Rayany Cristina de Souza

Chalcones, a naturally occurring class of molecules found in various plants, serve as both precursors and final products in the biosynthesis of flavonoids. Renowned for their diverse therapeutic actions, chalcones demonstrate anti-inflammatory, antitumoral, antimalarial and antiviral activities. The structure of chalcones allows chemical manipulation, making them attractive for metal coordination, such as with copper, an essential metal for living organisms. Here, we characterize the activity of CuL ₂ phen and CuL ₁ phen against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in which L1 and L2 are two forms of the chalcones 3-(4-(benzyloxy)phenyl)-1-(4-fluoro-2-hydroxyphenyl)prop-2-en-1-one and 3-(4-(benzyloxy)phenyl)-1-(2-hydroxyphenyl)prop-2-en-1-one, respectively, and phen is phenanthroline. CuL ₁ phen and CuL ₂ phen anti-SARS-CoV-2 activity were studied in the viral replication cycle employing both the SARS-CoV-2-NeonGreen infectious clone and wild-type isolates. The SI of CuL ₁ phen and CuL ₂ phen was found to be 1.7 and 5.5, respectively, demonstrating that CuL ₂ phen is a more promising compound. CuL ₂ phen impaired SARS-CoV-2 entry, predicted by molecular docking calculations to disrupt the glycoprotein S and angiotensin-converting enzyme 2 (ACE2) binding, emphasized by the low EC ₅₀ in pseudotyped virus entry assay. Further, CuL ₂ phen was identified as SARS-CoV-2 post-entry inhibitor, probably due to its strong interaction with SARS-CoV-2 double stranded RNA. Altogether, the data suggest that CuL ₂ phen acts by impairing SARS-CoV-2 entry by disrupting the viral envelope as well as interrupting RNA replication through specifically intercalating into the dsRNA. The obtained results give us mechanistic insights into the activity of this promising Cu(II) metallodrug candidate in SARS-CoV-2 infection.

Objective: To determine whether implementing a ventilator weaning protocol in a Pediatric Intensive Care Unit (PICU) can decrease the duration of invasive mechanical ventilation (IMV), the PICU and hospital length of stay (LOS), mortality rates, and extubation failure compared to usual care. Methods: PubMed, EMBASE, CINAHL, Web of Science, and Cochrane Central Register of Controlled Trials were searched. The randomized controlled trials reporting a weaning protocol compared with usual care in a PICU were selected. The risk of bias and the certainty of evidence were assessed. The duration of IMV was the main outcome, and PICU and hospital LOS, extubation failure, and mortality were the secondary outcomes. Results: Seven trials were included ( n = 11,742). The implemented protocols included a weaning sedation plus ventilation protocol, a weaning protocol, and automated computer‐driven weaning. The IMV time was shorter with the weaning protocol (MD −1.2, 95% CI −1.27 to −1.13; 1 trial, N = 260; moderate‐certainty evidence) and the automated computer drive weaning protocol (MD −2.33, 95% CI −3.42 to −1.24; 1 trial, N = 2199; moderate‐certainty evidence). The weaning sedation plus ventilation protocol reduced hospital LOS in children intubated for respiratory disease (MD −1.2, 95% CI −1.27 to −1.13; 1 trial, N = 260; moderate‐certainty evidence). However, no significant differences were observed between protocols and usual care in PICU LOS, extubation failure, or mortality. Conclusion: Limited evidence indicates that weaning protocols may shorten IMV duration and that sedation and weaning protocols may reduce hospital stay in children with respiratory disease admitted to the PICU. However, their safety and effectiveness in reducing extubation failure or mortality remain unproven. This underscores the need for high‐quality studies, as current practice is based on low‐certainty evidence.

This study aimed to analyze the association between sociodemographic factors, maternal and neonatal characteristics and the time taken to introduce complementary feeding in low birthweight and preterm newborns. This is a prospective cohort study of 79 preterm newborns weighing less than or equal to 1,800g. Data were collected at the time of hospital discharge and at the 6th, 9th ,and 12th months of corrected gestational age (CGA), using a structured questionnaire to analyze the time taken to introduce complementary feeding and the texture of the foods introduced. Furthermore, the Survey of Well-being of Young Children (SWYC-BR) was used to assess the risk of developmental delay. Cox proportional hazards regression was used to analyze the variables. The introduction of complementary feeding was assessed in preterm newborns based on the median age of introduction of liquid foods (3.50; IQR: 2.50-5.00), followed by solid (4.70; IQR: 3.205.20) and soft foods (5.00; IQR: 4.50-5.50). There was also an association with gestational age (RR = 1.25; 95%CI: 1.02-1.52) throughout the process of food introduction. For solid and soft foods, those with the longest length of stay (RR = 1.03; 95%CI: 1.10-1. 05) and on mixed breastfeeding (RR = 2.97; 95%CI: 1.24-7.09) delayed the introduction of complementary feeding the longest. For liquid foods, less severe preterm newborns (Score for Neonatal Acute Physiology and Perinatal Extension - SNAPPE II [RR = 0.96; 95%CI: 0.94-0.98]) and mothers who were breastfeeding at hospital discharge (RR = 11.49; 95%CI: 1.57-84.10) delayed the introduction of complementary feeding. Guidelines are needed to better advise professionals and parents and/or guardians on the ideal time to introduce feeding.

Background Invasive Mechanical ventilation (IMV) is necessary for most Pediatric Intensive Care Units (PICU) patients. Although it is a complex process, weaning should be performed as soon as possible due to the adverse effects of IMV. This review aims to identify whether the use of a weaning protocol in a PICU, compared to usual care, can reduce the duration of IMV, length of stay in the PICU, mortality, and adverse events in children. Methods The strategy review and selective reports were developed using the population, intervention, comparison, outcome, and study design (PICOS) format. PUBMED, EMBASE, CINHAL, Web of Science, Cochrane Central Register of Controlled Trials, International Clinical Trials Registration Platform, and gray literature will be systematically searched for randomized controlled trials (RCTs). The studies’ methods should have been compared to protocol and nonprotocol weaning in children older than 28 days and younger than 18 years old, assisted at the PICU, and mechanically ventilated through an endotracheal tube. The risk of bias will be evaluated using the Cochrane Risk of Bias Tool for Randomized Trials. A meta-analysis will be conducted to compare the differences in the outcomes if at least two studies are sufficiently homogeneous concerning participants, interventions, and outcome measures. Subgroup analyses will also be performed looking for protocol type, indication for IMV, clinical condition, and age group differences. Discussion The results will synthesize the weaning protocol in a PICU and compare it to usual care to provide information to guide the pediatric intensivist therapist in weaning children from mechanical ventilation. Systematic review registration: PROSPERO CRD42023399650.

Potential medium- and long-term neurodevelopmental sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy have not been ruled out. We aimed to systematically review and summarize the evidence regarding the effects of intrauterine exposure to SARS-CoV-2 on infant development and behavior. Scopus, PubMed, Web of Science, CINAHL, and PsycNet databases were searched for studies published up to February 6, 2023, investigating the effects of gestational SARS-CoV-2 on infant development and behavior. We performed narrative synthesis according to updated protocols. Studies using comparison groups and with the Ages and Stages Questionnaires-Third Edition (ASQ-3) scores available were included in a meta-analysis performed according to Cochrane protocols. We used the Newcastle–Ottawa Quality Assessment Scale to analyze the risk of bias. Heterogeneity was calculated using the I² statistic. The search identified 2,782 studies. After removing duplicates and applying the eligibility criteria, we performed a narrative synthesis of 10 included studies and a meta-analysis of three. There was no evidence of higher developmental delay rates in infants exposed to SARS-CoV-2 during pregnancy compared to non-exposed infants. However, the exposed infants scored lower than either the non-exposed children or pre-pandemic cohorts in some domains. Pooled results from the random-effects model indicated that SARS-CoV-2-exposed infants had lower scores on fine motor (mean difference [MD] = -4.70, 95% confidence interval [CI]: -8.76; -0.63), and problem-solving (MD = -3.05, 95% CI: -5.88; -0.22) domains than non-exposed infants (heterogeneity: I² = 69% and 88%, respectively). There was no difference between the exposed and non-exposed infants in the communication, gross motor, and personal-social ASQ-3 domains.   Conclusion: We did not find evidence confirming the association between SARS-CoV-2 gestational exposure and neurodevelopmental delays. However, the meta-analysis indicated that gestational exposure negatively affected fine motor and problem-solving skills. Robust evidence on this topic is still incipient, and the available studies present methodological inconsistencies that limit the drawing of clear-cut conclusions.   PROSPERO registration: #CRD42022308002; March 14, 2022. What is Known: • COVID-19 is associated with adverse pregnancy outcomes potentially linked to neurodevelopmental delays. • SARS-CoV-2 vertical transmission is rare; however, infections during pregnancy can be deleterious to the fetus, possibly mediated by maternal immune activation and other inflammatory mechanisms. What is New: • No evidence of increased developmental delay rates among SARS-CoV-2 gestational-exposed infants was found. However, a meta-analysis of three studies showed lower scores in fine motor and personal social ASQ-3 domains among exposed infants. • SARS-CoV-2 gestational exposure and the pandemic can affect child development via many mechanisms. Potential neurodevelopmental sequelae of SARS-CoV-2 exposure during gestation have not been ruled out.

Objective: to analyze the relationship between knowledge and the adequacy of nursing annotations and their determinants. Method: An exploratory, descriptive and quantitative approach, carried out in the Medical Clinic and in the Adult Intensive Care Unit of a Brazilian university hospital. A total of 114 professionals and 41 medical records were included. Results: The professionals had a high mean score of knowledge and a low mean score of adequacy and there was no correlation between them (rs = -0,122; p > 0.05). The knowledge score was higher for professionals graduated in Nursing. The mean score of adequacy was higher for the professional category nurse if packed in Medical Clinic and with the professional that was dissatisfied with the training. Conclusion: there is no relationship between the professional's knowledge about nursing notes and the adequacy of the notes, which leads to serious ethical, legal and patient safety issues.

A segurança do paciente é um componente essencial para a qualidade do cuidado em saúde. No Brasil, em abril de 2013, foi lançado o Programa Nacional de Segurança do Paciente (PNSP) que tem impulsionado ações em todo território nacional para o alcance de um sistema de assistência à saúde mais seguro. Esse relato tem o objetivo de descrever a realização de uma campanha, realizada durante o mês de abril de 2017, nas escolas técnicas de enfermagem da cidade de Uberlândia, onde foi ofertado palestras com o enfoque no PNSP. Durante a campanha foi discutido a identificação e prevenção de eventos adversos e promoção da cultura de segurança, de modo a contribuir para a formação do técnico de enfermagem, uma vez que muitos não conheciam o PNSP. A segurança do paciente deve ser incisivamente revisada entre alunos e profissionais da saúde por meio de educação continuada e inclusão do tema nos projetos pedagógicos dos cursos relacionados à saúde.

Although satisfaction is a key point in the evaluation of continuing education, few studies have conducted its assessment, particularly in relation to long-term programmes. The objective of this study was to evaluate the evolution of satisfaction indicators applied to a continuing education program in a university hospital of high complexity. For this, a satisfaction form was filled out after each of the 11 Cycles of Training, and the findings were related to the rates of attendance. It was observed that the nursing professionals gave a positive evaluation of the cycles when each course was evaluated individually, with a tendency to change over time. However, dissatisfaction was observed in relation to the organization criteria for the event, which tended to get worse over time. In addition, different nursing professional categories apparently presented different satisfaction levels, although this association cannot be proven. The results proved that the evaluation of satisfaction with the course or program over time can offer quality indicators for the better management of continuing education programs, and future works should take into account the profile of professionals involved with the program.