Search

Background: Cardiovascular diseases constitute one of the leading causes of morbidity and mortality worldwide. Herbal medicines represent viable alternatives to the synthetic drugs currently employed in the control of hypertension. This study aimed to isolate and identify the chemical markers of Kalanchoe crenata and to investigate the antihypertensive and anti-matrix metalloproteinase (MMP2) activities of an aqueous extract of the leaves. Methods: The main constituents of the aqueous extract of K. crenata were separated by ultra-performance liquid chromatography–mass spectrometry, and their presence was identified by NMR spectroscopy. Renovascular hypertension was induced in male Wistar rats using the two-kidney one-clip method (HTN groups), while control animals (Sham groups) were submitted to Sham surgery. Six groups of 10 animals each were treated daily for eight weeks as follows: Sham 1 (carrier), Sham 2 (K. crenata extract), HTN.1 (carrier), HTN.2 (K. crenata extract), HTN 3 (losartan), and HTN 4 (K. crenata extract with losartan). Results: The main compounds of the extract were patuletin 3-O-(4″-O-acetyl-α-L-rhamnopyranosyl)-7-O-(3‴-O-acetyl-α-L-rhamnopyranoside) (1), patuletin 3-O-α-L-rhamnopyranosyl-7-O-L-rhamnopyranoside (2), and trans-caffeoyl-malic acid (3), with compounds 1 and 2 being chemical markers of the species. Significant reductions (p < 0.05) in systolic blood pressure and MMP2 (72kDa isoform) activity were observed in the HTN 4 group. Conclusions: The association of K. crenata extract and losartan presented in vivo effects against hypertension.

BackgroundUncaria tomentosa (Willd. ex Schult.) DC. (Rubiaceae) is traditionally used by Amazonian indigenous groups to treat inflammatory diseases. To date, there are no systematic reviews and meta-analyses on the use of U. tomentosa for inflammation control in animals supporting the traditional knowledge about this species. This study was conducted to evaluate the effect of U. tomentosa extracts in modulating inflammatory mediators and to determine which types of inflammatory diseases can be treated by this species.MethodsWe conducted a systematic review and meta-analysis of preclinical studies published before 26 July 2023, identified in PubMed, Embase, and Scopus. Four independent reviewers extracted the data and assessed the risks of bias. The effects of U. tomentosa on inflammatory diseases and the inflammatory mediators involved were extracted from the studies. Standardized mean differences (SMD) and 95% confidence intervals (95%CI) of the outcomes were estimated. The meta-analyses were conducted using RevMan 5.4 (Cochrane Collaboration). This protocol was registered in PROSPERO (CRD42023450869).ResultsTwenty-four of 523 studies were included. U. tomentosa extracts decreased the cytokines interleukin (IL)-6 (SMD: −0.72, 95%CI: −1.15, −0.29, p = 0.001) and transcription factor nuclear factor kappa-B (NF-κB) (SMD: −1.19, 95%CI: −1.89, −0.48, p = 0.001). However, the extracts did not significantly alter IL-1 (SMD: −0.16, 95%CI: −0.87, +0.56, p = 0.67), IL-10 (SMD: −0.05, 95%CI:–0.35, 0.45, p = 0.80), or tumor necrosis factor-alpha (TNF-α) levels (SMD: 0.18, 95%CI: −0.25, 0.62, p = 0.41).ConclusionMany extracts of stem bark, roots, and leaves of U. tomentosa, mostly aqueous and hydroethanolic, exhibited anti-inflammatory and/or immunomodulatory activities and low toxicity. The extracts decreased NF-κB and IL-6. These findings suggest that this species has the potential to treat inflammatory diseases in which these markers are increased, according to the ethnopharmacological use. These activities are not related to a specific class of compounds.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=450869, Identifier CRD42023450869.

Objectives: Several Flaviviruses can co-circulate. Pre-existing immunity to one virus can modulate the response to a heterologous virus; however, the serological cross-reaction between these emerging viruses in dengue virus (DENV)-endemic regions are poorly understood. Methods: A cross-sectional study was performed among the residents of Manaus city in the state of Amazonas, Brazil. The serological response was assessed by hemagglutination inhibition assay (HIA), enzyme-linked immunosorbent assay, and neutralization assay. Results: A total of 74.52% of the participants were immunoglobulin G-positive (310/416), as estimated by lateral flow tests. Overall, 93.7% of the participants were seropositive (419/447) for at least one DENV serotype, and the DENV seropositivity ranged between 84.8% and 91.0%, as determined by HIA. About 93% had antiyellow fever virus 17D-reactive antibodies, whereas 80.5% reacted to wild-type yellow fever virus. Zika virus (ZIKV) had the lowest seropositivity percentage (52.6%) compared with other Flaviviruses. Individuals who were DENV-positive with high antibody titers by HIA or envelope protein domain III enzyme-linked immunosorbent assay reacted strongly with ZIKV, whereas individuals with low anti-DENV antibody titers reacted poorly toward ZIKV. Live virus neutralization assay with ZIKV confirmed that dengue serogroup and ZIKV-spondweni serogroup are far apart; hence, individuals who are DENV-positive do not cross-neutralize ZIKV efficiently. Conclusion: Taken together, we observed a high prevalence of DENV in the Manaus-Amazon region and a varying degree of cross-reactivity against emerging and endemic Flaviviruses. Epidemiological and exposure conditions in Manaus make its population susceptible to emerging and endemic arboviruses.

Abstract Objective: Emergency contraception (EC) is an effective and safe method for preventing unplanned pregnancy after unprotected sexual intercourse among adolescents but is infrequently prescribed by pediatricians. Because of the scarcity of data on the discomfort with EC prescription among physicians in Brazil, this study aimed to identify associated factors with discomfort with EC prescription among pediatricians in the state of Amazonas. Methods: A web-based, cross-sectional study including sociodemographic data, knowledge, attitudes, and discomfort with EC prescription was used. Multivariate logistic regression and artificial intelligence methods such as decision tree and random forest analysis were used to identify factors associated with discomfort with EC prescriptions. Results: Among 151 physicians who responded to the survey, 53.0% were uncomfortable with prescribing EC, whereas only 33.1% had already prescribed it. Inexperience was significantly associated with discomfort with EC prescription (odds ratio 4.47, 95% confidence interval 1.71–11.66). Previous EC prescription was protective against discomfort with EC prescription in the three models. Conclusions: EC is still infrequently prescribed by pediatricians because of inexperience and misconceptions. Training these professionals needs to be implemented as part of public health policies to reduce unplanned adolescent pregnancy.

Abstract Background The emergence and re-emergence of infectious diseases are a cause for worldwide concern. The introduction of Zika and Chikungunya diseases in the Americas has exposed unforeseen medical and logistical challenges for public health systems. Moreover, the lack of preventive measures and vaccination against known and emerging mosquito-transmitted pathogens, and the occurrence of unanticipated clinical complications, has had an enormous social and economic impact on the affected populations. In this study, we aimed to measure the seroprevalence of endemic and emerging viral pathogens in military personnel stationed in Manaus, Amazonas state. Methods We measured the seropositivity of antibodies against 19 endemic and emerging viruses in a healthy military personnel group using a hemagglutination inhibition assay (HIA). Results Overall, DENV positivity was 60.4%, and 30.9% of the individuals reacted against ZIKV. Also, 46.6%, 54.7%, 51.3% and 48.7% individuals reacted against West Nile virus (WNV), Saint Louis encephalitis virus (SLEV), Ilheus virus (ILHV) and Rocio virus (ROCV), respectively. Individuals with high DENV HIA titer reacted more frequently with ZIKV or WNV compared to those with low HIA titers. Observed cross-reactivity between Flaviviruses varied depending on the virus serogroup. Additionally, 0.6% and 0.3% individuals were seropositive for Oropouche virus (OROV) and Catu virus (CATUV) from the family Peribunyaviridae, respectively. All samples were negative for Eastern Equine Encephalitis virus (EEEV), Western Equine Encephalomyelitis virus (WEEV), Mayaro virus (MAYV), Mucambo virus (MUCV) and CHIKV from the family Togaviridae. Conclusions A high proportion of individuals in our high-risk population (~ 60%) lacked antibodies against major endemic and emerging viruses, which makes them susceptible for further infections. Military personnel serving in the Amazon region could serve as sentinels to strengthen global infectious disease surveillance, particularly in remote areas. Graphical abstract

A pandemia causada pelo novo coronavírus (SARS-CoV-2) impôs um cenário mundial de isolamento social e suspensão de atividades didáticas presenciais em todos os níveis de ensino. Isto levou à adoção emergencial de estratégias de ensino remoto para dar continuidade, ainda que de forma limitada, às atividades didáticas. Por outro lado, boa parte dos professores, em todos os níveis de ensino, possuía pouco ou nenhum conhecimento e experiência com o ensino remoto. Embora as instituições de ensino tenham oferecido suporte, em maior ou menor grau, coube individualmente ao docente a maior parte da tarefa de se capacitar, preparar e oferecer suas unidades de ensino. Além disso, muitos cursos foram transferidos para o ambiente virtual sem as devidas adaptações, o que pode resultar em piores resultados de aprendizagem. Embora existam diferentes metodologias para planejar e implantar o ensino à distância, usando plataformas baseadas na rede mundial de computadores, o modelo ADDIE é bastante popular e relativamente simples de ser implantado e, por isso, foi escolhido para o desenvolvimento deste artigo. Dessa forma, apresentamos as etapas de análise, desenho, desenvolvimento, implementação e avaliação de curso oferecido de forma online. Além disso, incluímos elementos práticos como indicação de equipamentos, softwares, links e sugestões para completar estas etapas.

Após a suspensão das aulas presenciais em 2020, devido à pandemia da Covid-19, foi necessário viabilizar educação remota emergencial para milhares de estudantes de todos os níveis do ensino no Brasil. Quase ninguém estava preparado para enfrentar um desafio desta grandeza. Por conta da falta de familiaridade com as estratégias de educação mediada por tecnologia, única modalidade de ensino disponível naquele momento, essa situação logo trouxe à tona sinais de fadiga e estresse entre professores e estudantes. Era perceptível também a necessidade, por parte dos professores, de treinamento para apropriarem-se dos recursos existentes na universidade para a educação remota. A energia dispendida para preparação das aulas, atividades e avaliações no contexto da educação remota era enorme e seria necessário adquirir competências básicas para manter os processos de ensino-aprendizagem e avaliação dos estudantes acontecendo e com boa qualidade. Estes sinais e pedidos de ajuda, por parte dos professores e estudantes, começam a ficar evidentes no final de maio de 2020 na Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP). Estudantes reclamavam de sobrecarga de conteúdo, sobreposição e desorganização das atividades propostas para o ambiente virtual e estavam muito ansiosos com a avaliação que teriam ao final do semestre. Por outro lado, víamos professores inseguros para oferecerem atividades online, ou em dúvida sobre como cuidar de vários aspectos, tais como registro de frequência, participação ativa nas aulas, e, principalmente, avaliação do estudante. Enfim, como utilizar recursos de educação remota, partindo de pouca ou quase nenhuma experiência prévia? Neste contexto, o Centro de Desenvolvimento Docente para o Ensino (CDDE) da FMRP-USP identifica as necessidades dos docentes e propõe um treinamento voltado para a plataforma e-Disciplinas da USP, assegurando os princípios básicos de boa educação e avaliação dos estudantes. Daí nasce o módulo básico de educação remota para profissões da saúde, que busca atender docentes com diferentes necessidades na FMRP-USP. Para aqueles professores com maior expertise em educação a distância, realizamos dois cursos completos empregando o ensino híbrido a partir da estratégia da sala de aula invertida, mas de maneira remota (remote flipped classroom). Para um público mais iniciante ou que não teria condições de se dedicar ao curso completo, disponibilizamos ajuda personalizada. Esta é a experiência que apresentamos neste artigo e que servirá de base para adequações necessárias para o enfrentamento do desafio da educação durante e após a fase mais aguda da pandemia da Covid-19.

Todo o conhecimento acumulado sobre o processo de ensino e aprendizagem, considerando as melhores práticas docentes e os conceitos sobre aprendizado de adultos, aprendizagem significativa e aprendizado centrado no estudante devem ser continuamente exercitados e revisitados, independente do formato: presencial, ensino remoto (ER) ou ensino a distância (EaD). A necessidade de ampliação da utilização do ER emergencial, determinada pela crise pandêmica de 2020, trouxe novos desafios para professores e estudantes em todo o mundo. Dentre os desafios se apresenta a reinterpretação dos conceitos presentes no processo de ensino e aprendizagem sob a lente do mundo digital. Esta revisão busca apresentar as melhores práticas sob o prisma do novo contexto da vida digital no ensino para as profissões da saúde, incluindo aqui as oportunidades oferecidas pela pandemia

O processo educativo vivenciado por estudantes e professores deve ser focado na aquisição de conhecimento, habilidades e atitudes relevantes para compreensão dos fenômenos da vida e sua aplicação na prática profissional, exigindo a participação ativa e efetiva dos muitos envolvidos: estudantes, professores, gestores acadêmicos e outros atores importantes. Ainda que essa máxima faça parte dos discursos dos cursos da área da saúde, ressalta-se, neste trabalho, o valor fundamental do planejamento para uma ação educacional de qualidade. A adoção de instrumentos pedagógicos próprios para este fim pode favorecer uma melhor reflexão, desenvolvimento e comunicação do percurso de formação dos estudantes. Na Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP-USP), o instrumento utilizado é conhecido como Plano de Ensino e Aprendizagem, o PEA. Neste relato de experiência, apresenta-se o seu contexto de implementação, as discussões envolvendo a comunidade acadêmica, as ações formativas para torná-lo um recurso vivo e potente para o fazer docente, elementos estes que fortaleceram o ensino nos cursos de graduação da FMRP. Ao longo deste artigo, o leitor conhecerá as partes que compõem o PEA, orientações sobre como elaborá-lo, exemplos produzidos por professores e um conjunto de rubricas e critérios que contribuem para nortear o planejamento no contexto da docência nas profissões da saúde.

Objectives: to determine the prevalence of pulmonary hemorrhage in newborns and evaluate the associated risk factors and outcomes. Methods: this was a retrospective case-control study involving 67 newborns who met the criteria for pulmonary hemorrhage. A control was selected for each case: the next-born child of the same gender, similar weight (± 200 g) and gestational age (± 1 week), with no previous pulmonary hemorrhage and no malformation diagnosis. Factors previous to pulmonary hemorrhage onset, as well as aspects associated to the condition, were assessed. Results: the prevalence was 6.7 for 1,000 live births, and the rates observed were: 8% among newborns

OBJETIVO: Avaliar se a aprotinina em altas doses hemostáticas pode reduzir o processo inflamatório após circulação extracorpórea (CEC) em crianças. MÉTODOS: Estudo prospectivo randomizado em crianças de 30 dias a 4 anos de idade, submetidas à correção de cardiopatia congênita acianogênica, com CEC e divididas em dois grupos, um denominado Controle (n=9) e o outro, Aprotinina (n=10). Neste, o fármaco foi administrado antes e durante a CEC. A resposta inflamatória sistêmica e disfunções hemostática e multiorgânicas foram analisadas por marcadores clínicos e bioquímicos. Foram consideradas significantes as diferenças com POBJECTIVE: To assess if the hemostatic high-dose aprotinin is able to reduce the inflammatory process after cardiopulmonary bypass (CPB) in children. METHODS: A prospective randomized study was performed on children aged 30 days to 4 years who underwent correction of acyanogenic congenital heart disease with CPB and were divided into two groups: Control (n=9) and Aprotinin (n=10). In the Aprotinin Group the drug was administered before and during CPB and the systemic inflammatory response and hemostatic and multiorgan dysfunctions were assessed through clinical and biochemical markers. Differences were considered to be significant when P

OBJETIVO: Avaliar se o uso de aprotinina em altas doses hemostáticas pode influenciar as funções miocárdicas, renais e metabólicas em crianças operadas com circulação extracorpórea (CEC). MÉTODOS: Estudo prospectivo randomizado em crianças de 30 dias a 4 anos de idade, submetidas à correção de cardiopatia congênita acianogênica, com CEC e divididas em dois grupos, um denominado Controle (n=9) e o outro, Aprotinina (n=10). Neste, a droga foi administrada antes e durante a CEC. As disfunções miocárdicas e multiorgânicas foram analisadas por marcadores clínicos e bioquímicos. Foram consideradas significantes as diferenças com POBJECTIVE: To evaluate if the use of hemostatic high-dose aprotinin seems influence to myocardial, renal and metabolic functions in children submitted to surgical correction with extracorporeal circulation (ECC). Material and Methods A prospective randomized study was conducted on children aged 30 days to 4 years submitted to correction of acyanogenic congenital heart disease with ECC and divided into two groups: Control (n=9) and Aprotinin (n=10). In the Aprotinin Group the drug was administered before and during ECC and the myocardial and multiorgan dysfunctions were analyzed on the basis of clinical and biochemical markers. Differences were considered to be significant when P

OBJETIVO: Avaliação dos efeitos hemostáticos e plaquetários em crianças submetidas a correção de cardiopatias congênitas acianogênicas com circulação extracorpórea que receberam aprotinina. MÉTODOS: Estudo prospectivo randomizado em crianças de 30 dias a 4 anos de idade, submetidas a correção de cardiopatia congênita acianogênica, com circulação extracorpórea (CEC) e divididas em dois grupos, um denominado Controle (n=9) e o outro, Aprotinina (n=10). Neste, a droga foi administrada antes e durante a CEC. A disfunção hemostática foi analisada por marcadores clínicos e bioquímicos. Foram consideradas significantes as diferenças com POBJECTIVE: Evaluation of the hemostatic and platelets effects in children with acyanogenic congenital heart disease undergone on-pump surgery who received aprotinin. METHODS: A prospective randomized study was performed on children aged 30 days to 4 years who had undergone correction of acyanogenic congenital heart disease using cardiopulmonary bypass (CPB) and were divided into two groups: Control (n=9) and Aprotinin (n=10). In the Aprotinin Group the drug was administered before and during CPB and the hemostatic dysfunction was analyzed by clinical and biochemical markers. Differences were considered to be significant when P

Brazil has reported more than 1,600 cases of hantavirus cardiopulmonary syndrome (HPS) since 1993, with a 39% rate of reported fatalities. Using a recombinant nucleocapsid protein of Araraquara virus, we performed ELISA to detect IgG antibodies against hantavirus in human sera. The aim of this study was to analyze hantavirus antibody levels in inhabitants from a tropical area (Amazon region) in Rondônia state and a subtropical (Atlantic Rain Forest) region in São Paulo state, Brazil. A total of 1,310 serum samples were obtained between 2003 and 2008 and tested by IgG-ELISA, and 82 samples (6.2%), of which 62 were from the tropical area (5.8%) and 20 from the subtropical area (8.3%), tested positive. Higher levels of hantavirus antibody were observed in inhabitants of the populous subtropical areas compared with those from the tropical areas in Brazil.

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To assess the predictive value of selected growth phenotypes for neonatal morbidity and mortality in preterm infants < 30 weeks and to compare them with INTERGROWTH-21st (IG21). Method: Retrospective analysis of data from the Brazilian Neonatal Research Network (BNRN) database for very low birth weight (VLBW) at 20 public tertiary-care university hospitals. Outcome: the composite neonatal morbidity and mortality (CNMM) consisted of in-hospital death, oxygen use at 36 weeks, intraventricular hemorrhage grade 3 or 4, and Bell stage 2 or 3 necrotizing enterocolitis. Selected growth phenotypes: small-for-gestational-age (SGA) defined as being < 3rd (SGA3) or 10th (SGA10) percentiles of BW, and large-for-gestational-age (LGA) as being > 97th percentile of BW. Stunting as being < 3rd percentile of the length and wasting as being < 3rd percentile of BMI. Single and multiple log-binomial regression models were fitted to estimate the relative risks of CNMM, comparing them to IG21. Results: 4,072 infants were included. The adjusted relative risks of CNMM associated with selected growth phenotypes were (BNRN/IG21): 1.45 (0.92–2.31)/1.60 (1.27–2.02) for SGA; 0.90 (0.55–1.47)/1.05 (0.55–1.99) for LGA; 1.65 (1.08–2.51)/1.58 (1.28–1.96) for stunting; and 1.48 (1.02–2.17) for wasting. Agreement between the two references was variable. The growth phenotypes had good specificity (>95%) and positive predictive value (70-90%), with poor sensitivity and low negative predictive value. Conclusion: The BNRN phenotypes at birth differed markedly from the IG21 standard and showed poor accuracy in predicting adverse neonatal outcomes.

Objetivo: Este estudo teve como objetivo avaliar a satisfação dos pacientes ou seus responsáveis e dos profissionais de saúde em relação à telemedicina implantada no HC-Criança, um hospital pediátrico terciário, durante a pandemia da COVID-19. Métodos: Para cada grupo (pacientes/cuidadores e médicos) foi enviado um questionário eletrônico contendo perguntas que foram respondidas em escala de Likert sobre suas experiências com o uso da telemedicina. Resultados: Foram obtidas 81 respostas válidas de médicos e 1.721 de pacientes ou responsáveis. Entre pacientes ou cuidadores, 892 (52%) relataram não ter recebido nenhum atendimento por telemedicina. A maioria dos pacientes/cuidadores que receberam atendimento por telemedicina pelo menos uma vez relatou não ter sido treinada para usar a telemedicina (77%), enquanto a satisfação geral foi de 56%. A maioria (78%) acredita que a telemedicina pode ser adotada após a pandemia. Entre os médicos, 77% relataram não terem sido treinados para usar a telemedicina, 56% avaliaram sua experiência com a telemedicina como satisfatória, e 78% acreditam que a telemedicina pode ser adotada no futuro. Conclusão: A satisfação com a telemedicina de pacientes, seus cuidadores e profissionais de saúde do HC Criança foi boa durante a pandemia da COVID-19, mesmo sem receberem treinamento adequado, e eles acreditam que a telemedicina pode ser adotada após a pandemia.

A população brasileira, em especial a que vive em ambiente rural, amplamente mesclada por várias etnias e culturas, sempre fez uso de plantas medicinais e fitoterápicos, estruturando um saber tradicional que passou de geração a geração e se popularizou nos ambientes urbanos. As experiências empíricas das comunidades tradicionais, associadas ao conhecimento acadêmico, contribuíram para o estabelecimento, no Brasil, da Política Nacional de Plantas Medicinais e Fitoterápicos (PNPMF). Nesse contexto, o Ministério da Saúde estabeleceu, no âmbito do Sistema Único de Saúde (SUS), o programa denominado Farmácia Viva, cuja base ideológica está assentada no trabalho realizado pelo professor emérito Dr. Francisco José de Abreu Matos, da Universidade Federal do Ceará. A farmácia viva deve ser um ambiente de troca de saberes e, ao mesmo tempo, um ponto de encontro entre a tradicionalidade e outras áreas do conhecimento humano, como a agronomia sustentável, farmacognosia, farmacotécnica e assistência farmacêutica, bem como a atuação de médicos e de outros profissionais da área da saúde. No Brasil, os temas plantas medicinais, fitoterápico e farmácia viva são permeados por normas consolidadas pelos Ministério da Saúde, Ministério do Meio Ambiente, e da Agricultura, Pecuária e Abastecimento, e pela Agência Nacional de Vigilância Sanitária (ANVISA). Essas normas visam regulamentar a utilização de plantas medicinais como patrimônio genético, bem como a produção de fitoterápicos e o seu acesso pela população brasileira. Isso, sem dúvida, significa avanço na área de saúde pública do Brasil. O objetivo desse relato foi compartilhar a experiência, realizada por mais de duas décadas, da Farmácia da Natureza de Jardinópolis em produzir fitoterápicos, a partir de um programa que integra a tradicionalidade, pelo envolvimento da comunidade, a academia, com o apoio técnico de universidades, as ações de voluntariado, a valorização da biodiversidade brasileira e o apoio de políticas públicas em nível municipal, estadual e federal.

Objective: After the Covid-19 pandemics hit Brazil and sanitary measures were adopted to contain its dissemination, pediatric hospital admissions were apparently fewer than usual. The authors aimed to describe the time trends of public hospital admissions of children and adolescents due to respiratory infections (RIs) in São Paulo State, Brazil, before and after the adoption of sanitary measures to contain the dissemination of Covid-19. Methods: Ecological, time-series study on the monthly average number of admissions per day of children and adolescents (< 16 years) admitted to public hospitals of São Paulo due to acute RIs between January 2008 and March 2021. Data from 2008 to 2019 were used to adjust the statistical model, while data from 2020 and 2021 were compared to the values predicted by the model. Results: In 2020 and 2021, the number of hospital admissions was significantly lower than predicted by the time series. However, lethality was three times higher in these years, compared to the previous, and six times higher in patients with Covid-19, compared to those without the disease. Hospitalization costs in 2020 and 2021 were lower than in previous years. Conclusions: These findings suggest that the sanitary measures adopted to contain the dissemination of Covid-19 also effectively reduce the transmission of other respiratory viruses. Policymakers and administrators can use this knowledge as a guide to planning preventative interventions that could decrease the number and severity of RIs and related hospital admissions in children and adolescents, decreasing the burden on the public health system.

Objectives. Medicinal plants and herbal medicines are widely used worldwide. However, patients with chronic health conditions or their caregivers do not often disclose these practices to their healthcare providers, leading to potentially severe interactions with current treatments, especially in children. We aimed to describe the prevalence of the use of medicinal plants and herbal medicines by children and adolescents with chronic health conditions and whether their physicians were informed about it. Methods. We conducted a cross-sectional electronic survey on parents and caregivers of children and adolescents with chronic health conditions seen at a university, tertiary-care pediatric outpatient clinic. The common names of the plants cited by respondents were reviewed and Latin names of the species were provided whenever possible. Results. From 20,213 text messages sent in May and June 2021, 521 valid responses were obtained. The prevalence of the use of medicinal plants and herbal medicines was 34.6%, most without a medical prescription (self-medication), and few physicians (4.0%) were aware of it. The five most used species were: Mentha spicata L. (mint), Foeniculum vulgare Mill. (fennel), “cidreira” (a common name possibly corresponding to Cymbopogon citratus (DC.) Stapf, Melissa officinalis L. or Lippia alba (Mill.) N.E. Br. ex Britton & Wilson, P.), Matricaria chamomilla L. (German chamomile), and Plectranthus barbatus Andrews (boldo). Conclusions. The prevalence of the use of medicinal plants and herbal medicines by children and adolescents with chronic health conditions in a tertiary-care outpatient clinic was 34.6%, and only a few physicians were aware of it.

Abstract Objective: The handoff is the act of transferring information and responsibility among healthcare providers, and it is critical for the patient safety and the quality of service. The aim of this study was to evaluate the implementation of a standardized medical handoff system [I-PASS (Illness severity, Patient summary, Action list, Situation awareness and contingency planning, Synthesis by receiver)] and assess the effect on the amount and quality of the information transmitted during medical handoffs in a pediatric ward. Methods: In a prospective intervention study, physicians (staff and residents) who work in 12- or 24-h shifts in the pediatric ward of a single tertiary care Brazilian hospital were eligible. Those who agreed to participate were trained in an online session (lecture plus simulation). Medical handoffs were recorded pre- and post-intervention (training) to compare the amount and quality of information transmitted in handoffs. Results: The handoff standardization significantly increased the number of relevant information delivered for 12 out of the 16 items assessed without increasing, in seconds, the handoff duration (45.9 vs. 48.0; p=0.349). The protocol training and the following discussion about communication resulted in greater focus and attention among participants during transfers, decreasing time spent with interruptions and communication unrelated to the patient (18 vs. 2.7%). Regarding the I-PASS elements, there was an increase in the number of action lists and contingency plans reported (31 vs. 81% and 16 vs. 73%, respectively; p

Abstract Introduction: Major adverse events (MAE) are unexpected but undesirably frequent after pediatric congenital heart surgery and contribute to poorer outcomes. The aim of this study was to test the predictive value of a ratio between central venous oxygen saturation and arterial lactate (ScvO2/lactate) for MAE after pediatric congenital heart surgery in a Brazilian university hospital. Methods: We conducted a retrospective observational study in a tertiary care university hospital, including 194 infants and children submitted to surgery for congenital heart disease. The predictive value of ScvO2, lactate, and ScvO2/lactate ratio were assessed by the area under the receiver operating characteristics curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: The incidence of MAE was 16% — cardiac arrest/death, unplanned reoperation, and low cardiac output syndrome were the most common events. Overall, ScvO2/lactate ratio discriminated patients with and without MAE very well (AUC 0.842), performing better than either variable alone, with sensitivity of 48%, specificity of 94%, PPV of 60%, and NPV of 91%. Conclusion: A ScvO2/lactate ratio > 5 can accurately identify patients at low risk of MAE after pediatric congenital heart surgery, with very good specificity and NPV, but poor sensitivity and PPV.

Objectives: The objective was to calculate weight/length (W/L) ratio values and percentiles by sex and gestational age (GA) to estimate fat mass (FM), fat-free mass (FFM) and body fat percentage (BF%) as well as to compare these indices in preterm, small (SGA), and large (LGA) for GA, stunted and wasted infants from a Brazilian cohort of newborns, comparing with the INTERGROWTH-21st. Methods: Secondary, cross-sectional analysis of data obtained of 7427 live-born infants from the BRISA Cohort Study in the city of Ribeirão Preto, SP, Brazil in 2010. For body composition estimation, W/L ratio was used in multiple regression models. The 3rd, 50th, and 97th percentiles for W/L ratio and body composition measures (FM, FFM, and BF%) were calculated using fractional polynomial regression models. Results: Average W/L ratio was 6.50 kg/m (SD 0.87), while for FM, BF%, and FFM the corresponding values were 359.64 g (145.76), 10.90% (3.05) and 2798.84 g (414.84), respectively. SGA (< 3rd percentile), and wasted infants showed the lowest W/L ratios and measures of body composition. The 3rd, 50th, and 97th percentiles charts of W/L, FM, BF%, and FFM by GA and sex are presented. Conclusions: W/L ratio values of the RP-BRISA Cohort are higher than IG-21st. SGA (< 3rd) and wasted infants showed the lowest W/L ratio and measures of body composition. The body composition references presented here could be used to refine the nutritional assessment of Brazilian newborns and to facilitate comparisons across populations.

Abstract Objective: To describe the characteristics of stage-5 chronic kidney disease (CKD) children and adolescents undergoing renal replacement therapy (RRT) in Amazonas, Brazil, estimating the frequencies of current and new cases, describing the presence of anemia and bone metabolism disorders. Methods: Thirty-five patients aged 7 to 19 years-old on hemodialysis (HD) or peritoneal dialysis (PD) were studied between June 2018 and April 2019. The frequencies of current and new cases were estimated based on the 0 to 19 years-old population of Amazonas, in the same period. Data were collected about the underlying cause and diagnosis of CKD, dialysis, and biochemical analysis. Results: The frequencies of current and new cases were 24 and 15 patients per million people of compatible age (pmpca), respectively. The causes of CKD were nephrotic syndrome (22.8%), nephritic syndrome (14.3%), and neurogenic bladder (14.3%); in 48.6%, the cause was unknown/not investigated. Ten patients underwent renal biopsy, seven with segmental and focal glomerulosclerosis. The majority (80%) were on HD, with an average kt/V of 1.4, and in 51.4% the vascular access was the double lumen catheter. Hypocalcemia was found in 82.8% of patients, hyperphosphatemia in 57.2%, vitamin D insufficiency or deficiency in 60%, and altered parathyroid hormone values in 48.6%. Hemoglobin was low in 80%, with absolute/functional iron deficiency in 28.6%. Conclusions: In children and adolescents of Amazonas, Brazil, we found 24 pmpca with stage-5 CKU currently in RRT and 16.3 pmpca per year of new cases requiring RRT. Most patients were adolescents on HD, half without a causal diagnosis of CKD, with a high frequency of anemia and bone metabolism disorder.

ObjectiveTo evaluate the clinical efficacy of a mixture of probiotics (Lactobacillus and Bifidobacterium) in children and adolescents with atopic dermatitis (AD) and the effects on sensitization, inflammation, and immunological tolerance.MethodsIn this double-blind, randomized, placebo-controlled clinical trial, we enrolled 60 patients aged between 6 months and 19 years with mild, moderate, or severe AD, according to the criteria proposed by Hanifin and Rajka. Patients were stratified to receive one gram per day of probiotics or placebo for 6 months. The primary outcome was a decrease in SCORing Atopic Dermatitis (SCORAD). Secondary outcomes were to assess the role of probiotics on the use of topical and oral medicines (standard treatment), serum IgE levels, skin prick test (SPT), and tolerogenic and inflammatory cytokines. Background therapy was maintained.ResultsForty patients completed the study (24 probiotics, 16 placebo). After treatment for six months, the clinical response was significantly better in the probiotics group; the SCORAD decreased [mean difference (MD) 27.69 percentage points; 95% confidence interval (CI), 2.44–52.94], even after adjustment for co-variables (MD 32.33 percentage points; 95%CI, 5.52–59.13), especially from the third month of treatment on. The reduction of the SCORAD in probiotic group persisted for three more months after the treatment had been discontinued, even after adjustment for co-variables (MD 14.24 percentage points; 95%CI, 0.78–27.70). Patients in the probiotics group required topical immunosuppressant less frequently at 6 and 9 months. No significant changes were found for IgE levels, SPT and cytokines.ConclusionsChildren and adolescents with AD presented a significant clinical response after 6 months with a mixture of probiotics (Lactobacillus rhamnosus, Lactobacillus acidophilus, Lactobacillus paracasei, and Bifidobacterium lactis. However, this clinical benefit is related to treatment duration. Probiotics should be considered as an adjuvant treatment for AD.

Abstract Background Neutrophil extracellular traps (NETs) are innate defense mechanisms that are also implicated in the pathogenesis of organ dysfunction. However, the role of NETs in pediatric sepsis is unknown. Methods Infant (2 weeks old) and adult (6 weeks old) mice were submitted to sepsis by intraperitoneal (i.p.) injection of bacteria suspension or lipopolysaccharide (LPS). Neutrophil infiltration, bacteremia, organ injury, and concentrations of cytokine, NETs, and DNase in the plasma were measured. Production of reactive oxygen and nitrogen species and release of NETs by neutrophils were also evaluated. To investigate the functional role of NETs, mice undergoing sepsis were treated with antibiotic plus rhDNase and the survival, organ injury, and levels of inflammatory markers and NETs were determined. Blood samples from pediatric and adult sepsis patients were collected and the concentrations of NETs measured. Results Infant C57BL/6 mice subjected to sepsis or LPS-induced endotoxemia produced significantly higher levels of NETs than the adult mice. Moreover, compared to that of the adult mice, this outcome was accompanied by increased organ injury and production of inflammatory cytokines. The increased NETs were associated with elevated expression of Padi4 and histone H3 citrullination in the neutrophils. Furthermore, treatment of infant septic mice with rhDNase or a PAD-4 inhibitor markedly attenuated sepsis. Importantly, pediatric septic patients had high levels of NETs, and the severity of pediatric sepsis was positively correlated with the level of NETs. Conclusion This study reveals a hitherto unrecognized mechanism of pediatric sepsis susceptibility and suggests that NETs represents a potential target to improve clinical outcomes of sepsis.

Este artigo traz uma reflexão sobre transformações possíveis e necessárias, a partir das experiências vividas por docentes, estudantes e instituições de ensino ao longo do ano de 2020, na medida em que sobreviviam, aprendiam e se adaptavam à pandemia da COVID-19. Não resta dúvidas de que a maneira de ensinar deverá estar alicerçada em conhecimentos pedagógicos, práticas colaborativas, na tecnologia educacional, infraestrutura de informática e práticas avaliativas que favoreçam a aprendizagem, através do feedback e da interação mais próxima entre aprendiz e professor. O futuro aponta para o ensino híbrido que deve auxiliar os estudantes a alcançarem a competência para a prática profissional. O desenvolvimento de habilidades interpessoais será fundamental, em especial na formação de profissionais da área da saúde. A oferta de oportunidades para o desenvolvimento docente e a estruturação de comunidades de prática para a aprendizagem colaborativa também serão essenciais. A maior flexibilização dos currículos e a mediação tecnológica do processo de ensino e aprendizagem devem favorecer intercâmbios e a internacionalização das instituições de ensino. Deste modo, tanto o ensino de graduação, pós-graduação lato e stricto-sensu tende a ampliar seu escopo e deixará de ficar circunscrito aos seus nichos de origem, expandindo-se para a realização de convênios nacionais e internacionais. Os espaços universitários e os momentos presenciais deverão estar adaptados a nova realidade, que permita ao estudante a aquisição de competências clínicas e relacionais essenciais e que requerem atividades presenciais em cenários da prática profissional. Na área da saúde garantir estes momentos de formação seguirá como um requisito fundamental, assim, as salas de aula, os laboratórios e os campos de estágios devem ser seguros, permitindo uma orientação e supervisão direta por parte dos docentes e preceptores. Além disso, será necessário reafirmar que não existe dilema entre a formação de profissionais da saúde e a segurança do paciente, como houve a partir da suspensão das atividades práticas da maioria dos estudantes dos cursos da saúde no Brasil. Formar profissionais da saúde, num contexto de emergência sanitária, tem importância equivalente a cuidar de pessoas em qualquer cenário. Isso vale também para o acesso a equipamentos de proteção individual e a vacinas. Os desafios estão lançados e as possibilidades de avanço emergem e precisam ser aproveitadas a partir de um trabalho coeso entre gestores universitários, corpo docente, técnico administrativo e discentes.

ABSTRACT OBJECTIVE: To verify whether an intervention based on disseminating health evidence summaries by e-mail to health professionals increases access to health evidence databases, and whether health professionals intend to apply the evidence received by e-mail in their clinical practice. METHODS: This quantitative study started with a survey to collect demographic data and patterns of access to health evidence databases. It was followed by a longitudinal intervention, over 48 weeks, that disseminated 143 health evidence summaries to 339 health professionals with higher education degree who work in the Brazilian Unified Health System. In the longitudinal intervention phase, health professionals voluntarily assessed the received health evidence summaries using the information assessment method. Finally, the study concluded with a survey to identify changes in accessing health evidence databases. RESULTS: Of the 339 Brazilian health professionals participating in this research, 90 (26.5%) answered the initial and final surveys. After 48 weeks, there was an increase in the use of health evidence databases; 186 (54.9%) participants submitted 7,942 assessments of health evidence summaries, which were relevant for patient care in 5,409 (68%) assessments. CONCLUSIONS: The dissemination of health evidence summaries by e-mail to health professionals in Brazil increases the reported use of evidence in clinical practice.

In a greenhouse study, the effect of increasing doses of dry sewage sludge (class A), equivalent to 0 mg, 20 mg, 40 mg, and 80 mg of N dm-3 of soil, from the Franca sewage treatment plant (São Paulo State), was compared to the mineral nitrogen fertilization (40 kg urea ha-1). The experiment was conducted in 2005, using pots with 5 kg of an Oxisol, evaluating the soil fertility, nutrition of Brachiaria decumbens, and dehydrogenase activity. The experimental design was a completely randomized block, with four replications. The application of higher doses of sewage sludge increased the level of soil P by approximately 70%. The increased activity of dehydrogenase in soil showed significant correlation with increasing doses of sludge applied to soil. Only the highest dose of applied sludge (80 mg N dm-3 of soil) increased the dry weight shoot production, while all the doses of sludge applied to soil increased the N leaf content on Brachiaria decumbens. KEY-WORDS: Microbial activity; pasture; biosolid; N mineralization. Em condições de casa de vegetação, estudou-se o efeito das doses crescentes de lodo de esgoto seco (classe A), equivalentes a 0 mg, 20 mg, 40 mg e 80 mg de N dm-3 de solo, originário da Estação de Tratamento de Esgoto de Franca, SP, comparado aos da adubação mineral nitrogenada (40 kg uréia ha-1), quando aplicado a um Argissolo Vermelho-Amarelo distroférrico, sobre a fertilidade do solo, nutrição de Brachiaria decumbens e atividade da enzima desidrogenase. O experimento foi conduzido em Presidente Prudente, SP, utilizando-se vasos com 5 kg de solo, durante o ano de 2005. O delineamento experimental foi em blocos inteiramente casualizados, com quatro repetições. A aplicação das maiores doses de lodo de esgoto aumentou o teor de fósforo no solo, em cerca de 70%. O aumento da atividade da desidrogenase no solo apresentou correlação significativa com o aumento das doses de lodo aplicadas ao solo. Somente a maior dose de lodo aplicada (80 mg de N dm-3 de solo) proporcionou aumento na produção de massa seca da parte aérea, ao passo que todas as doses de lodo aplicadas no solo proporcionaram aumento no teor foliar de N da Brachiaria decumbens. PALAVRAS-CHAVE: Atividade microbiana; pastagens; biosólido; mineralização de N.

The use of intravenous immunoglobulin (IVIG) is relatively infrequent in patients admitted to intensive care units (ICUs). However, “off-label” IVIG prescriptions for different conditions are highly prevalent. The aim of this paper is to review the existing evidence for the use of IVIG in patients admitted to ICUs, emphasizing non-infectious diseases and complications: hypogammaglobulinemia of the critically ill, hemophagocytic lymphohistiocytosis (HLH), Guillain-Barré syndrome (GBS), Kawasaki disease (KD), chylothorax, acute myocarditis, toxic shock syndrome (TSS), Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN), and sepsis. In conclusion, in critically ill patients, IVIG use is of benefit in KD, GBS, and TSS. It may benefit patients with fulminant acute myocarditis. The benefit is not proven in patients with HLH, chylothorax, and SJS/TEN.

O presente artigo apresenta ao leitor as principais indicações de ventilação mecânica assistida emcrianças e as principais modalidades existentes, além de trazer orientações para o ajuste dos parâmetros iniciais de ventilação de acordo com a indicação e listar as principais complicações relacionadasà ventilação mecânica e seu tratamento imediato.