Although proposed as a clinical prompt to sepsis based on predictive validity for mortality, the Quick Sepsis-related Organ Failure Assessment (qSOFA) score is often used as a screening tool, which ...requires high sensitivity.
To assess the predictive accuracy of qSOFA for mortality in Brazil, focusing on sensitivity.
We prospectively collected data from two cohorts of emergency department and ward patients. Cohort 1 included patients with suspected infection but without organ dysfunction or sepsis (22 hospitals: 3 public and 19 private). Cohort 2 included patients with sepsis (54 hospitals: 24 public and 28 private). The primary outcome was in-hospital mortality. The predictive accuracy of qSOFA was examined considering only the worst values before the suspicion of infection or sepsis.
Cohort 1 contained 5,460 patients (mortality rate, 14.0%; 95% confidence interval CI, 13.1-15.0), among whom 78.3% had a qSOFA score less than or equal to 1 (mortality rate, 8.3%; 95% CI, 7.5-9.1). The sensitivity of a qSOFA score greater than or equal to 2 for predicting mortality was 53.9% and the 95% CI was 50.3 to 57.5. The sensitivity was higher for a qSOFA greater than or equal to 1 (84.9%; 95% CI, 82.1-87.3), a qSOFA score greater than or equal to 1 or lactate greater than 2 mmol/L (91.3%; 95% CI, 89.0-93.2), and systemic inflammatory response syndrome plus organ dysfunction (68.7%; 95% CI, 65.2-71.9). Cohort 2 contained 4,711 patients, among whom 62.3% had a qSOFA score less than or equal to 1 (mortality rate, 17.3%; 95% CI, 15.9-18.7), whereas in public hospitals the mortality rate was 39.3% (95% CI, 35.5-43.3).
A qSOFA score greater than or equal to 2 has low sensitivity for predicting death in patients with suspected infection in a developing country. Using a qSOFA score greater than or equal to 2 as a screening tool for sepsis may miss patients who ultimately die. Using a qSOFA score greater than or equal to 1 or adding lactate to a qSOFA score greater than or equal to 1 may improve sensitivity.Clinical trial registered with www.clinicaltrials.gov (NCT03158493).
The high numbers of COVID-19 cases and deaths in Brazil have made Latin America an epicentre of the pandemic. SARS-CoV-2 established sustained transmission in Brazil early in the pandemic, but ...important gaps remain in our understanding of virus transmission dynamics at a national scale. We use 17,135 near-complete genomes sampled from 27 Brazilian states and bordering country Paraguay. From March to November 2020, we detected co-circulation of multiple viral lineages that were linked to multiple importations (predominantly from Europe). After November 2020, we detected large, local transmission clusters within the country. In the absence of effective restriction measures, the epidemic progressed, and in January 2021 there was emergence and onward spread, both within and abroad, of variants of concern and variants under monitoring, including Gamma (P.1) and Zeta (P.2). We also characterized a genomic overview of the epidemic in Paraguay and detected evidence of importation of SARS-CoV-2 ancestor lineages and variants of concern from Brazil. Our findings show that genomic surveillance in Brazil enabled assessment of the real-time spread of emerging SARS-CoV-2 variants.
Fatores relacionados a quedas em idosos Danielle de Freitas Lopes; Silas Dias Dos Santos; Simone Aparecida Noronha de Souza ...
Revista de Iniciação Científica e Extensão,
08/2019, Letnik:
2, Številka:
3
Journal Article
Recenzirano
Odprti dostop
A queda pode ser definida como uma mudança inesperada e não intencional de posição, que leva inadvertidamente o indivíduo a um nível inferior. O objetivo dessa pesquisa foi identificar os fatores ...relacionados à queda em idosos no cotidiano da vida, propondo uma visão ampla, capaz de divulgar os principais aspectos ligados à queda.A pesquisa foi realizada através de um estudo de campo descritivo analítico com abordagem quantitativa. Os elementos de análise selecionados para este estudo foram os fatores relacionados para queda, composta por 40 idososacima de 65 anos de idade, que são atendidos no CAIS I de Luziânia- GO. 75% dos idosos sofreram algum tipo de queda, 52,5%até 2 a 5 quedas.O número de idosos com algum tipo de grau de incapacidade aumenta com a idade. O envelhecimento é um processo normal da vida, marcado por alterações fisiológicas e progressivas no nosso organismo reduzindo a capacidade do idoso nas atividades funcionais afetando o equilíbrio.
Essential oils are volatile compounds that contain chemical constituents with different biological activities, including repellent activity. Thus, the investigation of aromatic species with repellent ...potential against insect vectors, such as Aedes aegypti (Linnaeus 1762) has increased. The present study evaluated the spatial activity index, the chemical composition of the essential oil from Croton tetradenius leaves, as well as the effective repellent concentration and protection time against female Ae. aegypti mosquitoes. For the biological assays, mosquitoes with up to seven days of emergence were used, which were subjected to different essential oil concentrations in a non-ionic emulsion. The chemical composition was determined by gas chromatography, coupled with mass spectrometry and flame ionization detector. The essential oil showed a higher repellent spatial activity for the concentrations of 200 and 300 mg/cm2. The estimated concentration of 14.1 and 163.4 mg/cm2 showed an effective repellency of 50 and 99%, respectively. Regarding the protection time, 84% landing inhibition, and 100% blood-feeding inhibition were observed for the concentration of 200 mg/cm2 within 240 min. Thirty-three compounds were identified in the chemical characterization, and camphor (30.25%), p-cymene (13.39%), α-terpinene (10.59%), and γ-terpinene (5.32%) were the major compounds. Therefore, the essential oil from Croton tetradenius leaves proved to be a promising repellent alternative in protecting against the Aedes aegypti mosquito.
•Essential oils: repellent potential and viable alternative against Aedes aegypti.•Croton tetradenius essential oil shows spatial repellency against Aedes aegypti.•Croton tetradenius essential oil inhibits the blood feeding of Aedes aegypt.•Croton tetradenius essential oil, protection similar to DEET synthetic repellent.
Plant residues such as animal feed weeds and bean straws are excellent sources of raw material for the production of organic fertilizers. In view of this, the objective of this work was to evaluate ...the effect of organic fertilization on the agromorphological and nutritional aspects in bean grains. The experiment was implemented in the field, in a randomized block design, with three replications, in a split plot scheme, with two types of organic compound (elephant grass enriched with cattle manure) and (bean straw enriched with cattle manure) applied in six increasing doses (0.0, 33.32, 66.65, 100.00, 133.32 and 166.65%) control treatment (recommended mineral fertilization). It was possible to identify interaction between the type of compound and the doses applied only to PL. With a yield of 2.8 t ha-1, mineral fertilization did not differ from treatment with 0.0% organic fertilizer. The dose of 166.65% organic fertilizer increased grain yield reaching 3.8 t ha-1 compared to 2.4 t ha-1 obtained in the treatment with 0.0%. In addition, this treatment increased the K content in the grains. On the other hand, the application of 133.32% of organic fertilizer can be indicated for the increase in mg content in the grains.
Since 2020, developed countries have rapidly shared both publicly and academically relevant wastewater surveillance information. Data on SARS-CoV-2 circulation is pivotal for guiding public health ...policies and improving the COVID-19 pandemic response. Conversely, low- and middle-income countries, such as Latin America and the Caribbean, showed timid activities in the Wastewater-Based Epidemiology (WBE) context. In these countries, isolated groups perform viral wastewater monitoring, and the data are unevenly shared or accessible to health agencies and the scientific community. This manuscript aims to highlight the relevance of a multiparty effort involving research, public health, and governmental agencies to support usage of WBE methodology to its full potential during the COVID-19 pandemic as part of a joint One Health surveillance approach. Thus, in this study, we explored the results obtained from wastewater surveillance in different regions of Brazil as a part of the COVID-19 Wastewater Monitoring Network ANA (National Water Agency), MCTI (Ministry of Science, Technology, and Innovations) and MS (Ministry of Health). Over the epidemiological weeks of 2021 and early 2022, viral RNA concentrations in wastewater followed epidemiological trends and variations. The highest viral loads in wastewater samples were detected during the second Brazilian wave of COVID-19. Corroborating international reports, our experience demonstrated usefulness of the WBE approach in viral surveillance. Wastewater surveillance allows hotspot identification, and therefore, early public health interventions. In addition, this methodology allows tracking of asymptomatic and oligosymptomatic individuals, who are generally underreported, especially in emerging countries with limited clinical testing capacity. Therefore, WBE undoubtedly contributes to improving public health responses in the context of this pandemic, as well as other sanitary emergencies.
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•WBE should be implemented as part of COVID-19 pandemic response in emerging countries.•The wastewater surveillance data from four Brazilian municipalities are presented.•The emergence of the Omicron variant (B.1.1.529) caused a large increase in clinical cases in early 2022.
A síndrome de Burnout é uma resposta de estresse crônico, afetando o desempenho de tarefas, relacionamento interpessoal, produtividade e até mesmo a qualidade de vida do trabalho, do indivíduo e da ...organização devido a exposição direta com paciência, a uma ampla jornada de trabalho em condições muitas vezes adversas. Constitui um quadro bem definido, caracterizado por exaustão emocional, despersonalização e ineficácia. A exaustão emocional representa o esgotamento dos recursos emocionais do indivíduo. A despersonalização é caracterizada pela instabilidade emocional do profissional. A ineficácia (ou sentimento de incompetência) revela uma autoavaliação negativa associada à insatisfação e infelicidade com o trabalho. O objetivo é determinar sinais e sintomas possíveis e já existentes da síndrome de Burnout nos profissionais de enfermagem na Santa Casa Nossa Senhora do Perpétuo Socorro de Alfenas, no setor de Centro de Terapia Intensiva (CTI). Trata-se de uma pesquisa exploratória de caráter descritivo, de cunho quantitativo que foi realizada com aplicação de um questionário semi-estruturado aos profissionais de enfermagem, entre eles auxiliares, técnicos e enfermeiros do setor de Centro de Terapia Intensiva (CTI) da Santa Casa de Caridade de Alfenas Nossa Senhora Perpétuo Socorro, contabilizando uma população total de 20 profissionais de enfermagem, sendo enfermeiros e técnicos de enfermagem. Os resultados foram obtidos através da análise da percepção dos profissionais de enfermagem em relação ao conhecimento sobre os sintomas da síndrome de Burnout. A avaliação se dá através dos questionamentos a respeito da percepção dos entrevistados sobre o motivo da opção profissional, o sentimento de realização no trabalho, o desempenho profissional, o cansaço relacionado ao trabalho, os sintomas relacionado ao exercício profissional, o desgaste emocional, o relacionamento com colegas de profissão, o uso de substâncias que alteram o sono, a falta de concentração no trabalho, conflitos interpessoais no trabalho ou na família, o conhecimento sobre a síndrome de Burnout e o pensamento em mudança de profissão devido a frustrações no trabalho desenvolvido. Com a pesquisa percebe-se que alguns fatores como a falta de concentração e os conflitos interpessoais no trabalho possuem dados estatísticos elevados para o problema, pois esses dois questionamentos, se tratando de setor de Centro de Terapia Intensiva, não devem acontecer nas proporções em que foram apresentadas, assim como a frequência alta de profissionais que apresentam irritabilidade ou falta de paciência relacionado ao exercício profissional no setor de Terapia Intensiva.
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