O que mudou em relação à manobra de RCP em tempos de pandemia do SARS-CoV-2?

Introdução: Diante da COVID-19, doença altamente contagiosa que se alastrou pelo mundo, e impondo aos profissionais de saúde o desafio de prestar atendimento seguro nas situações que, muitas vezes, são graves, novos protocolos foram estabelecidos como forma de evitar a disseminação do vírus e proteger a equipe de profissionais da saúde . A pandemia do SARS-CoV-2 acometeu milhões de pessoas no mundo, levando centenas a óbito, e trouxe a necessidade de modificações nas práticas de ressuscitação cardiopulmonar, procedimento que gera grande quantidade de aerossóis e risco de contágio. No ambiente hospitalar, são esperadas ações, como: limitar o número de pessoas para fazer o atendimento, iniciar as compressões torácicas com o monitoramento e procedimentos necessários e priorizar a intubação precoce - sempre que tiver um médico experiente disponível . Objetivo(s): Refletir sobre as principais mudanças no atendimento de pacientes, com suspeita ou diagnóstico confirmado de COVID-19, e que estejam em parada cardiorrespiratória, para atualizar os profissionais em relação ao procedimento, aumentando a chance de sobrevida dos pacientes e diminuindo o risco de contágio à equipe. Métodos: Trata-se de um estudo de reflexão teórica, de caráter descritivo e abordagem qualitativa com base em documentos emitidos pelos principais órgãos reguladores de saúde e periódicos indexados na SciELO e PubMed, realizado em outubro de 2021. O recorte temporal utilizado foi o tempo da pandemia (2019- 2021). Resultados: A transmissão do SARS-CoV-2 se dá por via respiratória através de gotículas salivares emitidas por meio da tosse ou espirro do indivíduo infectado, ou ainda pelo contato com superfícies/objetos contaminados. Alguns procedimentos hospitalares, como: a intubação e a aspiração traqueal, a ventilação mecânica não invasiva, a ventilação manual, a nebulização, as coletas de amostras nasotraqueais, assim como a RCP, emitem aerossóis responsáveis pelo aumento do risco de transmissibilidade . Dessa forma, os profissionais dos serviços de saúde constituem um grupo de alto risco para a COVID19, tornando‑se necessária a adoção de medidas de prevenção, controle e proteção da saúde desses trabalhadores . Conclusão: Evidenciou-se que as principais adequações foram a organização de uma equipe mínima para esses atendimentos, a utilização dos Equipamentos de Proteção Individual adequados e a realização de ventilação segura, com dispositivos que minimizem a formação e disseminação de aerossóis e a utilização de dispositivos mecânicos para a realização de compressões torácicas. Referências 1. Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R. Features, evaluation and treatment coronavirus (COVID-19). Treasure Island (FL): StatPearls Publishing LLC; 2020 [citado 2020 jul 31]. Disponível em: https://www.ncbi.nlm.nih.gov/books/NBK554776/ 2. Organização Mundial de Saúde (OMS). Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations. Genebra: OMS; 2020 [citado 2020 jul 31]. Disponível em: https://www.who.int/publicationsdetail/modes-of-transmission-of-viruscausing-covid-19-implicationsfor-ipc-precaution-recommendations 3. American Heart Association (AHA). Destaques das atualizações direcionadas nas diretrizes de 2019 da American Heart Association para ressuscitação cardiopulmonar e atendimento cardiovascular de emergência. Dallas: AHA; 2019 [citado 2020 jul 31]. Disponível em: https://eccguidelines.heart.org/wp-content/uploads/2019/11/2019- Focused-Updates_Highlights_PTBR.pdf PALAVRAS-CHAVE: Parada Cardíaca, Ressuscitação Cardiopulmonar, Infecções por Coronavírus, Pandemias, Saúde do Trabalhador

Margaret Mahy and the Golden Age of Children's Literature

<p>Margaret Mahy’s novels contain numerous allusions to the classics of Victorian fiction for children. Some of these take the form of passing references; in 24 Hours, for example, protagonist Ellis thinks of himself as “Ellis in Wonderland.” But Mahy also draws on Victorian precedents for some of her settings, taking imaginary islands from Peter and Wendy and Treasure Island, and the secret garden from Frances Hodgson Burnett’s novel of the same name. She also invokes the forest of the fairy tales that (although they were not invented by the Victorians) featured so prominently in the reading of Victorian children. To date, little attention has been paid to what might be described as the “Victorian dimension” of Mahy’s work. In what follows, I examine its function in five novels. It emerges that Mahy’s response to the values embodied by her Victorian texts is critical on at least three counts. Mahy’s heroines (or, rather, female heroes) reject the passivity and silence exhibited by fairytale characters such as Jorinda in the Grimms’ ‘Jorinda and Joringel’, and the lack of emotional growth displayed by Lewis Carroll’s Alice. They are also shown in the process of leaving childhood (nostalgically idealized by Carroll, J.M. Barrie and other Victorian authors) behind. Moreover, this thesis exposes the tension between Mahy’s insistent allusion to quintessential fantasy spaces such as Wonderland on one hand, and the distinct anxiety present in her work about the dangerously isolating nature of fantasy on the other. While for Mahy’s teenage protagonists the domestic “real” wins out more often than not over the fantastic but dangerous “true”, the transformative journey of maturation that each undergoes is figuratively sparked by their belief in the Red Queen’s “six impossible things before breakfast”. Perhaps by the same token, they learn that fantasy worlds (like Barrie’s “Neverland”) can be dangerously isolating.</p>

Margaret Mahy and the Golden Age of Children's Literature

<p>Margaret Mahy’s novels contain numerous allusions to the classics of Victorian fiction for children. Some of these take the form of passing references; in 24 Hours, for example, protagonist Ellis thinks of himself as “Ellis in Wonderland.” But Mahy also draws on Victorian precedents for some of her settings, taking imaginary islands from Peter and Wendy and Treasure Island, and the secret garden from Frances Hodgson Burnett’s novel of the same name. She also invokes the forest of the fairy tales that (although they were not invented by the Victorians) featured so prominently in the reading of Victorian children. To date, little attention has been paid to what might be described as the “Victorian dimension” of Mahy’s work. In what follows, I examine its function in five novels. It emerges that Mahy’s response to the values embodied by her Victorian texts is critical on at least three counts. Mahy’s heroines (or, rather, female heroes) reject the passivity and silence exhibited by fairytale characters such as Jorinda in the Grimms’ ‘Jorinda and Joringel’, and the lack of emotional growth displayed by Lewis Carroll’s Alice. They are also shown in the process of leaving childhood (nostalgically idealized by Carroll, J.M. Barrie and other Victorian authors) behind. Moreover, this thesis exposes the tension between Mahy’s insistent allusion to quintessential fantasy spaces such as Wonderland on one hand, and the distinct anxiety present in her work about the dangerously isolating nature of fantasy on the other. While for Mahy’s teenage protagonists the domestic “real” wins out more often than not over the fantastic but dangerous “true”, the transformative journey of maturation that each undergoes is figuratively sparked by their belief in the Red Queen’s “six impossible things before breakfast”. Perhaps by the same token, they learn that fantasy worlds (like Barrie’s “Neverland”) can be dangerously isolating.</p>

Iodoral-Induced Iatrogenic Hypothyroidism

Background: Iodine is essential for the formation of thyroid hormones. Therefore, the thyroid gland is generally able to maintain normal hormone synthesis despite changes in iodine availability. When there is an increase in iodide load, the thyroid gland is able to inhibit the formation of organic iodide via the Wolff-Chaikoff effect (WCE). This prevents the formation of large quantities of thyroid hormones, thus preventing hyperthyroidism1. Continued exposure to excess iodine is also overcome by the “escape” phenomenon and hormone synthesis resumes in a normal fashion2. However, some patients may lack this autoregulation and develop hypothyroidism. Clinical Case: An 86-year-old male with a history of subclinical hypothyroidism initially presented to his PCP for evaluation of cognitive decline. Workup revealed a TSH of 10 mcIU/mL (0.34 – 5.6 mcIU/mL), a normal FT4 and a negative TPOAb. It was subsequently revealed that the patient was started on Iodoral 12.5 mg daily, an iodine/potassium iodide supplement, 1 month prior to presentation by a naturopathic doctor. Prior to all this, his TSH had always ranged between 4 – 6 mcIU/mL for many years. It was recommended that he discontinue Iodoral and repeat thyroid labs in the future. Despite this, the patient continued on varying doses of Iodoral supplementation. Repeat labs obtained 8 months later revealed an elevated TSH of 99 mcIU/mL and a low FT4 of 0.43 ng/mL (0.6 – 2.6 ng/mL). Despite these numbers, he was asymptomatic and did not exhibit any overt signs of hypothyroidism. He was referred to Endocrinology and finally stopped taking Iodoral.7 weeks post-discontinuation, his repeat labs showed a resolution of hypothyroidism and return to his baseline subclinical disease with a TSH of 8.2 mcIU/mL and a normal FT4. A urine iodine/creatinine was normal at 244.2 ug/g (35 – 540 ug/g) indicating that there was no residual iodine excess from the Iodoral. Conclusion: As far as we are aware, we present the first reported case of Iodoral-induced iatrogenic hypothyroidism. As with past cases of iodine-induced hypothyroidism, our patient had underlying thyroid disease in subclinical hypothyroidism which could explain why he was unable to escape from the WCE. The half-life of Iodoral is unknown but it is generally understood that the effects of iodide are reversed between 2 to 4 weeks after withdrawal. Our patient did not repeat his thyroid function tests until 7 weeks post-discontinuation but did demonstrate a return to baseline with no other intervention. Reference: 1. Markou K, Georgopoulos N, Kyriazopoulou V, Vagenakis AG. Iodine-Induced hypothyroidism. Thyroid. 2001 May;11(5):501-10. doi: 10.1089/105072501300176462. PMID: 11396709.2. Torti JF, Correa R. Potassium Iodide. 2020 Oct 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 31194460.

LITERARY CARTOGRAPHY: MAP AS A PARATEXTUAL ELEMENT IN BRITISH CHILDREN’S LITERATURE

Объект исследования данной статьи – литературная карта как визуальный элемент детской книги на рубеже XIX–XX веков – малоизученная область визуальной культуры детства. Карта становится важной составляющей визуальной культуры детства во второй половине XIX века. Целью исследования было проследить становление картографической традиции в детской литературе Великобритании. Для достижения поставленной цели потребовалось, во-первых, изучить ведущие современные направления в изучении литературной карты. Во-вторых, сформировать терминологический аппарат для описания карты как документального и эстетического объекта в рамках литературного произведения, который в силу малой изученности отсутствует в русском языке. В-третьих, описать пять литературных карт из классических произведений британской детской литературы Золотого периода в их взаимодействии с текстом. В результате работы автор приходит к выводу, что, являясь важным паратекстуальным элементом детской книги, эти карты представляют различные типы взаимодействия с основным текстом: карта-сюжет, карта-документ эпохи, карта-рассказчик, карта-память. Since one of the first representations of the Earth in “The Map Psalter”, marine maps from the Age of Discovery and the first literary atlases, maps have held a special place in British culture. Since the map of the Treasure Island, which is considered to be a pioneer of the kind, from Robert Louis Stevenson’s novel of the same name, maps have always played a significant role in British children’s literature. A literary map, especially a map in children’s books, is an important paratextual element. Although the roles and functions of maps may vary greatly, the place of a map (most frequently it is an endpaper or a frontispiece) makes literary cartography the first visual element for the reader, which enables a map to set the setting, genre, and particular audience expectations. The fact that it is not an obligatory element of a book makes the presence of a map in a book an essential part of the author’s artistic vision and a key (para)textual element of the book. The five maps from the classic books written for younger readers between 1883 and 1926 may prove that maps perform multiple functions and play a greater role than that of beautiful drawings on frontispieces. The maps are the 17th-century marine map of the imaginary island from Robert Louis Stevenson’s Treasure Island; the actual map of India from Rudyard Kipling’s Kim; the map of Kensington Gardens presumably drawn by a child from James M. Barrie’s Peter Pan in Kensington Gardens; the map of the Thames Valley inhibited by anthropomorphic animals from Kenneth Graham’s The Wind in the Willows. The analysis of these maps’ paratextual powers and textual-visual interactions leads to the conclusion that the five literary maps from the classic children’s books of the Golden Age period reveal the five potential ways of interaction between the textual and the visual: map as a plot device, map as a document, map as a narrator, map as the transcendent, and map as memory, correspondingly. The conclusion poses the following questions: What happens to maps during the act of translation from English into Russian or any other language? Is it possible to translate cartography? How crucial is the omission of a map? The answers to these questions are yet to be discovered.

When Caddy's Went Viral

With the sun losing its glare and now appearing as a beautiful orange orb just above the distant horizon where the sky meets the sea, Barry O’Connor thought to himself, “This is as close to paradise as you can get.” Yet, the vast empty sea of white sand surrounding him told a very different story. It was July 17, 2020, and this beautiful area should have been overrun with college students and young families as they enjoyed their summer vacation. Instead, the executive order that came as a result of the COVID-19 epidemic four months earlier forced him to immediately close his four bars and six Caddy’s Waterfront Dining restaurants, laying off 600 employees and dashing his dreams of another lucrative season. Barry gazed at the beautiful sunset one more time before turning his thoughts to the monumental problem that faced him. While he agreed that the health and safety of his employees and loyal customers was paramount, he couldn’t help but feel the pang that losing a few million dollars a month brings. Now, as businesses began to reopen their doors in the face of new restrictions brought about by COVID, Barry was left to figure out how to navigate the uncharted landscape of new in-house capacity restrictions, everyone’s fear of contracting the virus, and the unknown of when this pandemic would end. All the while, Barry’s bar business was in shambles due to a second government shutdown of bars, which only added pressure on the Caddy’s brand to drive revenue and keep the other half of the business afloat. A potential solution loomed on the horizon, however. This Caddy’s location in Treasure Island had an extensive beach immediately outside its doors, which could expand its footprint, allowing an additional 450-500 customers to enjoy the Caddy’s experience in the safety of an outdoor arena. However, due to local government zoning restrictions, Caddy’s was not legally allowed to treat this area as a traditional restaurant setting. But Barry had become a self-made man because he understood that the nature of business was never static. He knew that the best way forward was to disregard the inconvenience of circumstances beyond his control, and instead pour his efforts into a search for the opportunities that always accompanied such impacts. But just what opportunities did the pandemic create? How could he best leverage technology to exploit them? How would he manage the impact of the changes on his customers and employees?

CUIDADO ESTA LOCO

Objetivo: La comorbilidad médica en la adicción por alcohol es compleja y en ocasiones puede llegar a resultar mortal. Presentaremos el caso de un paciente de 43 años que acude al servicio de urgencias traído por la Policía Nacional por ideas de perjuicio. Material y método: Revisión sistemática de la literatura científica publicada en PubMed. Resultados: Hombre de 43 años con dependencia por alcohol grave, que acude al servicio de urgencias traído por la policía nacional por presentar episodio de agitación psicomotriz en domicilio por ideación delirante de perjuicio, sospechando que un francotirador le quería disparar, asegurando haber visto un punto rojo en la pared de su casa que seguía sus movimientos. A su llegada, se encuentra inadecuado, con pérdida de distancia con el entrevistador, hiperfamiliaridad, perplejo, hiperalerta, inatento, bradipsiquico, con desorientación temporo-espacial, ambitendencia a las órdenes sencillas, marcha dubitativa y llamativo descuido en el autocuidado. Se realiza analítica sanguínea en la que destaca rabdomiolisis severa con hipertrasaminasemia grave, sin repercusión en la función renal. El paciente posteriormente refiere quejas de dolor generalizado y astenia. Se realiza TC Craneal en el que se objetivan lesiones periventriculares inespecíficas. Inicialmente, se sospecha Sd. Wernicke, por lo que se pauta tratamiento con Tiamina i.v. Destaca en historia clínica consumo de alcohol a razón de media botella de vodka con bebidas energéticas que suspende de forma brusca días antes del ingreso, con lo que inicia con cuadro compatible con Delirium Tremens, donde prevalece ideación de perjuicio, alucinaciones visuales y táctiles (bichos) y confusión. Recupera capacidad cognitiva con limitaciones, lagunas de memoria, dificultad para cálculo y organización en general. Recupera orientación ad íntegrum. Discusión: Al inicio del ingreso se sospecha un Sd. Wernicke por lo que se inicia tratamiento con Tiamina, en base al cuadro confusional y alteración de la marcha, en un paciente con consumo crónico de alcohol y deterioro de la alimentación y el autocuidado. A pesar de ello, el paciente persiste con sintomatología confusional en la que va incorporando nueva clínica psicótica (alteraciones sensoperceptivas en forma de alucinaciones visuales y táctiles), por lo que se sospecha delirium tremens. Conclusiones: el delirium tremens se caracteriza por ser un cuadro confusional agudo por la deprivación por alcohol. Pueden aparecer alucinaciones visuales, delirios, desorientación, labilidad emocional, estupor, temblores, sudoración, hipertensión, taquicardia, agitación psicomotriz, pudiendo llegar a a presentar convulsiones. Representa la complicación más grave del síndrome de abstinencia alcohólica, aumentando significativamente la morbilidad y mortalidad de los pacientes. Bibliografía Mainerova B, Prasko J, Latalova K, Axmann K, Cerna M, Horacek R, Bradacova R. Alcohol withdrawal delirium - diagnosis, course and treatment. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2015 Mar;159(1):44-52. doi: 10.5507/bp.2013.089. Epub 2013 Dec 11. PMID: 24399242. Rahman A, Paul M. Delirium Tremens. 2020 Aug 29. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 29489272.