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BACKGROUND: The intensity of dengue virus (DV) replication and circulating non-structural protein 1 (NS1) levels may promote changes in the human immune response and favor severe forms of infection. We investigated the correlations between NS1 with CXCL-8, CXCL-10, IFN-γ, and IL-12p40 serum levels, and IFN-γ receptor α chain (CD119) expression, and CXCL10 production by peripheral blood mononuclear cells (PBMCs) stimulated with recombinant IFN-γ in DV-infected patients with different clinical forms. METHODS: Dengue virus NS1, CXCL-8, CXCL-10, IFN-γ, and IL-12p40 serum levels were measured in 152 DV-infected patients with different clinical forms and 20 non-infected individuals (NI) using enzyme-linked immunosorbent assay (ELISA). In addition, we investigated the CXCL-10 production after in vitro IFN-γ stimulation of PBMCs from 48 DV-infected individuals (with different clinical forms of dengue fever) and 20 NI individuals using ELISA, and CD119 expression on CD14+ cells with flow cytometry. RESULTS: Patients with dengue hemorrhagic fever (DHF) had significantly higher NS1, CXCL-8, and CXCL-10 serum levels than those with classic dengue fever (DF). The response of PBMCs to IFN-γ stimulation was lower in patients with DHF than in those with DF or dengue with complications (DWC), with lower CD119 expression and reduced CXCL-10 synthesis. In addition, these alterations are associated with high NS1 serum levels. CONCLUSIONS: Patients with DHF reported high NS1 levels, low CD119 expression, and low CXCL-10 synthesis in PBMCs, which may be associated with infection progression and severity.
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Quimiocina CXCL10 , Ensaio de Imunoadsorção Enzimática , Dengue Grave , Proteínas não Estruturais Virais , Humanos , Quimiocina CXCL10/sangue , Masculino , Dengue Grave/sangue , Dengue Grave/imunologia , Feminino , Adulto , Pessoa de Meia-Idade , Leucócitos Mononucleares/metabolismo , Estudos de Casos e Controles , Adulto Jovem , Interferon gama/sangue , Adolescente , Citometria de FluxoRESUMO
ABSTRACT Background: The intensity of dengue virus (DV) replication and circulating non-structural protein 1 (NS1) levels may promote changes in the human immune response and favor severe forms of infection. We investigated the correlations between NS1 with CXCL-8, CXCL-10, IFN-γ, and IL-12p40 serum levels, and IFN-γ receptor α chain (CD119) expression, and CXCL10 production by peripheral blood mononuclear cells (PBMCs) stimulated with recombinant IFN-γ in DV-infected patients with different clinical forms. Methods: Dengue virus NS1, CXCL-8, CXCL-10, IFN-γ, and IL-12p40 serum levels were measured in 152 DV-infected patients with different clinical forms and 20 non-infected individuals (NI) using enzyme-linked immunosorbent assay (ELISA). In addition, we investigated the CXCL-10 production after in vitro IFN-γ stimulation of PBMCs from 48 DV-infected individuals (with different clinical forms of dengue fever) and 20 NI individuals using ELISA, and CD119 expression on CD14+ cells with flow cytometry. Results: Patients with dengue hemorrhagic fever (DHF) had significantly higher NS1, CXCL-8, and CXCL-10 serum levels than those with classic dengue fever (DF). The response of PBMCs to IFN-γ stimulation was lower in patients with DHF than in those with DF or dengue with complications (DWC), with lower CD119 expression and reduced CXCL-10 synthesis. In addition, these alterations are associated with high NS1 serum levels. Conclusions: Patients with DHF reported high NS1 levels, low CD119 expression, and low CXCL-10 synthesis in PBMCs, which may be associated with infection progression and severity.
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BACKGROUND: Porteirinha is endemic for visceral leishmaniasis (VL), with intense disease transmission of the disease. We evaluated the impact of canine euthanasia as a single control measure on the incidence of VL in humans and canines. METHODS: A prospective observational cohort study was carried out over four years (1998-2002) in 8 of the 12 neighborhoods of the city. The dynamics of canine visceral leishmaniasis (CVL) transmission were evaluated for 2 years, before beginning the screening-culling intervention. The comparative morbidity index (CMI) was used to stratify areas with the greatest risk of CVL, and the spatial distribution of human and canine VL cases was compared using univariate and bivariate K-functions. RESULTS: Human cases conglomerated in three neighborhoods. Spatial clusters were detected for CVL in 1998, 2000, and 2001, but not in 1999, when greater spatial dispersion occurred. The screening and culling intervention reduced the number of human VL cases and decreased the incidence of CVL, mainly in neighborhoods with a high CMI. CONCLUSIONS: The systematic euthanasia of seropositive dogs was shown to be an effective control action of the Program for Control of Visceral Leishmaniasis (PCLV) in Brazil. The fundamental role of domestic dogs in the epidemiological chain of VL was reaffirmed.
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BACKGROUND: Snakebite is a neglected global health problem with high morbidity. We describe compartment syndrome (CS) cases related to snakebites by Bothrops spp. METHODS: The medical records of patients admitted with snakebites envenomation were reviewed. RESULTS: Of 47 patients with Bothrops spp. envenomation (4 male; mean age: 42 years), 7 (15%) developed CS. The mean time to antivenom administration was 9.5 hours. The time to fasciotomy was variable. Seven patients developed infection and four had acute kidney injury. CONCLUSIONS: The incidence of CS is higher than that reported previously. This may be due to the clinical severity and long delay before administering antivenom.
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Bothrops , Síndromes Compartimentais , Brasil , Animais , Mordeduras de Serpentes , Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , IdosoRESUMO
ABSTRACT Background: Snakebite is a neglected global health problem with high morbidity. We describe compartment syndrome (CS) cases related to snakebites by Bothrops spp. Methods: The medical records of patients admitted with snakebites envenomation were reviewed. Results: Of 47 patients with Bothrops spp. envenomation (4 male; mean age: 42 years), 7 (15%) developed CS. The mean time to antivenom administration was 9.5 hours. The time to fasciotomy was variable. Seven patients developed infection and four had acute kidney injury. Conclusions: The incidence of CS is higher than that reported previously. This may be due to the clinical severity and long delay before administering antivenom.
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Objetivo: Avaliar se a estratégia protetora de ventilação mecânica na síndrome do desconforto respiratório agudo (SDRA) por Influenza é capaz de reduzir o tempo de ventilação mecânica e aumentar a sobrevida. Métodos: A busca foi realizada nas bases de dados Pubmed, Embase, Cochrane, Lilacs, Medline, Scopus, Web of Science, Science Direct, Cinahl e SAGE, entre 2009 e 2019. Buscou-se por ensaios clínicos controlados e randomizados, estudos analíticos com grupo controle: coorte prospectiva ou controle histórico. A população estudada foi de indivíduos adultos com diagnóstico de síndrome respiratória aguda grave por Influenza, que receberam estratégia protetora de ventilação com baixos volumes correntes e/ou manobra de recrutamento alveolar comparada com qualquer outra estratégia. Resultados: A busca resultou em 445 referências; apenas 1 artigo preencheu os critérios de elegibilidade. O estudo incluído trouxe que o uso de baixos volumes traz benefícios para os pacientes com SDRA de etiologias virais, como menor tempo de ventilação mecânica, de internação em UTI e hospitalar. Conclusão: A escassez de artigos sobre a estratégia de ventilação protetora em SDRA secundário à infecção por Influenza não permite concluir se essa estratégia é capaz de reduzir o tempo de ventilação e/ou melhorar a sobrevida nessa população. A literatura carece de mais estudos que permitam conclusões robustas.
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Clinical similarities among viral diseases become even more relevant considering the current scenario, especially in Brazil, where there is a high incidence of these diseases and overlapping seasonality. We report the case of a patient with acute clinical manifestations composed of predominant respiratory symptoms and alveolar hemorrhage in which three etiologies (dengue, influenza and COVID-19) were investigated concomitantly. Only the diagnosis of dengue was confirmed. Then, the patient's immunological profile in response to stimulation of mononuclear cells with dengue virus antigen was analyzed in an attempt to identify specific characteristics that could be associated with the clinical manifestation.
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COVID-19 , Dengue , Dengue/complicações , Dengue/diagnóstico , Diagnóstico Diferencial , Hemorragia/diagnóstico , Humanos , SARS-CoV-2 , SíndromeRESUMO
Resumo Este ensaio teórico tem por objetivo propor reflexões acerca da morte e do morrer sob o prisma de possíveis antagonismos, do adoecimento e das ocupações humanas envolvidas nesse processo. Os antagonismos são colocados em pauta obedecendo ao sentido de oposição mútua entre vida e morte, nascimento e morte, bem como entre sua previsão e sua negação. O adoecimento é discutido sob o prisma dos modelos dinâmico e ontológico de Laplantine, abrindo-se reflexões sobre o significado do adoecimento para o doente, muitas vezes expropriado de seu processo de morrer. Também aborda como a morte é impelida, atualmente, para os bastidores da vida social. Por último, são abordadas as ocupações da morte pautadas nos "princípios da boa morte", sob o olhar da terapia ocupacional, sendo discorridos os preparativos e os ritos fúnebres desenvolvidos pelo morrente, seu círculo social e pelos profissionais da saúde, religiosos, agentes fúnebres e funcionários de cemitérios. Depreendemos que a morte é um processo social.
Abstract This theoretical essay aims to propose reflections on death and dying through the prism of possible antagonisms, illness and human occupations involved in this process. The antagonisms are put up for discussion obeying the sense of mutual opposition between life and death, birth and death, as well as between their prediction and their negation. Illness is discussed from the perspective of Laplantine's dynamic and ontological models, opening up reflections on the meaning of illness for the patient, who is often expropriated from their dying process. It also addresses how death is currently pushed behind the scenes of social life. Finally, the occupations of death based on the "principles of good death" are approached from the perspective of occupational therapy, discussing funeral preparations and rites developed by the deceased, their social circle and by health professionals, religious people, funeral agents and cemetery workers. We understand that death is a social process.
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ABSTRACT Clinical similarities among viral diseases become even more relevant considering the current scenario, especially in Brazil, where there is a high incidence of these diseases and overlapping seasonality. We report the case of a patient with acute clinical manifestations composed of predominant respiratory symptoms and alveolar hemorrhage in which three etiologies (dengue, influenza and COVID-19) were investigated concomitantly. Only the diagnosis of dengue was confirmed. Then, the patient's immunological profile in response to stimulation of mononuclear cells with dengue virus antigen was analyzed in an attempt to identify specific characteristics that could be associated with the clinical manifestation.
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Resumo: Introdução: Programas de mentoria têm se mostrado estratégias para o aprimoramento da formação dos futuros médicos, com alcance em aspectos pouco contemplados nos currículos formais. Este relato discute a experiência docente do exercício da mentoria para uma turma de graduação em Medicina, durante o período de seis anos (de 2014 a 2020). Relato de experiência: As ações da mentoria foram planejadas semestralmente, em reuniões entre mentor e mentorados. As temáticas elegíveis foram escolhidas por meio de tempestade de ideias para convergir nas principais demandas coletivas. Abordaram-se os seguintes assuntos: visão do paciente ante a interação com estudantes das profissões da saúde, futuro dos médicos recém-formados, matriz de competências essenciais para a formação do médico, entre outros. Utilizaram-se mais frequentemente as seguintes ferramentas: rodas de conversa, atividades baseadas em metodologias ativas em pequenos e grandes grupos, encontros informais com a turma, encontros individuais, e espaços formais e informais de tecnologia da informação. As ações foram realizadas, ao longo dos seis anos, pelo mesmo docente, o que permitiu a construção e consolidação do vínculo entre mentor e mentorados. Discussão: Assim, a mentoria se configurou como uma potente estratégia, conduzida com flexibilidade para permear as necessidades dos educandos, direcionando-as para o desenvolvimento individual e coletivo de profissionalismo. Entre os ganhos paralelos, destaca-se o estímulo ao desenvolvimento docente, condição que exigiu receptividade à interação e reconhecimento dos saberes dos aprendizes. Conclusão: Por meio desta experiência, foi possível compreender que a essência da mentoria está relacionada ao vínculo e ao preparo de seres humanos para lidar com seres humanos, independentemente do papel social que estejam ocupando.
Abstract: Introduction: Mentoring programs have been strategies for improving the training of future doctors, covering aspects rarely contemplated in formal curriculum. This report discusses the teaching experience of mentoring for an undergraduate medicine class over the course of a six-year period (2014 to 2020). Experience report: The mentoring actions were planned every six months in a meeting between mentor and mentees. The eligible themes were chosen through brainstorming to converge on the main collective demands. The topics included, for example: The patient's view of interaction with health students; The future of recently graduated doctors; Core skills of a doctor. The most frequently used tools were: Circle learning; Activities based on methodologies in small and large groups; Informal meetings with the whole class; Individual meetings; Formal and informal digital spaces. The actions were developed, over the six years, by the same teacher, which helped construct and consolidate the bond between mentor and mentees. Discussion: Mentoring was configured as a powerful strategy, conducted with flexibility to permeate the needs of students, directing them towards the individual and collective development of professionalism. Among the secondary gains, the stimulation of teacher development stands out, a condition that required receptivity to interaction and recognition of the learners' experience. Conclusion: This experience demonstrated that the essence of mentoring is related to the connection and the preparation of humans to deal with humans, regardless of the social role they are playing.