ARS-CoV-2 is an enveloped positive-sense RNA coronavirus belonging to the Coronaviridae family, and its cellular entry depends mainly on the binding of S protein 1,2 to angiotensin-converting enzyme 2, a specific cellular receptor located at the surface of the host cells. 3,4 The SARS-CoV-2 viral particles' presence in the retina of deceased patients with COVID-19 has been suggested through the real-time polymerase chain reaction (PCR) and immunological methods to detect its main proteins. The eye is affected by COVID-19 infection, 5,6 and retinal changes were attributed to secondary microvascular and immunological changes. The aim of this study was to detect the presence of presumed SARS-CoV-2 viral particles in the retina of individuals who died of COVID-19 using fluorescence microcopy of tissues immunostained for S1 and nucleocapsid proteins and transmission electron microscopy of thin sections. MethodsThis investigational study was approved by the ethical and research committee at the Federal University of São Paulo in São Paulo, Brazil, and all patients' representatives agreed to participate through written consent applied after the patient's death. They were informed of the procedure and potential benefits and risks, and no compensation was received for agreeing to participate. Detailed demographic, medical history, concomitant events, medication history, hospitalization details, IMPORTANCE The presence of the SARS-CoV-2 virus in the retina of deceased patients with COVID-19 has been suggested through real-time reverse polymerase chain reaction and immunological methods to detect its main proteins. The eye has shown abnormalities associated with COVID-19 infection, and retinal changes were presumed to be associated with secondary microvascular and immunological changes.OBJECTIVE To demonstrate the presence of presumed SARS-CoV-2 viral particles and its relevant proteins in the eyes of patients with COVID-19. DESIGN, SETTING, AND PARTICIPANTSThe retina from enucleated eyes of patients with confirmed COVID-19 infection were submitted to immunofluorescence and transmission electron microscopy processing at a hospital in São Paulo, Brazil, from June 23 to July 2, 2020. After obtaining written consent from the patients' families, enucleation was performed in patients deceased with confirmed SARS-CoV-2 infection. All patients were in the intensive care unit, received mechanical ventilation, and had severe pulmonary involvement by COVID-19. MAIN OUTCOMES AND MEASURESPresence of presumed SARS-CoV-2 viral particles by immunofluorescence and transmission electron microscopy processing.RESULTS Three patients who died of COVID-19 were analyzed. Two patients were men, and 1 was a woman. The age at death ranged from 69 to 78 years. Presumed S and N COVID-19 proteins were seen by immunofluorescence microscopy within endothelial cells close to the capillary flame and cells of the inner and the outer nuclear layers. At the perinuclear region of these cells, it was possible to observe by transmission electron microscopy dou...

Understand the meaning of the experiences of parents of children with congenital heart disease regarding feelings, obstacles and expectations. Methods: exploratory qualitative study conducted at a pediatric intensive care unit of a reference hospital. Participants corresponded to seven mothers and four fathers of children with congenital heart defect, surgically corrected and with more than 8 hours of admission, totalling 11 participants.  Data collection was performed through semi-structured individual recorded interviews. Data were described according to thematic content analysis. Results: five thematic categories emerged: (1) unpreparedness to face the problem; (2) feelings involved (3) factors that make difficult to face the problem; (4) factors that facilitate facing the problem; (5) spirituality. Conclusion: each family is unique and needs support to better face the disease and its process. It is essential to develop interdisciplinary network support, providing comprehensive care.

Objective: to identify scientific production about validation methods of nursing care protocols. Method: an integrative review with search at Scielo, Pubmed/MEDLINE, Virtual Health Library, Web of Science, Scopus, and EBSCOhost. The descriptors “validation studies”, “validation studies as topic”, “protocols”, “clinical protocols”, “practice guidelines as topic”, “nursing” and “nursing assessment” and the uncontrolled descriptor “validation” were used. Results: thirty-two articles were selected, most of them Brazilian. Content validation by experts was the most frequent method, with no consensus on the number of participants for the process. The collection instruments were mostly created by the authors. Data analysis was performed using descriptive statistics and Content Validity Index, with a variable consensus rate in the analyzed articles. Conclusion: protocols validated by experts are robust tools for use in clinical practice, with methodological rigor in development essential for its quality.

Objetivo: relatar a experiência vivenciada de um serviço de emergência hospitalar do Sistema Único de Saúde (SUS) sobre os fluxos de atendimento a pacientes suspeitos ou confirmados por COVID-19. Método: trata-se de um estudo qualitativo com caráter descritivo, do tipo relato de experiência, visando a reflexão e discussão crítica acerca da experiência vivenciada por profissionais da enfermagem em um hospital de referência da região sul do Brasil no enfrentamento à pandemia. Resultados: para atendimento dos pacientes suspeitos ou confirmados de infecção por coronavírus, foram organizados planos de contingência e fluxos de atendimento nos setores de emergência em conexão com as demais áreas do hospital. Criou-se o Centro de Triagem e a sala vermelha COVID-19. Conclusão: constatou-se a importância da participação multidisciplinar para organização logística, de recursos humanos e materiais para o estabelecimento das novas rotinas assistenciais em curto prazo.Descritores: Pandemias; Coronavírus; Enfermagem; Serviço Hospitalar de Emergência; Gestão de Riscos. SUS HOSPITAL EMERGENCY SERVICE: SERVICE FLOWS FOR SUSPECTED OR CONFIRMED PATIENTS FOR COVID-19Objective: to report the experience of a hospital emergency service of the Sistema Único de Saúde (SUS) on the flows of care to patients suspected or confirmed by COVID-19. Method: it is a qualitative study with a descriptive character, of the experience report type, aiming at reflection and critical discussion about the experience lived by nursing professionals in a reference hospital in the southern region of Brazil in facing the pandemic. Results: for the care of patients suspected or confirmed of coronavirus infection, contingency plans and care flows were organized in the emergency departments in connection with the other areas of the hospital. The Triage Center and the COVID-19 red room were created. Conclusion: the importance of multidisciplinary participation for logistical, human and material resources was found to establish new care routines in the short term.Descriptors: Pandemics; Coronavirus; Nursing; Emergency Service, Hospital; Risk Management. SERVICIO DE EMERGENCIA DEL HOSPITAL SUS: FLUJOS DE SERVICIO PARA PACIENTES SUSPECTADOS O CONFIRMADOS PARA COVID-19Objetivo: informar la experiencia de un servicio de emergencia hospitalario del Sistema Único de Saúde (SUS) sobre los flujos de atención a pacientes sospechosos o confirmados por COVID-19. Método: es un estudio cualitativo con carácter descriptivo, del tipo de informe de experiencia, con el objetivo de reflexionar y debatir críticamente sobre la experiencia vivida por profesionales de enfermería en un hospital de referencia en la región sur de Brasil frente a la pandemia. Resultados: para la atención de pacientes sospechosos o confirmados de infección por coronavirus, se organizaron planes de contingencia y flujos de atención en los departamentos de emergencia en conexión con las otras áreas del hospital. Se crearon el Centro de detección y la sala roja COVID-19. Conclusión: se encontró la importancia de la participación multidisciplinaria para los recursos logísticos, humanos y materiales para establecer nuevas rutinas de atención a corto plazo.Descriptores: Pandemias; Coronavirus; Enfermería; Servicio de Urgencia en Hospital; Gestión de Riesgos.

No abstract

Objectives: to map the available evidence about nursing care aimed at adult patients using external ventricular drain. Methods: this is a review using the scoping review method. Results: Initially, 965 studies were identified and, after the eligibility criteria, a sample of 54 publications was obtained. Each of them was assessed according to GRADE, resulting in three studies with high quality; 14 with moderate quality; 32 with low quality; and five with very low quality. It was highlighted 20 nursing care subdivided into nine categories, namely: drainage system; bed positioning and mobilization; catheter care; monitoring of intracranial pressure; and medication administration. Conclusions: the scoping review made it possible to identify the main nursing care directed to adult patients undergoing placement of external ventricular drain from the evidence available to date.

Objetivo: Relatar a experiência de enfermeiras sobre o conhecimento construído em uma disciplina de tecnologias em saúde, com enfoque na tecnologia leve-dura dos protocolos existentes. Relato de experiência: Uma Universidade Federal brasileira oferece uma disciplina sobre tecnologias da saúde, abordando tipos existentes, sua avaliação e aplicação no cenário da saúde. Essa temática envolve a construção do saber fundamentado na prática baseada em evidências, utilizando a tecnologia como coadjuvante no processo educacional e assistencial dos profissionais da saúde. Para enfermeiros, a disciplina viabiliza novas perspectivas acerca das práxis diárias, pois promove conhecimentos específicos e propicia uma visão crítica sobre processos de trabalho. Além disso, a aplicação dos conhecimentos adquiridos na disciplina fomenta o desenvolvimento de protocolos e ferramentas que auxiliam nas tomadas de decisão, qualificando a assistência. Protocolos são tecnologias leve-duras fundamentadas em evidências científicas que oportunizam a assistência, a educação e o empoderamento dos profissionais da saúde. Considerações finais: Há modelos distintos de protocolos, categorizados conforme o conteúdo e enfoque prático, sendo sua aplicabilidade o maior diferencial entre eles. O Protocolo Assistencial vem sendo o instrumento mais utilizado para promover a enfermagem baseada em evidências, permitindo ao enfermeiro implementar o conhecimento científico na assistência, qualificando-a e tornando-a segura.

No abstract