OBJECTIVE: to analyze determinant factors for the immediate survival of persons who receive cardiopulmonary resuscitation from the advanced support units of the Mobile Emergency Medical Services (SAMU) of Belo Horizonte. METHOD: this is a retrospective, epidemiological study which analyzed 1,165 assistance forms, from the period 2008 - 2010. The collected data followed the Utstein style, being submitted to descriptive and analytical statistics with tests with levels of significance of 5%. RESULTS: the majority were male, the median age was 64 years, and the ambulance response time, nine minutes. Immediate survival was observed in 239 persons. An association was ascertained of this outcome with "cardiac arrest witnessed by persons trained in basic life support" (OR=3.49; p<0.05; CI 95%), "cardiac arrest witnessed by Mobile Emergency Medical Services teams" (OR=2.99; p<0.05; CI95%), "only the carry out of basic life support" (OR=0.142; p<0.05; CI95%), and "initial cardiac rhythm of asystole" (OR=0.33; p<0.05; CI 95%). CONCLUSION: early access to cardiopulmonary resuscitation was related to a favorable outcome, and the non-undertaking of advanced support, and asystole, were associated with worse outcomes. Basic and advanced life support techniques can alter survival in the event of cardiac arrest.

Objective: To describe the reorganization of Belo Horizonte’s Mobile Emergency Care Service during the new coronavirus pandemic using the Plan Do-Check-Act quality tool. Methods: Descriptive study, of the experience report type, on the reorganization of care in a mobile pre-hospital care service during the new coronavirus pandemic, from March to July 2020. The Plan-Do-Check-Act quality tool was applied for the process. Results: Preparation of care protocol, meetings, training, addition of ambulances, hiring of professionals, and other actions were carried out, with subsequent evaluation and monitoring. When failures or new needs were identified, actions and changes were implemented while keeping monitoring and evaluation during the work routine. Final considerations: The reorganization of the service through the construction of a protocol and using the Plan-Do-Check-Act as a management tool was essential to promote safe care for professionals and patients.

Teredinidae is a family of highly adapted wood-feeding and wood-boring bivalves, commonly known as shipworms, whose evolution is linked to the acquisition of cellulolytic gammaproteobacterial symbionts harbored in bacteriocytes within the gills. In the present work we applied metagenomics to characterize microbiomes of the gills and digestive tract of Neoteredo reynei, a mangrove-adapted shipworm species found over a large range of the Brazilian coast. Comparative metagenomics grouped the symbiotic gammaproteobacterial community of gills of different N. reynei specimens, indicating closely related bacterial types are shared, while intestine and digestive glands presented related, and more diverse microbiomes that did not overlap with gills. Annotation of assembled metagenomic contigs revealed that the symbiotic community of N. reynei gills was a hotspot of woody-polysaccharides degrading hydrolase genes, and Biosynthetic Gene Clusters (BGCs), while in contrast, the digestive tract microbiomes seems to play little role in wood digestion and secondary metabolites biosynthesis. Metagenome binning recovered the nearly complete genome sequences of two symbiotic Teredinibacter strains from the gills, a representative of Teredinibacter turnerae “clade I” strain, and a yet to be cultivated Teredinibacter sp. type. These Teredinibacter genomes, as well as unbinned gill-derived gammaproteobacteria contigs, code for novelty including an endo-β-1,4-xylanase/acetylxylan esterase multi-catalytic carbohydrate-active enzyme, and a trans-acyltransferase polyketide synthase (trans-AT PKS) gene cluster with the gene cassette for generating β-branching on complex polyketides. Multivariate analyzes have shown that the secondary metabolome encoded on the genomes of Teredinibacter representatives, including the genomes binned from N. reynei gill’s metagenomes, stand out within the Cellvibrionaceae family by size, and enrichments for polyketide, nonribosomal peptide and hybrid BGCs. Results grouped here add to the growing characterization of shipworm symbiotic microbiomes and indicate that the N. reynei gill gammaproteobacterial community is a prolific source of biotechnologically relevant enzymes for wood-digestion and bioactive compounds production.

RESUMO O uso de Desfibriladores Externos Automáticos (DEAs) pode ser benéfico para pacientes com Parada Cardiorrespiratória (PCR), mesmo se utilizado por indivíduos treinados a manuseá-lo ou leigos. Este estudo teve o objetivo de caracterizar atendimentos às vítimas de PCR, de provável etiologia cardíaca realizados pelas equipes do Serviço de Atendimento Móvel de Urgência de Belo Horizonte após a incorporação do DEA nas Unidades de Suporte Básico (USB). Trata-se de um estudo epidemiológico, retrospectivo. As variáveis utilizadas foram baseadas no estilo Utstein e os dados submetidos à estatística descritiva. Dos 543 atendimentos, 58,4% das vítimas eram do sexo masculino e a mediana da idade foi de 56 anos. Em 39,0% das ocorrências houve o acionamento e atendimento conjunto de uma USB e uma Unidade de Suporte Avançado (USA) e, em 86,6% destes as USBs chegaram, em média, 15,5 minutos primeiro. Em 46,6% dos atendimentos houve indicação de manobras de Ressuscitação Cardiopulmonar (RCP). Das 112 pessoas que receberam manobras de RCP com um desfibrilador, a maioria (75,0%) delas foi pelo DEA. O choque foi indicado para 14,3% e mais da metade (58,3%) teve retorno da circulação espontânea. Esse resultado demonstra a importância do DEA, permitindo acesso à desfibrilação precoce às vítimas de PCR.

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Background Previous studies have demonstrated the feasibility of using an asthma app to support medication management and adherence but failed to compare with other measures currently used in clinical practice. However, in a clinical setting, any additional adherence measurement must be evaluated in the context of both the patient and physician perspectives so that it can also help improve the process of shared decision making. Thus, we aimed to compare different measures of adherence to asthma control inhalers in clinical practice, namely through an app, patient self‐report and physician assessment. Methods This study is a secondary analysis of three prospective multicentre observational studies with patients (≥13 years old) with persistent asthma recruited from 61 primary and secondary care centres in Portugal. Patients were invited to use the InspirerMundi app and register their inhaled medication. Adherence was measured by the app as the number of doses taken divided by the number of doses scheduled each day and two time points were considered for analysis: 1‐week and 1‐month. At baseline, patients and physicians independently assessed adherence to asthma control inhalers during the previous week using a Visual Analogue Scale (VAS 0–100). Results A total of 193 patients (72% female; median [P25–P75] age 28 [19–41] years old) were included in the analysis. Adherence measured by the app was lower (1 week: 31 [0–71]%; 1 month: 18 [0–48]%) than patient self‐report (80 [60–95]) and physician assessment (82 [51–94]) ( p < 0.001). A negligible non‐significant correlation was found between the app and subjective measurements ( ρ 0.118–0.156, p > 0.05). There was a moderate correlation between patient self‐report and physician assessment ( ρ = 0.596, p < 0.001). Conclusions Adherence measured by the app was lower than that reported by the patient or the physician. This was expected as objective measurements are commonly lower than subjective evaluations, which tend to overestimate adherence. Nevertheless, the low adherence measured by the app may also be influenced by the use of the app itself and this needs to be considered in future studies.

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Objetivo: Descrever a elaboração de um protocolo de restrição de movimento de coluna (RMC) vertebral do Serviço de Atendimento Móvel de Urgência de Belo Horizonte. Relato da experiência: Trata-se de um relato de experiência sobre a construção de um protocolo de RMC vertebral. Foi realizada a busca na literatura das melhores evidências sobre o tema, seguida de análise crítica dos estudos e a construção de um fluxograma de decisão para indicação ou não de RMC vertebral. Ficou definido que a RMC vertebral será realizada sempre que a equipe atender pacientes, vítimas de trauma, que apresentarem ao menos uma das seguintes características: instabilidade na avaliação primária, idade maior que 65 anos, presença de dor em coluna, déficit de consciência, déficit sensitivo ou motor, deformidade na coluna, distração, dinâmica do trauma significativa. Considerações finais: Ficou evidente a importância de se construir um protocolo clínico para guiar os profissionais aos melhores cuidados aos pacientes acometidos por trauma, assim como a necessidade de mudança de paradigmas com relação ao manejo destas vítimas e por fim a redução do tempo para seu tratamento definitivo.