The importance of psychological messages and the “questionbehavior effect” about remdesivir

Background: The FDA has been requiring that information about using remdesivir to treat COVID-19 be made available to healthcare providers and patients, including dosing instructions, potential side effects, and drug interactions. It is important to observe the initial indicators of anxiety, fear, and euphoria for families during emergencies, including information on the possible side effects. This situational context is very important in all the world, because it opens doors for providing the use of updated information about treatment follow-up and for offering improved mental health services. Method: The studies were identified in well-known international journals found in two electronic databases: Scopus and Embase. The data were cross-checked with information from the main international newspapers. Results: The high expectations supported by an immediate discourse culminate in frustration and displeasure, while more consistent empirical results are not generated. These two are predictors of psychic suffering, especially due to the scarcity of information and uncertainties. In parallel, recent studies indicate that spreading information without scientific basis intensifies damage to the routine and health of people, which are already impacted by the pandemic situation. This misrepresented spread may be a factor for unleashing fear and, as a consequence, social despair. Conclusions: Based on the impulsive scenarios stimulated in the context of hydroxychloroquine and on the high spread of fake or distorted news, the psychiatric impacts of COVID-19 pandemic associated with the use of remdesivir may be worsened and reflected directly on the population’s self-esteem.

Vitamin D and mental health during the Covid-19 outbreak

The relationship between hypovitaminosis D and depressive disorder is well documented in the medical literature. However, the biological mechanisms by which vitamin D can modulate psychological distress are still unclear. Containment measures can decrease individual’s exposure to the sun, significantly increasing their needs for vitamin D, a nutrient already deficient in patients with depression. Therefore, it can be inferred that by ingesting the same amount of vitamin D, depressive individuals seem to obtain a lesser amount of this nutrient from the sun's rays when compared to healthy people. We found the relationship between vitamin D and COVID-19 has been increasingly studied, mainly due to the changes that this substance can cause in the inflammatory process - especially in the release of cytokines, in SARS and in lung injuries. Despite the benefits, the existing observational studies on this exchange are not enough to definitively associate vitamin D as a protective factor for COVID-19.

Resistência aos antibióticos de uso oral a partir de isolados de urina de pacientes não hospitalizados

O índice da resistência antimicrobiana (RAM) cresce progressivamente no mundo e acaba limitando a eficácia de tratamento de doenças comuns, como a infecção do trato urinário (ITU). Além disso, na atualidade, a RAM é apontada como um dos principais problemas de saúde pública. Diante do exposto, o objetivo do presente estudo foi avaliar a resistência bacteriana frente aos antibióticos orais mais comumente utilizados para o tratamento das ITU em pacientes ambulatoriais, bem como a identificação das bactérias isoladas. Foi realizado um estudo observacional experimental com abordagem quantitativa no período de janeiro a maio de 2019, desenvolvido em um hospital privado de alta complexidade localizado na cidade do Recife, PE. Foram incluídas no estudo todas as uroculturas positivas de pacientes adultos atendidos no ambulatório do referido hospital, onde foi utilizado, para a identificação bacteriana, o equipamento MALDI – TOF (Matrix Associated Laser Desorption-Ionization – Time of Flight). Foram analisadas um total de 379 amostras positivas de uroculturas, das quais 16 (4,2%) representavam espécies sem interesse clínico, pois obtiveram uma porcentagem de frequência muito baixa, bem como 327 (86,3%) pertenciam a três espécies de bactérias Gram-negativas: Escherichia coli (72,8%), Klebsiella pneumoniae (16,2%) e Proteus mirabilis (11%). Enquanto nas 36 (9,5%) amostras foram identificadas duas espécies Gram-positivas: Staphylococcus saprophyticus (66,7%) e Enterococcus faecalis (33,3%). Foi possível observar que o antibiótico oral com maior percentual de resistência foi o sulfametoxazol + trimetoprima com 24,5% seguido da ciprofloxacina com 22,1%, cefuroxima (16,7%), amoxicilina + clavulanato (13,0%) e nitrofurantoína (8,1%). De acordo com recomendação, é excluído o uso de antibióticos que apresentarem resistência acima de 20%, desta forma os únicos antibióticos por via oral que possui perfil terapêutico adequado para o tratamento empírico dos pacientes adultos com ITU na região do presente estudo são cefuroxima, amoxicilina + clavulanato e nitrofurantoína.

The memory of an outrageous public health scandal

Introduction: Manaus is an isolated city, localized in the hearth of the Amazonas rainforest, with two million inhabitants, a big territorial extension, distant from neighbor cities and next to the shores of Negro and Solimões rivers. The access overland is difficult, which obligates the oxygen tanks be transported by river or air. This created and enormous logistical problem, added to the neglect of the Federal Government with the northern region of the country. Objective: Analyze what are the psychiatric repercussions on the explosion of in the lack of oxygen in Manaus, capital of the Amazonas, Brazil. Methods: Studies were identified using large-circulation international journals. Results: A scandal is happening. This situation is creating a grief community – particular grief became a common and public one – to the memory of an outrageous public health scandal. Therefore, dramatic stories of families of patients and the overwhelmed healthcare professionals shared on the social media and local press brings glimpses of the angst of this chaos. An entire wing of patients died caused by the oxygen depletion. Conclusion: This situation is causing a collective hysteria, taking healthcare workers and families of patients to desperation. Fear appears to be a consequence of the feeling of powerlessness. Anxiety levels are really elevated causing direct side effects to another mental health measures.

Child sexual abuse: increasing pandemic incidence

Introduction: The increase of violence against children is characterized as a serious public health problem. The media has continuously reported cases of: rape perpetrated against children, increased violence against this age group and alarming epidemiological data resulting from the isolation of the pandemic by SARS-CoV-2. Methods: Studies were identified using large-circulation international journals found in two electronic databases: Scopus and Embase. Results: Cases of harassment, rape, manipulation of the child's genitals, oral, anal or genital penetration, pedophilia, exploitation, dissemination of erotic images of children in social networks, exhibitionism, masturbation, Voyeurism and incestuous abuse are classified as child sexual abuse. The numbers of legal abortions in child and adolescent victims of rape tends to increase a 100% taking into account the in the first cases of 2020. Conclusion: discussions for the implementation of public policies and healthcare for children victims of sexual abuse are important for prevention, treatment, rehabilitation and reintegration into the society, considering all the sequel that this vulnerable group acquires after the crime.

The spread of covid-19 and psychiatric impact on indigenous peoples

Background: Information on strategies adopted by Indigenous peoples against COVID-19 is scarce, and history shows that Indigenous peoples in the Amazon region may be particularly affected by the pandemic. Method: The studies were identified in well-known international journals found in two electronic databases: Scopus and Embase. The data were cross-checked with information from the main international newspapers. Results: Mental disorders in the affective spectrum (unipolar major depression, dysthymia, bipolarity) and anxiety disorders (generalized anxiety disorder, panic attacks, social phobia) also mark the reality of Indigenous psychiatric vulnerability. Conclusions: To mitigate the impact of COVID-19 on Indigenous communities in Brazil, a health service for Indigenous groups, a crisis office, and a monitoring panel were created. In the state of Amazonas, home to more Indigenous people than any other Brazilian state, 95% of the intensive care beds are occupied. Thus, mental health disparities between Indigenous and non-Indigenous peoples may be related to the underlying economic, social, and political inequities that are legacies of colonization and oppression of Indigenous cultures; the disproportionate rates of mental disorders must be understood in context, not as intrinsic predisposition of Indigenous peoples, but as reflecting persistent inequalities.

Pênfigo vulgar: uma manifestação cutânea autoimune na síndrome pós-Covid-19

Comentário

UNBEARABLE TRAUMA AND IRREPARABLE DAMAGE: MATERNAL DEATH BY SUICIDE RAISES SERIOUS PERPLEXITIES

INTRODUCTION: Maternal death by suicide raises serious perplexities. The ICD-10 classifies maternal suicide as an indirect form of maternal death. Due to this current misclassification, a classificatory consensus of maternal suicide as a direct form of maternal death is urgent. OBJECTIVE: Analyze the psychological that permeate the phenomenon of maternal suicide, to define the profile of mothers in the postpartum period and pregnant women who commit suicide, with the purpose of elucidating ways of preventing maternal suicide. METHOD: A systematic review was made following the PRISMA protocol (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). RESULTS: Twenty-one studies reported the urgent need to implement interventions in order to prevent or reduce mental health problems caused by mothers and pregnant women who commit suicide. Twenty studies demonstrate the need for interventions to organizational adjustments, especially related to the emotional conflicts involved suicide and maternity. CONCLUSION: Maternal suicide is mainly caused by severe psychiatric disorders, however, higher suicide rates are seen due to psychosocial factors, such as poor familial support and domestic violence, illegal substance abuse and alcoholism, history of sexual or physical violence, racial oppression, economic instability, unwanted pregnancy, difficulty in accessing intentional abortion, and trauma related to past maternity experiences.

Long Covid e complicações que impactam na qualidade de vida dos sobreviventes

A pandemia de COVID-19 assolou a humanidade tomando proporções nunca antes vivenciadas desde 2020, atingindo os países de maneira rápida e letal, ceifando vidas em todas as faixas etárias, deixando órfãos, gerando impactos envolvendo diversos aspectos econômicos, sociais, emocionais, epidemiológicos e demais em larga escala, evidenciando a fragilidade dos sistemas de saúde em vários continentes e deixando efeitos que persistem após a infecção para os sobreviventes. Compreendendo essa situação a ser enfrentada pelos sistemas mundiais de saúde escrevemos essas notas com o objetivo de averiguar na literatura as complicações, sintomas e sequelas persistentes mais frequentes, no período de recuperação da infecção pelo SARS-CoV-2, apresentados pelos sobreviventes da Covid-19. As evidências encontradas revelam o comprometimento de vários sistemas biológicos a partir das complicações e sequelas deixadas pela infecção. Variam desde leves a incapacitantes e impactam diretamente na qualidade de vida dos sobreviventes, assim como nos custso diretos e indiretos para os sistemas de saúde dos continentes afetados pela pandemia. É necessário o desenvolvimento de maiores estuds para dimensionar os efeitos da long Covid para a sociedade.

Esclerodermia (morfeia) “em placa”

Esclerodermia (morfeia) “em placa”