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OBJECTIVE: To analyze risk factors (maternal, obstetric and demographic) associated with congenital syphilis and the clinical characteristics of the newborns. METHOD: A cross-sectional study carried out in ten public maternity hospitals in Fortaleza, Ceará, Brazil that included cases of live births reported with congenital syphilis in 2015. RESULTS: 469 cases were analyzed; 199 (42.4 %) showed some sign or symptom suggestive of congenital syphilis; of these, 65 (32.7 %) were preterm, 87 (43.7 %) had low birth weight, 116 (58.3 %) had jaundice that required phototherapy, 13 (6.5 %) had hepatomegaly, 10 (5 %) had skin lesions, eight (4.0 %) had splenomegaly and one (0.5 %) had limb pseudoparalysis. Records of other clinical changes were identified in 36 (7.7 %) children. Children whose mothers were not treated or who received a drug other than penicillin and those whose mothers had a VDRL titer ≥ 1:16 at birth were 3.7 and 3.2 times more likely to be born with signs of congenital syphilis (p < 0.001- 95 % CI 2.41-5.58; p < 0.001 - 95 % CI 2.41-5.58) respectively. CONCLUSIONS: The findings of this study draw attention to the importance of improving the quality of prenatal care and the development of studies aimed at finding alternative drugs for the treatment of syphilis in pregnant women and the prevention of congenital syphilis.

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Background: Proinflammatory diet contributes to greater symptomatology in patients with knee osteoarthritis (KOA); however, in Mexico there seems to be no evidence of the dietary inflammatory role, being a country with high prevalence of overweight and obesity with an inclination towards a Western diet. Objective: To analyze the relationship between dietary inflammatory index (DII) and KOA symptomatology in Mexican patients. Material and methods: Analytical cross-sectional study in 100 patients aged 40 to 70 years. Pain, stiffness, and functionality were evaluated with the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the DII was calculated from the semi-quantitative food consumption frequency questionnaire (QFCFQ). For its analysis, linear regression was calculated. Results: DII was significantly associated with pain (p = 0.001, R² = 0.118), functionality (p = 0.003, R² = 0.087) and WOMAC score (p = 0.001, R² = 0.099). In the second linear regression model with the dependent variable functionality, waist circumference (WC) was adjusted obtaining an R² = 0.144 and higher significance p = 0.001. Conclusions: Proinflammatory DII was related to greater pain, lower functionality and a high WOMAC score, which is why the anti-inflammatory diet could be considered as a support for the treatment of the patient with KOA.

Introducción: la dieta proinflamatoria contribuye a una mayor sintomatología en pacientes con osteoartritis de rodilla (OAR); sin embargo, en México parece no existir evidencia del papel inflamatorio dietético, pues es un país con alta prevalencia de sobrepeso y obesidad con inclinación hacia una dieta occidental. Objetivo: analizar la relación del índice inflamatorio dietético (IID) con la sintomatología de OAR en pacientes mexicanos. Material y métodos: estudio transversal, analítico en 100 pacientes de 40 a 70 años. Se evaluó el dolor, la rigidez y la funcionalidad con el Western Ontario and McMaster Universities Arthritis Index (WOMAC) y el IID se calculó a partir del cuestionario semicuantitativo de frecuencia de consumo de alimentos (CSFC). Para su análisis, se calculó regresión lineal. Resultados: el IID se asoció significativamente con dolor (p = 0.001, R² = 0.118), funcionalidad (p = 0.003, R² = 0.087) y puntaje del WOMAC (p = 0.001, R² = 0.099). En el segundo modelo de regresión lineal con la variable dependiente funcionalidad, se ajustó la circunferencia de cintura (CC) y se obtuvo una R² = 0.144 y una mayor significación: p = 0.001. Conclusiones: el IID proinflamatorio se relacionó con un mayor dolor, una menor funcionalidad y un puntaje alto del WOMAC, por lo cual la dieta antiinflamatoria podría considerarse como un apoyo para el tratamiento del paciente con OAR.

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The persistence of symptoms for more than three months following infection with severe acute respiratory syndrome coronavirus 2 is referred to as "Long COVID". To gain a deeper understanding of the etiology and long-term progression of symptoms, this study aims to analyze the prevalence of Long COVID and its associated factors in a cohort of Brazilian adults and elders, twelve months after hospital discharge. An observational, prospective, and follow-up study was performed with a cohort of adults and older adults diagnosed with COVID-19 in 2020 in the State of Paraná, Brazil. Twelve months after hospital discharge, patients answered a phone questionnaire about the persistence of symptoms after three levels of exposure to COVID-19's acute phase (ambulatory, medical ward, and intensive care unit). According to the characteristics of participants, the prevalence of Long COVID-19 was calculated, and logistic regression analyses were conducted. We analyzed data from 1822 participants (980 adults [≥18-<60 years] and 842 older people [≥60 years]) across three exposure levels. The overall Long COVID prevalence was 64.2%. Long COVID was observed in 646 adults (55%; of which 326 were women) and 523 older people (45%; of which 284 were women). Females had a higher prevalence of long-term symptoms (52%) compared with men. The most common post-COVID-19 conditions in the 12-month follow-up were neurological (49.8%), followed by musculoskeletal (35.1%) and persistent respiratory symptoms (26.5%). Male individuals were less likely to develop Long COVID (aOR = 0.50). Other determinants were also considered risky, such as the presence of comorbidities (aOR = 1.41). Being an adult and having been hospitalized was associated with the development of Long COVID. The risk of developing Long COVID was twice as high for ward patients (aOR = 2.53) and three times as high for ICU patients (aOR = 3.56) when compared to non-hospitalized patients. Presenting clinical manifestations of digestive (aOR = 1.56), endocrine (aOR = 2.14), cutaneous (aOR = 2.51), musculoskeletal (aOR = 2.76) and psychological systems (aOR = 1.66) made adults more likely to develop Long COVID. Long COVID was present in a large proportion of people affected by the SARS-CoV-2 infection. Presence of Long COVID symptoms displayed a dose-response relationship with the level of disease exposure, with a greater prevalence of symptoms associated with the severe form in the acute period.

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PURPOSE: To analyze self-perceived vocal symptoms and discomfort in amateur church singers and compare them between genders and church types. METHODS: It was a quantitative cross-sectional study involving 99 amateur church singers aged between 18 and 59years. Data collection was carried out through the completion of a sociodemographic questionnaire, the Voice Symptom Scale (VoiSS), and the Vocal Tract Discomfort Scale (VTDS). The Mann-Whitney test was used for comparisons, and Spearman's correlation test was used for analyzing correlations between scale scores. The adopted significance level was 5% (P < 0.05). RESULTS: There was a prevalence of females (71.7%), amateur singers from Protestant churches (73.7%), with a mean age of 27.5years. The average VoiSS total score was 22.6 points, the "limitation" domain was 12.3, the "emotional" domain was 2.55, and the "physical" domain was 7.7. The most self-perceived sensations in the VTDS were "dryness," "sore throat," and "itchiness" with mild to moderate intensity. There was a statistically significant difference between genders (P < 0.05) and a positive correlation from weak (r = 0.212) to strong magnitude (r = 0.660) between vocal symptoms and vocal tract discomfort. There was no statistically significant difference between types of churches. CONCLUSION: Amateur singers self-report high levels of vocal symptoms, which impact limitation, emotional, and physical domains. Furthermore, they experience vocal tract discomfort sensations, with dryness being the most frequently reported, followed by sore throat and itching. No significant differences were found between the scale scores and church types. However, females reported a greater frequency and intensity of vocal tract discomfort sensations. The greater the self-reported vocal symptoms in this population, the higher their self-reported frequency and intensity of vocal tract discomfort sensations. These findings underscore the importance of addressing vocal health issues in amateur singers to enhance their overall well-being.

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Human T-lymphotropic virus type 1 (HTLV-1) is classically associated with the HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), although the mechanisms of this neurological disorder remain unclear. In addition, some patients who develop "minor" neurological signs that do not meet diagnostic criteria for HAM/TSP are classified as asymptomatic carriers. This study aims to demonstrate the neurological symptoms of Brazilian patients living with HTLV-1 classified as not-HAM.TSP. This observational study evaluated patients treated in an HTLV reference center in Bahia, Brazil, between February 2022 and July 2023. The data were obtained through the analysis of medical records and neurological consultation. Those individuals classified as HAM/ TSP were excluded from this study. 74 patients were submitted to a careful neurological evaluation: 23 HAM/TSP, 22 were classified with intermediate syndrome (IS), and 29 were oligosymptomatic. Self-reported symptoms were significantly more common in the IS group, including urinary symptoms such as nocturia, urgency, incontinence, dysuria, weakness, paresthesia, lumbar pain, xerostomia, and xerophthalmia. Physical examination findings consistent with reduced vibratory and tactile sensitivity were more common in the IS group (p = 0.017 and p = 0.013). Alterations in the V and VIII cranial nerves were present in both groups. HTLV-1 can lead to the development of important neurological signs and symptoms in apparently asymptomatic individuals. This data highlights the need for more research into the neurological aspects of HTLV-1 infection and emphasizes the importance of early diagnosis, treatment, and support for individuals living with this virus.

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OBJECTIVE: To identify the first symptoms and signs of patients with suspected infection or sepsis and their association with the composite outcome of admission to the Intensive Care Unit (ICU) or mortality. DESIGN: Prospective cohort study between June 2019 and March 2020. SETTING: Hospital Universitario San Vicente Fundación, Colombia. PATIENTS: Over 18 years of age with suspicion or confirmation of sepsis, which required hospitalization. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Symptoms and signs associated with infection, with their time of evolution, specified in the study. RESULTS: From 1005 eligible patients, 261 were included. After multivariable adjustment with a logistic regression model, the main factors for ICU admission or mortality were heart rate (OR 1.04 with 95% CI 1.04-3.7), respiratory rate (OR 1.19 with 95% CI 1.0-1.4) and capillary refill time (OR 3.4 with 95% CI 1.9-6.1). CONCLUSIONS: Heart rate, respiratory rate, and capillary refill may behave as early predictors of ICU admission and mortality in cases of sepsis.

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OBJECTIVE: To validate the Vocal Tract Discomfort Scale for the Brazilian Portuguese (VTDS-BR), based on internal consistency, reliability, and accuracy. METHODS: The participants were 431 adults of both sexes, divided in two groups: dysphonia (DG) and vocally healthy (VHG). We built a digital database with personal, professional information and the item-by-item VTDS-BR responses of the participants. We applied Cronbach's alpha, exploratory factor analysis; confirmatory factor analysis; Item Response Theory (IRT) using the Samejima model; and ROC (Receiver Operating Characteristic) curve analysis to obtain the VTDS-BR cut-off point. RESULTS: The VTDS-BR has an eight-item structure and two factors: vocal hyperfunction without phonotraumatic injury and with phonotraumatic injury. Each item is evaluated based on two facets related to frequency and intensity, with a Likert scale response key. There are four possible answers: never, sometimes, often, and always for frequency and none, mild, moderate, and intense for intensity. We applied an IRT model, which allowed the identification of which items are more related to dysphonia, based on higher values in the parameters discrimination (a) and difficulty (b), which contributed to the calculation of each participant's aptitude for the development of voice problems, by means of a score. The cut-off value was determined using the ROC curve, in which values greater than - 1.432 indicate a higher probability of voice alterations. CONCLUSION: VTDS-BR went through the stages of validation of internal consistency, reliability, and accuracy. It presents an 8-item, two-factor, and two-facet structure to assess frequency and intensity of vocal tract discomfort symptoms. VTDS-BR is suitable for clinical use or in screening activities, as it is quick to apply and its interpretation is indicative of people with and without phonotraumatic injury.

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BACKGROUND: Fatigue is significant in the context of Parkinson's disease (PD), considering that one-third of patients classify it as the most restricting symptom in their daily life activities (DLAs). The objective was to verify the relationship (association) between fatigue and non-motor and motor symptoms of PD. METHODS: A cross-sectional study which included 100 individuals with PD. Initially, demographic and clinical data (modified Hoehn and Yahr scale-HY, anxiety, and depression) were collected. To assess the non-motor and motor symptoms of PD, the Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) was applied. Fatigue was evaluated using the Parkinson Fatigue Scale. RESULTS: A higher HY score, greater severity of non-motor aspects of DLAs and motor aspects of DLAs, more motor complications, and higher levels of anxiety as well as depression were observed in the "fatigue" group. Fatigue was associated with a lower daily equivalent levodopa dose (LEDD), a higher body mass index (BMI), anxiety, depression, and the presence of non-motor symptoms. CONCLUSION: Non-motor symptoms are more determining factors for fatigue than the motor condition itself, with an association between fatigue and higher BMI scores, increased anxiety and depression, lower LEDD, and greater severity of non-motor aspects of DLAs. Individuals in the "fatigue" group had higher HY scores, anxiety, and depression, worse non-motor and motor symptoms related to experiences of daily life, as well as motor complications.

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Introducción: La enfermedad cerebrovascular isquémica tiene una alta frecuencia debida, fundamentalmente, al envejecimiento poblacional. Objetivo: Comparar las características clínicas de pacientes con enfermedad cerebrovascular isquémica de dos grupos etarios. Métodos: Se realizó un estudio descriptivo, transversal y retrospectivo en 36 pacientes con enfermedad cerebrovascular isquémica correspondientes a dos grupos etarios (65 y menos años y mayores de 65), quienes fueron atendidos en el Instituto de Neurología y Neurocirugía, La Habana, de enero a diciembre del 2017. Al respecto, se analizaron variables demográficas y clínicas y se aplicaron diferentes pruebas estadísticas para comparar. Resultados: Se obtuvo un aumento significativo de pacientes hipertensos (88,9 %) en el grupo etario mayor de 65 años. La mediana de la escala de ictus del National Institute of Health fue superior en estos pacientes (mediana [10-90 percentil]: 9,5 (4-19]). Hubo incremento estadístico de los mayores de 65 años con parálisis parcial de la mirada y ataxia; en tanto, la monoparesia y la extinción visual predominaron en los de 65 y menos años. Dicha escala mostró un aumento estadístico en el ictus aterotrombótico y cardioembólico en comparación con otras causas en ambos grupos. Los pacientes mayores de 65 años con solo un factor de riesgo o ninguno y los que eran hipertensos tuvieron mayor puntuación de la escala. Conclusiones: El grado de afectación neurológica fue superior en los mayores de 65 años que tenían un factor de riesgo y en aquellos con hipertensión arterial. Puede sugerirse que los mecanismos moleculares y fisiopatológicos de estos pacientes varían según la edad.

Introduction: The ischemic cerebrovascular disease has a high frequency due to the population aging mainly. Objective: To compare clinical characteristics of patients with ischemic cerebrovascular of two age groups. Methods: A descriptive, cross-sectional, retrospective study was carried out in the Neurology and Neurosurgery Institute in Havana, from January to December, 2017 in patients with ischemic cerebrovascular disease; 36 individuals of both age groups. In this regard, demographic variables, risk factors, clinical manifestations, coma scale and neurological deficiency, etiology and localization of the ischemic ictus were analyzed. Results: The 65 years group had a significant increase of hypertensive patients (88.9%). The average of the National Institute of Health stroke scale was superior in these patients (median [10-90 percentile]: 9.5 [4-19]). There was statistical increment of over 65 years patients with partial paralysis of the look and ataxia, but monoparesis and visual extinction in the age under 65 years. Such a scale had a statistical increase in the atherothrombotic and cardioembolic ictus in comparison with other etiologies in both patient groups. The over 65 years patients with just one risk factor or and those with hypertension had a higher punctuation of the scale. Conclusions: The degree of neurological affectation was higher in over 65 years patients that had a risk factor and in those with hypertension. As a result it could be suggested that the molecular and pathophysiolologic mechanisms of these patients vary with the age.

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PURPOSE: To identify the prevalence of the nursing diagnosis of compromised end-of-life syndrome in patients in end-of-life care. METHODS: This is a clinical validation based on a cross-sectional epidemiological clinical study conducted at the National Cancer Institute in Rio de Janeiro, Brazil. The defining characteristics of a syndrome diagnosis were identified, defined as a "subset of nursing diagnoses," using sensitivity and specificity measures through the application of latent class statistical methods. FINDINGS: The statistical results revealed seven nursing diagnoses characterizing the syndrome: imbalanced nutrition: less than body requirements, nausea, anxiety, ineffective breathing pattern, disturbed sleep pattern, ineffective thermoregulation, and fatigue. Compromised end-of-life syndrome was present in 76% of the sample. CONCLUSION: The study demonstrated the presence of compromised end-of-life syndrome in most end-of-life patients from the sample. IMPLICATIONS FOR NURSING PRACTICE: Recognizing the presence of the syndrome diagnosis enables nurses to have efficient and effective clinical reasoning for implementing the nursing process in palliative care. CAAE Number: 85415618.0.3001.5274.

OBJETIVO: Identificar a prevalência do diagnóstico de enfermagem Síndrome de fim de vida comprometido em pacientes em cuidados de fim de vida. MÉTODO: Trata-se de uma validação clínica baseada em um estudo clínico epidemiológico transversal, desenvolvido no Instituto Nacional do Câncer no Rio de Janeiro, Brasil. Foram identificadas as características definidoras de um diagnóstico de síndrome, definido como um "subconjunto de diagnósticos de enfermagem" utilizando-se medidas de sensibilidade e especificidade a partir da aplicação do método estatístico de classe latente. RESULTADOS: Os resultados estatísticos identificaram sete diagnósticos de enfermagem caracterizadores da síndrome: nutrição desequilibrada: menor que as necessidades corporais, náusea, ansiedade, padrão respiratório ineficaz, padrão de sono perturbado, termorregulação ineficaz e fadiga. O diagnóstico Síndrome de fim de vida comprometido esteve presente em 76% da amostra. CONCLUSÃO: O estudo demonstrou a presença da Síndrome de fim de vida comprometido na maioria dos pacientes em cuidados de fim de vida da amostra. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: O reconhecimento da presença do diagnóstico de síndrome permite ao enfermeiro um raciocínio clínico eficaz e eficiente para a implantação do processo de enfermagem em cuidados paliativos. Número CAAE: 85415618.0.3001.5274.