agreed that oral immunosuppressant agents should not be used. Patients should be evaluated at the acute and postacute stages using functional and cognitive scales, such as the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), the Modified Rankin Scale (mRS), and the Clinical Assessment Scale in Autoimmune Encephalitis (CASE). CONCLUSION: The present study provides tangible evidence for the effective management of AIE patients within the Brazilian healthcare system.

ANTECEDENTES: Encefalites autoimunes (EAIs) são um grupo de doenças inflamatórias caracterizadas pela presença de anticorpos contra antígenos neuronais e gliais, que ocasionam sintomas psiquiátricos subagudos, queixas de memória e distúrbios anormais do movimento. A maioria dos pacientes é jovem, e o atraso no tratamento está associado a pior prognóstico. OBJETIVO: Com o apoio da Academia Brasileira de Neurologia (ABN) e da Sociedade Brasileira de Neurologia Infantil (SBNI), desenvolvemos um consenso sobre o diagnóstico e o tratamento da EAIs no Brasil utilizando a metodologia Delphi. MéTODOS: Um total de 25 especialistas, incluindo neurologistas e neurologistas infantis, foram convidados a participar. RESULTADOS: Os especialistas concordaram que os pacientes com critérios de possíveis EAIs devem ser submetidos ao rastreio de anticorpos antineuronais no soro e no líquido cefalorraquidiano (LCR) por meio das técnicas de ensaio baseado em tecidos (tissue-based assay, TBA, em inglês) e ensaio baseado em células (cell-based assay, CBA, em inglês). As crianças também devem ser submetidas ao rastreio de de anticorpo contra a glicoproteína da mielina de oligodendrócitos (anti-myelin oligodendrocyte glycoprotein, anti-MOG, em inglês). O tratamento deve ser iniciado dentro das primeiras 4 semanas dos sintomas, sendo as opções de primeira linha metilprednisolona combinada com imunoglobulina intravenosa (IGIV) ou plasmaférese. O tratamento de segunda linha inclui rituximabe e ciclofosfamida. Bortezomib e tocilizumab são opções de tratamento de terceira linha. A maioria das crises epilépticas nas EAIs são sintomáticas, e os fármacos anticrise podem ser desmamadas após a fase aguda. Em relação à encefalite antirreceptor de N-metil-D-aspartato (anti-N-methyl-D-aspartate receptor, anti-NMDAR, em inglês), os especialistas concordaram que agentes imunossupressores orais não devem ser usados. Os pacientes devem ser avaliados na fase aguda e pós-aguda mediante escalas funcionais e cognitivas, como Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Modified Rankin Scale (mRS), e Clinical Assessment Scale in Autoimmune Encephalitis (CASE). CONCLUSãO: Esta pesquisa oferece evidências tangíveis do manejo efetivo de pacientes com EAIs no sistema de saúde Brasileiro.

Assessment of health-related quality of life after mild COVID-19 infection.

INTRODUCTION: Coronavirus disease 19 (COVID-19) affected the health-related quality of life (HRQoL), and its impact on well-being is not sufficiently understood yet. The worsening of HRQoL and symptoms such as fatigue, anxiety, depression, chronic Headache, Myalgia, ageusia, olfactory disorders, and cognitive impairment can be seen in people of different ages and genders after COVID-19 infection, even mild infections without hospitalization. These issues generate a disease burden that can reduce work skills and cause social, psychological, and neuropsychiatric challenges. OBJECTIVE: To evaluate the HRQoL of patients affected by COVID-19, the domains most affected, and their relationship with fatigue, anxiety, depression, chronic Headache and Myalgia, ageusia, olfactory disorders, and cognitive impairment. METHODS: An analytical transverse was conducted with 143 patients after COVID-19 infection. The patient-reported outcomes measures (PROMS) were collected by the 36-item Short Form survey (SF-36), Fatigue Severity Scale (FSS), Hospital Anxiety and Depression Scale (HADS), Mini-Mental State Examination-2 (MMSE-2), Symbol Digit Modalities Test (SDMT), and a questionnaire regarding symptoms such as chronic Headache, myalgia, and olfactory disorders. Spearman's correlation test was used to correlate the performance of the patients on different PROMS. RESULTS: Fatigue, depression, and anxiety were negatively correlated with all the SF-36 domains, and patients with subjective cognitive complaints had low scores in all SF-36 domains. Furthermore, those with chronic Headaches had low scores in physical functioning, role-physical functioning, and vitality. Regarding myalgia complaints, the worst scores were observed in the physical functioning and vitality domains. Patients with ageusia had low scores in general health perceptions, and those with olfactory dysfunction had low scores in the vitality and mental health domains. CONCLUSIONS: Although the acute phase of COVID-19 has resolved, knowledge about HRQoL after this period is essential since many individual and collective changes have been taking place until today-patients with neuropsychiatric manifestations that persisted after the acute phase showed lower overall quality of life.

Long COVID: plasma levels of neurofilament light chain in mild COVID-19 patients with neurocognitive symptoms.

It is well known the potential of severe acute respiratory coronavirus type 2 (SARS-CoV-2) infection to induce post-acute sequelae, a condition called Long COVID. This syndrome includes several symptoms, but the central nervous system (CNS) main one is neurocognitive dysfunction. Recently it has been demonstrated the relevance of plasma levels of neurofilament light chain (pNfL), as a biomarker of early involvement of the CNS in COVID-19. The aim of this study was to investigate the relationship between pNfL in patients with post-acute neurocognitive symptoms and the potential of NfL as a prognostic biomarker in these cases. A group of 63 long COVID patients ranging from 18 to 59 years-old were evaluated, submitted to a neurocognitive battery assessment, and subdivided in different groups, according to results. Plasma samples were collected during the long COVID assessment and used for measurement of pNfL with the Single molecule array (SIMOA) assays. Levels of pNfL were significantly higher in long COVID patients with neurocognitive symptoms when compared to HC (p = 0.0031). Long COVID patients with cognitive impairment and fatigue symptoms presented higher pNfL levels when compared to long COVID patients without these symptoms, individually and combined (p = 0.0263, p = 0.0480, and 0.0142, respectively). Correlation analysis showed that levels of cognitive lost and exacerbation of fatigue in the neurocognitive evaluation had a significative correlation with higher pNfL levels (p = 0.0219 and 0.0255, respectively). Previous reports suggested that pNfL levels are related with higher risk of severity and predict lethality of COVID-19. Our findings demonstrate that SARS-CoV-2 infection seems to have a long-term impact on the brain, even in patients who presented mild acute disease. NfL measurements might be useful to identify CNS involvement in long COVID associated with neurocognitive symptoms and to identify who will need continuous monitoring and treatment support.

Brazilian consensus recommendations on the diagnosis and treatment of autoimmune encephalitis in the adult and pediatric populations / Consenso brasileiro sobre o diagnóstico e o tratamento de encefalites autoimunes nas populações adulta e pediátrica

Abstract Background Autoimmune encephalitis (AIE) is a group of inflammatory diseases characterized by the presence of antibodies against neuronal and glial antigens, leading to subacute psychiatric symptoms, memory complaints, and movement disorders. The patients are predominantly young, and delays in treatment are associated with worse prognosis. Objective With the support of the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, ABN) and the Brazilian Society of Child Neurology (Sociedade Brasileira de Neurologia Infantil, SBNI), a consensus on the diagnosis and treatment of AIE in Brazil was developed using the Delphi method. Methods A total of 25 panelists, including adult and child neurologists, participated in the study. Results The panelists agreed that patients fulfilling criteria for possible AIE should be screened for antineuronal antibodies in the serum and cerebrospinal fluid (CSF) using the tissue-based assay (TBA) and cell-based assay (CBA) techniques. Children should also be screened for anti-myelin oligodendrocyte glucoprotein antibodies (anti-MOG). Treatment should be started within the first 4 weeks of symptoms. The first-line option is methylprednisolone plus intravenous immunoglobulin (IVIG) or plasmapheresis, the second-line includes rituximab and/or cyclophosphamide, while third-line treatment options are bortezomib and tocilizumab. Most seizures in AIE are symptomatic, and antiseizure medications may be weaned after the acute stage. In anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis, the panelists have agreed that oral immunosuppressant agents should not be used. Patients should be evaluated at the acute and postacute stages using functional and cognitive scales, such as the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), the Modified Rankin Scale (mRS), and the Clinical Assessment Scale in Autoimmune Encephalitis (CASE). Conclusion The present study provides tangible evidence for the effective management of AIE patients within the Brazilian healthcare system.

Resumo Antecedentes Encefalites autoimunes (EAIs) são um grupo de doenças inflamatórias caracterizadas pela presença de anticorpos contra antígenos neuronais e gliais, que ocasionam sintomas psiquiátricos subagudos, queixas de memória e distúrbios anormais do movimento. A maioria dos pacientes é jovem, e o atraso no tratamento está associado a pior prognóstico. Objetivo Com o apoio da Academia Brasileira de Neurologia (ABN) e da Sociedade Brasileira de Neurologia Infantil (SBNI), desenvolvemos um consenso sobre o diagnóstico e o tratamento da EAIs no Brasil utilizando a metodologia Delphi. Métodos Um total de 25 especialistas, incluindo neurologistas e neurologistas infantis, foram convidados a participar. Resultados Os especialistas concordaram que os pacientes com critérios de possíveis EAIs devem ser submetidos ao rastreio de anticorpos antineuronais no soro e no líquido cefalorraquidiano (LCR) por meio das técnicas de ensaio baseado em tecidos (tissue-based assay, TBA, em inglês) e ensaio baseado em células (cell-based assay, CBA, em inglês). As crianças também devem ser submetidas ao rastreio de de anticorpo contra a glicoproteína da mielina de oligodendrócitos (anti-myelin oligodendrocyte glycoprotein, anti-MOG, em inglês). O tratamento deve ser iniciado dentro das primeiras 4 semanas dos sintomas, sendo as opções de primeira linha metilprednisolona combinada com imunoglobulina intravenosa (IGIV) ou plasmaférese. O tratamento de segunda linha inclui rituximabe e ciclofosfamida. Bortezomib e tocilizumab são opções de tratamento de terceira linha. A maioria das crises epilépticas nas EAIs são sintomáticas, e os fármacos anticrise podem ser desmamadas após a fase aguda. Em relação à encefalite antirreceptor de N-metil-D-aspartato (anti-N-methyl-D-aspartate receptor, anti-NMDAR, em inglês), os especialistas concordaram que agentes imunossupressores orais não devem ser usados. Os pacientes devem ser avaliados na fase aguda e pós-aguda mediante escalas funcionais e cognitivas, como Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Modified Rankin Scale (mRS), e Clinical Assessment Scale in Autoimmune Encephalitis (CASE). Conclusão Esta pesquisa oferece evidências tangíveis do manejo efetivo de pacientes com EAIs no sistema de saúde Brasileiro.

Fatores associados ao autocuidado praticado por pessoas com estomias de eliminação / Factors associated with self-care practiced by people with intestinal elimination stomas / Factores asociados al autocuidado practicado por personas con estomas de eliminación

Objetivo: avaliar os fatores associados ao autocuidado praticado por pessoas com estomias de eliminação. Método: estudo transversal analítico, baseado nas respostas de 153 pessoas com estomia de eliminação, atendidas em um ambulatório de referência no cuidado de pessoas com estomas, no município de Teresina. A coleta de dados ocorreu por meio de um formulário semiestruturado com dados demográficos e acerca do autocuidado. Os dados foram analisados mediante estatística descritiva e inferencial. O teste Qui-quadrado de Pearson foi utilizado na análise inferencial. Resultados: o esvaziamento da bolsa, limpeza do estoma, secagem da pele periestoma, descolamento da placa, medição do estoma, realização do molde, adaptação, autoestima e isolamento social apresentaram associação significativa com o autocuidado (p<0,05). Conclusão: evidenciou-se que os fatores associados ao autocuidado foram os cuidados com o estoma e com o equipamento coletor, além dos impactos na autoestima e na vida social(AU)

Objective: to evaluate the factors associated with self-care practiced by people with elimination stomas. Method: analytical cross-sectional study, based on the responses of 153 people with elimination stoma, treated at a reference outpatient clinic for the care of people with stoma, in the city of Teresina. Data collection took place through a semi-structured form with demographic data and about self-care. Analyzes were performed using inferential statistics, using the chi-square test. Results: Emptying the pouch, cleaning the stoma, drying the peristomal skin, detaching the plaque, measuring the stoma, making the mold, fitting, , self-esteem and social isolation were significantly associated with self-care (p<0.05). Conclusion: it was evident that the factors associated with self-care were care for the stoma and the collection equipment, in addition to the impacts on self-esteem and social life(AU)

Objetivo: evaluar los factores asociados al autocuidado practicado por personas con estomas de eliminación. Método: estudio transversal analítico, basado en las respuestas de 153 personas con estoma de eliminación, atendidos en un ambulatorio de referencia para la atención de personas con estoma, en la ciudad de Teresina. Se realizó la recolección de datos a través de un formulario semiestructurado con datos demográficos y sobre autocuidado. Los datos se analizaron utilizando estadística descriptiva e inferencial, utilizando la prueba Chi-cuadrado de Pearson. Resultados: vaciar la bolsa, limpiar la estoma, secar la piel periestomal, despegar la placa, medir la estoma, hacer el molde, adaptarlo, vaciar la bolsa, la autoestima y el aislamiento social se asociaron significativamente con el autocuidado (p<0,05). Conclusión: se evidenció que los factores asociados al autocuidado fueron el cuidado de la estoma y del equipo de recolección, además de los impactos en la autoestima y la vida social(AU)

Desafios e perspectivas na atuação de estomaterapeutas durante a pandemia de COVID-19 / Challenges and perspectives in the work of stomatherapists during the COVID-19 pandemic

Objetivo: Analisar os desafios e perspectivas na atuação de estomaterapeutas durante a pandemia de COVID-19.Métodos: Pesquisa descritiva de abordagem qualitativa, por meio de entrevista semiestruturada com oito estomaterapeutas, selecionadas pela técnica snowball. Utilizou-se a Análise de Conteúdo, da qual emergiram três categorias: Desafios na atuação de estomaterapeutas durantea pandemia da COVID-19; Estratégias para viabilizar a assistência remota e presencial na estomaterapia; e Impacto da pandemia no cuidado de estomaterapia. Resultados: Os principais desafios citados foram: fechamento de ambulatórios e agravamento do quadro de saúde dos pacientes. As estratégias incluíram: adaptação da metodologia dos atendimentos, utilização de precauções-padrão e comunicação remota. Dentre as perspectivas futuras, destacam-se o crescimento da especialidade e valorização por outros profissionais da saúde. Conclusão: Houve diversos desafios na atuação de estomaterapeutas na pandemia, contornados, sobretudo, com a diversificação de estratégias assistenciais e modificações nos atendimentos. No entanto, destaca-se como perspectiva futura o aumento da visibilidade da especialidade. Descritores: Enfermagem; Estomaterapia; COVID-19

Objective: To analyze the challenges and perspectives in the work of stomatherapists during the COVID-19 pandemic. Methods: Descriptive research with a qualitative approach, through semi-structured interviews with eight stomatherapists, selected by the snowball technique. Content Analysis was used, emerging three categories: Challenges in the work of stomatherapists during the COVID-19 pandemic; Strategies to enable remote and face-to-face assistance in stomatherapy; and Impact of the pandemic on stomatherapy care. Results: The main challenges mentioned were: closure of outpatient clinics and worsening of the patients' health situation. The strategies included: adaptation of the care methodology, use of standard precautions and remote communication. Among the future perspectives, the growth of the specialty and appreciation by other health professionals stand out. Conclusion: There were several challenges in the work of stomatherapists in the pandemic, circumvented, above all, with the diversification of care strategies and modifications in care. However, the increased visibility of the specialty stands out as a future perspective. Descriptors:Nursing; Enterostomal Therapy; COVID-19.

SARS-CoV-2 Spike protein induces TLR4-mediated long-term cognitive dysfunction recapitulating post-COVID-19 syndrome in mice.

Cognitive dysfunction is often reported in patients with post-coronavirus disease 2019 (COVID-19) syndrome, but its underlying mechanisms are not completely understood. Evidence suggests that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Spike protein or its fragments are released from cells during infection, reaching different tissues, including the CNS, irrespective of the presence of the viral RNA. Here, we demonstrate that brain infusion of Spike protein in mice has a late impact on cognitive function, recapitulating post-COVID-19 syndrome. We also show that neuroinflammation and hippocampal microgliosis mediate Spike-induced memory dysfunction via complement-dependent engulfment of synapses. Genetic or pharmacological blockage of Toll-like receptor 4 (TLR4) signaling protects animals against synapse elimination and memory dysfunction induced by Spike brain infusion. Accordingly, in a cohort of 86 patients who recovered from mild COVID-19, the genotype GG TLR4-2604G>A (rs10759931) is associated with poor cognitive outcome. These results identify TLR4 as a key target to investigate the long-term cognitive dysfunction after COVID-19 infection in humans and rodents.

Cognitive Complaints Assessment and Neuropsychiatric Disorders After Mild COVID-19 Infection.

OBJECTIVES: This study aimed to analyze cognitive impairment associated with long-term coronavirus disease 2019 (COVID-19) syndrome and its correlation with anxiety, depression, and fatigue in patients infected with severe acute respiratory syndrome coronavirus. METHODS: This was a cross-sectional study of 127 patients with COVID-19. Tests to screen for neuropsychiatric symptoms included the Fatigue Severity Scale, Mini-Mental State Exam 2 (MMSE-2), Symbol Digit Modalities Test (SDMT), and Hospital Anxiety and Depression Scale. RESULTS: In cognitive tests, SDMT was abnormal in 22%, being more sensitive than MMSE-2 to detect cognitive changes. Furthermore, although manifestations such as fatigue, depression, and anxiety were frequent in the post-COVID-19 phase, these 3 conditions, known to contribute to cognitive impairment, were slightly correlated with worse performance on the rapid screening tests. CONCLUSIONS: In patients with mild COVID-19 and cognitive complaints, SDMT helped to confirm disturbances in the attention domain and processing speed.

Medidas comportamentais de prevenção à COVID-19 e letramento em saúde / Behavioral measures for the prevention of COVID-19 and health literacy

Resumo Introdução A prevenção da infecção pelo coronavírus (SARS-CoV-2) é propagada pela mídia e recomendada pelos órgãos oficiais de saúde pública. Entretanto, há desafios para adoção de medidas comportamentais de prevenção, sendo o letramento em saúde (LS) uma preocupação que deve permear essas ações de comunicação na saúde. Objetivo Discutir o impacto que um baixo LS da população tem na compreensão e adesão às orientações relativas à prevenção da SARS-CoV-2. Método Trata-se de uma reflexão que resgata, na literatura especializada, o conceito e os fundamentos do LS, as principais orientações de prevenção da SARS-CoV-2 e como operacionalizar orientações letradas em saúde. Resultados A literatura aponta que o baixo LS dos indivíduos repercute negativamente no empoderamento e na operacionalização de informações de saúde recebidas. Não adianta a elaboração de ações educativas se a população não entende e/ou não percebe a importância de se adequar a essas propostas. Os fundamentos do LS são apresentados em guias de comunicação oral, escrita e midiática. Há ferramentas e estratégias para melhor compor uma mensagem educativa segundo o LS. Conclusão É recomendável generalizar que a população tem um letramento inadequado, para deixarmos muito claras as mensagens que transmitimos. Isto é possível seguindo os fundamentos do LS.

Abstract Background Prevention of coronavirus (SARS-CoV-2) infection is propagated by the media and recommended by official public health bodies. However, there are challenges for the adoption of preventive behavioral measures, with health literacy (HL) being a concern that must permeate these health communication actions. Objective To discuss the impact that a low LS of the population has on the understanding and adherence to guidelines regarding the prevention of SARS-CoV-2. Method This is a reflection that rescues, in the specialized literature, the concept and fundamentals of the LS, the main SARS-CoV-2 prevention guidelines and how to operationalize literate health guidelines. Results The literature points out that the low HL of individuals has a negative impact on empowerment and on the operationalization of received health information. There is no point in developing educational actions if the population does not understand and/or does not perceive the importance of adapting to these proposals. The fundamentals of LS are presented in oral, written and media communication guides. There are tools and strategies to better compose an educational message according to the LS. Conclusion It is recommended to generalize that the population has inadequate literacy, so that we can make the messages we transmit very clear. This is possible by following the fundamentals of LS.

Nursing knowledge about incontinence-associated dermatitis in a teaching hospital.

OBJECTIVE: Verify the nursing knowledge about incontinence-associated dermatitis in a teaching hospital. METHOD: Descriptive, cross-sectional research with quantitative analysis carried out with 90 nurses from a university hospital in the northeast of the country between January and February 2021. Data were collected through a self-administered online questionnaire. Applied Fisher's exact association statistical test for crossing the variables. RESULTS: 75.6% of the participants had knowledge about the definition of incontinence-associated dermatitis, however most participants were wrong about several factors, such as: image identification (58.9%), evaluation (66.7%), prevention and treatment (58.9%), risk assessment method (62.2%). CONCLUSION: Participants have weaknesses in the knowledge of incontinence-associated dermatitis. It is recommended that this study should be reproduced in other scenarios, in order to contribute to the production of protocols to optimize the management of incontinence-associated dermatitis.

Eosinophils: Focus on DNA extracellular traps.

Eosinophils are multitasking granulocytes with implications for allergies, host response to helminths and, more recently, described roles in immunomodulation, homeostasis and tissue remodeling. Eosinophils secrete their preformed granule proteins by different pathways, especially piecemeal degranulation and cytolysis with granule release. Currently, there are different insights related to eosinophils' functional roles and biology that deserve to be highlighted. Cytolysis with granule release has also been associated with DNA extracellular trap formation, one of the most intriguing, recently described mechanisms of leukocyte activation. Focusing on DNA extracellular trap release, there are lessons to be learned from neutrophils considering the multitasking roles of these structures in inflammation, and the mechanisms involved in their release. This review explores a comparative analysis of the current knowledge considering DNA traps extrusion in neutrophils and eosinophils and update the major findings regarding the presence of these entities in eosinophilic-associated immune responses, inflammation and diseases.

Reasons correlated with omission of nursing care.

OBJECTIVE: To evaluate the reasons correlated with the omission of nursing care in a university hospital. METHOD: Analytical cross-sectional design, developed in a university hospital in Northeast Brazil, from January to February 2020. The study population consisted of nurses and nursing technicians who worked in direct patient care. The Brazilian version of the Missed Nursing Care Survey was applied in a convenience sample consisting of 227 participants (79 nurses and 148 nursing technicians). Univariate and bivariate statistics were calculated in the software Statistical Package for Social Science, version 26.0. RESULTS: The most omitted nursing care was walking three times a day or as prescribed (70.9%). The most prevalent reason was an unexpected increase in the volume and/or severity of patients in the unit (93.0%). Positive, albeit weak, correlations were found between overall care omission, as well as omissions by priority level, and reasons for omission given by nurses and nursing technicians (p < 0.05). CONCLUSION: The study showed that the omission of nursing care covered all five dimensions of the instrument, mainly correlated with labor and material resources.

Converting recycled membranes into photocatalytic membranes using greener TiO2-GRAPHENE oxide nanomaterials.

Despite the widespread use of membrane separation processes for water treatment, operation costs and fouling still restrict their application. Costs can be overcome by recycled membranes whereas fouling can be mitigated by membrane modification. In this work, the performance of recycled reverse osmosis membranes modified by greener titanium dioxide (TiO2) and graphene oxide (GO) in different modification routes were investigated and compared. The use of recycled membranes as a support acted more than a strategy for costs reduction, but also as an alternative for solid waste reduction. Low adhesion of nanoparticulate materials to the membrane surfaces were verified in depositions by self-assembly, whereas filtration and modification with dopamine generated membranes with well adhered and homogeneous layers. Considering the stability, permeability, and rejection efficiency of dyes as model substrates, the membranes modified with the aid of dopamine-TiO2-GO were the most promising. The nanomaterials increased the membrane hydrophilicity and formed a hydrated layer that repels the organic contaminants and reduces fouling. Besides membrane rejection, adsorption (contribution: ∼10%) and photocatalysis (contribution: ∼20%) were additional mechanisms for pollutants removal by the modified membranes. The photocatalytic membrane modified with dopamine-TiO2-GO was furthermore evaluated for the removal of six different pharmaceutical active compounds (PhACs), noticing gains in terms of removal efficiency (up to 95.7%) and fouling mitigation for the modified membrane compared to the original membranes. The photocatalytic activity still contributed to a simultaneous degradation of PhACs avoiding the generation of a concentrated stream for further disposal.

Major depression favors the expansion of Th17-like cells and decrease the proportion of CD39+Treg cell subsets in response to myelin antigen in multiple sclerosis patients.

BACKGROUND: Mood disorders have been associated with risk of clinical relapses in multiple sclerosis (MS), a demyelinating disease mediated by myelin-specific T cells. OBJECTIVES: We aimed to investigate the impact of major depressive disorder (MDD) and cytokine profile of T-cells in relapsing remitting MS patients. METHODS: For our study, plasma and PBMC were obtained from 60 MS patients (30 with lifetime MDD) in remission phase. The PBMC cultures were stimulated with anti-CD3/anti-CD28 beads or myelin basic protein (MBP), and effector and regulatory T cell phenotypes were determined by flow cytometry. The cytokine levels, both in the plasma or in the supernatants collected from PBMC cultures, were quantified by Luminex. In some experiments, the effect of serotonin (5-HT) was investigated. RESULTS: Here, higher Th17-related cytokine levels in response to anti-CD3/anti-CD28 and MBP were quantified in the plasma and PBMC cultures of the MS/MDD group in comparison with MS patients. Further, elevated frequency of CD4+ and CD8+ T cells capable of producing IL-17, IL-22 and GM-CSF was observed in depressed patients. Interestingly, the percentage of myelin-specific IFN-γ+IL-17+ and IFN-γ+GM-CSF+ CD4+ T cells directly correlated with neurological disabilities. In contrast, the occurrence of MDD reduced the proportion of MBP-specific CD39+Tregs subsets. Notably, the severity of both neurological disorder and depressive symptoms inversely correlated with these Tregs. Finally, the addition of 5-HT downregulated the release of Th17-related cytokines in response to anti-CD3/anti-CD28 and myelin antigen. CONCLUSIONS: In summary, our findings suggested that recurrent major depression, by favoring imbalances of effector Th17 and Treg cell subsets, contributes to MS severity.

"Dry oral and ocular manifestations and autoantibodies characteristic of primary Sjögren's syndrome in multiple sclerosis".

INTRODUCTION: The relationship between primary Sjögren syndrome (pSS) and demyelinating diseases is still not well understood. These diseases seem to coexist amidst autoimmunity, raising questions about clinical characteristics, relationship with immunomodulatory treatment, and possible common immunological background underlying their pathogenesis. OBJECTIVE: calculate the frequency of dry oral and ocular manifestations and autoantibodies characteristic of primary Sjögren's Syndrome in Multiple Sclerosis. METHODS: 202 patients with multiple sclerosis answered a questionnaire to identify complaints of xerostomia and xerophthalmia, according to diagnostic criteria for primary Sjögren's syndrome; 43 answered positively to at least one question; 27 had comorbidities or used drugs that cause dry symptoms and were excluded; 16 patients were selected for examinations for oral, ocular and serum anti-Ro/SS-A autoantibody evaluation. RESULTS: Eleven (68.75%) patients complained of xerostomia; 14 (87.5%) of xerophthalmia. Sialometry < 0.1 ml/min was observed in three (18.8%); 13 patients underwent minor salivary gland biopsy and histopathological examination: focal score > 1 in three (23.1%). Schirmer test was < 5 mm/5 min in four (25%). Lyssamine green/fluorescein dye score was > 5 in three (18.8%). Anti-Ro/SS-A > 10 UI/mm in two (12.5%). Three (1,49%) patients met current criteria for primary Sjögren's syndrome. CONCLUSIONS: Patients with MS may report xerostomia and/or xerophthalmia even in the absence of comorbidities and use of medications capable of causing these symptoms, which may fulfill the diagnostic criteria for pSS. In this study, the frequency of pSS according to current criteria was within the range observed in the literature with older criteria. But the question remains whether the association between these diseases is fortuitous or whether there is a pathogenic link.

Post-COVID-19 olfactory dysfunction: carbamazepine as a treatment option in a series of cases.

Olfactory dysfunction is reported frequently in patients with coronavirus disease 2019. However, an effective treatment for this dysfunction is unknown. The present study evaluated carbamazepine as a treatment option for olfactory dysfunction based on its use in cases of neuralgia, especially of the V cranial nerve. The study included 10 patients with coronavirus disease with olfactory complaints who were part of a cohort of 172 coronavirus disease patients monitored for late neurological manifestations. Carbamazepine was administered for 11 weeks. The adverse effects reported were drowsiness (9/10) and dizziness (2/10); 9 of the 10 patients reported improved olfactory function after carbamazepine treatment. While the role of carbamazepine in the control of post-coronavirus disease olfactory dysfunction could not be confirmed in this study, the satisfactory response observed in most patients in this series suggests that further studies are warranted.

Utilização de Podcast para Educação em Estomaterapia Durante a Pandemia de Covid-19 / Podcasting for Education in Enterostomal Therapy During the Covid-19 Pandemic / Uso de Podcasts para la Educación Sobre Estomaterapia Durante la Pandemia Covid-19

Objetivo:Descrever a experiência de acadêmicas de Enfermagem a respeito da utilização de podcast para educação em estomaterapia durante a pandemia de Covid-19. Método: Relato de experiência acerca de atividade de educação em saúde realizada entre junho e outubro de 2021, que descreve a criação de um canal de podcaste a divulgação de conteúdos em estomaterapia. Resultados: Foram realizados 16 episódios abordando as três áreas de estudo da estomaterapia, um introdutório, oito sobre feridas, quatro sobre estomias e três sobre incontinências. Conclusão: Com a utilização do podcast para disseminar conteúdos em estomaterapia, observaram-se a praticidade e o custo-benefício da tecnologia para implementar educação em saúde a distância.

Objective:To describe the experience of nursing academics on the use of podcast for education in enterostomal therapy during the pandemic of COVID-19. Method: Experience report on health education activity held between June and October 2021, which describes the creation of a podcast channel and disclosure of contents in stomatherapy. Results: Sixteen episodes approached the three stomatherapy study areas, one containing the introduction, eight on wounds, four on ostomies and three on incontinences. Conclusion: Through the use of the podcast to disseminate contents in stomach therapy, the practicality and cost-benefit of technology to implement distance health education were observed

Objetivo:describir la experiencia de los académicos de enfermería sobre el uso del podcast por la educación en estómago durante la pandemia de covid-19. Método: Informe de experiencia en la actividad de educación para la salud celebrada entre junio y octubre de 2021, que describe la creación de un canal de podcast y divulgación de contenidos en estomatherapia. Resultados: 16 Episodios se acercaron a las tres áreas de estudio de estomaterapia, siendo una introducción, ocho en heridas, cuatro en Stomias y tres en incontinencias. Conclusión: Desde el uso del podcast para difundir contenidos en la terapia estomacal, se observó que la practicidad y el costo-beneficio de la tecnología implementaran la educación a distancia

Reasons correlated with omission of nursing care / Motivos correlacionados con la omisión de cuidados de enfermería / Razões correlacionadas a omissão de cuidados de enfermagem

ABSTRACT Objective: To evaluate the reasons correlated with the omission of nursing care in a university hospital. Method: Analytical cross-sectional design, developed in a university hospital in Northeast Brazil, from January to February 2020. The study population consisted of nurses and nursing technicians who worked in direct patient care. The Brazilian version of the Missed Nursing Care Survey was applied in a convenience sample consisting of 227 participants (79 nurses and 148 nursing technicians). Univariate and bivariate statistics were calculated in the software Statistical Package for Social Science, version 26.0. Results: The most omitted nursing care was walking three times a day or as prescribed (70.9%). The most prevalent reason was an unexpected increase in the volume and/or severity of patients in the unit (93.0%). Positive, albeit weak, correlations were found between overall care omission, as well as omissions by priority level, and reasons for omission given by nurses and nursing technicians (p < 0.05). Conclusion: The study showed that the omission of nursing care covered all five dimensions of the instrument, mainly correlated with labor and material resources.

RESUMEN Objectivo: Evaluar los motivos correlacionados con la omisión de cuidados de enfermería en un hospital universitario. Método: Diseño transversal analítico, desarrollado en un hospital universitario en el Nordeste de Brasil, de enero a febrero de 2020. La población de estudio estuvo compuesta por enfermeros y técnicos de enfermería que actuaban en el cuidado directo del paciente. La versión brasileña de la Missed Nursing Care Survey en una muestra por conveniencia compuesta por 227 participantes (79 enfermeros y 148 técnicos de enfermería). Las estadísticas univariadas y bivariadas se calcularon en el Software Statistical Package for Social Science, versión 26.0. Resultados: El cuidado de enfermería más omitido fue caminar tres veces al día o según prescripción (70,9%). El motivo más prevalente fue un aumento inesperado en el volumen y/o gravedad de los pacientes en la unidad (93,0%). Se encontraron correlaciones positivas, aunque débiles, entre la omisión de cuidados generales, así como por nivel de prioridad, y las razones de omisión atribuidas por enfermeros y técnicos de enfermería (p < 0,05). Conclusión: El estudio mostró que la omisión del cuidado de enfermería abarcó las cinco dimensiones del instrumento, principalmente correlacionadas con los recursos laborales y materiales.

RESUMO Objetivo: Avaliar as razões correlacionadas à omissão de cuidados de enfermagem em um hospital universitário. Método: Delineamento transversal analítico, desenvolvido em um hospital universitário do Nordeste do Brasil, nos meses de janeiro a fevereiro de 2020. A população do estudo compreendeu enfermeiros e técnicos de enfermagem que atuavam na assistência direta ao paciente. Aplicou-se a versão brasileira do Missed Nursing Care Survey em uma amostra por conveniência composta por 227 participantes (79 enfermeiros e 148 técnicos de enfermagem). Foram calculadas estatísticas uni e bivariadas no software Statistical Package for social Science, versão 26.0. Resultados: O cuidado de enfermagem mais omitido foi deambulação três vezes por dia ou conforme prescrito (70,9%). A razão mais prevalente foi aumento inesperado do volume e/ou gravidade dos pacientes da unidade (93,0%). Foram verificadas correlações positivas, embora fracas, entre a omissão de cuidados geral, bem como por nível de prioridade, e razões de omissão atribuídas pelos enfermeiros e técnicos de enfermagem (p < 0,05). Conclusão O estudo evidenciou que a omissão de cuidados de enfermagem abrangeu todas as cinco dimensões do instrumento correlacionados principalmente aos recursos laborais e materiais.

Nursing knowledge about incontinence-associated dermatitis in a teaching hospital / Conocimiento de enfermeras sobre dermatitis asociada a incontinencia en un hospital docente / Conhecimento de enfermeiros sobre dermatite associada à incontinência em um hospital de ensino

ABSTRACT Objective: Verify the nursing knowledge about incontinence-associated dermatitis in a teaching hospital. Method: Descriptive, cross-sectional research with quantitative analysis carried out with 90 nurses from a university hospital in the northeast of the country between January and February 2021. Data were collected through a self-administered online questionnaire. Applied Fisher's exact association statistical test for crossing the variables. Results: 75.6% of the participants had knowledge about the definition of incontinence-associated dermatitis, however most participants were wrong about several factors, such as: image identification (58.9%), evaluation (66.7%), prevention and treatment (58.9%), risk assessment method (62.2%). Conclusion: Participants have weaknesses in the knowledge of incontinence-associated dermatitis. It is recommended that this study should be reproduced in other scenarios, in order to contribute to the production of protocols to optimize the management of incontinence-associated dermatitis.

RESUMEN Objectivo: Controlar el conocimiento de las enfermeras sobre la dermatitis asociada a incontinencia en un hospital universitario. Método: Investigación descriptiva, transversal con análisis cuantitativo, realizada con 90 enfermeros de un hospital universitario del nordeste del país entre enero y febrero de 2021. Los datos fueron recolectados a través de un cuestionario en línea autoaplicado. Aplicó la prueba estadística de asociación exacta de Fisher para cruzar las variables. Resultados: 75,6 % de los participantes tenía conocimiento sobre la definición de dermatitis asociada a incontinencia, sin embargo, la mayoría de los participantes se equivocaron en varios factores, como: identificación de imágenes (58,9 %), evaluación (66,7 %), prevención y tratamiento (58,9 %), riesgo método de evaluación (62,2%). Conclusión: Los participantes tienen debilidades en el conocimiento de la dermatitis asociada con la incontinencia. Se recomienda que este estudio se reproduzca en otros escenarios, con el fin de contribuir a la elaboración de protocolos que optimicen el manejo de la dermatitis asociada a incontinencia.

RESUMO Objetivo: Verificar o conhecimento de enfermeiros acerca da dermatite associada à incontinência em um hospital de ensino. Método: Pesquisa descritiva, transversal e com análise quantitativa, realizado com 90 enfermeiros de um hospital universitário do nordeste do País entre janeiro e fevereiro de 2021. Os dados foram coletados através de um questionário online auto aplicado. Os dados foram analisados através do teste Exato de Fisher. Resultados: 75,6% dos participantes apresentaram conhecimento sobre a definição de dermatite associada à incontinência, contudo a maioria dos participantes errou sobre diversos fatores, tais como: identificação da imagem (58,9%), avaliação (66,7%), prevenção e tratamento (58,9%), método de avaliação de risco (62,2%). Conclusão: Os participantes apresentam fragilidades no conhecimento de dermatite associada à incontinência. Recomenda-se a reprodução deste estudo em outros cenários, a fim de contribuir com a produção de protocolos que otimizem o manejo.

Nurses' best practices in the management of fecal incontinence in the hospital context: an integrative review / Prácticas de enfermería recomendadas en el manejo de la incontinencia fecal en el contexto hospitalario: una revisión integradora / Melhores práticas de enfermeiros no manejo da incontinência fecal em contexto hospitalar: revisão integrativa

ABSTRACT Objective to analyze, in the literature, the nurses' best practices towards management of Fecal Incontinence in the hospital context. Method this is an integrative literature review with a search carried out in September 2021 in the MEDLINE/PubMed and Web of Science, as well as in the Biblioteca Virtual em Saúde database, which included the Literatura Latino-Americana e do Caribe em Ciências da Saúde, Base de Dados de Enfermagem and Índice Bibliográfico Español en Ciencias de la Salud databases. The analysis considered the descriptive methods and elaboration of a textual corpus in the Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires software program. Results a total of 11 studies were included (and their analysis allowed evidencing prevalence of the English language) published between 1977 and 2021 and which presented, in a greater proportion, an observational methodological design with level of evidence 2C. The results were grouped into two categories: "Care evidence for the management of Fecal Incontinence", with greater predominance of the use of fecal drainage systems; and "Support devices and prevention of complications", presenting, in a greater proportion, the containment devices. Conclusion it was identified that the best practices adopted by nurses in the hospital context are associated with the use of drainage systems and fecal content containment devices. A limitation was evidenced in the nursing team regarding use of other beneficial practices for patients with Fecal Incontinence.

RESUMEN Objetivo analizar, en la literatura, las prácticas de Enfermería recomendadas con respecto al manejo de la Incontinencia Fecal en el contexto hospitalario. Método se trata de una revisión integradora de la literatura en la que la búsqueda se realizó en septiembre de 2021 en las bases de dados MEDLINE/PubMed y Web of Science y en el banco de datos de la Biblioteca Virtual en Salud, que incluyó a las bases de datos Literatura Latino-Americana y del Caribe en Ciencias de la Salud, Base de Datos de Enfermería e Índice Bibliográfico Español en Ciencias de la Salud. En el análisis se consideraron los métodos descriptivos y la elaboración de un corpus textual por medio del software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires. Resultados se incluyeron 11 estudios (y su análisis permitió evidenciar prevalencia del idioma inglés) publicados entre 1977 y 2021 y que, en mayor proporción, presentaron diseños metodológicos observacionales con nivel de evidencia 2C. Los resultados se agruparon en dos categorías: "Evidencias de medidas de atención para el manejo de la Incontinencia Fecal", con mayor predominancia del empleo de sistemas de drenaje fecal, y "Dispositivos de apoyo y prevención de complicaciones", con mayor proporción de dispositivos de contención. Conclusión se identificó que las prácticas recomendadas adoptadas por los enfermeros en el contexto hospitalario están asociadas al uso de sistemas de drenaje y dispositivos de contención del contenido fecal. Se puso en evidencia una limitación del personal de Enfermería en relación al uso de otras prácticas beneficiosas para los pacientes con Incontinencia Fecal.

RESUMO Objetivo analisar, na literatura, as melhores práticas de enfermeiros acerca do manejo da Incontinência Fecal em contexto hospitalar. Método trata-se de uma revisão integrativa da literatura com busca realizada em setembro de 2021 nas bases de dados MEDLINE/PubMed, Web of Science e no banco de dados da Biblioteca Virtual em Saúde, que incluiu as bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde, Base de Dados de Enfermagem e Índice Bibliográfico Español en Ciencias de la Salud. A análise considerou os métodos descritivos e a elaboração de um corpus textual mediante o software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires. Resultados foram incluídos 11 estudos (e a análise destes permitiu evidenciar a prevalência do idioma inglês) publicados entre os anos de 1977 e 2021 e que apresentaram, em maior ocorrência, delineamento metodológico observacional com nível de evidência 2C. Os resultados foram agrupados em duas categorias: "Evidências de cuidados para gerenciamento da Incontinência Fecal", tendo como maior predominância o uso dos sistemas de drenagem fecal, e "Dispositivos de apoio e prevenção de complicações", apresentando, com maior ocorrência, os dispositivos de contenção. Conclusão identificou-se que as melhores práticas adotadas pelos enfermeiros no contexto hospitalar estão associadas ao uso de sistemas de drenagem e dispositivos de contenção do conteúdo fecal. Evidenciou-se a limitação da equipe de Enfermagem quanto ao uso de outras práticas benéficas ao paciente com Incontinência Fecal.