Cerebral Tuberculosis After Therapy With Adalimumab for Hidradenitis Suppurativa: A Rare Case.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with limited therapeutic options. Adalimumab, an anti-tumor necrosis factor-alpha (TNF-α) monoclonal antibody, was the first biological agent approved for the treatment of moderate to severe HS. Tuberculosis (TB) is a highly prevalent global public health problem, affecting individuals worldwide. Continuous immunosuppression from TNF-α treatment increases the risk of TB development. Isolated neurotuberculosis, in the absence of other symptoms, emerges as a rarely observed infection pattern in such patients. We present a case of a 23-year-old woman with severe HS undergoing treatment with adalimumab. After two years, she developed a pronounced occipital tension headache, constant nausea, and persistent fever. The patient's latent TB status was unknown without annual screening. Subsequent magnetic resonance imaging revealed a lesion in the cerebellar vermis. Immunosuppressive therapy was suspended and an etiological study was conducted; the only positive result was the interferon-gamma release assay. Empirically, antituberculosis treatment and prednisolone were initiated, leading to clinical and neurological improvement. After one year of treatment, symptoms resolved without neurological sequelae. This case highlights the importance of vigilant monitoring before, during, and after immunosuppressive treatment. Early recognition, discontinuation of anti-tumor necrosis factor medications, and appropriate management of TB are crucial to prevent complications.

Löfgren Syndrome: A Mosaic of Sarcoidosis Phenotypes.

Sarcoidosis is an autoimmune multisystemic granulomatous disease with an unknown etiology. Löfgren syndrome (LS), an infrequent initial presentation of acute sarcoidosis, is characterized by the classic triad of acute arthritis, erythema nodosum (EN), and bilateral hilar lymphadenopathy (BHL). The presence of this triad offers high diagnostic specificity for sarcoidosis, eliminating the need for a confirmatory biopsy. Typically, LS follows a predictable, self-limiting clinical course. However, atypical presentations require early suspicion and closer monitoring. This case report highlights an unusual clinical manifestation of LS, marked by an incomplete presentation with acute panniculitis and joint lesions in the absence of EN. Acute sarcoidosis should be considered among the differential diagnoses when these clinical manifestations are present, and chest radiography should be performed to rule out BHL. In atypical cases, the disease course becomes less predictable, as exemplified in our case, where recurrence of the disease may occur, necessitating consistent monitoring.

Construção de um aplicativo: promoção à saúde do idoso com incapacidade e dor lombar / Building an app: promoting the health of elderly people with disabilities and low back pain

Introdução: A incapacidade funcional e o desempenho físico são definidos pela dificuldade ou necessidade de ajuda para o indivíduo executar tarefas diárias, podendo repercutir na capacidade adaptativa das atividades diárias, tanto nas suas capacidades físicas quanto mentais. O processo de envelhecimento acarreta incapacidade funcional, comprometendo a qualidade de vida. Objetivo geral: Construir um aplicativo em saúde com foco na saúde do idoso com incapacidade na lombar. Métodos: Trata-se de um estudo do tipo construção de um aplicativo, desenvolvido durante o período de agosto de 2021 a maio de 2022 em Fortaleza-CE, na página https://fabricadeaplicativos.com.br e será disponibilizado com um instrumento composto pelo índice de Oswestry 2.0 de Incapacidade. Resultados: Telas explicativas para download e acesso ao aplicativo desenvolvido para facilitar o alcance de informações relevantes aos idosos que sofrem limitações no seu dia a dia, provenientes do processo de envelhecimento. Conclusão: Tendo visto que existem poucos estudos e aplicativos sobre esse assunto, se faz necessário a criação de um aplicativo voltado ao tema.(AU)

Introduction: Functional disability and physical performance are defined by the difficulty or need for help for the individual to perform daily tasks. It can have repercussions on the adaptive capacity of daily activities, both in their physical and mental capacities. The aging process causes functional disability, thus compromising quality of life. General objective: To build a health application focused on the health of the elderly with disabilities in the lumbar. Methods: This is a study of the type of construction of an application, developed during the period from August 2021 to May 2022 in Fortaleza-Ceará, on page https://fabricadeaplicativos.com.br and will be made available with an instrument composed of the Oswestry 2.0 Disability Index. Results: Explanatory screens for download and access to the application that was developed to facilitate the reach of relevant information to the elderly who suffer limitations in their day-to-day coming from the aging process. Conclusion: Having seen that there are few studies and applications on this subject, it is necessary to create an application focused on the subject.(AU)

Introducción: La discapacidad funcional y el rendimiento físico se definen por la dificultad o necesidad de ayuda del individuo para realizar las tareas diarias, lo que puede repercutir en la capacidad adaptativa de las actividades diarias, tanto en sus capacidades físicas como mentales. El proceso de envejecimiento conduce a una discapacidad funcional, comprometiendo la calidad de vida. Objetivo general: Construir una aplicación de salud centrada en la salud de personas mayores con discapacidad lumbar. Métodos: Se trata de un estudio del tipo constructivo de una aplicación, desarrollado durante el período de agosto de 2021 a mayo de 2022 en Fortaleza-CE, en la página https://fabricadeaplicativos.com.br y estará disponible con un instrumento compuesto. por el Índice de Discapacidad Oswestry 2.0. Resultados: Pantallas explicativas de descarga y acceso a la aplicación desarrollada para facilitar el acceso a información relevante a personas mayores que sufren limitaciones en su vida diaria, derivadas del proceso de envejecimiento. Conclusión: Dado que existen pocos estudios y aplicaciones sobre este tema, es necesario crear una aplicación enfocada en el tema.(AU)

Thermoregulatory capacity of goat kids from birth to weaning in a dry hot climate.

This study aimed to evaluate the thermoregulatory capacity and performance of Saanen goat kids from birth to weaning in a hot climate. Twelve newborn males and female goat kids with an initial body weight of 4.17 ± 0.81 kg were used. Physiological responses, climatic variables, and biometric traits data were collected. Univariate and multivariate analysis techniques were used. Heart rate (HR) was high up to the 6th week of life, with a reduction from the 7th week on (P < 0.001). Rectal temperature (RT) was lower in the first 2 weeks (P < 0.001), with an increase and stabilization occurring in the 7th and 8th weeks. Coat surface temperature (ST) was more activated from the 5th week onwards (P < 0.001). Body weight (BW) and withers height (WH) were higher in later weeks of the calving phase with a linear effect (P < 0.001). The first principal component demonstrated the relationship of sensible heat dissipation × body area of the goat kids; the second component shows the relationship of meteorological data with RT, having a positive relationship between RT with RH and negative with AT, and the third component points to the association of RR and HR. Of the animals, 81.3% were correctly classified in their group of origin in discriminant canonical analysis, with emphasis on the classification of the kids in the 1st-2nd and 3rd-4th weeks (classification percentage Æ© = 95.8%). It is concluded that (i) newborn kids activate latent mechanisms to maintain their homoeothermic during the first 2 weeks of life, and as they grow, they use sensitive heat loss processes, especially from the 5th week of life onwards and (ii) male and female goats do not show sexual dimorphism effect on body performance and body morphometric measurements up to 60 days of life.

[Risk Factors for Delayed Discharge Due to Social Factors: A Retrospective Study]. / Factores de Risco para Alta Prorrogada por Motivos Sociais: Um Estudo Retrospectivo.

INTRODUCTION: The hospital setting faces a rate of bed occupation by patients whose discharge is limited by other factors apart from clinical needs. This urges the need for an early identification of the patients at risk of delayed discharge due to social factors in order to reduce expenses and to add value that converts itself into the patient health. The aim of this study was to identify the demographic and clinical factors that may be associated with delayed discharge. MATERIAL AND METHODS: Demographic and clinical comorbidity data on 582 patients of an internal medicine ward from a tertiary hospital center during the years 2018 and 2019 was analyzed. A binomial logistic regression model was used, adjusted for sex, age, and length of clinical stay, in order to identify potential risk factors associated with delayed discharge. RESULTS: A total of 473 patients admitted in the internal medicine ward throughout the two years of study were included. Ninety-four (19%) of these patients had their discharge delayed beyond their clinical needs; sixty-four (68%) of these were females. The most representative age was between 75 - 89 years old (45.7%). The characteristics that significantly differed between both non-delayed and delayed discharge were female sex (OR 2.84, 95% CI 1.65 - 4.90, p-value < 0.05), prolonged clinical stay (OR 2.64, 95% CI 1.60 - 4.937, p-value < 0.05) and diabetes mellitus (OR 1.87, 95% CI 1.08 - 3.23, p-value < 0.05). Besides these, the presence of heart failure (OR 0.52, 95% CI 0.27 - 0.99, p-value < 0.05) and chronic kidney disease (OR 0.34, 95% CI 0.14 - 0.86, p-value < 0.05) were associated with a lower risk of delayed discharge. CONCLUSION: Female sex, a prolonged clinical stay and diabetes mellitus were associated with a higher risk of delayed discharge, while heart failure and chronic kidney disease were associated with a reduced risk. These findings create a basis for a possible future multicentre study aimed at creating a clinical prediction rule to stratify the risk of delayed hospital discharge in the Portuguese population.

Introdução: Os hospitais deparam-se com uma percentagem das suas camas ocupadas por doentes cuja alta hospitalar está limitada não pela alta clínica, mas por outros fatores. Cria-se a necessidade da identificação precoce dos indivíduos que estão em risco de uma alta prorrogada por motivos sociais (internamentos sociais - IS), de forma a reduzir gastos e a acrescentar valor que se traduza em saúde dos utentes. O objetivo deste estudo foi identificar os fatores de risco demográficos e clínicos que condicionam risco de internamento social. Material e Métodos: Foram analisados 582 internamentos referentes a um serviço de Medicina Interna de hospital terciário nos anos de 2018 e 2019, e consideradas as características demográficas e comorbidades clínicas dos doentes. Foi feita uma regressão logística binominal ajustada ao sexo, idade e internamento clínico prolongado, para identificação de potenciais fatores de risco associados a alta prorrogada. Resultados: Foram incluídos neste estudo um total de 473 doentes admitido no serviço no período de dois anos em estudo. Noventa e quatro (19%) doentes tiveram a sua alta prorrogada, dos quais 64 (68%) eram do sexo feminino. As principais características estatisticamente significativas associadas a maior risco de prorrogação da alta foram o sexo feminino (OR 2,84, 95% IC 1,65 ­ 4,90, p-value < 0,05), o internamento clínico prolongado (OR 2,64, 95% IC 1,60 ­ 4,937, p-value < 0,05) e a diabetes mellitus (OR 1,87, 95% IC 1,08 ­ 3,23, p-value < 0,05); para além destes, a presença de insuficiência cardíaca (OR 0,52, 95% IC 0,27 ­ 0,99, p-value < 0,05) e de doença renal crónica (OR 0,34, 95% IC 0,14 ­ 0,86, p-value < 0,05) associaram-se a um risco inferior de prorrogação de alta. Conclusão: O sexo feminino, os internamentos clínicos prolongados e diabetes mellitus associaram-se a um maior risco de internamento social, enquanto a insuficiência cardíaca e a doença renal crónica se associaram a um risco inferior de IS. Estes achados servem de base de construção para um futuro estudo multicêntrico para criação de uma regra de predição clínica para estratificação do risco de internamento social na população portuguesa.

Perspectivas de enfermeiros em saúde mental sob a ótica da atenção psicossocial / Perspectives of mental health nurses from the perspective of psychosocial care / Perspectivas de enfermeros en salud mental bajo el concepto de atención psicosocial

Objetivo:identificar por meio dos discursos dos enfermeiros os princípios que sustentam suas práticas nos Centros de Atenção Psicossocial.Método:estudo descritivo-exploratório e com abordagem qualitativa. A coleta de dados ocorreu por entrevistas individuais e semiestruturadas com enfermeiros trabalhadores da área de saúde mental em um município do Nordeste do Brasil, de setembro a outubro de 2021. Utilizou-se a análise temática. Resultados:foram definidas as seguintes categorias: apostando no modopsicossocial; desafios para atuação dos enfermeiros em saúde mental. Os entrevistados falaram das vivências profissionais, evidenciando aspectos que aludem à necessidade de modificações do olhar sobre a assistência em saúde mental na perspectiva da atenção psicossocial nos serviços substitutivos. Considerações Finais:os enfermeiros ressaltam a importância dos preceitos da reforma psiquiátrica e seus avanços, com ações baseadas no modelo psicossocial. Contudo, observou-se que a apropriação teórica das temáticas relativas à saúde mental, incluindo aspectos legais, carece de maior aprofundamento.

Objective:to identify, through the nurses' speeches, the principles that support their practices in Psychosocial Care Centers. Method:descriptive-exploratory study with a qualitative approach. Data collection took place through individual and semi-structured interviews with Nurses working in the mental health area in a Brazilian Northeast city from September through October 2021. Thematic analysis was used. Results:the following categories were defined: betting on the psychosocial mode; challenges for the performance of nurses in mental health. The interviewees spoke of their professional experiences, highlighting aspects that allude to the need for changes in the perspective of mental health care from the perspective of psychosocial care in substitutive services. Final Considerations:the nurses emphasize the importance of the precepts of the psychiatric reform and its advances, with actions based on the psychosocial model. However, it was observed that the theoretical appropriation of themes related to mental health, including legal aspects, lacks further deepening.

Objetivo:identificar, a través de los discursos de los enfermeros, los principios que sustentan sus prácticas en los Centros de Atención Psicosocial. Método:estudio descriptivo-exploratorio con abordaje cualitativo. Larecolección de datos se realizó a través de entrevistas individuales y semiestructuradas con Enfermeros que actúan en el área de salud mental en un municipio del Nordeste de Brasil, de septiembre a octubre de 2021. Se utilizó el análisis temático. Resultados:se definieron las siguientes categorías: apostando por la modalidad psicosocial; Desafíos para la actuación de los enfermeros en salud mental. Los entrevistados hablaron de sus experiencias profesionales, destacando aspectos que aluden a la necesidad de cambios en la perspectiva de la atención a la salud mental desde la perspectiva de la atención psicosocial en servicios sustitutivos. Consideraciones Finales:los enfermeros destacan la importancia de los preceptos de la reforma psiquiátrica y sus avances, con acciones pautadas en el modelo psicosocial. Sin embargo, se observó que la apropiación teórica de temas relacionados con la salud mental, incluidos los aspectos legales, carece de mayor profundización.

Cytokine Adsorption Therapy during Extracorporeal Membrane Oxygenation in Adult Patients with COVID-19.

Respiratory failure and systemic inflammation are paramount features of severe SARS-CoV-2 disease (COVID-19). Extracorporeal membrane oxygenation (ECMO) therapy has a potential role in patients with refractory disease. An inflammatory response due to blood contact with hemofilters, functioning as a synergic inflammatory stimulus, can lead to a hyperinflammatory state, relatable to cytokine release syndromes. After the first patient succumbed to a refractory vasodilatory shock believed to be due to hyperinflammatory state, a strategy of blood purification through cytokine adsorption therapy (CAT) with CytoSorb® was designed. In this case series, the authors describe the initial experience with such strategy. CAT was employed with no direct complications and helped controlling the inflammatory state, with all patients halting vasopressor support in 72 h and biomarker levels (C-reactive protein, ferritin, and interleukin-6) showing negative trends in most patients. Analysis of inflammatory biomarkers evolution highlighted 2 biomarker profiles related to the presence or absence of superinfection at the time of CAT implementation. In this case series of severe COVID-19 patients, 3 patients died - irreversible lung fibrosis, complications of critical hypoxemia before ECMO induction and complications of systemic anticoagulation were the causes. This case series aimed to contribute to the body of evidence substantiating CAT utilization in hyperinflammatory patients, namely, COVID-19 patients requiring ECMO rescue.

Renal Dysplasia and Progressive Renal Failure in a Newborn with Interstitial Chromosome 4 Deletion 4q25-28.3: A New Phenotype?

The deletion of the long arm of chromosome 4 is rare, presenting with a variable phenotype depending on the chromosomic area affected. A term newborn with prenatal diagnosis of anhydramnios, dysplastic cystic kidneys, and cardiomegaly was born with generalized subcutaneous edema, several dysmorphic features, and progressive renal failure requiring dialysis. The infant continued to deteriorate and died at 52 days of age. Autopsy confirmed bilateral renal dysplasia with cysts. Array-comparative genomic hybridization (CGH) identified a large deletion on 4q25-q28.3, which is not yet described in association with renal disease. The clinical progression could be expected due to the severity of the perinatal clinical presentation.

Fatores contribuintes para ocorrência de eventos adversos em unidade de terapia intensiva: perspectiva do enfermeiro / Contributive factors for adverse events occurrence in an intensive therapy unit: nurse's perspective

Objetivo: avaliar as atitudes dos enfermeiros sobre as condições que contribuem para a ocorrência de eventos adversos. Método: estudo descritivo, com abordagem quantitativa, realizado com 28 enfermeiros das UTI´s, em hospital público de Fortaleza-CE, utilizando a Escala de Predisposição a Eventos Adversos (EPEA).Na análise exploratória, foram calculadas as frequências absolutas e percentuais para as variáveis nominais. No caso de variáveis quantitativas, foram apresentados a média e o desvio padrão e as médias das duas escalas (ideal e real). Resultados: encontrou-se, no estudo, o nível de importância que os enfermeiros atribuem aos aspectos da estrutura e processo (nível ideal) como, também, a percepção sobre a existência dos aspectos da estrutura e processos no seu ambiente de trabalho (nível real). Conclusão: o estudo determinou as atitudes dos enfermeiros frente às condições que podem favorecer a ocorrência de eventos adversos através dos itens da EPEA.

Utilização da escala de avaliação da espiritualidade em pacientes portadores de lesão renal em hemodiálise / Use of a spirituality self-rating scale in patients with kidney disease undergoing hemodialysis / Utilización de la escala de evaluación de la espiritualidad en pacientes con lesión renal en hemodiálisis

Objetivou-se avaliar a espiritualidade de pacientes em hemodiálise, fundamentada na Escala de Avaliação da Espiritualidade em Contextos de Saúde. Estudo descritivo e transversal, realizado com 80 pacientes internados por lesão renal em hemodiálise. Dados coletados de dezembro de 2011 a janeiro de 2012, por meio de uma escala autoaplicável de avaliação da espiritualidade. Dos 80 pacientes, 93,75% possuíam alguma crença religiosa. Quanto às expressões de espiritualidade, 57,5% estavam de acordo com a variável "As minhas crenças espirituais/religiosas dão sentido à minha vida"; 70%, com "Minha fé e crença dão-me força nos momentos difíceis"; 48,8%, com "Vejo o futuro com esperança"; 21,3%, "Sinto que minha vida mudou para melhor"; e 63,7%, com "Aprendi a dar valor às pequenas coisas da vida". Constatou-se que o espiritual/religioso exerce grande influência na saúde do paciente com lesão renal em hemodiálise, evidenciando a importância de profissionais preparados para lidarem com esta temática (AU).

The present study aimed to assess the spiritual well-being of patients undergoing hemodialysis, based on a Spirituality Self-Rating Scale for use in health care. Cross-sectional descriptive study with 80 patients hospitalized to treat kidney disease undergoing hemodialysis. Data collected from December 2011 to January 2012, through a self-rating scale for assessment of spirituality. Of the 80 patients, 93.75% had some religious belief. Regarding the expressions of spirituality, 57.5% agreed with the expression "My spiritual/religious beliefs give a meaning to my life"; 70%, with the expression "My faith and belief give me strength at difficult times"; 48.8%, with "I have hope in the future"; 21.3% with "I feel my life has changed for the better"; and 63.7%, with "I learned to appreciate the little things in life". It has been observed that the spiritual/religious aspect has great influence on the health status of patients with kidney disease undergoing hemodialysis, highlighting the importance for health professionals to be prepared for dealing with this issu (AU).

Se objetivó evaluar la espiritualidad de pacientes en hemodiálisis, fundamentada en la Escala de Evaluación de la Espiritualidad en Contextos de Salud. Estudio descriptivo y transversal, realizado con 80 pacientes internados por lesión renal en hemodiálisis. Datos obtenidos de diciembre de 2011 a enero de 2012, por medio de una escala autoaplicable de evaluación de la espiritualidad. De los 80 pacientes, 93,75% presentaban alguna creencia religiosa. Cuanto a las expresiones de espiritualidad, 57,5% estaban de acuerdo con la variable "Mis creencias espirituales/religiosas dan sentido a mi vida"; 70%, con "Mi fe y creencia me dan fuerza en los momentos difíciles"; 48,8%, con "Miro el futuro con esperanza"; 21,3%, "Siento que mi vida se cambió para mejor"; e 63,7%, con "He aprendido a valorar las pequeñas cosas de la vida". Se constató que el espiritual/religioso ejerce grande influencia en la salud del paciente con lesión renal en hemodiálisis, evidenciándose la importancia de profesionales preparados para proceder con esta temática (AU).