In vitro activity of gepotidacin and comparator antimicrobials against isolates of nontuberculous mycobacteria (NTM).

Novel antimicrobials are needed to treat rising nontuberculous mycobacteria (NTM) infections. Using standard broth microdilution methods, 68 NTM isolates were tested against gepotidacin, a new, first-in-class, oral triazaacenaphthylene bacterial topoisomerase inhibitor. MICs varied (0.25 to >64 µg/mL) with the lowest being M. fortuitum complex (0.25-8 µg/mL), M. mucogenicum complex (1-2 µg/mL), M. kansasii (0.25-8 µg/mL), and M. marinum (4-16 µg/mL). Testing greater numbers of some species is suggested to better understand gepotidacin activity against NTM.

Moderate Traumatic Brain Injury in Adult Population: The Latin American Brain Injury Consortium Consensus for Definition and Categorization.

Moderate traumatic brain injury (TBI) is a diagnosis that describes diverse patients with heterogeneity of primary injuries. Defined by a Glasgow Coma Scale between 9 and 12, this category includes patients who may neurologically worsen and require increasing intensive care resources and/or emergency neurosurgery. Despite the unique characteristics of these patients, there have not been specific guidelines published before this effort to support decision-making in these patients. A Delphi consensus group from the Latin American Brain Injury Consortium was established to generate recommendations related to the definition and categorization of moderate TBI. Before an in-person meeting, a systematic review of the literature was performed identifying evidence relevant to planned topics. Blinded voting assessed support for each recommendation. A priori the threshold for consensus was set at 80% agreement. Nine PICOT questions were generated by the panel, including definition, categorization, grouping, and diagnosis of moderate TBI. Here, we report the results of our work including relevant consensus statements and discussion for each question. Moderate TBI is an entity for which there is little published evidence available supporting definition, diagnosis, and management. Recommendations based on experts' opinion were informed by available evidence and aim to refine the definition and categorization of moderate TBI. Further studies evaluating the impact of these recommendations will be required.

Construção e validação de um formulário para a transição de cuidados para o recém-nascido prematuro / Construcción y validación de un formulario para la transición de la atención al recién nacido prematuro / Construction and validity of a form for transition of care for premature newborns

Objetivo: construir e validar um formulário para a transição de cuidados com o neonato prematuro. Método: estudo metodológico realizado em três etapas: levantamento do referencial teórico-metodológico, análise semântica e validação de conteúdo, baseado no Modelo de Construção de Instrumentos e utilizando o método de Delphi, sendo considerado aprovado quando o índice de validação de conteúdo foi maior que 80%.Resultados: o formulário composto por seis domínios foi aprovado após três rodadas, com 64itens e alcançou uma aprovação média de 89%.Conclusão: o formulário de transição de cuidados foi validado quanto a face e conteúdo, disponibilizando uma nova tecnologia a ser utilizada para a transição de informações de forma padronizada e segura.

Objective:to construct and validate a form for transition of care for premature newborns. Method:a methodological study carried out in three steps: theoretical-methodological framework survey, semantic analysis and content validity, based on the instrument construction model and using the Delphi method, being considered approved when the Content Validity Index was greater than 80%. Results:the form consisting of six domains was approved after three rounds, with 64 items, and achieved a mean approval of 89%. Conclusion:the transition of care form was validated in terms of face and content, providing a new technology to be used for standardized and safe transition of information.

Objetivo:construir y validar un formulario para la transición de la atención al recién nacido prematuro. Método:estudio metodológico realizado en tres etapas: levantamiento del marco teórico-metodológico, análisis semántico y validación de contenido, con base en el modelo de construcción de instrumentos y mediante el método Delphi, considerándose aprobado cuando el índice de validación de contenido fue superior al 80%. Resultados:el formulario compuesto por seis dominios fue aprobado después de tres rondas, con 64 ítems, y alcanzó una tasa de aprobación promedio del 89%. Conclusión:el formulario de transición de atención fue validado en términos de apariencia y contenido, proporcionando una nueva tecnología para ser utilizada para la transición de información de forma estandarizada y segura.

Emergence of Inducible Macrolide Resistance in Mycobacterium chelonae Due to Broad-Host-Range Plasmid and Chromosomal Variants of the Novel 23S rRNA Methylase Gene, erm(55).

Macrolides are a mainstay of therapy for infections due to nontuberculous mycobacteria (NTM). Among rapidly growing mycobacteria (RGM), inducible macrolide resistance is associated with four chromosomal 23S rRNA methylase (erm) genes. Beginning in 2018, we detected high-level inducible clarithromycin resistance (MICs of ≥16µg/mL) in clinical isolates of Mycobacterium chelonae, an RGM species not previously known to contain erm genes. Using whole-genome sequencing, we identified a novel plasmid-mediated erm gene. This gene, designated erm(55)P, exhibits <65% amino acid identity to previously described RGM erm genes. Two additional chromosomal erm(55) alleles, with sequence identities of 81% to 86% to erm(55)P, were also identified and designated erm(55)C and erm(55)T. The erm(55)T is part of a transposon. The erm(55)P allele variant is located on a putative 137-kb conjugative plasmid, pMchErm55. Evaluation of 133 consecutive isolates from 2020 to 2022 revealed 5 (3.8%) with erm(55). The erm(55)P gene was also identified in public data sets of two emerging pathogenic pigmented RGM species: Mycobacterium iranicum and Mycobacterium obuense, dating back to 2008. In both species, the gene appeared to be present on plasmids homologous to pMchErm55. Plasmid-mediated macrolide resistance, not described previously for any NTM species, appears to have spread to multiple RGM species. This has important implications for antimicrobial susceptibility guidelines and treatment of RGM infections. Further spread could present serious consequences for treatment of other macrolide-susceptible RGM. Additional studies are needed to determine the transmissibility of pMchErm55 and the distribution of erm(55) among other RGM species.

Construção e validação de simulação clínica sobre testagem e aconselhamento para o hiv em gestantes / Construction and validation of a clinical simulation on hiv testing and counseling in pregnant women / Construcción y validación de un simulacro clínico sobre pruebas y asesoramiento del vih en mujeres embarazadas

RESUMO Objetivo: construir e validar um cenário de simulação clínica sobre a testagem rápida e aconselhamento para o HIV em gestantes. Método: estudo metodológico, de validação de aparência e conteúdo, desenvolvido no período de junho a outubro de 2020 por meio da técnica Delphi. Para a validação, foram incluídos os juízes que obtiveram cinco ou mais pontos segundo os critérios de Fehring adaptados. Os dados foram analisados mediante o cálculo do Índice de Validade de Conteúdo (IVC). Resultados: depois da primeira rodada Delphi, dois itens (5,7%) não atingiram o I-CVI necessário para validação em todos os critérios avaliados, que foram: comportamental, objetividade, simplicidade, clareza, relevância, precisão, variedade, modalidade, tipicidade e credibilidade. Ao final da segunda rodada Delphi, todos os itens (100%) atingiram o I-CVI necessário para validação. Conclusão: o roteiro se mostrou válido, contribuindo para subsidiar o ensino da testagem e do aconselhamento de gestante sobre o HIV.

ABSTRACT Objective: to construct and validate a clinical simulation scenario on rapid HIV testing and counseling in pregnant women. Method: methodological study, of appearance and content validation, developed between June and October 2020 through the Delphi technique. For validation, the judges who obtained five or more points according to the adapted Fehring criteria were included. The data were analyzed by calculating the Content Validity Index (CVI). Results: After the first Delphi round, two items (5.7%) did not reach the I-CVI required for validation in all the criteria evaluated, which were: behavioral, objectivity, simplicity, clarity, relevance, accuracy, variety, modality, typicality, and credibility. At the end of the second Delphi round, all items (100%) reached the I-CVI required for validation. Conclusion: the script proved to be valid, contributing to subsidize the teaching of HIV testing and counseling of pregnant women.

RESUMEN Objetivo: construir y validar un escenario de simulación clínica sobre pruebas rápidas y asesoramiento para el VIH en mujeres embarazadas. Método: estudio metodológico, de valoración de la apariencia y el contenido, desarrollado en el período de junio a octubre de 2020 mediante la técnica Delphi. Para la validación, se incluyeron los jueces que obtuvieron cinco o más puntos según los criterios adaptados de Fehring. Los datos se analizaron calculando el Índice de Validez del Contenido (IVC). Resultados: Tras la primera ronda Delphi, dos ítems (5,7%) no alcanzaron el I-CVI requerido para la validación en todos los criterios evaluados, que fueron: comportamiento, objetividad, simplicidad, claridad, relevancia, precisión, variedad, modalidad, tipicidad y credibilidad. Al final de la segunda ronda Delphi, todos los ítems (100%) alcanzaron el I-CVI requerido para la validación. Conclusión: el rodillo se mostró válido, contribuyendo a subvencionar la enseñanza de la prueba y el asesoramiento de gestores sobre el VIH.

Teaching during the COVID-19 Pandemic: Sharing Results and Data Obtained from the Ames Test.

We present a resource for instructors that contains results and data sets from the Ames test. Our aim is to share the results we have collected in previous semesters with other instructors, so they will be able to "conduct" the Ames test without the need to set foot in a laboratory classroom. Instructors will be able to use our online resource to perform the test remotely, as a supplement to their laboratory classroom, or even under hybrid circumstances. The coronavirus disease 2019 (COVID-19) pandemic brought many changes, including the way we, as instructors, were able to carry out our educational curricula, since access to laboratory classrooms was not always possible. While COVID-19 restrictions are still in place, and thus access to laboratory classrooms is limited or null, instructors can use our online resource, without the need to set foot in a laboratory classroom. When COVID-19 restrictions are lifted and access to laboratory classrooms is permitted, instructors can follow the procedures we describe and compare their results with ours, which appear in Results and Discussion, or use our data sets as take-home assignments for their students. In addition to its use in detecting the potential mutagenicity of different samples, we have found the Ames test to be extremely useful for developing problem-solving skills by means of exercises like the ones included in this resource. Furthermore, the potential of this test as a starting point for problem-based learning is remarkable. Some suggestions for its use in active learning settings are provided.

Ferric citrate is a safe and digestible source of iron in broilers and piglets.

BACKGROUND: Iron (Fe) is traditionally supplemented in poultry and swine diets using inorganic forms (e.g. sulfates, oxides). However, research suggests that organic sources are more beneficial due to greater bioavailability. In this paper, we present results from four studies aimed at assessing ferric citrate (CI-FER™, Akeso Biomedical Inc., Burlington, MA, USA) as a safe and effective source of Fe for broilers and piglets. METHODS: A total of four studies were performed in Germany following standard farming practices for each species. One study in day-old broiler chicks and one study in weaned piglets were designed as target animal safety studies where animals were randomly allocated to one of three treatment groups: a negative control group, the proposed dose group and a multifold dose group. Broilers and pigs were fed the experimental diets for 35 and 42 days, respectively. In each study, average daily feed intake, average daily weight gain and feed conversion ratio were measured, and blood samples were taken at study end for routine biochemistry and haematology. The other two studies were designed to evaluate different sources of dietary Fe for weaned piglets bred and managed under standard farm conditions. All piglets received routine Fe injections (200 mg Fe dextran, intramuscular) on day 3 of age, as well as the experimental diets for 42 days. In both studies, performance parameters were measured. In one study, Fe digestibility and serum Fe, superoxide dismutase and haptoglobin were also measured. In all studies, the general health status of the animals was monitored daily and all culls and mortality recorded. Each study followed a complete randomised block design. RESULTS: In broilers, ferric citrate was well tolerated up to 2,000 mg/kg feed (×10 the recommended inclusion rate) and no adverse effects on growth, blood parameters or mortality were observed. In piglets, ferric citrate was well tolerated up to 5,000 mg/kg feed (×10 the recommended inclusion rate) with no adverse effects on growth, blood parameters or mortality. In addition, piglets fed ferric citrate performed significantly better than animals fed the negative control diet (containing only endogenous Fe) and those fed inorganic forms of Fe. Moreover, piglets fed ferric citrate demonstrated improved Fe digestibility and improved oxidative status. Altogether, these findings show that ferric citrate is a safe and easily digestible source of dietary Fe for broilers and piglets.

Safety in equipment and dressing changes for central vascular catheters: an observational study / Seguridad en el cambio de equipos y vendajes para el catéter vascular central: un estudio de observación / Segurança na troca de equipos e curativos para cateter vascular central: um estudo observacional

ABSTRACT Objective: to evaluate the compliance of the nursing team's care practice in handling the central vascular catheter when changing dressings and equipment in an intensive care unit. Method: a descriptive, prospective, and observational research study. Data collection was conducted from January to March 2016 in an Intensive Care unit of a public hospital in Sergipe, northeastern Brazil. Direct observation of the professionals was conducted using a safe checklist. Descriptive statistics was used to determine the process indicators, and inferential statistics to determine the association between the variables, using the chi-square and Fisher's tests, with a 5% significance level. Results: 534 procedures corresponding to the exchange of equipment and dressings were observed, corresponding to 5,073 actions. As for the change of equipment, 2,136 actions were evaluated, most of them carried out by nursing technicians. Of the eight actions evaluated in each procedure, only two (25%) reached the desired compliance, with a positivity index between 90% and 99%. Regarding the dressing change, 2,937 actions were evaluated, all of which were performed by nurses. Of the eleven evaluated actions, eight (72%) achieved desired compliance, with a positivity index between 80% and 100%. Conclusion: the results analyzed are far from the desired compliances, demonstrating the need to implement strategies to ensure the safety culture during the care provided.

RESUMEN Objetivo: evaluar la conformidad de la práctica asistencial del equipo de Enfermería en la manipulación del catéter vascular central al momento de cambiar vendajes y equipos en una Unidad de Cuidados Intensivos. Método: investigación descriptiva, prospectiva y de observación. La recolección de datos tuvo lugar entre enero y marzo de 2016 en una Unidad de Cuidados Intensivos de un hospital público de Sergipe, noreste de Brasil. Se realizó una observación directa de los profesionales por medio de una checklist de verificación segura. Se utilizó análisis descriptivo para determinar los indicadores de proceso, y estadística inferencial para determinar la asociación entre las variables, usando las pruebas de chi-cuadrado y de Fisher, con un nivel de significancia del 5%. Resultados: se observaron 534 procedimientos correspondientes al cambio de equipos y vendajes, lo que correspondió a 5.073 acciones. En relación al cambio de equipos, se evaluaron 2.136 acciones, la mayoría realizadas por técnicos en Enfermería. De las ocho acciones evaluadas en cada procedimiento, solamente dos (25%) alcanzaron la conformidad deseada, con un índice de positividad del 90% al 99%. En relación con el cambio de vendajes, se evaluaron 2.937 acciones, todas ejecutadas por Enfermeros. De las once acciones evaluadas, ocho (72%) alcanzaron la conformidad deseada, con un índice de positividad del 80% al 100%. Conclusión: los resultados analizados distan de los niveles de conformidad deseados, lo que demuestra la necesidad de implementar estrategias para garantizar la cultura de la seguridad durante la atención provista.

RESUMO Objetivo: avaliar a conformidade da prática assistencial da equipe de enfermagem no manuseio do cateter vascular central na troca de curativos e de equipos em unidade de terapia intensiva. Método: pesquisa descritiva, prospectiva, observacional. A coleta de dados ocorreu de janeiro a março de 2016 em uma unidade de terapia intensiva de um hospital público do Sergipe, nordeste do Brasil. Realizada observação direta dos profissionais utilizando checklist de verificação segura. A análise descritiva foi utilizada para determinação dos indicadores de processo, e a estatística inferencial para determinar a associação entre as variáveis, usando os testes de Qui-Quadrado e Fisher, com nível de significância de 5%. Resultados: observados 534 procedimentos correspondentes a troca de equipos e curativos, correspondendo a 5073 ações. Quanto à troca de equipo 2.136 ações foram avaliadas, a maioria realizadas por técnicos em Enfermagem. Das oito ações avaliadas em cada procedimento, apenas duas (25%) alcançaram conformidade almejada, com índice de positividade entre 90% e 99%. Referente a troca de curativo, 2.937 ações foram avaliadas, sendo todas executadas por Enfermeiros. Das onze ações avaliadas, oito (72%) alcançaram conformidade desejada, com índice de positividade entre 80% e 100%. Conclusão: os resultados analisados estão distantes das conformidades almejadas, demonstrando a necessidade de implementação estratégias para garantir a cultura de segurança durante a assistência prestada.

Evaluación y seguimiento de tele - cuidados en pacientes pediátricos del servicio de oncología / Evaluation and monitoring of tele - care in pediatric patients of the oncology service

El cáncer infantil se considera mayoritariamente una enfermedad crónica. La información acerca de la enfermedad y los tratamientos es una necesidad presente en todos los miembros de la familia, en los primeros momentos puede ser difícil de entender y recordar por lo cual una información clara y sencilla permitirá una mejor comprensión. Las nuevas tecnologías de la información hacen posible establecer conexiones infinitas y el campo de la salud no ha escapado a este fenómeno, han aparecido términos como "Tele cuidados" o "Tele-Enfermería", refiere al uso de las tecnologías de la información y las comunicaciones. Objetivo: evaluar los beneficios que brinda la implementación del Tele cuidado en la continuidad de los cuidados en pacientes pediátricos oncológicos y su familia. Material y Método: estudio descriptivo - evaluativo, la población fué de 9 pacientes incorporados al Proyecto de Telecuidado. Se utilizaron entrevistas, telefonía celular, fichas y listas de cotejo. El programa lleva implementado 6 meses en la institución, esta evaluación corresponde a una primera etapa de desarrollo del mismo. Resultados: según las dimensiones de Evaluación de necesidades, Evaluación de conceptualización y lógica del programa, Evaluación de proceso y Evaluación de resultados. Conclusión: El presente estudio nos ha permitido determinar al Tele Cuidado como una herramienta que nos ayuda a mejorar la atención de enfermería, además incrementa los procesos de comunicación y apoya la continuidad de los cuidados en el hogar[AU]

Childhood cancer is mostly considered a chronic disease. Information about the disease and treatments is a necessity present in all family members, in the first moments it can be difficult to understand and remember why clear information and simple it will allow a better understanding. The new information technologies make it possible to establish infinite connections and the field of Health, has not escaped this phenomenon, they have jumped into the health arena terms such as "Tele care" or "Tele-Nursing" , which refers to the use of information and communications technologies. Objective: to evaluate the benefits of implementing Tics in the continuity of care in pediatric cancer patients and their family. Material and Method: descriptive - evaluative study, the population was of 9 patients who joined the Telecare Project. Interviews, records and checklist were used. The program has been implemented for 6 months in the institution, this evaluation corresponds to a first stage of its development. Results: these are analyzed according to the dimensions of Needs Assessment, Evaluation of conceptualization and logic of the program, Process evaluation and Evaluation of results. Conclusion: This study has allowed us to determine Tele Care as a tool that helps us improve nursing care, also increases communication processes and allows continuity of care[AU]

O câncer infantil é considerado principalmente uma doença crônica. Informações sobre a doença e tratamentos são uma necessidade presente em todos os membros da família; nos primeiros momentos, pode ser difícil entender e lembrar, razão pela qual informações claras e simples permitirão uma melhor compreensão. As informações possibilitam o estabelecimento de conexões infinitas e o campo da Saúde, não escapou a esse fenômeno, foram destacados termos como "Telecare" ou "Tele- Nursing", que se referem ao uso das tecnologias da informação. e comunicações. Objetivo: avaliar os benefícios proporcionados pela implementação das TICs na continuidade do atendimento em pacientes com câncer pediátrico e sua família. Material e Método: estudo descritivo-avaliativo, a população foi de 9 pacientes que ingressaram no Projeto Telecare. Foram utilizadas entrevistas, arquivos e uma lista de verificação. O programa foi implementado por 6 meses na instituição, esta avaliação corresponde a um primeiro estágio de desenvolvimento. Resultados: são analisados de acordo com as dimensões Avaliação de Necessidades, Conceitualização de Programas e Avaliação Lógica, Avaliação de Processos e Avaliação de Resultados. Conclusão: Este estudo nos permitiu determinar o TeleCare como uma ferramenta que nos ajuda a melhorar os cuidados de enfermagem, também aumenta os processos de comunicação e permite a continuidade dos cuidados[AU]

Molecular Characterization of Tc964, A Novel Antigenic Protein from Trypanosoma cruzi.

The Tc964 protein was initially identified by its presence in the interactome associated with the LYT1 mRNAs, which code for a virulence factor of Trypanosoma cruzi. Tc964 is annotated in the T. cruzi genome as a hypothetical protein. According to phylogenetic analysis, the protein is conserved in the different genera of the Trypanosomatidae family; however, recognizable orthologues were not identified in other groups of organisms. Therefore, as a first step, an in-depth molecular characterization of the Tc946 protein was carried out. Based on structural predictions and molecular dynamics studies, the Tc964 protein would belong to a particular class of GTPases. Subcellular fractionation analysis indicated that Tc964 is a nucleocytoplasmic protein. Additionally, the protein was expressed as a recombinant protein in order to analyze its antigenicity with sera from Chagas disease (CD) patients. Tc964 was found to be antigenic, and B-cell epitopes were mapped by the use of synthetic peptides. In parallel, the Leishmania major homologue (Lm964) was also expressed as recombinant protein and used for a preliminary evaluation of antigen cross-reactivity in CD patients. Interestingly, Tc964 was recognized by sera from Chronic CD (CCD) patients at different stages of disease severity, but no reactivity against this protein was observed when sera from Colombian patients with cutaneous leishmaniasis were analyzed. Therefore, Tc964 would be adequate for CD diagnosis in areas where both infections (CD and leishmaniasis) coexist, even though additional assays using larger collections of sera are needed in order to confirm its usefulness for differential serodiagnosis.

(Des)conformidade do processo de trabalho no centro de material e esterilização / (Dis)conformity of the working process in the material and sterilization center / (Des)conformidad del proceso de trabajo en el centro de material y esterilización

Objetivo: Avaliar o processo de trabalho de enfermagem em um Centro de Material e Esterilização (CME) de um hospital de ensino no Nordeste brasileiro e calcular os índices de conformidades dos processos de trabalho dos produtos para saúde (PPS) hospitalares no CME. Método: Estudo observacional, com análises quantitativas. A população-alvo constituiu-se de técnicos e auxiliares de enfermagem, por meio de observação sistemática no desenvolvimento dos processos de trabalho. A amostra resultou em 24 profissionais, correspondendo a 80% da população. Resultados: Dos processos observados, o índice de conformidade foi menor (29,17%) na esterilização e maior (56,94%) na guarda/distribuição dos produtos. Quanto aos subprocessos, foi maior (90,28%) na selagem e menor (8,33%) no enxágue dos PPS. Conclusão: A média de conformidade dos processos apresentou índice abaixo do limite de 70%, comprometendo a maioria do processo de trabalho da equipe de enfermagem.

Objectives: To evaluate the nursing work process in a Material and Sterilization Center (MSC) of a teaching hospital in Northeastern Brazil and to calculate the compliance rates of the work processes of hospital health products (HP) in the CME. Method: Observational study, with quantitative analyses. The target population consisted of nursing technicians and assistants, through systematic observation in the development of work processes. The sample resulted in 24 professionals, corresponding to 80% of the population. Results: Of the observed processes, the compliance rate was lower (29.17%) in sterilization and higher (56.94%) in the storage/distribution of the products. As for subprocesses, it was higher (90.28%) in sealing and lower (8.33%) in rinsing the HP. Conclusion: The average process compliance showed an index below the limit of 70%, compromising most of the nursing team's work process

Objetivos: Evaluar el proceso de trabajo de enfermería en un Centro de Material y Esterilización (CME) de un hospital docente en el noreste de Brasil y calcular las tasas de cumplimiento de los procesos de trabajo de productos de salud (PS) en hospitales en CME. Método: Estudio observacional, con análisis cuantitativos. La población objetivo consistió en técnicos de enfermería y asistentes, a través de la observación sistemática en el desarrollo de procesos de trabajo. La muestra resultó en 24 profesionales, que corresponden al 80% de la población. Resultados: De los procesos observados, la tasa de cumplimiento fue menor (29.17%) en esterilización y mayor (56.94%) en el almacenamiento / distribución de productos. En cuanto a los subprocesos, fue mayor (90.28%) en sellado y menor (8.33%) en enjuague del PS. Conclusión: El cumplimiento promedio del proceso mostró un índice por debajo del límite del 70%, comprometiendo la mayor parte del proceso de trabajo del equipo de enfermería.

Evaluation of concordance among surgeons and pathologists regarding the diagnosis and classification of acute appendicitis in children.

Acute appendicitis is the most frequent urgent abdominal surgical pathology in children. Therapeutic decisions in patients who have undergone an appendectomy are made based on the macroscopic findings at the moment of surgery. There is high variability between surgical and histopathological findings. METHOD: Concordance among surgeons and pathologists regarding the diagnosis and classification of acute appendicitis was assessed in children who have undergone an appendectomy. Surgical site infection (SSI) incidence was measured for both the surgical and pathological classification. RESULTS: The statistical analysis included 1092 children. The pathologists confirmed the presence of appendicitis in 90.4% of the patients. Concordance in the diagnosis of appendicitis among surgeons and pathologists was weak (kappa 0.57), while concordance in the classification of perforated or non-perforated appendicitis was moderate (kappa 0.7). There were no significant differences in these findings determined by the surgeons' experience or the open or laparoscopic approach. In the discordant group of 70 patients in which the surgeon classified the appendicitis as non-perforated but the pathologist classified as perforated, just one patient developed an intra-abdominal abscess. CONCLUSIONS: The classification of appendicitis as perforated or non-perforated shows moderate concordance between the surgical and histopathological diagnosis. This concordance is not determined by the surgeons' experience or the surgical approach. TYPE OF STUDY: Diagnostic Test LEVEL OF EVIDENCE: Level II.

Special education of students with Down Syndrome for self-care / Educación especial de estudiantes con Síndrome de Down para el autocuidado / Educação especial de estudantes com Síndrome de Down para o autocuidado

ABSTRACT Objective: to analyze the care taught by teachers and parents and learned by students with Down Syndrome. Method: descriptive study with qualitative approach carried out in a special education school, based in the city of Manaus. Eleven students with Down Syndrome, 11 parents of students and 11 teachers from the school participated in the study. Data were collected from November 2017 to February 2018, through a semi-structured interview, and analyzed by the content analysis technique. The theoretical framework regarded Down Syndrome. Results: three thematic categories emerged: the care learned by the student; the care taught by the teacher and; the care taught by the parents. Conclusion and implications for practice: family and teachers play a facilitating role in the learning to care for themselves and in the socio-cognitive and affective development of the person with Down Syndrome. The care learned by the student involved dialogic communication for care through learning of good habits, autonomy, independence and healthy eating. The study shows that nursing has the role of teaching the family how to help the child's progress, which results in significant future changes.

RESUMEN Objetivo: analizar la enseñanza del cuidado realizado por profesores y padres y el aprendizaje de estudiantes con Síndrome de Down. Método: Estudio descriptivo con enfoque cualitativo, realizado en una escuela de educación especial, con sede en la ciudad de Manaos. Once estudiantes con Síndrome de Down, 11 padres y 11 profesores de la escuela participaron del estudio. Los datos se recopilaron de noviembre de 2017 a febrero de 2018, a través de entrevista semiestructurada, y se analizaron mediante la técnica de análisis de contenido. El marco teórico abordó el Síndrome de Down. Resultados: surgieron tres categorías temáticas: el cuidado aprendido por el estudiante; el cuidado enseñado por el profesor y; el cuidado enseñado por los padres. Conclusión e implicaciones para la práctica: familiares y profesores desempeñan un papel facilitador en el aprendizaje para el autocuidado y en el desarrollo sociocognitivo y afectivo de la persona con Síndrome de Down. El aprendizaje del estudiante involucró la comunicación dialógica para el cuidado a través del aprendizaje de buenos hábitos, autonomía, independencia y alimentación saludable. El estudio evidencia que la enfermería tiene el papel de enseñar la familia y ayudar el progreso del hijo, lo que resulta en cambios significativos futuros.

RESUMO Objetivo: analisar o cuidado ensinado por professores e pais e aprendido por estudantes com Síndrome de Down. Método: estudo descritivo de abordagem qualitativa, realizado em uma escola de educação especial, sediada na cidade de Manaus. Participaram do estudo 11 estudantes com Síndrome de Down, 11 pais dos estudantes e 11 professores da escola. Os dados foram coletados no período de novembro de 2017 a fevereiro de 2018, por meio de entrevista semiestruturada, e analisados pela técnica de análise de conteúdo. O embasamento teórico versou sobre a doença Síndrome de Down. Resultados: emergiram três categorias temáticas: o cuidado aprendido pelo aluno; o cuidado ensinado pelo professor e; o cuidado ensinado pelos pais. Conclusão e implicações para a prática: a família e os professores exercem um papel de facilitadores do aprendizado para o cuidado de si e no desenvolvimento sócio-cognitivo e afetivo da pessoa com Síndrome de Down. O cuidado aprendido pelo estudante envolveu comunicação dialógica para o cuidado por meio de aprendizagem de bons hábitos, autonomia, independência e alimentação saudável. O estudo evidencia que a enfermagem tem o papel de ensinar a família como ajudar no progresso do filho, o que resulta em mudanças significativas futuras.

Insertion of central vascular catheter: adherence to infection prevention bundle.

OBJECTIVE: To evaluate the compliance of the care process involving insertion of central vascular catheter (CVC) in hemodialysis. METHOD: Cross-sectional quantitative approach developed at the hemodialysis service of a reference hospital in Sergipe, Brazil. Sample consisting of 1,342 actions evaluated, corresponding to 122 forms for monitoring and control of CVC insertion. Data collection was held from July to December 2016. RESULTS: The adherence rate to the use of the insertion form was 54.9%. The procedure evaluated achieved 93% overall compliance. Of the 11 specific actions observed, seven (64%) presented 100% compliance. The density of the overall incidence of primary bloodstream infections reduced from 10.6 to 3.1 infections per 1,000 patients/day. CONCLUSION: Although the observed actions reached specific desired conformities, the use of the checklist was lower than expected. Strategies for monitoring, coaching and educational and organizational actions can contribute to safe care.

Insertion of central vascular catheter: adherence to infection prevention bundle / Inserción de catéter venoso central: adhesión a bundle de prevención de infección / Inserção de cateter vascular central: adesão a bundle de prevenção de infecção

ABSTRACT Objective: To evaluate the compliance of the care process involving insertion of central vascular catheter (CVC) in hemodialysis. Method: Cross-sectional quantitative approach developed at the hemodialysis service of a reference hospital in Sergipe, Brazil. Sample consisting of 1,342 actions evaluated, corresponding to 122 forms for monitoring and control of CVC insertion. Data collection was held from July to December 2016. Results: The adherence rate to the use of the insertion form was 54.9%. The procedure evaluated achieved 93% overall compliance. Of the 11 specific actions observed, seven (64%) presented 100% compliance. The density of the overall incidence of primary bloodstream infections reduced from 10.6 to 3.1 infections per 1,000 patients/day. Conclusion: Although the observed actions reached specific desired conformities, the use of the checklist was lower than expected. Strategies for monitoring, coaching and educational and organizational actions can contribute to safe care.

RESUMEN Objetivo: Evaluar la conformidad del proceso asistencial relacionada a inserción del catéter venoso central(CVC) en hemodiálisis. Método: Enfoque cuantitativo, corte transversal, realizado en el servicio de hemodiálisis de un hospital de referencia del estado de Sergipe, Brasil. Muestra constituida por 1342 acciones evaluadas, que corresponden a 122 formularios para monitoreo y control de la inserción de CVC. La recolección de datos fue realizada de julio a diciembre del 2016. Resultados: La tasa de adhesión al uso del formulario de inserción fue del 54,9%. El procedimiento evaluado obtuvo un 93% de conformidad general. De 11 acciones específicas observadas,7(64%) presentaron 100% de conformidad. Se observó reducción en la incidencia global de infecciones primarias de corriente sanguínea de 10,6 para 3,1 por 1000 pacientes/día. Conclusión: Aunque las acciones observadas tuvieron conformidades específicas, el uso de la lista de verificación fue inferior a lo esperado. Estrategias para monitoreo, coaching y acciones educativas podrian contribuir para una asistencia segura.

RESUMO Objetivo: Avaliar a conformidade do processo assistencial envolvendo a inserção do cateter vascular central (CVC) em hemodiálise. Método: Abordagem quantitativa, de corte transversal, desenvolvida no serviço de hemodiálise de um hospital de referência do estado de Sergipe, Brasil. Amostra constituída por 1.342 ações avaliadas, correspondendo a 122 formulários para monitoramento e controle da inserção de CVC. A coleta de dados ocorreu de julho a dezembro de 2016. Resultados: A taxa de adesão ao uso do formulário de inserção foi de 54,9%. O procedimento avaliado alcançou 93% de conformidade geral. Das 11 ações específicas observadas, sete (64%) apresentaram 100% de conformidade. Observou-se redução da densidade de incidência global das infecções primárias da corrente sanguínea de 10,6 para 3,1 infecções por 1.000 pacientes/dia. Conclusão: Apesar das ações observadas alcançarem conformidades específicas desejadas, a utilização do checklist foi aquém do esperado. Estratégias para monitoramento, coaching e ações educativas e organizacionais podem contribuir para uma assistência segura.

Kipi crudo: accion del jugo de limón, aceptabilidad satisfacción y preferencia en una población de San Fernando del Valle de Catamarca / Raw kipi: action of lemon juice, acceptability, satisfaction and preference in a population in San Fernando del Valle de Catamarca

Introducción: El Kebbe Naihe o kipi crudo es un producto cárneo que tiene como ingredientes la carne bovina u ovina molida y trigo burgol, condimentos y especias y se consume crudo. La carne es el vehículo de microorganismos que causan brotes de enfermedades, infecciones e intoxicaciones microbianas y resulta riesgosa su incorporación, dada la frecuencia con la que se pueden aislar bacterias patógenas a partir del producto crudo. El uso de diferentes sustancias controla el número de microorganismos en preparaciones alimenticias. Objetivos: Determinar el efecto del jugo de limón sobre los microorganismos presentes en el kipi crudo, analizar la aceptabilidad y satisfacción del kipi crudo con limón, y la preferencia del kipi crudo con limón respecto del kipi crudo sin limón. Metodología: Estudio de tipo descriptivo, correlacional y explicativo, y con un diseño en dos etapas, una etapa experimental- experimento puro y en otra etapa experimental-preexperimento. Resultados: Los análisis microbiológicos indicaron que en el momento de elaboración y a las 6, 12 y 24hs, el número de microorganismos fue menor en el kipi crudo tratado con limón, comparado con el que no recibió este tratamiento. Asimismo, el jugo de limón disminuyó el número de bacterias del kipi crudo a medida que el tiempo de exposición a este fue mayor. El kipi crudo con jugo de limón resultó ser más aceptado, satisfactorio y preferido por la población no árabe, en comparación con la población árabe. El kipi crudo es un producto apto para el consumo desde el punto de vista microbiológico si se consume antes de las 6hs posteriores a su elaboración, lo cual permite a la población árabe continuar consumiendo este plato sin el agregado de limón. Conclusión: Es posible, para quienes les resulta agradable el kipi crudo con limón, incrementar su inocuidad mediante el agregado de esta sustancia natural

Introduction: Kebbe Naihe or raw kipi is a meat-derived food, which has bovine or ovine ground meat and wheat burgol, condiments and spices as ingredients, and is consumed in raw state. Meat is the vehicle of microorganisms that cause diseases outbreaks, infections and microbial poisoning and its incorporation is risky given the frequency of isolation of pathogenic bacteria from raw products. The use of different substances controls the number of microorganisms in food preparations. Objectives: to determine the effect of lemon juice on the microorganisms present in raw kipi, to analyze the acceptability and satisfaction of raw kipi with lemon, and the preference of raw kipi with lemon compared to raw kipi without lemon. Methodology: Descriptive, correlational and explanatory type study, with a two-stage design, a pure experimental-experimental stage and pre-experiment in another stage. Results: The microbiological analysis indicated that at the time of elaboration and at 6, 12 and 24 hours, the number of microorganisms was lower in the raw kipi treated with lemon, compared to the one that did not receive this treatment. The lemon juice decreased the number of bacteria of the raw kipi at higher exposure times. The raw kipi with lemon juice resulted highly accepted, satisfactory and preferred by the non- Arabic population, compared to the Arabic group. Raw kipi is a suitable product for consumption from the microbiological point of view only if consumed before 6 hours after its preparation, which allows the Arabic population to continue consuming this plate without the addition of lemon. Conclusion: It is possible, for those who like the raw kipi with lemon, to increase its safety by adding lemon juice, a natural substance

Estresse ocupacional em profissionais de enfermagem / Occupational stress in nursing personnel / Estrés ocupacional en profesionales de enfermería

Objetivo: analisar os fatores de estresse em enfermeiros de um hospital universitário da cidade de Aracaju, Sergipe, Brasil. Método: pesquisa descritiva e correlacional. A amostra foi composta por 101 profissionais de enfermagem. Os dados foram coletados pela técnica de entrevista, com aplicação do Inventário para Estresse em Enfermeiros e posteriormente analisados utilizando o teste t de Student para amostras independentes. O projeto do estudo foi aprovado por Comitê de Ética em Pesquisa. Resultados: 43% dos itens analisados foram fontes de estresse ocupacional entre os profissionais de enfermagem, sendo o fator papéis estressores da carreira o responsável por maior influência ao estresse (54%). O local de trabalho foi a única variável que apresentou diferença significativa quando associada aos fatores analisados. Conclusão: a enfermagem se revelou como uma profissão de risco para o estresse ocupacional, sofrendo diversas influências dos fatores analisados, relacionados à organização e ao processo de trabalho.

ABSTRACT Objective: to examine stress factors in nurses at a university hospital in Aracaju, Sergipe, Brazil. Method: in this descriptive, correlational study, data were collected by interview from a sample of 101 nursing personnel, by applying a Nursing Stress Inventory, and analyzed using Student's t-test for independent samples. The study was approved by the research ethics committee. Results: 43% of the items examined were sources of occupational stress among nursing professionals, with stressful career roles being responsible for most influence on stress (54%). Work place was the only variable that displayed significant difference when associated with the factors examined. Conclusion: Nursing revealed itself to be a profession with risk of occupational stress, which was influenced in various manners by the work organization and work process factors examined.

Objetivo: analizar los factores de estrés en enfermeros de un hospital universitario de la ciudad de Aracaju, Sergipe, Brasil. Método: investigación descriptiva y correlacional. La muestra se compuso de 101 profesionales de enfermería. Los datos fueron recolectados por la técnica de entrevista, con aplicación del Inventario para Estrés en Enfermeros y, posteriormente, analizados utilizando la prueba t de Student para muestras independientes. El proyecto de estudio fue aprobado por el Comité de Ética en Investigación. Resultados: El 43% de los ítems analizados fue fuente de estrés ocupacional entre los profesionales de enfermería, siendo el factor papeles estresores de la carrera el responsable por mayor influencia al estrés (54%). El lugar de trabajo fue la única variable que presentó diferencia significativa cuando se asoció a los factores analizados. Conclusión: la enfermería se reveló como una profesión de riesgo en cuanto al estrés ocupacional, sufriendo diversas influencias de los factores analizados, relacionados a la organización y al proceso de trabajo.

Patient safety in nursing care during medication administration.

OBJECTIVE: to evaluate the conformity of care practices of the nursing team during the administration of drugs through central vascular catheter. METHOD: a descriptive, prospective, observational study conducted in an Intensive Care Unit. The non-probabilistic intentional sample consisted of 3402 observations of drug administrations in patients with central vascular catheters. The previously validated collection instrument was constructed based on the Guideline for Prevention of Intravascular catheter-related infections. Data was collected through direct observations of nursing practices performed by the nursing team. The analysis used analytical, descriptive and inferential statistics (Chi-square test and Fisher's exact test). RESULTS: a total of 3402 procedures of drug administrations were observed. Female nursing technicians performed the highest number of actions. In none of the procedures did the professional perform all necessary actions. 0.2% of drug administrations were preceded by hand hygiene and 1.3% by disinfection of the multidose vial, ampoule or injectors. CONCLUSION: the practice evaluated was classified as undesirable. Failure to achieve the desired conformity was probably due to the low adherence of professionals to the practice of hand hygiene and disinfection of materials, injectors and connectors.