Clinical and Epidemiological Assessment of Children and Adolescents Hospitalized with SARS-CoV-2 in the Pre-Amazon Region.

INTRODUCTION: SARS-CoV-2 infection usually presents similarly to other respiratory viral pathogens. Children and adolescents do not present as a group that is highly affected by the disease, having low infection rates. However, limited publications are associated with the findings of pneumonia in pediatric patients with COVID-19. OBJECTIVE: To analyze the clinical and epidemiological aspects of children and adolescents hospitalized with SARS-CoV-2 in a pre-Amazon region. METHODS: A retrospective study, carried out in four public hospitals in São Luís, Brazil where medical records of children and adolescents aged from 0 to 13 years, of both sexes, with clinical diagnosis of community-acquired pneumonia were evaluated from March 2020 to March 2021. RESULTS: Almost 40.0% of children were aged between 1 year and 5 years. Of the 128 children who had SARS-CoV-2, 3 are of indigenous ethnicity. Additionally, 78.6% of the children had fever and there was no significant difference between COVID-19 patients and those of other respiratory viruses. Eighteen patients had chronic neurological disease, which is the most common comorbidity observed in patients with coronavirus infection. Ground glass opacity attenuation was observed in 24.8% of children and adolescents with COVID-19. Anemia and increased inflammatory response markers were related to SARS-CoV-2 infection. More than 90.0% of patients admitted to hospital, regardless of etiology, were treated with antibiotics. Eighteen patients died. Pediatric multisystem inflammatory syndrome (PMIS) was diagnosed in 17 patients. CONCLUSIONS: SARS-CoV-2 in children and adolescents is mild, but the condition of patients with PMIS is more serious, with an increase in inflammatory biomarkers which can lead to death. Therefore, rapid diagnosis and differentiation of agents causing respiratory diseases are necessary for better therapeutic decision making, since the results of this study make us question the excessive use of antibiotics without meeting well-defined clinical-epidemiological criteria.

Molecular epidemiology of SARS-CoV-2 variants in circulation in the state of Maranhão, Brazil.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a coronavirus belonging to the beta CoV genus, responsible for SARS in humans, which became known as COVID-19. The emergence of variants of this virus is related to the presence of cases of reinfection, reduced vaccine effectiveness and greater transmission of the virus. Objective: In this study, we evaluated the molecular epidemiology of SARS-CoV-2 lineages circulating in the state of Maranhão. This is a cross-sectional and retrospective epidemiological study of genomic surveillance of SARS-CoV-2. The study comprised of 338 genomes sequenced by the Next Generation Sequencing technique on Illumina's Miseq equipment, submitted to Global Initiative on Sharing Avian Influenza Data, 190 (56.2%) are from samples of female and 148 (43.8%) from male patients. Sequencing performed covered samples of patients aged between 1 and 108 years, with emphasis on the age groups from 30 to 39 years with 15.0% of sequenced genomes and 20 to 29 years with 12.4%. As for the distribution of sequenced genomes by health macro-regions, 285 (84.3%) are from cities in the northern macro-region. We evidenced the circulation of 29 lineages and sub-lineages, four of which belonging to the Delta variant (AY.43, AY.99.1, AY.99.2 and AY.101 responsible for 4.5% of the genomes) and the others belonging to the Omicron variant, with emphasis on: BA.1 and sub-lineages (42.8%); BA.4, BA.5 and sub-lineages (5.3% and 41.1%); the sub-lineages DL.1 and BQ.1 (5% and 2%). A strong genomic surveillance system allows the study of the natural history of the disease, when there is a resurgence of SARS-CoV-2 cases.

High Incidence of Respiratory Syncytial Virus in Children with Community-Acquired Pneumonia from a City in the Brazilian Pre-Amazon Region.

INTRODUCTION: Although fewer children have been affected by the severe form of the coronavirus disease 2019 (COVID-19), community-acquired pneumonia (CAP) continues to be the leading global cause of child hospitalizations and deaths. AIM: This study investigated the incidence of respiratory syncytial virus (RSV) as well its subtypes (RSV A and B), adenovirus (ADV), rhinovirus (HRV), metapneumovirus (HMPV), coronavirus (NL63, OC43, 229E and HKU1), parainfluenza virus subtypes (PI1, PI2 and PI3), bocavirus and influenza A and B viruses (FluA and FluB) in children diagnosed with CAP during the COVID-19 pandemic. METHODS: A total of 200 children with clinically confirmed CAP were initially recruited, of whom 107 had negative qPCR results for SARS-CoV-2 and were included in this study. Viral subtypes were identified using a real-time polymerase chain reaction in the nasopharyngeal swab samples. RESULTS: Viruses were identified in 69.2% of the patients. RSV infections were the most frequently identified (65.4%), with type RSV B being the most prevalent (63.5%). In addition, HCoV 229E and HRV were detected in 6.5% and 3.7% of the patients, respectively. RSV type B was associated with severe acute respiratory infection (ARI) and a younger age (less than 24 months). CONCLUSIONS: New strategies for preventing and treating viral respiratory infections, particularly RSV infections, are necessary.

Lower mean phosphate independently predicts mortality in critically ill patients: Results from a prospective cohort study.

PURPOSE: To evaluate lower mean phosphate as a prognostic tool in critically ill patients. METHODS: This is a prospective single-center cohort study including adult patients (> 18 years) with a length of intensive care unit (ICU) stay of at least 24 h. Phosphatemia was evaluated within 1 h of ICU admission and once daily. Mean phosphate, calculated by the simple arithmetic mean of daily phosphate measurements, was proposed and tested. Standard severity scores were applied. Multivariate and survival analyses were performed. RESULTS: A total of 317 patients were included, of whom 111 (35%) presented hypophosphatemia. Hypophosphatemia associated with surgical conditions, nutritional therapy, hypovitaminosis D, hyperparathyroidism, mechanical ventilation (need and duration), and ICU and hospital length of stay were evaluated. Admission APACHE II and SOFA (ICU days 1, 3, and 7) scores and ICU and in-hospital mortality were greater in the hypophosphatemia group than control group. Higher APACHE II (RR: 1.1; 95%CI: 1.01-1.2; p = 0.045) and lower mean phosphate (RR: 0.02; 95%CI: 0.001-0.09; p = 0.044) independently predicted ICU and in-hospital mortality. CONCLUSIONS: Hypophosphatemia is frequent in the ICU, and was associated with unfavorable outcomes. This study introduces the importance of longitudinal monitoring of phosphate levels, since lower mean phosphate is an independent predictor of mortality in critically ill patients.

Convergent end-to-end neurorrhaphy: An alternative technique for dual innervation of the gastrocnemius muscle in rats.

INTRODUCTION: Muscle contraction generated by electrical impulses simultaneously originating from two different neural sources may be an interesting treatment alternative for long term facial palsy. An experimental model was designed to compare single and dual innervation of the gastrocnemius muscle (GM) in rats. METHODS: Fifty adult Wistar rats underwent transection of their right peroneal nerve and were divided into five groups (n = 10): control (C), tibial nerve section (TS), tibial nerve primary end-to-end neurorrhaphy (PEE), tibial nerve primary repair associated with end-to-side peroneal-to-tibial nerve transfer (PRES), and tibial nerve repair by convergent end-to-end (CEE) neurorrhaphy between the proximal stumps of the tibial and peroneal nerves to the distal stump of the tibial nerve. The outcomes were assessed 12 weeks after the experiment by walking track, electromyography, GM mass index, and histomorphometric analysis of the distal tibial nerve. RESULTS: The functional recovery of the PRES (-33.77 ± 24.13) and CEE (-42.15 ± 31.14) groups was greater (P < 0.003) than the PEE group (-80.26 ± 17.20). The CEE group (18.35 ± 7.84) showed greater amplitude (P = 0.006) than the PEE group (8.2 ± 4.64). There was no difference in the muscle mass index among the reinnervation groups (P > 0.705). Histologic analysis revealed greater (P < 0.002) axonal density in the CEE group (126.70 ± 15.01) compared to PEE (99.70 ± 12.82) and PRES (92.00 ± 19.17) groups. CONCLUSIONS: The dual innervation techniques showed earlier and greater functional recovery of the GM than did the single innervation technique. The CEE group showed a 40% higher number of regenerated axons in the distal tibial nerve stump.

Contralateral Botulinum Toxin Improved Functional Recovery after Tibial Nerve Repair in Rats.

BACKGROUND: There is clinical and experimental evidence that botulinum toxin applied to the healthy side of patients with facial paralysis positively affects functional recovery of the paralyzed side. The authors created an experimental model to study the effects of botulinum toxin injection in the gastrocnemius muscle contralateral to the side of tibial nerve lesion/repair in rats. METHODS: Fifty rats were allocated into five groups: group I, control; group II, tibial nerve section; group III, tibial nerve section and immediate neurorrhaphy; group IV, tibial nerve section, immediate neurorrhaphy, and botulinum toxin injected into the contralateral gastrocnemius muscle; and group V, botulinum toxin injected into the gastrocnemius muscle and no surgery. Assessment tools included a walking track, electromyography, gastrocnemius muscle weight measurement, and histologic analysis of the nerve. RESULTS: Paralysis in group V was transient, with function returning to normal at 8 weeks. At 12 weeks, group V had lower latency levels. At week 12, group IV showed higher functional outcomes and amplitude levels than group III, and lower muscle atrophy on the side injected with botulinum toxin compared with group V. CONCLUSION: Transient paralysis of the contralateral gastrocnemius muscle by botulinum toxin type A improved functional recovery in rats that underwent section and repair of the tibial nerve.

Treinamento resistido reduz riscos cardiovasculares em idosas / Resisted training reduces cardiovascular risk in elderly women / Entrenamiento resistido reduce el riesgo cardiovascular en mujeres mayores

INTRODUÇÃO: O envelhecimento humano aliado ao estilo de vida sedentário é marcado por alterações metabólicas com modificação na composição corporal, que repercutem diretamente na proteína C-reativa (PCR), sendo este um importante marcador de risco de doenças cardiovasculares (DCV). O treinamento resistido (TR) é um método muito utilizado na prevenção de doenças associadas ao envelhecimento. Objetivo: Avaliar os efeitos de oito semanas de TR sobre a composição corporal, força muscular e PCR em um grupo de idosas.MÉTODO: Foi realizado um estudo experimental com 10 idosas (63 ± 2 anos de idade). Para o ensaio de PCR, análises bioquímicas de hemograma e lipidograma completos foram coletadas amostras de sangue venoso periférico antes do exercício e 24 horas depois. Para medidas antropométricas calcularam-se índice de massa corporal (IMC), relação cintura/quadril (RCQ) e composição corporal. O TR foi realizado por Série Combinada - Bi-Set. Para a análise estatística, primeiramente foi realizado o teste de normalidade de Shapiro-Wilk (p > 0,05) para testes paramétricos. As variáveis do grupo foram apresentadas como média e desvio padrão. Para variáveis de PCR, antropométricas, composição corporal e perfil lipídico foram realizados o teste t de Student,tanto anterior quanto posteriormente às oito semanas de treinamento. Para as amostras da evolução das cargas e médias do consumo alimentar foi realizado o teste One Way ANOVA e, quando necessário, o teste post hoc de Tukey. O nível de significância adotado foi de p ≤ 0,05.RESULTADOS: Houve redução estatisticamente significativa (p = 0,02) para as concentrações séricas de PCR, o que significa uma redução de 70,96%, além de diminuir a massa gorda e aumentar a massa magra e a carga de treino após oito semanas.CONCLUSÃO: Oito semanas de TR reduziram as concentrações séricas de proteína C-reativa, assim como diminuíram a massa gorda e aumentaram o volume muscular, demonstrando ser uma estratégia eficiente para a diminuição dos fatores de riscos de doenças cardiovasculares.

INTRODUCTION: Human aging combined with a sedentary lifestyle is marked by metabolic changes with change in body composition reflecting directly on the C-reactive protein (CRP), which is an important risk marker for cardiovascular disease (CVD). Resistance Training (RT) is a widely used method in the prevention of diseases associated with aging. Objective: To evaluate the effects of eight weeks of TR on body composition, muscle strength and CRP in a group of elderly women.METHOD: An experimental study was conducted with 10 elderly women (63 ± 2 years). For the CRP analysis, biochemical analysis, complete blood count and lipid profile samples of peripheral venous blood were collected before exercise and 24 hours later. For anthropometric measurements were calculated the body mass index (BMI), waist/hip ratio (WHR) and body composition. The TR was conducted by Combined Series - Bi-Set. Statistical analysis was first conducted with the Shapiro-Wilk normality test (p>0.05) for parametric tests. Group variables were presented as mean and standard deviation. For CRP, anthropometric, body composition and lipid profile variables, the Student t test was performed, for both previous and later to eight weeks of training. For samples of the loads evolution and average food consumption was performed the One Way ANOVA test and, where necessary, the Tukey's post hoc test. The significance level was set at p≤0.05.RESULTS: There was a statistically significant reduction (p=0.02) for the serum concentrations of CRP, which means a decrease of 70.96%, and reduction of the fat mass and increased lean body mass and the training load after eight weeks.CONCLUSION: Eight weeks of RT reduced serum concentrations of C-reactive protein, as well as decreased fat mass and increased muscle volume, proving to be an effective strategy in reducing the risk factors for cardiovascular disease.

INTRODUCCIÓN: El envejecimiento humano combinado con un estilo de vida sedentario está marcado por cambios metabólicos con el cambio en la composición corporal que afectan directamente a la proteína C-reactiva (PCR), que es un marcador importante de riesgo de enfermedad cardiovascular (ECV). El entrenamiento de resistencia (RT) es un método ampliamente utilizado en la prevención de las enfermedades asociadas con el envejecimiento. Objetivo: Evaluar los efectos de las ocho semanas de TR en la composición corporal, la fuerza muscular y la PCR en un grupo de personas de edad avanzada.MÉTODO: Un estudio experimental se llevó a cabo con 10 mujeres de edad avanzada (63 ± 2 años). Para prueba PCR, el análisis bioquímico, hemograma completo y perfil lipídico completo se recogieron muestras de sangre venosa periférica antes del ejercicio y 24 horas después. Para las medidas antropométricas se calcularon el índice de masa corporal (IMC), índice cintura/cadera (ICC) y composición corporal. El TR fue realizado por la Serie Combinada - Bi-Set. El análisis estadístico se realizó por primera vez con la prueba de normalidad de Shapiro-Wilk (p > 0,05) para las pruebas paramétricas. Las variables de grupo se presentan como media y desviación estándar. La PCR, las variables antropométricas, la composición corporal y el perfil lipídico se realizaron con la prueba de la t de Student, tanto anterior cuanto posteriormente a las ocho semanas de entrenamiento. Para las muestras de cambios de carga y el consumo medio de alimentos se realizó la prueba One Way ANOVA y, cuando necesario, la prueba post hoc de Tukey. El nivel de significación se fijó en p ≤ 0,05.RESULTADOS: Hubo una reducción estadísticamente significativa (p = 0,02) para las concentraciones séricas de PCR, lo que significa un descenso del 70,96%, y reducción la masa grasa y aumento de la masa corporal magra y la carga de entrenamiento después de ocho semanas.CONCLUSIÓN: Ocho semanas de RT reducen las concentraciones séricas de proteína C-reactiva, así como de la masa grasa, aumentaron el volumen muscular, demostrando ser una estrategia eficaz para la reducción de los factores de riesgo de enfermedad cardiovascular.

Competência política do enfermeiro: achados bibliográficos / Political competence of nurses: literature findings

Pesquisa bibliográfica sobre competência política do enfermeiro em textos científicos de cinco livros, 12periódicos e duas dissertações de mestrado com análise das abordagens em termos de conteúdo e contextualização.Os achados revelam que, quando da institucionalização em 1920, a enfermagem se apresentava acrítica e passivafrente aos acontecimentos da época. Em 1940 inicia-se um ensaio de sua projeção política, mas, somente nas décadasde 1970 e 1980, o posicionamento do enfermeiro estabelece concretude social frente ao sistema público de saúdee da rediscussão do rumo intelectual e político da profissão. É a partir de 1990 que se observa uma discussãodo pensamento crítico e da prática social da enfermagem. Conclui-se que ainda há uma cisão na profissão, na qual,de um lado, há um grupo consciente, crítico e politizado e, de outro, um grupo ainda passivo e acomodado, o quetorna incipiente o posicionamento político dos enfermeiros.

[Political competence of nurses: literature findings]. / Competência política do enfermeiro: achados bibliográficos.

This is a literature review on the political competence of nurses in scientific texts of five books, 12 journals, and two master's degrees dissertations, analyzing approaches in terms of content and context. The findings revealed that in the 1920s, when nursing was institutionalized, nurses seemed to be non-critical and passive as to the events of their time. There was a shy political movement in the 1940s, but only in the 1970s and 1980s the nurse position becomes socially concrete as to public health care system and when discussing the intellectual and political directions of the profession. In 1990s, a discussion on critical thinking and the social practice of nursing emerged. It was concluded that there is still a gap in the profession, with a politically aware and critical group in one hand, and a passive and lethargic on the other hand, making the political position of nurses incipient.