Physical, psychological, and cognitive changes among sepsis survivors after ICU discharge: a systematic review Jéssica Cristina Caretta Teixeira, João Vitor Cestari Lima, Angelita Maria Stabile Revista Enfermagem Uerj, 2025 Objetivo: sintetizar as evidências sobre as alterações físicas, psíquicas e cognitivas apresentadas pelos pacientes que tiveram alta da UTI após um episódio de sepse. Método: revisão sistemática, norteada pela pergunta “Quais as alterações físicas, cognitivas e psíquicas apresentadas pelos pacientes que receberam alta hospitalar da UTI após um episódio de sepse?”. As buscas foram realizadas nas bases The Cochrane Library, CINAHL, Embase, LILACS, PubMed, Scopus e Web of Science, incluindo estudos publicados a partir do Consenso do American College of Chest Physicians e da Society of Critical Care Medicine - 1991. Resultados: foram identificados 5799 estudos, dos quais 18 atenderam aos critérios de elegibilidade e foram analisados qualitativamente. Conclusão: os sobreviventes de sepse podem apresentar graus variados de comprometimento nas três esferas analisadas. Adicionalmente, pode haver uma sobreposição de alterações físicas, psíquicas e cognitivas nos sobreviventes, o que pode comprometer a capacidade desses indivíduos de viver de forma independente e com qualidade.
Clinical profile of patients with suspected and confirmed sepsis admitted to an emergency unit Ana Laura Mendes Campoi, Angelita Maria Stabile Revista Enfermagem, 2024 Objetivo: avaliar a relação entre o perfil clínico dos pacientes suspeitos com os confirmados de sepse em uma unidade de emergência. Método: estudo quantitativo, transversal, desenvolvido na emergência de um hospital privado no interior do estado de São Paulo, com análise de 218 prontuários de pacientes com suspeita de sepse, atendidos entre janeiro de 2019 e abril de 2020. Análise estatística descritiva e inferencial (testes t-student e Mann-Whitney), com nível de significância de 5%. Estudo aprovado pelo Comitê de Ética em Pesquisa. Resultados: dos 218 casos suspeitos de sepse, 176 foram classificados como sepse confirmada, predominando em indivíduos com idade superior a 60 anos. Pacientes com sepse confirmada apresentaram maior frequência de parâmetros clínicos significativamente alterados quando comparados aos não sepse (p<0,05). Conclusão: evidenciou-se a vulnerabilidade de indivíduos acima de 60 anos e a relevância do monitoramento rigoroso de parâmetros clínicos alterados.
Long-term effects on cardiorespiratory and behavioral responses in male and female rats prenatally exposed to cannabinoid Luis Gustavo A. Patrone, Alana T. Frias, Gabriel T. Fantinatti, Angelita M. Stabile, Wilfried Klein, et al. American Journal of Physiology Lung Cellular and Molecular Physiology, 2024 The surge in recreational cannabis use and cannabinoid-based medication prescription among pregnant women has been notable in recent years, fueled by the misconception that natural products are inherently safe. Significant gaps persist regarding the potential risks of maternal consumption of cannabinoids and the long-term effects on the cardiorespiratory system of their offspring, which may be determined by sex. Accordingly, this research aims to diminish this lack of information and raise a note of caution.
Management of Infections in Palliative Care Patients at the End-of-Life and Active Process of Death: A Brazilian Retrospective Study Isabela Fernandes de Aguiar Tonetto, Angelita Maria Stabile, Dieyeni Yuki Kobayasi, Rita de Cássia Quaglio, Ana Carolina de Souza, et al. Palliative Medicine Reports, 2024 Background There is a lack of specific studies on the management of infections in patients receiving palliative care (PC) in the final stages of life and during the active process of death, related to specific nursing care. There is clinical and social importance as patients in PC represent a vulnerable population, and adequate management of infections is crucial to improve quality of life and the experience of comfort. Objective This study analyzed how infections are managed in patients undergoing PC at the end-of-life and in the active process of death in two hospital health services. Design This is an observational, analytical, and retrospective study. Settings Data collection took place in two hospitals that assist individuals who are hospitalized under PC, located in Brazil, in a city in the interior of the state of São Paulo. Measurements and Results The sample consisted of 113 medical records, in which the oncological diagnosis was the most prevalent. There was a predominance of infection diagnoses based on the patient's clinical symptoms, the main focus being the pulmonary, in individuals at the end-of-life. The management of infection in the study sample occurred through care and procedures that generate physical discomfort, however aiming at relieving symptoms. Such findings must be documented, as they invite us to reflect on our practical attitudes and what it means to be comfortable for these people, making it possible to incorporate this information into the design of interventions focused on enhancing the experience of comfort.
COMPLICATIONS RELATED TO PERIPHERALLY INSERTED CENTRAL CATHETERS IN COVID-19 PATIENTS AND THE POTENTIAL OF INSERTION TECHNOLOGIES Danielle Cortêz da Silva, Carolina Scoqui Guimarães, Angelita Maria Stabile, Suellen Karina de Oliveira Giroti, Flávia Meneguetti Pieri, et al. Texto E Contexto Enfermagem, 2024 Objective: to assess the incidence of complications related to peripherally inserted central catheters in hospitalized adult patients with Covid-19 and to discuss the potential benefits of employing insertion technologies to prevent complications. Method: a descriptive, exploratory and cross-sectional study was conducted from March 2020 to December 2021 at a high-complexity hospital. The study included patients over 18 years old with a positive diagnosis for Covid-19 who made use of peripherally inserted central catheters for venous infusion. Data collection included sociodemographic and clinical information regarding catheter insertion and use. The analysis involved Chi-square and Fisher's Exact tests, with a significance level of 0.05. Results: a total of 123 inserted catheters were analyzed. The patients' mean age was 50 years old (SD=16.37), most of them male and in the acute phase of infection (59.3%). The following significant complications related to the insertion process were identified: catheter material (p=0.01); use of Sherlock (p=0.03); need for traction (p<0.001); number of punctures (p<0.001); and difficulty in catheter progression (p<0.001). Conclusion: the study identified the main complications related to the insertion and use of PICCs and showed that employing vascular visualization technologies such as ultrasound and Sherlock 3CG® can mitigate complications, as well as maximize patient comfort, experience and safety. The research provides support for the implementation of protocols for insertion and management of peripherally inserted central catheters, thus avoiding the occurrence of adverse events.
Advancing Digital Education Technologies by Empowering Nurses With Point-of-Care Ultrasound: Protocol for a Mixed Methods Study Fernanda Raphael Escobar Gimenes, Angelita Maria Stabile, Rodrigo Magri Bernardes, Vinicius Batista Santos, Mayra Gonçalves Menegueti, et al. Jmir Research Protocols, 2024 Background Bedside ultrasonography, also known as point-of-care ultrasound (PoCUS), is a promising technological tool that enhances clinical assessment, enriching diagnostic capabilities and clinical reasoning. Its use in nursing spans various patient populations and health care settings, providing nurses with a valuable health assessment tool to improve care quality and patient safety. Despite its growing integration into clinical practice, PoCUS training has mainly focused on physicians, leaving a gap for trained nurses who demonstrate similar proficiency in conducting scans and interpreting images. Previous research highlights the value of digital tools in PoCUS training, showing their role in improving professionals’ and students’ knowledge, image interpretation skills, and clinical acumen. Objective This study aimed to (1) establish an assessment instrument gauging nurses’ competency milestones in PoCUS and evaluate its content and appearance validity, (2) develop a series of 5 educational videos focused on PoCUS and assess their content and appearance validity, and (3) construct an online learning environment tailored to nurses’ PoCUS training needs and evaluate its content and appearance validity. Methods We will conduct a methodological study of technological production guided by Rogers’ diffusion of innovations theory. Subproject 1 will design and validate a comprehensive assessment tool for evaluating nurses’ competency milestones in PoCUS use. For this purpose, a scoping review will be conducted. The review will be based on JBI Collaboration guidelines and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extended for Scoping Reviews (PRISMA-ScR) checklist. Subproject 2 involves an evaluation of content and appearance validity for a series of 5 educational videos on PoCUS, designed specifically for nurses about applying peripherally inserted central catheter lines, inserting nasogastric feeding tubes, assessing gastric residual volume, assessing pressure injuries and soft tissue conditions, and assessing muscle mass to monitor patient nutritional status. In subproject 3, a comprehensive online learning environment dedicated to PoCUS training for nurses will be developed and validated. The launch of an online learning environment represents a cornerstone of our dissemination strategy, scheduled to coincide with the inaugural Brazilian PoCUS symposium for nurses, an event organized by the project members. This platform will serve as a pivotal resource for continuous learning and professional development. Results Subproject 1 will start in the second half of 2024 and is expected to be completed by mid-2025. Subproject 2 is currently ongoing and is expected to be completed in early 2026. Subproject 3 is set to begin in early 2025 and is planned to be completed by 2026. Conclusions Through these concerted efforts, the project aims to bridge the existing gap in PoCUS training for nurses, thereby fostering their proficiency and enhancing patient care outcomes. International Registered Report Identifier (IRRID) PRR1-10.2196/58030
Inhibition of Pro-Inflammatory Microglia with Minocycline Improves Cognitive and Sleep-Wake Dysfunction Under Respiratory Stress in a Sporadic Model for Alzheimer's Disease Mariane C. Vicente, Julia L. Paneghini, Angelita M. Stabile, Mateus Amorim, Conceição E. Anibal Silva, et al. Journal of Alzheimer S Disease, 2023 Background: Neuroinflammation in Alzheimer’s disease (AD) can occur due to excessive activation of microglia in response to the accumulation of amyloid-β peptide (Aβ). Previously, we demonstrated an increased expression of this peptide in the locus coeruleus (LC) in a sporadic model for AD (streptozotocin, STZ; 2 mg/kg, ICV). We hypothesized that the STZ-AD model exhibits neuroinflammation, and treatment with an inhibitor of microglia (minocycline) can reverse the cognitive, respiratory, sleep, and molecular disorders of this model. Objective: To evaluate the effect of minocycline treatment in STZ model disorders. Methods: We treated control and STZ-treated rats for five days with minocycline (30 mg/kg, IP) and evaluated cognitive performance, chemoreflex response to hypercapnia and hypoxia, and total sleep time. Additionally, quantification of Aβ, microglia analyses, and relative expression of cytokines in the LC were performed. Results: Minocycline treatment improved learning and memory, which was concomitant with a decrease in microglial cell density and re-establishment of morphological changes induced by STZ in the LC region. Minocycline did not reverse the STZ-induced increase in CO2 sensitivity during wakefulness. However, it restored the daytime sleep-wake cycle in STZ-treated animals to the same levels as those observed in control animals. In the LC, levels of A and expression of Il10, Il1b, and Mcp1 mRNA remained unaffected by minocycline, but we found a strong trend of minocycline effect on Tnf- α. Conclusion: Our findings suggest that minocycline effectively reduces microglial recruitment and the inflammatory morphological profile in the LC, while it recovers cognitive performance and restores the sleep-wake pattern impaired by STZ.
Sex- and age-specific respiratory alterations induced by prenatal exposure to the cannabinoid receptor agonist WIN 55,212-2 in rats Luis Gustavo A. Patrone, Gustavo D. Ferrari, Rodrigo Moreira da Silva, Luciane C. Alberici, Norberto Peporine Lopes, et al. British Journal of Pharmacology, 2023 Background and PurposeCannabis legalization has risen in many countries, and its use during pregnancy has increased. The endocannabinoid system is present in the CNS at early stages of embryonic development, and regulates functional brain maturation including areas responsible for respiratory control, data on the influence of external cannabinoids on the development of the respiratory system and possible consequences during postnatal life are limited.Experimental ApproachWe evaluated the effects of prenatal exposure to synthetic cannabinoid (WIN 55,212‐2 [WIN], 0.5 mg·kg−1·day−1) on the respiratory control system in neonatal (P0, P6–7 and P12–13) and juvenile (P27–28) male and female rats.Key ResultsWIN administration to pregnant rats interfered sex‐specifically with breathing regulation of offspring, promoting a greater sensitivity to CO2 at all ages in males (except P6–7) and in juvenile females. An altered hypoxic chemoreflex was observed in P0 (hyperventilation) and P6–7 (hypoventilation) males, which was absent in females. Along with breathing alterations, brainstem analysis showed an increase in the number of catecholaminergic neurons and cannabinoid receptor type 1 (CB1) and changes in tissue respiration in the early males. A reduction in pulmonary compliance was observed in juvenile male rats. Preexposure to WIN enhanced spontaneous apnoea and reduced the number of serotoninergic (5‐HT) neurons in the raphe magnus nucleus of P0 females.Conclusions and ImplicationsThese data demonstrate that excess stimulation of the endocannabinoid system during gestation has prolonged and sex‐specific consequences for the respiratory control system.
