Prevalence of COVID-19 Among 8000 Patients at a Hospitalized and Mortality in Old Age.

BACKGROUND: COVID-19 created a general challenge to healthcare systems throughout the world and was an important cause of mortality. AIM: The aim of the present study was to report the general evolution of patients with COVID-19 at a teaching hospital and analyze differences by age group and sex considering mortality rates in the years 2020 and 2021 among patients older than 60 years of age. METHODS: A cross-sectional study was conducted with patients hospitalized with a diagnosis of COVID-19 confirmed by RT-PCR at the São Jose do Rio Preto university hospital between March 2020 and March 2022. The patients were male and female patients, of varying ages belonging to the region of Sao Jose do Rio Preto, were accommodated in the wards or intensive care units (ICUs). Overall mortality was analyzed for the hospital as well as in the ICUs and wards. This analysis was performed separately in two years considering age group, sex, and main comorbidities in patients older than 60 years of age. RESULTS: A total of 8032 patients with COVID-19 were hospitalized between March 2020 and March 2022: 2866 patients with 658 deaths (22.92%) in 2020; 4324 patients with 1168 deaths (27.01%) in 2021; and 842 patients with 205 deaths (24.35 %) in 2022 up to the month of March. More than half (53.60%) of the patients were hospitalized in the ICUs and 46.39% were hospitalized in the wards. Differences in the mortality rate were found for the different age groups in the comparison of the years, with more deaths occurring among individuals up to 90 years of age in the second year (p <0.05). Men were affected more and had a higher mortality rate (p <0.0001). The main comorbidities were cardiovascular disease (70.93%), diabetes (37.76%), and obesity (23.68%). CONCLUSION: The mortality rate of older people hospitalized with COVID-19 was higher than the average, it was higher in 2021 compared to 2020 and increased with age. Cardiovascular disease, diabetes, and obesity were the main comorbidities.

COVID-19-related multisystem inflammatory syndrome in adult: the first death in Brazil.

The precise pathogenesis of COVID-19-related multisystem inflammatory syndrome remains largely elusive, despite its rarity. The syndrome symptoms often overlap with those of other infections, posing challenges for prompt diagnosis. A male patient, 34 years old, was admitted with suspicion of severe dengue, rapidly progressing to multiple organ dysfunction. Dengue tests resulted negative, and he passed away after four days. This case occurred approximately four weeks after the initial onset of COVID-19 and met all diagnostic criteria as defined by the Centers for Disease Control and Prevention. This report presents the first documented case of fatal multisystem inflammatory syndrome in adult (MIS-A) in Brazil. Recognizing the significance of suspecting this syndrome and promptly initiating treatment at an early stage are essential for minimizing damage and mortality.

The impact of chronic cardiovascular disease on COVID-19 clinical course.

Background: According to previous univariate analyses, chronic cardiovascular disease (CVD) has been associated with worse prognoses in severe cases of coronavirus disease 2019 (COVID-19). However, in the presence of a complex system, such as a human organism, the use of multivariate analyses is more appropriate and there are still few studies with this approach. Aim: Using a significant sample of patients hospitalized in a single center, this study aimed to evaluate, whether the presence of CVD was an independent factor in death due to COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We also aimed to identify the clinical and laboratory predictors of death in an isolated group of cardiac patients. Methods: This case-control study was conducted with patients admitted to a tertiary hospital and affected by COVID-19 in 2020. Variables were collected from the Brazilian surveillance system of hospitalized cases (SIVEP-Gripe) and electronic medical records. Multivariate logistic regressions with backward elimination were performed to analyze, whether CVD was an independent risk factor for death, and variables with P < 0.05 remained in the final model. Results: A total of 2675 patients were analyzed. The median age was 60.4 years, and 55.33% of the patients were male. Odds ratios showed that age (OR 1.059), male sex (OR 1.471), Down syndrome (OR 54.980), diabetes (OR 1.626), asthma (OR 1.995), immunosuppression (OR 2.871), obesity (OR 1.432), chronic lung disease (OR 1.803), kidney disease (OR 1.789), and neurological diseases (OR 2.515) were independently associated with death. Neither the presence of heart disease nor the isolated analysis of each chronic CVD element (systemic arterial hypertension, congenital heart disease, previous acute myocardial infarction and cardiac surgery, obstructive coronary artery disease, valvular heart disease, and pacemaker use) showed as independent risk factors for death. However, an analysis restricted to 489 patients with chronic CVD showed troponin T (TnT) as an independent predictor of death (OR 4.073). Conclusions: Neither chronic CVD nor its subcomponents proved to be independent risk factors for death due to SARS-CoV-2 infection. A TnT level of 14 pg/mL was associated with a higher occurrence of death in the isolated group of patients with chronic heart disease. Relevance for Patients: Patients with chronic CVD may require more attention in the context of COVID-19 due to higher proportions of these individuals having a more severe progression of disease. However, regarding mortality in these patients, further studies should be conducted concerning comorbidities and acute myocardial injury.

Hospitalizations for COVID-19 in a tertiary hospital in Brazil: a parallel with vaccination.

This study aimed to evaluate the COVID-19 hospitalizations in a tertiary hospital by age group and month, considering the introduction and the advance of the vaccination against the disease. The laboratory-confirmed COVID-19-associated hospitalizations among people aged 20 years or older, that occurred between March 2020 and June 2021, were distributed by month of symptom onset and age group. The proportion of hospitalizations by age group was calculated for the year 2021. The proportions were compared using the chi-square test for trends. The marks of vaccination advances among different age groups were taken from the official website LocalizaSUS. In 2020, hospitalizations among people aged 60-80 years old were the most frequent (39.1%). From January-June 2021, when the vaccination commenced, while hospitalizations of patients aged 20 to < 40 and 40 to 60 years old showed an increasing trend, the older age groups and those with vaccination recommendations (from 60 to < 80 and from 80 or over) showed a downward trend. As of June 2021, with widespread vaccination, a drop in hospitalizations was observed in > 60 years old. At 20 to <40 and 40 to < 60, an increase in hospitalizations was observed. It demonstrates the important role of vaccination in combating the COVID-19 pandemic.

Evolution of Mortality by Age Group in Patients With COVID-19 Above 60 Years of Age.

Introduction The severity of the diseases associated with the coronavirus worsen the results, increasing the mortality of these patients. Objective The aim of the present study is to report coronavirus disease 2019 (COVID-19) hospitalizations and mortality in 2,359 patients aged over 60 years in a reference center in Brazil. Method The evolution of hospitalizations and overall mortality of patients admitted to Hospital de Base were evaluated in a clinical trial, then selecting patients aged over 60 years, by age group every 10 years, from March 2020 to April 2021, and analyzing whether there was an increase in mortality in age groups, assessed by Fisher's exact test. Results There was an increase in mortality over the decades in this period, but a reduction in hospitalizations after patient vaccination. Conclusion Mortality in patients over 60 years of age is higher than in younger patients, where the vaccine has reduced their hospitalization, but individual patient protection regarding mortality needs further evaluation.

Cross-cultural adaptation and validation of the instrument Diabetes - 39 (D-39): brazilian version for type 2 diabetes mellitus patients - stage 1.

The study aimed to accomplish a cross-cultural adaptation of the 'Diabetes - 39 - D-39' instrument for Brazil, to test the validity of the adapted version in a sample of type 2 diabetes mellitus patients and to describe the participants of the study, according to the scores obtained on the Likert-type scale. The instrument adaptation process followed several steps: instrument translation; achievement of the consensus in Portuguese; evaluation by an expert committee; back-translation; achievement of the consensus in English; comparison of the original and consensus versions in English; semantic analysis and pre-test of the Portuguese version. Results showed that the instrument items, in the first stage of cultural adaptation to Portuguese, presented high internal consistency levels.

Excess mortality is associated with influenza A (H1N1) in patients with severe acute respiratory illness.

BACKGROUND: Acute respiratory infections caused by viruses are among the leading causes of morbidity and mortality. The inflammatory response that follows viral infection is important for the control of virus proliferation. However, if overwhelming, may be associated with complicated outcomes. OBJECTIVES: We assessed the clinical characteristics of patients with severe acute respiratory illness (SARI) evolving to acute respiratory distress syndrome (ARDS) and the factors related to death. STUDY DESIGN: Prospective study in 273 adult patients with SARI performed in a university-affiliated 800-bed hospital serving an area of epidemiologic vigilance of 102 municipalities and more than 2 million inhabitants. Influenza A (H1N1) 2009 (A/H1N1), influenza A H3N2, and influenza B were tested in all patients by RT-PCR. RESULTS: The overall hospital mortality rate was 17.6%. A total of 30.4% of patients tested positive for influenza A/H1N1. Patients with SARI that evolved to ARDS took significantly longer to take the first dose of oseltamivir (6.0 vs 1.0 days, p=0.002). Patients with H1N1 positive tests had almost 3 times higher probability of death, despite having significantly less comorbidities (p=0.027). The influenza A/H1N1 pdm09 vaccine reduced the odds of death by 78%. Nonsurvivors had a more intense inflammatory response than did survivors at 48 h (C-reactive protein: 31.0 ± 17.5 vs. 14.6 ± 8.9 mg/dl, p=0.001) as well as a more positive fluid balance. CONCLUSIONS: Hospital mortality associated with influenza H1N1-associated SARI and ARDS continued to be high years after the 2009 pandemic in a population with low vaccine coverage. Antiviral treatment started more than two days after onset of symptoms was more frequently associated with ARDS and death and, having had vaccine against influenza A (H1N1) was a factor independently related to survival.

COVID-19-related multisystem inflammatory syndrome in adult: the first death in Brazil

ABSTRACT The precise pathogenesis of COVID-19-related multisystem inflammatory syndrome remains largely elusive, despite its rarity. The syndrome symptoms often overlap with those of other infections, posing challenges for prompt diagnosis. A male patient, 34 years old, was admitted with suspicion of severe dengue, rapidly progressing to multiple organ dysfunction. Dengue tests resulted negative, and he passed away after four days. This case occurred approximately four weeks after the initial onset of COVID-19 and met all diagnostic criteria as defined by the Centers for Disease Control and Prevention. This report presents the first documented case of fatal multisystem inflammatory syndrome in adult (MIS-A) in Brazil. Recognizing the significance of suspecting this syndrome and promptly initiating treatment at an early stage are essential for minimizing damage and mortality.

Hospitalizations for COVID-19 in a tertiary hospital in Brazil: a parallel with vaccination

ABSTRACT This study aimed to evaluate the COVID-19 hospitalizations in a tertiary hospital by age group and month, considering the introduction and the advance of the vaccination against the disease. The laboratory-confirmed COVID-19-associated hospitalizations among people aged 20 years or older, that occurred between March 2020 and June 2021, were distributed by month of symptom onset and age group. The proportion of hospitalizations by age group was calculated for the year 2021. The proportions were compared using the chi-square test for trends. The marks of vaccination advances among different age groups were taken from the official website LocalizaSUS. In 2020, hospitalizations among people aged 60-80 years old were the most frequent (39.1%). From January-June 2021, when the vaccination commenced, while hospitalizations of patients aged 20 to < 40 and 40 to 60 years old showed an increasing trend, the older age groups and those with vaccination recommendations (from 60 to < 80 and from 80 or over) showed a downward trend. As of June 2021, with widespread vaccination, a drop in hospitalizations was observed in > 60 years old. At 20 to <40 and 40 to < 60, an increase in hospitalizations was observed. It demonstrates the important role of vaccination in combating the COVID-19 pandemic.

[The preparation of the surgical team: significant aspect in the control of environmental contamination]. / O preparo da equipe cirúrgica: aspecto relevante no controle da contaminação ambiental.

The control of environmental contamination has been considered a rational measure for preventing surgical site infection. This study aims to present the current recommendations related to the preparation of the surgical team and to discuss the role of nurses in controlling environmental contamination. On the basis of current literature, we treat issues related to surgical garment and hand brushing. Studies indicate that the preparation of the surgical team constitutes an important protection barrier for preventing surgical site infection; nevertheless, the need is highlighted for health professionals to realize procedures adequately.

Estimativa do coeficiente de reaeração da água em canal raso de fundo deslizante / Estimation of reaeration coefficients of water in shallow moving-bed channel

O coeficiente de reaeração, K2, é a variável de maior influência na autodepuração de corpos hídricos; portanto, estimativas confiáveis são de suma importância. As previsões de K2, por meio de equações, em condições de escoamento raso são, geralmente, superestimadas. Por isso, neste trabalho, os objetivos foram estudar a reoxigenação da água limpa em canal hidráulico de fundo deslizante, com pequenas profundidades de água e diferentes velocidades de escoamento, inferir sobre as principais variáveis hidrodinâmicas intervenientes no processo e, com base nelas, propor equação de estimativa de K2. Com a concentração de oxigênio na água ao longo do tempo, estimou-se K2. Inferiu-se, dos resultados, que as variáveis velocidade média (V) e velocidade de corte (u*), profundidade (H), números de Froude (Fr) e de Reynolds (R), declividade (S) e fator de forma (ff) afetaram K2, e a melhor equação foi a que incluiu as três últimas variáveis.

The reaeration coefficient, K2, is the most influential variable in the self-purification of water bodies, thus reliable estimates are of great importance. The predictions of K2 by means of equations in shallow depths are usually overestimated. Therefore, in this study, the objectives were to study the reoxygenation of clean water moving-bed channel with shallow water depths and different flow velocities; identify the main hydrodynamic variables involved in the process and, based on them, propose equation(s) for estimation of K2. Oxygen concentration in the water over time, was used to estimated K2. From the results it was inferred that average velocity (V) and shear velocity (u*), depth (H), Froude number (Fr) and Reynolds number (R), slope (S), channel shape factor (ff), influenced K2 and the best predictive equation was the one which included the last three variables.

Impacto do uso de dieta imunomoduladora em pacientes com câncer colorretal submetidos a cirurgias eletivas com abreviação de jejum pré-operatório / Impact of the use of immunomodulatory diet in colorectal cancer patients under elective surgeries with preoperative fasting abbreviation / Impacto del uso de la dieta inmunomoduladora en pacientes con cáncer colorrectal sometidos a cirugía electiva con abreviatura de ayuno preoperatorio

Introdução: A função imune é geralmente suprimida por procedimentos cirúrgicos de grande porte e pela desnutrição proteico-energética. A imunomodulação se torna uma opção de terapêutica para pacientes com câncer submetidos a cirurgias, reduzindo complicações infecciosas no pós-operatório e tempo de internação hospitalar. Objetivo: Avaliar o impacto do uso de dieta imunomoduladora em pacientes com câncer colorretal submetidos a cirurgias eletivas com abreviação de jejum pré-operatório. Método: Foi realizada uma coorte de dados retrospectivos com pacientes com câncer colorretal submetidos à cirurgia no Instituto Nacional de Câncer José Alencar Gomes da Silva, em 2013. A amostra foi dividida em grupo 1 - pacientes que realizaram abreviação de jejum pré-operatório e receberam suplementação nutricional com dieta imunomoduladora no pré-operatório (n=20); e grupo 2 - pacientes que realizaram apenas a abreviação de jejum pré-operatório (n=30). Foram coletados dados de identificação do paciente, clínicos e cirúrgicos dos prontuários. As análises estatísticas foram realizadas utilizando o programa SPSS, 17.0. Resultados: A amostra foi composta por 50 pacientes, submetidos à ressecção anterior do reto, com idade média de 61,9 anos ±13,8 anos, sendo 52% do sexo masculino. O sítio tumoral mais prevalente foi o reto (44%). Não foram observadas diferenças significativas entre os grupos em relação às características nutricionais, clínicas e cirúrgicas, aos exames bioquímicos (pré e pós-operatórios), às intercorrências gastrointestinais, à ocorrência de complicações no pós-operatório e à permanência hospitalar. Conclusão: Nas condições estudadas, a imunomodulação no pré-operatório não contribuiu para redução de complicações pós-operatórias, da incidência de intercorrências gastrointestinais e do tempo de internação hospitalar.

Introduction: The immune function is usually suppressed by major surgical procedures and protein-energy malnutrition. The immunomodulation becomes a therapeutic option for cancer patients undergoing surgery, reducing infectious complications after surgery, as well as hospital stay. Objective: To evaluate the impact of the use of an immunomodulatory diet in colorectal cancer patients undergoing elective surgeries with preoperative fasting abbreviation. Method: A cohort with retrospective data was performed with colorectal cancer patients who underwent surgery in the Brazilian National Cancer Institute José Alencar Gomes da Silva, in 2013. The sample was divided into two groups. Group 1: patients who underwent preoperative fasting abbreviation and who received nutritional supplementation with a preoperative immunomodulatory diet (n=20); and group 2: patients who underwent only the abbreviation of fasting preoperatively (n= 0). The study collected patient identification data, together with clinical and surgical data from the records. Statistical analyzes were performed using SPSS, 17.0. Results: The sample consisted of 50 patients who underwent an anterior resection of the rectum, with a mean age of 61.9 years ± 13.8 years; and 52% male. The most prevalent tumor site was the rectum (44%). No significant differences were observed between the groups regarding nutritional, clinical and surgical characteristics, the biochemical tests (pre and postoperative), gastrointestinal complications, the occurrence of complications after surgery and hospital stay. Conclusion: Within the studied conditions, preoperative immunomodulation did not contribute to a reduction of postoperative complications, incidences of gastrointestinal complications and hospital stay.

Introducción: La función inmune generalmente se suprime por procedimientos quirúrgicos mayores y por la malnutrición proteico-energética. La inmunomodulación se convierte en una opción terapéutica para los pacientes con cáncer sometidos a cirugía mediante la reducción de las complicaciones infecciosas después de la cirugía y la estancia hospitalaria. Objetivo: Evaluar el impacto del uso de la dieta inmunomoduladora en pacientes con cáncer colorrectal sometidos a cirugía electiva con abreviatura ayuno preoperatorio. Método: A los datos retrospectivos de cohortes de pacientes con cáncer colorrectal que se sometió a una cirugía en el Instituto Nacional del Cáncer José Alencar Gomes da Silva se llevó a cabo en 2013. La muestra se dividió en el grupo 1: pacientes que se sometieron abreviatura ayuno preoperatorio y recibieron suplementos nutricionales con una dieta inmunomoduladora antes de la operación (n=20); y el grupo 2: pacientes que se sometieron a sólo abreviatura ayuno preoperatorio (n=30). Se recogieron los datos de identificación del paciente, clínica y quirúrgicos de los registros médicos. Los análisis estadísticos se realizaron con SPSS, 17.0. Resultados: La muestra estuvo constituida por 50 pacientes, que fueron sometidos a la que se sometieron a resección anterior rectal, con una edad media 61,9 años ± 13,8 años, 52% varones, (44%) No se observaron diferencias significativas entre los grupos en relación a las características nutricionales, clínicas y quirúrgicas, exámenes bioquímicos (pre y postoperatorios), a las complicaciones gastrointestinales, la aparición de complicaciones postoperatorias y la estancia hospitalaria. Conclusión: En las condiciones estudiadas, la inmunomodulación en el preoperatorio no contribuyó a la reducción de las complicaciones postoperatorias, la incidencia de complicaciones gastrointestinales y la estancia hospitalaria.

Cross-cultural adaptation and validation of the instrument Diabetes - 39 (D-39): brazilian version for type 2 diabetes mellitus patients - stage 1 / Adaptación cultural y validación del instrumento Diabetes - 39 (D-39): versión para brasileños con diabetes mellitus tipo 2-fase 1 / Adaptação cultural e validação do instrumento Diabetes - 39 (D-39): versão para brasileiros com diabetes mellitus tipo 2 - fase 1

The study aimed to accomplish a cross-cultural adaptation of the "Diabetes - 39 - D-39" instrument for Brazil, to test the validity of the adapted version in a sample of type 2 diabetes mellitus patients and to describe the participants of the study, according to the scores obtained on the Likert-type scale. The instrument adaptation process followed several steps: instrument translation; achievement of the consensus in Portuguese; evaluation by an expert committee; back-translation; achievement of the consensus in English; comparison of the original and consensus versions in English; semantic analysis and pre-test of the Portuguese version. Results showed that the instrument items, in the first stage of cultural adaptation to Portuguese, presented high internal consistency levels.

Este estudio tuvo como objetivos adaptar, culturalmente, para el Brasil el "Diabetes - 39 - D-39", comprobar la validez de la versión adaptada, en una muestra de personas con diabetes mellitus tipo 2, y describir los participantes del estudio, según los puntajes obtenidos por medio de la aplicación de la escala tipo Likert. El proceso de adaptación del instrumento siguió las siguientes etapas: traducción del instrumento, obtención del consenso en portugués, evaluación por un comité de jueces, back-translation, obtención del consenso en inglés, comparación de las versiones originales y consenso en inglés, análisis semántica y prueba piloto de las versiones en portugués. Los resultados mostraron que el instrumento, en su primera fase de adaptación cultural para el portugués, presentó índices elevados de consistencia interna de sus ítems.

Este estudo teve como objetivos adaptar, culturalmente, para o Brasil o "Diabetes - 39 - D-39", testar a validade da versão adaptada, em uma amostra de pessoas com diabetes mellitus tipo 2, e descrever os participantes do estudo, segundo os escores obtidos por meio da aplicação da escala tipo Likert. O processo de adaptação do instrumento seguiu as seguintes etapas: tradução do instrumento, obtenção do consenso em português, avaliação por um comitê de juízes, back-translation, obtenção do consenso em inglês, comparação das versões originais e consenso em inglês, análise semântica e pré-teste das versões em português. Os resultados mostraram que o instrumento, em sua primeira fase de adaptação cultural para o português, apresentou índices elevados de consistência interna dos seus itens.

Representação no campo do traumático: a enfermidade grave na infância e o impacto sobre o desenvolvimento / Representation in the field of trauma: a serious illness childhood

O presente trabalho teve como objetivo investigar a dinâmica psíquica de crianças vítimas de uma enfermidade grave e a possibilidade de permitir maior mobilidade da dinâmica psíquica dessas crianças por meio da técnica lúdica e do trabalho de busca de representabilidade, a partir da premissa de que a enfermidade grave na infância é uma situação traumática dentre tantas outras possíveis. Delineamos, para tal entendimento, um percurso que se inicia nas primeiras inscrições psíquicas e na construção de representações e, em seguida, apresentamos a maneira como uma situação traumática pode fragilizar a mente. Enfatizamos a possibilidade de representação, mediante as intervenções psicanalíticas, partindo do princípio de que é por intermédio da condição simbólica que o indivíduo se desenvolve. Realizamos um estudo teórico-clínico de duas crianças que foram submetidas à operação para correção de cardiopatia congênita e, consequentemente, internação em unidade de terapia intensiva. O estudo consistiu de intervenções psicanalíticas que privilegiaram o oferecimento de um continente com rêverie, com uma proposta de acompanhar a criança no confronto com questões que fogem da esfera de representações, por intermédio do brincar, favorecendo a não paralisação e o não congelamento de sua rede simbólica e de significados. O Procedimento de Desenhos-estórias foi utilizado no início e final do processo como apoio para as intervenções e avaliações. Por meio das intervenções psicanalíticas, dos recursos teóricos-técnicos utilizados, observamos algumas modificações na linha de representação dos conflitos e um início de mudança na forma das crianças brincarem e se expressarem graficamente

This study aimed to investigate the psychological dynamics of child victims of a serious illness and possibility of allowing greater mobility of the psychological dynamics of these children through recreational technical and search representative from the premise that serious illness in childhood is a traumatic situation among many others possible. Outline for such an understanding, a journey that starts in the first registration and the construction of mental representations and then present how a traumatic situation may weaken the mind. We emphasize the possibility of representation by the psychoanalytic interventions, assuming that it is through the symbolic condition that the individual develops. We conducted a theoretical and clinical study of two children who underwent surgery for repair of congenital heart disease and, consequently, admission to the intensive care unit. The study consisted of psychoanalytic interventions which recommended the offer of a continent with reverie, with a proposal to accompany the child in confronting issues that are beyond the realm of representations, through the play, not favoring the strike and not freeze your symbolic condition. The Drawing-stories was used at the beginning and end of the process as support for interventions and evaluations. Through psychoanalytic interventions, theoretical-technical resources used, we observed some changes in the line representing the beginning of a conflict and change in the way children play and express themselves graphically

Caracterização de pessoas com diabetes em unidades de atenção primária e secundária em relação a fatores desencadeantes do pé diabético / Characteristics of people with diabetes regarding factors associated with the development of diabetic foot ulcer

Objetivo: estudo descritivo que caraterizou pessoas com diabetes da rede básica de saúde em relação aos fatores desencadeantes do pé diabético, considerando variáveis sócio-demográficas, história clínica e risco para complicações nos pés. Métodos: obtiveram-se dados mediante entrevista e avaliação dos pés. Na análise foi considerada avaliação dermatológica, estrutural, circulatória e neurológica e classificados conforme proposta de Sims e colaboradores. Resultados: a idade média foi 58,5±8,5 anos; tempo da doença 8,7±6,7 anos, com ensino fundamental incompleto. Nos antecedentes clínicos 73 por cento referiram hipertensão arterial e 22 por cento dislipidemia. A glicemia média foi 159±79 mg / dl e HbA1c 7,8±2 por cento. Na avaliação dos pés 73 por cento apresentaram higiene/corte de unhas impróprios, 63 por cento pele ressecada/descamativa, 52 por cento unhas alteradas, 49 por cento calos/rachaduras e 33 por cento pé plano. Na classificação de risco identificou-se 7,9 por cento com insensibilidade plantar e 6,9 por cento com insensibilidade plantar e deformidade nos pés. Conclusões: estas alterações poderiam ser previnidas com intervenções básicas e educação para cuidados com os pés.

Características químicas de solo submetido ao tratamento com esterco líquido de suínos e cultivado com gramíneas forrageiras / Chemical characteristics of soil submitted swine liquid manure treatment and cultivated with forage grasses

Avaliou-se, neste trabalho, o efeito da aplicação intensiva de esterco líquido de suínos (ELS), pelo método do escoamento superficial, nas características químicas de um solo Podzólico Vermelho-Amarelo cultivado com quatro espécies forrageiras: quicuio da Amazônia (Brachiaria humidicola (Rendle) Schweick), braquiária (Brachiaria decumbens Stapf), coastcross (Cynodon dactylon (L.) Pers.) e tifton 85 (Cynodon spp.). O ELS foi aplicado em parcelas de 4m² e com 5 por cento de declividade, durante 4 meses, na taxa média equivalente a 800kg ha-1d-1 de demanda bioquímica de oxigênio (DBO5). Para caracterização química, amostras de solo foram coletadas à profundidade de 0-0,20m, antes de iniciar o experimento e após o término dele. A aplicação de ELS proporcionou acúmulo de P, K, Na e Zn no solo, enquanto as concentrações de Mg e Cu diminuíram e a de Ca se manteve inalterada. Houve aumento na acidez, na soma de bases, na CTC e redução na saturação por bases. Devido ao acúmulo de nutrientes, recomenda-se monitoramento das características químicas do solo, ao longo de seu perfil e das águas subterrâneas para que se avaliem riscos de contaminação ambiental.

O preparo da equipe cirúrgica: aspecto relevante no controle da contaminação ambiental / The preparation of the surgical team: significant aspect in the control of environmental contamination

O controle da contaminação ambiental tem sido considerado como medida racional para a prevenção da infecção do sítio cirúrgico. O objetivo deste estudo é apresentar as atuais recomendações relacionadas ao preparo da equipe cirúrgica e tecer considerações sobre o papel do enfermeiro no controle da contaminação ambiental. Baseados na literatura atual, abordamos pontos relacionados à paramentação cirúrgica e a escovação das mãos. Os estudos apontam que o preparo da equipe cirúrgica constitui barreira de proteção importante para a prevenção da infecção do sítio cirúrgico; entretanto salientam a necessidade dos profissionais de saúde realizarem os procedimentos de forma adequada