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The zoonotic visceral leishmaniasis is caused by the protozoan Leishmania infantum and dogs are reservoirs for this parasite. For the diagnosis of Leishmania at the species level in dogs in formalin-fixed, paraffin-embedded skin (FFPES) samples, colorimetric in situ hybridization (CISH) and quantitative real-time polymerase chain reaction (qPCR) are options, but their sensitivities are not well established. Therefore, the aim of this study was to determine the sensitivity of these two techniques in FFPES for the diagnosis of the L. infantum infection in dogs using culture as the reference standard. The FFPES of 48 dogs with cutaneous infection by L. infantum confirmed by culture and by multilocus enzyme electrophoresis were examined by CISH and qPCR using specific probes for L. infantum. The sensitivities of qPCR, CISH and their combination were, respectively, 77.0%, 58.0% and 83.3%. The sensitivities of qPCR in dogs with and without clinical signs were, respectively, 74.2% and 82.4%. The sensitivities of CISH in dogs with and without clinical signs were, respectively, 61.3% and 52.9%. The CISH and qPCR showed satisfactory sensitivities for the diagnosis of L. infantum in the FFPES of dogs, even in dogs without clinical signs, and their combination increases the sensitivity for this diagnosis.

Abstract Glucantime (SbV) is the first-line treatment against American Tegumentary Leishmaniasis. Resistance cases to this drug have been reported and related to host characteristics and parasite phenotypes. In this study, 12 Leishmania (Viannia) braziliensis isolates from patients that presented clinical cure (Responders—R) and relapse or therapeutic failure (Non-responders—NR) after treatment with antimony, were analyzed. These parasites were assessed by in vitro susceptibility to SbIII and SbV, serine proteases activity measured with substrate (z-FR-AMC) and specific inhibitors (TLCK, AEBSF and PMSF). In vitro susceptibility of axenic amastigotes to SbIII showed a significant difference between R and NR groups. The protease assays showed that TLCK inhibited almost 100% of activity in both axenic amastigotes and promastigotes while AEBSF inhibited around 70%, and PMSF showed lower inhibition of some isolates. Principal component and clustering analysis performed with these data yielded one homogeneous cluster with only NR isolates and three heterogeneous clusters with R and NR isolates. Additionally, differential expression of subtilisins (LbrM.13.0860 and LbrM.28.2570) and TXNPx (LbrM.15.1080) was evaluated in promastigotes and axenic amastigotes from both groups. The results showed a higher expression of LbrM.13.0860 and LbrM.15.1080 genes in axenic amastigotes, while LbrM.28.2570 gene had the lowest expression in all isolates, regardless of the parasite form. The data presented here show a phenotypic heterogeneity among the parasites, suggesting that exploration of in vitro phenotypes based on SbIII and serine proteases profiles can aid in the characterization of L. (V.) braziliensis clinical isolates.

Abstract Background Zoonotic visceral leishmaniasis is caused by the protozoan Leishmania infantum and is highly lethal in humans and dogs if left untreated. The frequency of this parasite and associated histological changes in the pancreas of dogs are poorly studied. Therefore, the objectives of this study were to evaluate the frequency of detection and load of amastigotes in the pancreas of L. infantum-seropositive dogs and to identify the clinical signs and histological changes associated with parasitism of this organ. Methods One hundred forty-three dogs from an endemic area in Brazil that tested seropositive for L. infantum were studied. The dogs were clinically examined, killed, and necropsied between 2013 and 2014. One fragment of the pancreas was randomly collected for histopathology and immunohistochemistry, and spleen and bone marrow were collected for culture. Results Leishmania amastigotes were detected in the pancreas of 22 dogs (15.4%) by immunohistochemistry, all exhibiting L. infantum parasitism in the spleen and/or bone marrow. Poor body condition and cachexia were only associated with infection of the pancreas with Leishmania spp. (p = 0.021) and were found in 40.9% of dogs with pancreatic infection. Anorexia, vomiting, and/or diarrhea were observed in 9.2% of dogs with pancreatitis. The median parasite load in the pancreas was 1.4 infected macrophages/mm2. Pancreatic histological changes and their frequencies were: granulomatous pancreatitis (28.0%), lymphoplasmacytic pancreatitis (23.8%), acinar cell degeneration (6.3%), fibrosis (5.6%), hemorrhage (2.1%), eosinophilic pancreatitis (0.7%), suppurative pancreatitis (0.7%), and necrosis (0.7%). Conclusions The present results demonstrate that L. infantum is one of the etiological agents of chronic pancreatitis in dogs; however, the frequency of detection and parasite load are low in this organ. The lack of an association of poor body condition and cachexia with pancreatitis and the low frequency of clinical signs commonly associated with pancreatitis suggest that a significant portion of the organ is not affected by this parasite. On the other hand, the association of poor body condition and cachexia with concomitant infection of the pancreas, spleen, and/or bone marrow with this parasite suggests that these manifestations are the result of a more advanced stage of canine visceral leishmaniasis. Graphic abstract

Proteases are virulence factors with a recognized impact on the Leishmania spp. life cycle. This study considers a set of analyses measuring phenotypic factors of L. (V.) braziliensis clinical isolates as promastigotes growth curves, murine peritoneal macrophages infection, inflammatory mediators production, and serine proteases gene expression (subtilisin 13: S13, subtilisin 28: S28, oligopeptidase B: OPB) assessing these isolates’ fitness on in vitro conditions. Parasites had different behavior during the early growth phase from day zero to day three, and all isolates reached the stationary growth phase between days four and seven. Macrophages infection showed two tendencies, one of decreased infection rate and number of parasites per macrophage (Infection Index

New world cutaneous leishmaniasis (NWCL) is an anthropozoonosis caused by different species of the protozoan Leishmania. Colorimetric in situ hybridization (CISH) was shown to satisfactorily detect amastigote forms of Leishmania spp. in animal tissues, yet it was not tested for the diagnosis of human NWCL. The aim of this study was to compare CISH, histopathology (HP), and immunohistochemistry (IHC) techniques to diagnose NWCL in human cutaneous lesions. The sample comprised fifty formalin-fixed, paraffin-embedded skin biopsy specimens from patients with NWCL caused by L. (V.) braziliensis. These specimens were analyzed by CISH, using a generic probe for Leishmania, IHC, and HP to assess the sensitivity of these methods by using a parasitological culture as a standard reference. Additional specimens from three patients diagnosed with cutaneous mycoses were also included to evaluate cross-reactions between CISH and IHC. The sensitivities of IHC, CISH, and HP for detecting amastigotes was 66%, 54%, and 50%, respectively. IHC, unlike CISH, cross-reacted with different species of fungi. Together, these results demonstrate that CISH may be a complementary assay for the detection of amastigote in the laboratorial diagnosis routine of human NWCL caused by L. (V.) braziliensis.

BackgroundTreatment of cutaneous leishmaniasis (CL) remains challenging since the drugs currently used are quite toxic, thus contributing to lethality unrelated to the disease itself but to adverse events (AE). The main objective was to evaluate different treatment regimens with meglumine antimoniate (MA), in a reference center in Rio de Janeiro, Brazil.MethodologyA historical cohort of 592 patients that underwent physical and laboratory examination were enrolled between 2000 and 2017. The outcome measures of effectiveness were epithelialization and complete healing of cutaneous lesions. AE were graded using a standardized scale. Three groups were evaluated: Standard regimen (SR): intramuscular (IM) MA 10-20 mg Sb5+/kg/day during 20 days (n = 46); Alternative regimen (AR): IM MA 5 mg Sb5+/kg/day during 30 days (n = 456); Intralesional route (IL): MA infiltration in the lesion(s) through subcutaneous injections (n = 90). Statistical analysis was performed through Fisher exact and Pearson Chi-square tests, Kruskal-Wallis, Kaplan-Meier and log-rank tests.ResultsSR, AR and IL showed efficacy of 95.3%, 84.3% and 75.9%, with abandonment rate of 6.5%, 2.4% and 3.4%, respectively. IL patients had more comorbidities (58.9%; p = 0.001), were mostly over 50 years of age (55.6%), and had an evolution time longer than 2 months (65.6%; p = 0.02). Time for epithelialization and complete healing were similar in IL and IM MA groups (p = 0.9 and p = 0.5; respectively). Total AE and moderate to severe AE that frequently led to treatment interruption were more common in SR group, while AR and IL showed less toxicity.Conclusions/significanceAR and IL showed less toxicity and may be good options especially in CL cases with comorbidities, although SR treatment was more effective. IL treatment was an effective and safe strategy, and it may be used as first therapy option as well as a rescue scheme in patients initially treated with other drugs.

In canine leishmaniosis caused by the protozoan Leishmania infantum, little is known about how co-infections with or co-seropositivities for other pathogens can influence aggravation of this disease. Therefore, the objectives of this study were to evaluate the frequency of co-infections with or co-seropositivities for certain pathogens in dogs seropositive for L. infantum and their relationship with clinical signs, histological changes and L. infantum load. Sixty-six L. infantum-seropositive dogs were submitted to clinical examination, collection of blood and bone marrow, culling, and necropsy. Antibodies against Anaplasma spp., Borrelia burgdorferi sensu lato, Ehrlichia spp. and Toxoplasma gondii and Dirofilaria immitis antigens were investigated in serum. Samples from different tissues were submitted to histopathology and immunohistochemistry for the detection of Leishmania spp. and T. gondii. Quantitative real-time PCR was used to assess the L. infantum load in spleen samples. For detection of Coxiella burnetii, conventional PCR and nested PCR were performed using bone marrow samples. All 66 dogs tested positive for L. infantum by qPCR and/or culture. Fifty dogs (76%) were co-seropositive for at least one pathogen: T. gondii (59%), Ehrlichia spp., (41%), and Anaplasma spp. (18%). Clinical signs were observed in 15 (94%) dogs monoinfected with L. infantum and in 45 (90%) dogs co-seropositive for certain pathogens. The L. infantum load in spleen and skin did not differ significantly between monoinfected and co-seropositive dogs. The number of inflammatory cells was higher in the spleen, lung and mammary gland of co-seropositive dogs and in the mitral valve of monoinfected dogs. These results suggest that dogs infected with L. infantum and co-seropositive for certain pathogens are common in the region studied. However, co-seropositivities for certain pathogens did not aggravate clinical signs or L. infantum load, although they were associated with a more intense inflammatory reaction in some organs.

Visceral leishmaniasis caused by the protozoan Leishmania infantum is a zoonosis. The domestic dog is the primary reservoir in urban areas. This study aimed to evaluate the frequency, active infection and load of L. infantum in the genital tract of male and female dogs seropositive for this parasite, as well as to identify histological genital alterations associated with this protozoan. We studied 45 male and 25 female L. infantum-seropositive noncastrated dogs from the same endemic area in Brazil. Tissue samples from the testis, epididymis, prostate, vulva, vagina, and uterus were examined by singleplex qPCR and parasitological tests (histopathology, immunohistochemistry, and parasitological culture). The latter were performed for the detection of active infection (parasites able to multiply and to induce lesions). Forty-four (98%) males and 25 (100%) females were positive for L. infantum in the genital tract (epididymis: 98%; vulva: 92%; vagina: 92%; testis: 91%; uterus: 84%; prostate: 66%). Active infection in the genital tract was confirmed in 69% of males and 64% of females (32% in the uterus). Parasite loads were similar in the testis, vulva, epididymis and vagina and lower in the prostate. Only the parasite load in the vagina was significantly associated with the number of clinical signs. Granulomatous inflammation predominated in all organs, except for the prostate. Only in the testis and epididymis was the inflammatory infiltrate significantly more intense among dogs with a higher parasite load in these organs. The high frequency, detection of active infection and similarity of L. infantum loads in the genital tract of infected males and females suggest the potential of venereal transmission of this parasite by both sexes and of vertical transmission by females in the area studied. Additionally, vertical transmission may be frequent since active L. infantum infection was a common observation in the uterus.

BackgroundThe specific roles of parasite characteristics and immunological factors of the host in Chagas disease progression and prognosis are still under debate. Trypanosoma cruzi genotype may be an important determinant of the clinical chronic Chagas disease form and prognosis. This study aimed to identify the potential association between T. cruzi genotypes and the clinical presentations of chronic Chagas disease.Methodology/principal findingsThis is a retrospective study using T. cruzi isolated from blood culture samples of 43 patients with chronic Chagas disease. From 43 patients, 42 were born in Brazil, mainly in Southeast and Northeast Brazilian regions, and one patient was born in Bolivia. Their mean age at the time of blood collection was 52.4±13.2 years. The clinical presentation was as follows 51.1% cardiac form, 25.6% indeterminate form, and 23.3% cardiodigestive form. Discrete typing unit (DTU) was determined by multilocus conventional PCR. TcII (n = 40) and TcVI (n = 2) were the DTUs identified. DTU was unidentifiable in one patient. The average follow-up time after blood culture was 5.7±4.4 years. A total of 14 patients (32.5%) died and one patient underwent heart transplantation. The cause of death was sudden cardiac arrest in six patients, heart failure in five patients, not related to Chagas disease in one patient, and ignored in two patients. A total of 8 patients (18.6%) progressed, all of them within the cardiac or cardiodigestive forms.Conclusions/significanceTcII was the main T. cruzi DTU identified in chronic Chagas disease Brazilian patients (92.9%) with either cardiac, indeterminate or cardiodigestive forms, born at Southeast and Northeast regions. Other DTU found in much less frequency was TcVI (4.8%). TcII was also associated to patients that evolved with heart failure or sudden cardiac arrest, the two most common and ominous consequences of the cardiac form of Chagas disease.

BackgroundWe identified the species of Leishmania isolated from traveling and migrant patients attended in a reference center from 2000 to 2015, we performed the georeferencing of these species in Rio de Janeiro (RJ) state and we had knowledge about the human flows between the likely location of infection (LLI) and place of residence (PR) in RJ state, Brazil.Methodology/principal findingsThis is a retrospective cross-sectional study including 171 patients diagnosed with ATL. Google Maps, OpenStreetMap, and Bing Maps were tools used to georeference LLI and PR. For etiological identification, we used isoenzyme electrophoresis, polymerase chain reaction-restriction fragment length polymorphism (molecular target hsp70C with restriction enzymes HaeIII and BstUI), and sequencing of the internal transcribed spacer of ribosomal DNA. ARCGIS software was used to create maps of the geographic distribution of Leishmania species in the state and municipality of RJ, together with flows between the LLI and PR. Isolates from 104 patients were identified as: L. (Viannia) braziliensis (80.8%), L. (V.) naiffi (7.7%), L. (V.) guyanensis (6.7%), L. (Leishmania) amazonensis (1%), and genetic variants of L. (V.) braziliensis (3.8%). The flow maps showed that the LLI included 4 countries, 19 Brazilian states, and 18 municipalities of RJ state. The Brazilian states with the highest density of cases were Amazonas (n = 32), Bahia (n = 18), and Ceará (n = 15).Conclusions/significanceThis work is the first contribution to the knowledge of the routes of Leishmania species introduced in RJ state by migrants and travelers patients. L. (V.) braziliensis, L. (V.) guyanensis, L. (V.) naiffi, L. (L.) amazonensis, and genetic variants of L. (V.) braziliensis were identified in RJ state. To determine whether the autochthonous transmission of these imported species is possible it is necessary the adaptation of these species to environmental conditions as well as the presence of reservoirs and phlebotomine vectors in this region.

Abstract In Brazil, meglumine antimoniate is the first drug of choice for mucosal leishmaniasis treatment followed by amphotericin B and pentamidine isethionate. We report the case of a patient with severe mucosal lesions caused by Leishmania (Viannia) braziliensis that were difficult to treat. Over a 14-year period, the patient showed low adherence and three treatment attempts with meglumine antimoniate failed. Additionally, there was an unsatisfactory response to liposomal amphotericin B and nephrotoxicity when using amphotericin B deoxycholate that persisted after new treatment attempt with liposomal amphotericin B. Finally, healing was achieved with pentamidine isethionate and maintained during nine months of monitoring.

Revisão Integrativa com o objetivo de identificar a metodologia, parâmetros e/ou instrumentos utilizados na prática para DPE nos serviços de saúde hospitalares, bem como identificar se o quantitativo destes profissionais está adequado à demanda de cuidados exigida pelos pacientes. Foram selecionados 27 artigos que atenderam os critérios de inclusão da base de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde com o descritor: downsizing organizacional e a palavra-chave dimensionamento de pessoal de enfermagem nos anos de 2000 a 2012. Os estudos evidenciaram que o enfermeiro conhece os métodos de dimensionamento de pessoal, porém nem sempre os utilizam adequadamente; que os parâmetros e instrumentos existentes são apropriados para realizar tal dimensionamento; que existe uma diversidade no nível de complexidade dos pacientes e muitos campos de trabalho apresentaram escassez de pessoal. Os resultados indicam a necessidade de uso sistemático de instrumentos para o dimensionamento.

Este artigo tem como objetivo refletir sobre a assistência em enfermagem na perspectiva da clínica ampliada em Unidade de Terapia Intensiva (UTI). O estudo caracteriza-se como reflexão. A ampliação da clínica prevê um olhar ao ser humano considerando seu aspecto biológico associado à subjetividade de cada caso em particular por meio de uma abordagem integral, interdisciplinar e compartilhada. Faz-se necessário que ações conjuntas de uma equipe interdisciplinar modifiquem o cenário da UTI, local onde o modelo hegemônico historicamente se perpetua. Na enfermagem a responsabilidade com o indivíduo, seu bem-estar e o ambiente fazem parte de sua prática sendo possível uma participação efetiva e uma mudança da prática hegemônica para uma clínica ampliada.En este artículo se pretende reflexionar sobre los cuidados de enfermeria a la vista de la clínica ampliada en la Unidad de Cuidados Intensivos (UCI). El estudio se caracteriza por la reflexión. La expansión de la clínica ofrece un vistazo a la hora de considerar su aspecto biológico humano de la subjetividad asociada a cada caso particular por un enfoque integral, interdisciplaria y compartida. Es necesario que los esfuerzos conjuntos de un equipo interdisciplinario para modificar la configuración de la UCI, donde históricamente se perpetúa el modelo hegemónico. En la enfermería la responsabilidad con el individuo, su bienestar y el medio ambiente son parte de su práctica puede ser una participación efectiva y una modificación de la práctica hegemónica de una clínica ampliada.This article aims to reflect on nursing care in view of the expanded clinic in the Intensive Care Unit (ICU). The study is characterized as a reflection. The expansion of the clinic provides a look at when considering their human biological aspect of subjectivity associated with each particular case by an integral approach, interdisciplinary and shared. It is necessary that joint efforts of an interdisciplinary team to modify the setting of the ICU, where historically the hegemonic model is perpetuated. In nursing responsibility with the individual, his welfare and the a change of hegemonic practice for extended clinic.

This study aimed to conceptualize the dimensioning of nursing staff, as it is understood by professionals who realize this task, and also to reveal their aim and use of estimation of nursing human resources. It is a descriptive and exploratory study with a qualitative approach analyzed through Content analysis. The definition obtained corresponds to those found in literature and, as to its aim, it serves to preview the number of professionals; to guarantee the operation of the nursing work; to attend clients' expectations regarding their needs; to provide personnel and to guarantee their allocation in the work scale. As to the use of this definition in personnel management, it provides a justification to increase staff through new contracts.La finalidad de este estudio fue la de conceptualizar el cálculo de personal de enfermería de acuerdo con la comprensión de los profesionales que lo hacen y mostrar la finalidad y utilización de la estimación de recursos humanos en enfermería según ellos. Esto es un estudio exploratorio descriptivo del tipo cualitativo. Fue realizado el análisis de contenido. La definición descubierta corresponde a aquellas encontradas en la literatura y, con respecto a la finalidad, sirve para prever el número de profesionales; garante la operacionalización del trabajo de enfermería; cumple la expectativa del cliente con respecto a sus necesidades; provee los sectores de personal y garantir la distribución de los profesionales en la escala. En cuanto a la utilización de la definición en la gestión del personal, sirve como justificación para aumentar el cuadro mediante contractación.Este estudo teve como objetivo conceituar dimensionamento de pessoal de enfermagem, segundo o entendimento dos profissionais que o realizam e desvelar, segundo eles, qual a finalidade e utilização da estimativa de recursos humanos em enfermagem. Trata-se de estudo exploratório-descritivo de natureza qualitativa. Procedeu-se à análise do conteúdo. A definição apreendida vem ao encontro daquelas encontradas na literatura e, quanto à finalidade, serve à previsão dos profissionais, garante a operacionalização do trabalho de enfermagem, atende à expectativa do cliente com relação às suas necessidades, provê os setores de pessoal e garante a distribuição desses, na escala. Quanto à utilização no gerenciamento do pessoal, ocorre como justificativa para aumentar o quadro por meio de contratação.

doi: 10.5216/ree.v15i2.18559 - http://dx.doi.org/10.5216/ree.v15i2.18559 RESUMO Revisão Integrativa com o objetivo de identificar a metodologia, parâmetros e/ou instrumentos utilizados na prática para DPE nos serviços de saúde hospitalares, bem como identificar se o quantitativo destes profissionais está adequado à demanda de cuidados exigida pelos pacientes. Foram selecionados 27 artigos que atenderam os critérios de inclusão da base de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde com o descritor: downsizing organizacional e a palavra-chave dimensionamento de pessoal de enfermagem nos anos de 2000 a 2012. Os estudos evidenciaram que o enfermeiro conhece os métodos de dimensionamento de pessoal, porém nem sempre os utilizam adequadamente; que os parâmetros e instrumentos existentes são apropriados para realizar tal dimensionamento; que existe uma diversidade no nível de complexidade dos pacientes e muitos campos de trabalho apresentaram escassez de pessoal. Os resultados indicam a necessidade de uso sistemático de instrumentos para o dimensionamento. Descritores: Downsizing Organizacional; Enfermagem; Recursos Humanos de Enfermagem no Hospital.

The aim of this study was to investigate genetic polymorphism in Leishmania braziliensis population previously typed through isoenzyme electrophoresis, isolated from the same patient in two different moments: (A) before the beginning of treatment and (B) after treatment failure to meglumine antimoniate or reactivation after successful initial treatment. Fifteen pairs of isolates were assessed using the polymorphic molecular marker LSSP-PCR and following the phenetic analysis. The genetic profiles of the 30 samples were grouped in four clusters. Only two patients presented total identity in the A and B isolates. Most isolates presented similarity coefficients varying from 0.63 to 0.91. In this group of patients genetic polymorphisms could be observed indicating low similarity between the pairs of isolates. The results demonstrate the existence of genetic polymorphism between the samples isolated before treatment and after reactivation or treatment failure, suggesting a possible differentiation of the structure of the original parasite population which could be involved in the mechanisms of resistance to treatment or reactivation of lesions in the ATL. This phenomenon is important, although other factors also could be involved in this context and are discussed in this paper.

Objetivos: identificar o estilo de liderança dos enfermeiros hospitalares sob a óptica dos auxiliares e técnicos de enfermagem. Investigação exploratória, com abordagem quantitativa realizada em um hospital do interior de Minas Gerais, tendo 44 profissionais de enfermagem de nível médio como sujeitos da pesquisa, com idade média de 34,7 anos cuja maioria é do sexo feminino. Para os auxiliares de enfermagem não foi verificada a diferença entre os estilos de liderança exercidos pelo enfermeiro. Já os técnicos de enfermagem definem os estilos de liderança exercidos pelo enfermeiro: a gerência em equipe e a gerência empobrecida. Espera-se que o enfermeiro atualize constantemente o seu conhecimento acerca da liderança e desenvolva habilidades, neste sentido, no intuito de influenciar a equipe de enfermagem promovendo a motivação humana no desenvolvimento do trabalho.

Trata-se de um estudo exploratório descritivo de natureza qualitativa. Objetivos: Conhecer os parâmetros que têm sido utilizados para o dimensionamento de pessoal de enfermagem e identificar quais facilidades e desafios o enfermeiro tem tido para realizá-lo. Procedeu-se a análise do conteúdo. Os parâmetros do dimensionamento evidenciados foram a média de permanência, característica da unidade, taxa de ocupação de leitos, modelo de assistência de enfermagem, tipo de clientela, tipo de convênio, composição da equipe de enfermagem e do setor, horas de trabalho, taxa de absenteísmo, Sistema de Classificação de Pacientes. As facilidades do dimensionamento destacadas foram a importância dada ao relacionamento com a diretoria da instituição e maior envolvimento das demais enfermeiras. Como desafios tem-se a própria política de recursos humanos, o baixo poder de decisão da enfermeira com relação à contratação de pessoal e àqueles ligados ao cálculo propriamente dito e à rotatividade.

Este estudo teve por objetivos levantar o que tem sido publicado na forma de artigos em periódicos nacionais no período de 10 anos e destacar os principais aspectos abordados sobre integralidade em saúde. Foi realizada revisão de literatura em 10 periódicos de saúde, online, no período de 1997 a 2007, sendo selecionados 15 artigos que versavam sobre o tema. Integralidade vem se construindo na saúde coletiva, no ensino e na atenção hospitalar, no entanto, é contextualizada de maneira diversa em cada um destes campos a partir de diferentes concepções veiculadas em literatura nacional. Verificou-se que o tema vem sendo debatido entre profissionais e que há esforços para a amplitude de reflexão e consolidação de conceito e princípios, o que requer mudanças na maneira de organização do trabalho vigente e também nas relações humanas.

Trata-se de um relato de experiência sobre a orientação para a equipe de enfermagem acerca da conduta em caso de acidentes com pérfuro-cortantes e fluidos orgânicos durante o Estágio Supervisionado II: Área Hospitalar, em uma unidade de internação cirúrgica de um hospital de grande porte do estado de Minas Gerais, de março a junho de 2007, com auxiliares, técnicos e enfermeiros. Foi desenvolvido um diagnóstico situacional durante o Estágio que resultou na elaboração de um folder contendo informações sobre a conduta em casos de acidentes de trabalho com pérfuro-cortantes e fluidos orgânicos e a divulgação das informações nele contidas por meio de atividade de educação em serviço. A atividade desenvolvida promoveu a reflexão do profissional de enfermagem sobre a importância da prevenção, notificação e compreensão das fases percorridas pelo profissional acidentado.

RESUMO: Os objetivos deste estudo foram caracterizar o entendimento sobre o estilo de vida dos estudantes de enfermagem de uma Universidade do interior de Minas Gerais e analisar se há mudanças ocorridas em seus próprios estilos de vida durante o período letivo, através de uma pesquisa exploratório-descritiva. Os participantes foram os alunos de enfermagem da instituição. Foram analisados 87 questionários de auto-preenchimento contendo questões semi-estruturadas. A análise das respostas procedeu-se pelo número de ocorrências que o tópico apareceu. O entendimento dos graduandos por estilo de vida evidenciou o modo como se vive e sobre estilo de vida saudável, a qualidade de vida. Apontam como seu estilo de vida não-saudável o sedentarismo e saudável a alimentação, tópico também destacado quanto a mudanças no seu estilo de vida durante o período letivo. Sugere-se que os acadêmicos repensem seu estilo de vida e que desenvolvam ações que permitam a melhoria do mesmo.

RESUMO: Este estudo tem como objetivo avaliar o conhecimento de Agentes Comunitários de Saúde (ACS) sobre os transtornos mentais e de comportamento de portadores de transtorno mental, em uma cidade do interior de Minas Gerais. Trata-se de um estudo de natureza descritivo-exploratório, realizado em duas unidades de Estratégia de Saúde da Família. Teve como sujeito os 13 ACSs que responderam a uma entrevista relacionada ao tema. Os ACSs possuem conhecimento empírico sobre Doença Mental, têm dificuldades de perceber manifestações indicativas de sinais e sintomas da doença e suas principais formas de tratamento. Destaca-se o encaminhamento ao médico como principal conduta realizada pelos ACS e quanto aos desafios no atendimento ao portador de transtorno mental, à resistência ao tratamento e a falta de conhecimento dos profissionais. Referem não ter participado de nenhuma capacitação sobre o assunto, tornando-se necessário os esforços neste sentido.

Este estudo tem por objetivo fazer um levantamento do que tem sido produzido na literatura nacional sobre a temática passagem de plantão na enfermagem e destacar os principais aspectos abordados. Foi realizada uma revisão de literatura em 11 periódicos de Enfermagem no período de 1996 a 2006, por meio de busca eletrônica e manual. Foram encontrados 8 artigos sobre o tema e os principais aspectos abordados foram: conceito, tipo de informação, modalidade utilizada, fatores que interferem e responsabilidade. Os resultados levam-nos a uma reflexão sobre a necessidade de profissionais com habilidade comunicacional, aptos a conscientizar suas equipes de trabalho sobre a importância dessa atividade e capazes de criar formas alternativas e eficazes de transmissão de informações consistentes e de qualidade durante a passagem de plantão.

Estudo descritivo-exploratório, cujo objetivo foi dimensionar o número de profissionais de enfermagem no Centro de TerapiaSemi-Intensiva (CTSI) de um hospital universitário. Os resultados do Nursing Activities Score (NAS) aplicado a 96 pacientes evidenciaram quea carga de trabalho junto a pacientes críticos neurológicos e semicríticos clínicos é maior, e menor para pacientes críticos cardiológicos. Acomplexidade e a intensidade do cuidado não sofrem influência da idade, mas das condições clínicas e da dependência do paciente em relação àEnfermagem. O atendimento das necessidades de cuidado dos pacientes requer 41% de profissionais de enfermagem a mais para o CTSI. O altoÍndice de Segurança Técnica para a Unidade deve-se principalmente pela jornada de trabalho de trinta horas semanais. O NAS é um instrumentogerencial que possibilita adequar o número de profissionais às reais necessidades de cuidado dos pacientes, a fim de que este seja realizado demodo seguro e com a qualidade almejada

BACKGROUND Cutaneous leishmaniasis (CL) generally presents with a single or several localised cutaneous ulcers without involvement of mucous membranes. Ulcerated lesions are susceptible to secondary contamination that may slow the healing process. OBJECTIVE This study verified the influence of non-parasitic wound infection on wound closure (epithelialisation) and total healing. METHODS Twenty-five patients with a confirmed diagnosis of CL and ulcerated lesions underwent biopsy of ulcer borders. One direct microbial parameter (germ identification in cultures) and four indirect clinical parameters (secretion, pain, burning sensation, pruritus) were analysed. FINDINGS Biopsies of ten lesions showed secondary infection by one or two microorganisms (Staphylococcus aureus, Pseudomonas aeruginosa, Enterococcus faecalis, Streptococcus pyogenes and Candida parapsilosis). “Secretion” and “burning sensation” influenced epithelialisation time but not total healing time. Positive detection of germs in the ulcer border and “pain” and “pruritus” revealed no influence on wound closure. CONCLUSIONS Our borderline proof of clinical CL ulcer infection inhibiting CL wound healing supports the need to follow antimicrobial stewardship in CL ulcer management, which was recently proposed for all chronic wounds.