Effects of the COVID-19 Pandemic on Breastfeeding Initiation and Duration: A Retrospective Cohort Study.

INTRODUCTION AND OBJECTIVES: Several studies support the health benefits of breastfeeding for both the mother and the newborn. However, a significant number of mothers discontinue breastfeeding within the first six months of childbirth, with several factors influencing breastfeeding adherence. The purpose of this study is to assess the impact of the COVID-19 pandemic on the prevention of mother-to-newborn infection transmission, breastfeeding patterns and duration, and the incidence of other infections during the first year of life. METHODS: Data from a sample of 39 mothers who gave birth at the Hospital Pedro Hispano in Porto, Portugual, between March 2020 and November 2021 were collected and a telephone questionnaire was administered. Statistical analysis was conducted using R software, v. 4.2.1 (R Foundation for Statistical Computing, Vienna, Austria). RESULTS AND DISCUSSION: In terms of the impact of the COVID-19 norm 18/2020, which went into effect on March 30th, our research found that the type of feeding during hospitalization was significantly influenced by this norm (X2=10.30, p=0.006). We also confirmed that mothers who received home assistance breastfed for an extra 4.5 months (95% CI: 1-7.5) compared with mothers who did not receive such assistance. Regarding the effect of COVID-19 and breastfeeding on newborn health, our study found that if the total duration of breastfeeding is less than six months, an infection is approximately five times more likely (95% CI = 1.06- 29.56). CONCLUSION: Overall, the findings of this study indicate that the efforts implemented at Hospital Pedro Hispano to limit the effects of the COVID-19 pandemic had some effect on immediate breastfeeding patterns, but not on the total duration of breastfeeding or newborn health. Nonetheless, more continuous assistance at home would have been beneficial.

Antifungal efficacy of imidazo[1,2-a]pyrazine-based thiosemicarbazones and thiazolidinediones against Sporothrix species.

Aim: To evaluate antifungal potential of 5,6,7,8-tetrahydroimidazo[1,2-a]pyrazine hybrids based on thiosemicarbazones and thiazolidinediones against pathogenic Sporothrix species. Methods: Antifungal activity of nine compounds were assessed by broth microdilution. Interactions between active compounds and itraconazole were evaluated by the checkerboard assay using non-wild-type isolates. Cytotoxicity of the compounds was determined. Results: Four C-3 substituted analogs showed antifungal activity, unrelated to thiosemicarbazone or thiazolidinedione functions. Synergistic interactions between the four compounds and itraconazole, and low toxicity on mouse fibroblast cells were observed. Activity of 5,6,7,8-tetrahydroimidazo[1,2-a]pyrazine hybrids against Sporothrix depended on the substitution on the imidazopyrazine ring. Conclusion: Antifungal potential, overcoming itraconazole resistance and low toxicity indicate the possible use of that series of compounds in a therapeutic alternative for treatment of sporotrichosis.

Congenital Infantile Myofibroma: The Importance of Molecular Diagnosis.

Infantile myofibromatosis is an uncommon soft tissue neoplasm that may present at birth or in early infancy. Although rare, this neoplasm is one of the most common benign fibrous tumors of infancy. Even though these tumors do not spread, they can compress or damage nearby organs. There is not an established management protocol, but it is advisable to maintain periodic clinical and imagological control until stability. Watchful waiting is an option to consider in the absence of problematic symptoms and visceral involvement. We report a case of solitary infantile myofibromatosis, without visceral involvement. It showed an initial rapid growth, raising concern among medical doctors and motivating soft tissue biopsy, always recommended as the clinical picture deviates from the classic presentation. Histology interpretation is often challenging, making genetics and clinical evaluation essential to exclude and prevent the misdiagnosing of more aggressive lesions.

Perceção dos enfermeiros sobre o contributo do Patient Care para a melhoria contínua da qualidade dos cuidados / Nurses' perception of the contribution of Patient Care to the continuous improvement of quality of care

As tecnologias digitais não podem ser vistas como uma interferência indesejada nos cuidados de saúde e nas relações terapêuticas que os enfermeiros têm com os seus clientes e famílias. Na prática de enfermagem, as tecnologias permitem fortalecer a relação e liderança nos sistemas de saúde, com garantia de melhores cuidados. Assim, o uso das tecnologias de informação e comunicação, potenciam o acesso ao conhecimento, à informação organizada, permitindo uma maior eficácia na tomada de decisão clínica, na efetividade do desempenho profissional e na garantia da qualidade e segurança da prestação de cuidados. Consubstanciando-se nestes pressupostos, o presente estudo tem como objetivo geral: conhecer a perceção dos enfermeiros sobre o contributo do PaTIENT CARE para a melhoria contínua da qualidade dos cuidados. Como objetivos específicos: conhecer as vantagens da utilização do PaTIENT CARE pelos enfermeiros, identificar as dificuldades na utilização do PaTIENT CARE pelos enfermeiros e conhecer as melhorias percecionadas pelos enfermeiros nos cuidados de enfermagem com a utilização do PaTIENT CARE. Foi desenvolvido um estudo qualitativo, descritivo e exploratório, tendo participando quatro enfermeiras gestoras e cinco enfermeiros de um Hospital da região norte de Portugal, através do Focus group. Recorreu-se à técnica de análise de conteúdo para tratamento dos resultados obtidos. Da análise realizada sobressai que os enfermeiros gestores e os enfermeiros reconheceram como vantagens da utilização do PaTIENT CARE: a monitorização de indicadores, a promoção de ambiente seguro, o mecanismo de comunicação entre a equipa e o cumprimento de padrões de qualidade. Partilharam da mesma opinião quanto à otimização das respostas, mencionando que tem vantagens na gestão de recursos. No que diz respeito, às dificuldades na utilização do PaTIENT CARE, ambos os grupos do Focus group apontaram a interoperabilidade dos sistemas de informação, o acompanhamento da empresa e a falta de formação, como os principais aspetos dificultadores. No entanto, os enfermeiros também mencionaram a otimização do processo de cuidados como uma dificuldade no seu uso. Quanto às suas perceções acerca das melhorias percecionadas com a utilização do PaTIENT CARE, os enfermeiros gestores referiram que permite a Integração de sistemas de informação, a coesão da equipa, a reflexão sobre as práticas, a gestão participativa e a comunicação com a equipa, sendo estas duas últimas reiteradas pelos enfermeiros, que também apontaram a facilidade com o uso de sistemas de informação e a uniformização da linguagem. Em suma a utilização do PaTIENT CARE, revelou-se ser uma ferramenta que ajuda os enfermeiros no desempenho das suas funções e permite melhorar a qualidade dos cuidados.

Digital technologies can`t be seen as unwanted interference in health care and in the therapeutic relationships that nurses have with their clients and families. In nursing practice, technologies make it possible to strengthen the relationship and leadership in health systems, guaranteeing better care. Thus, the use of information and communication technologies enhances access to knowledge, to organized information, allowing greater effectiveness in clinical decision-making, in the effectiveness of professional performance, and in ensuring the quality and safety of care provision. Based on these assumptions, the present study has the general objective: to know the perception of nurses about the contribution of PaTIENT CARE to the continuous improvement of the quality of care. As specific objectives: to recognize the advantages of the use of PaTIENT CARE by nurses, to identify the difficulties in the use of PaTIENT CARE by nurses, and to know the improvements perceived by nurses in nursing care with the use of PaTIENT CARE. A qualitative, descriptive, and exploratory study was developed, with the participation of four manager nurses and five nurses from a Hospital in the northern region of Portugal, through the Focus group. The content analysis technique was used to process the results obtained. From the analysis carried out, it stands out that nurse managers and nurses recognized the advantages of using PaTIENT CARE as advantages: the monitoring of indicators, the promotion of a safe environment, the communication mechanism between the team, and the fulfillment of quality standards. They shared the same opinion regarding the optimization of responses, mentioning that it has advantages in resource management. With regard to difficulties in using PaTIENT CARE, both Focus groups pointed to the interoperability of information systems, company monitoring, and lack of training as the main hindering aspects. However, nurses also mentioned the optimization of the care process as difficulty in its use. As for their perceptions about the improvements perceived with the use of PaTIENT CARE, the nurse managers mentioned that it allows the integration of information systems, team cohesion, reflection on practices, participatory management, and communication with the team, being the latter two reiterated by the nurses, who also pointed out the ease with the use of information systems and the standardization of language. In conclusion, the use of PaTIENT CARE proved to be a tool that helps nurses in the performance of their duties and allows for an improvement in the quality of care.

Human sporotrichosis: recommendations from the Brazilian Society of Dermatology for the clinical, diagnostic and therapeutic management

Abstract Background: The increase in the zoonotic epidemic of sporotrichosis caused by Sporothrix brasiliensis, which started in the late 1990s in Rio de Janeiro and is now found in almost all Brazilian states, has been equally advancing in neighboring countries of Brazil. Changes in the clinical-epidemiological profile, advances in the laboratory diagnosis of the disease, and therapeutic difficulties have been observed throughout these almost 25 years of the epidemic, although there is no national consensus. The last international guideline dates from 2007. Objectives: Update the clinical classification, diagnostic methods and recommendations on the therapeutic management of patients with sporotrichosis. Methods: Twelve experts in human sporotrichosis were selected from different Brazilian regions, and divided into three work groups: clinical, diagnosis and treatment. The bibliographic research was carried out on the EBSCOHost platform. Meetings took place via electronic mail and remote/face-to-face and hybrid settings, resulting in a questionnaire which pointed out 13 divergences, resolved based on the opinion of the majority of the participants. Results: The clinical classification and laboratory diagnosis were updated. Therapeutic recommendations were made for the different clinical forms. Conclusions: Publication of the first national recommendation, carried out by the Brazilian Society of Dermatology, aimed at the Brazilian scientific community, especially dermatologists, infectologists, pediatricians, family medicine personnel, and laboratory professionals who work in the management of human sporotrichosis.

Human sporotrichosis: recommendations from the Brazilian Society of Dermatology for the clinical, diagnostic and therapeutic management.

BACKGROUND: The increase in the zoonotic epidemic of sporotrichosis caused by Sporothrix brasiliensis, which started in the late 1990s in Rio de Janeiro and is now found in almost all Brazilian states, has been equally advancing in neighboring countries of Brazil. Changes in the clinical-epidemiological profile, advances in the laboratory diagnosis of the disease, and therapeutic difficulties have been observed throughout these almost 25 years of the epidemic, although there is no national consensus. The last international guideline dates from 2007. OBJECTIVES: Update the clinical classification, diagnostic methods and recommendations on the therapeutic management of patients with sporotrichosis. METHODS: Twelve experts in human sporotrichosis were selected from different Brazilian regions, and divided into three work groups: clinical, diagnosis and treatment. The bibliographic research was carried out on the EBSCOHost platform. Meetings took place via electronic mail and remote/face-to-face and hybrid settings, resulting in a questionnaire which pointed out 13 divergences, resolved based on the opinion of the majority of the participants. RESULTS: The clinical classification and laboratory diagnosis were updated. Therapeutic recommendations were made for the different clinical forms. CONCLUSION: Publication of the first national recommendation, carried out by the Brazilian Society of Dermatology, aimed at the Brazilian scientific community, especially dermatologists, infectologists, pediatricians, family medicine personnel, and laboratory professionals who work in the management of human sporotrichosis.

Epidemiological features and geographical expansion of sporotrichosis in the state of Pernambuco, northeastern Brazil.

Aim: Cases of sporotrichosis are emerging in several states of Brazil, especially in the southeast. Recently, sporotrichosis has been reported in the state of Pernambuco in the northeastern region. The goal of this study was to shed new light on sporotrichosis in terms of the geographic distribution of human cases and provide an overview of sporotrichosis associated with zoonotic transmission. Patients & methods: From March 2017 to November 2019, 179 patients were diagnosed with sporotrichosis. Georeferencing analysis, spatial distribution and epidemiological features of all cases are described. Results: The data show the dynamics of accelerated transmission of sporotrichosis across urban and coastal areas of the state of Pernambuco. Conclusion: There is a need to decentralize health services and implement a One Health approach to this emerging disease.

Exuberant bullous vasculitis associated with SARS-CoV-2 infection.

We described a case of exuberant cutaneous small-vessel vasculitis in a 27-year-old male with mild CoVID-19 in Brazil. The patient presented painful purpuric papules and vesicobullous lesions with hemorrhagic content located in the larger amount in the lower limbs and, to a lesser extent in the region of the back and upper limbs, saving palms and soles of the feet. Influenza-like syndrome with anosmia and ageusia was reported seven days before the skin lesions. A real-time reverse transcription polymerase chain reaction was positive on a nasopharyngeal swab for SARS-CoV-2. Histopathological study showed leukocytoclastic cutaneous vasculitis affecting small vessels and microthrombi occluding some vessels. The patient presented an improvement in skin lesions by the fifth day of prednisone therapy. This case highlights the importance of the SARS-CoV-2 test in investigating the etiology of cutaneous vasculitis during this pandemic.

Case Report: Sweet Syndrome in Patients with Sporotrichosis: A 10-Case Series.

Human sporotrichosis is an emerging disease caused by fungi of the genus Sporothrix, distributed worldwide, but mostly in tropical and subtropical regions. This disease is caused by traumatic inoculation of contaminated material (either animal or vegetal in origin) into the skin. Sporotrichosis cases caused by zoonotic transmission through felines have significantly increased over the last 20 years in Brazil. There is a spectrum of clinical outcomes, from classical lymphocutaneous and fixed forms to disseminated manifestations and extracutaneous lesions; however, hypersensitivity reactions related to sporotrichosis, including Sweet syndrome (acute febrile neutrophilic dermatoses), are uncommon. In Brazil, Sporothrix brasiliensis is repeatedly associated with feline infection and has consistently shown higher virulence, tendency to escalate to outbreaks or epidemics, and development of atypical forms. Therefore, the objective of the present study was to report the cases of 10 patients with sporotrichosis infected by S. brasiliensis species who developed Sweet syndrome to alert this association, especially in endemic areas.

Elaboração de protocolo de investigação de neuropatia periférica em pacientes diabéticos / Elaboration of a protocol for peripheral neuropathy investigation in diabetic patients / Elaboración de protocolo de investigación de neuropatía periférica en pacientes diabéticos

Introdução: A neuropatia distal diabética é uma das principais complicações do diabetes mellitus, acometendo metade dos pacientes com diabetes, e pode ser a causa de deformidades, úlceras e amputações. Mais de 70% dos pacientes com pé diabético apresentam neuropatias. A investigação e o reconhecimento precoce da presença da neuropatia distal diabética são importantes, pois permitem detectar pacientes que apresentam neuropatia distal diabética, que podem evoluir para úlcera e/ou amputação...(AU)

Introduction: Diabetic distal neuropathy is one of the main complications of diabetes mellitus, affecting half of diabetes patients, and may be the cause of deformities, ulcers and amputations. More than 70% of diabetic foot patients have neuropathies. Investigation and early recognition of the presence of diabetic distal neuropathy is important because it allows the detection of patients with diabetic distal neuropathy, which may progress to ulcer and / or amputation ... (AU)

Introducción: la neuropatía distal diabética es una de las principales complicaciones de la diabetes mellitus, afecta a la mitad de los pacientes con diabetes y puede ser la causa de deformidades, úlceras y amputaciones. Más del 70% de los pacientes con pie diabético tienen neuropatías. La investigación y el reconocimiento temprano de la presencia de neuropatía distal diabética es importante porque permite la detección de pacientes con neuropatía distal diabética, que puede progresar a úlcera y / o amputación ... (AU)

[The mental health promotion of children and teenagers in vulnerability and social violence: the challenges for an intersectoral network]. / La promotion de la santé mentale des enfants et adolescents en situation de vulnérabilité et violence sociale : les défis pour un réseau intersectoriel.

This paper presents and discusses the results of an intervention research conducted in Ouro Preto, Brazil from August 2014 to March 2016. The main objective was to contribute to the development of an intersectoral and interdisciplinary network to face psychosocial vulnerabilities of children and teenagers, especially related to sexual violence and drug use. To achieve this, we identified the difficulties faced by the Sistema de Garantia de Direitos Humanos da Criança e do Adolescente (SGDHCA) implemented by the municipality which take care of this population. We also identified protective and promotion factors accomplished to empower them. The methodology used combines Deleuze and Guattari Cartography, Institutional Analysis and the Cross Training. This latter methodology was developed by a group of researchers of Douglas Institute, in Montreal, which we met through scientific co-operation with our laboratory. On account of the practical-theoric and co-participative activities with the professional network of Ouro Preto, we produced a detailed diagnosis of the SGDHCA and a document proposing short, medium and long-term strategies. As final result, we intend to help the local collective-the Forum Intersetorial da Infância e Juventude-to develop a work plan from the proposed actions. In this paper we will concentrate the potential of the methodology used by presenting outcome from two important moments of the research: the discussions of successful and unsuccessful cases that elucidate the network operation and the potential and difficulties arising from the Rotation Positional, important technical of the Cross Training.

[A Rare Case of Neonatal Teeth]. / Um Caso Raro de Dentes Neonatais.

Neonatal teeth is a rare disorder of tooth eruption, arising in the oral cavity, usually in the anterior mandible, in the first month of life. Its etiology is unknown. This condition can cause breastfeeding difficulties, besides aspiration or swallowing of the teeth. We describe the case of a premature infant in the second day of life presented with gingival edema, redness and discrete swelling in the region of the mandibular central incisors. Ten days later, two small teeth with hypermobility were detected. Extraction of those teeth was performed. With this clinical case we intend to show the rarity of this entity, especially in premature infants, the possible association with various syndromes and the need for a multifactorial approach to the treatment decision (extraction / conservative treatment).

Os dentes neonatais correspondem a um distúrbio raro da erupção dentária, surgindo na cavidade oral no primeiro mês de vida, habitualmente na região anterior da mandíbula, sendo a sua etiologia desconhecida. Podem motivar dificuldades na amamentação e ser alvo de aspiração ou deglutição. Descreve-se o caso de um recém-nascido prematuro que no segundo dia de vida apresentava edema, hiperemia gengival e uma pequena tumefação na região dos incisivos centrais inferiores. Dez dias depois, foram detetados, nesse local, dois pequenos dentes com hipermobilidade, pelo que se procedeu a exodontia. Com este caso clínico pretende-se salientar a raridade dos dentes neonatais, sobretudo em recém-nascidos prematuros, a sua possível associação a várias síndromes e a necessidade de uma abordagem multifatorial na decisão terapêutica (exodontia/tratamento conservador).

Cutaneous tuberculosis: diagnosis, histopathology and treatment - part II.

The evolution in the knowledge of tuberculosis' physiopathology allowed not only a better understanding of the immunological factors involved in the disease process, but also the development of new laboratory tests, as well as the establishment of a histological classification that reflects the host's ability to contain the infectious agent. At the same time, the increasing bacilli resistance led to alterations in the basic tuberculosis treatment scheme in 2009. This article critically examines laboratory and histological investigations, treatment regimens for tuberculosis and possible adverse reactions to the most frequently used drugs.

Cutaneous tuberculosis: diagnosis, histopathology and treatment - Part II

The evolution in the knowledge of tuberculosis' physiopathology allowed not only a better understanding of the immunological factors involved in the disease process, but also the development of new laboratory tests, as well as the establishment of a histological classification that reflects the host's ability to contain the infectious agent. At the same time, the increasing bacilli resistance led to alterations in the basic tuberculosis treatment scheme in 2009. This article critically examines laboratory and histological investigations, treatment regimens for tuberculosis and possible adverse reactions to the most frequently used drugs.

Cutaneous tuberculosis: epidemiologic, etiopathogenic and clinical aspects - part I.

Cutaneous tuberculosis (CTB) is the result of a chronic infection by Mycobacterium tuberculosis, M. ovis and occasionally by the Calmette-Guerin bacillus. The clinical manifestations are variable and depend on the interaction of several factors including the site of infection and the host's immunity. This article revises the current knowledge about this disease's physiopathology and immunology as well as detailing the possible clinical presentations.

Cutaneous tuberculosis: epidemiologic, etiopathogenic and clinical aspects - Part I

Cutaneous tuberculosis (CTB) is the result of a chronic infection by Mycobacterium tuberculosis, M. ovis and occasionally by the Calmette-Guerin bacillus. The clinical manifestations are variable and depend on the interaction of several factors including the site of infection and the host's immunity. This article revises the current knowledge about this disease's physiopathology and immunology as well as detailing the possible clinical presentations.