Purulent Pericarditis as the First Manifestation of Esophageal Carcinoma.

INTRODUCTION: Purulent pericarditis secondary to esophago-pericardial fistula is a serious complication that has been previously reported in patients with esophageal cancer treated with radio/chemotherapy and esophageal stenting. However, the presence of esophago-pericardial fistula as the first manifestation of advanced carcinoma of the esophagus is exceedingly infrequent. We report the case of a 61-year-old male who presented with sepsis, cardiac tamponade and septic shock who was found to have an esophago-pericardial fistula secondary to squamous carcinoma of the esophagus. Emergency pericardiocentesis was performed with subsequent hemodynamic improvement. The drained pericardial fluid was purulent in nature and cultures were positive for Streptococcus anginosus. A CT scan followed by upper gastrointestinal endoscopy with tissue biopsy confirmed the diagnosis of squamous cell carcinoma of the esophagus. A self-expanding covered stent was endoscopically placed to exclude the fistula and restore the esophageal lumen. In this report, we discuss some aspects related to the diagnosis and management of this serious clinical entity.

Epithelial ovarian cancer and brain metastases: might the BRCA status, PARP inhibitor administration, and surgical treatment impact the survival?

OBJECTIVE: To evaluate disease characteristics and survival according to BRCA status, administration of poly-(ADP-ribose) polymerase inhibitors (PARPi), and surgery in patients with ovarian cancer and brain metastases. METHODS: This is a monocentric retrospective cohort of patients with ovarian cancer and brain metastases treated between 2000 and 2021. Data were collected by a retrospective review of medical records and analyzed according to: (1) BRCA mutation; (2) PARPi before and after brain metastases; (3) surgery for brain metastases. RESULTS: Eighty-five patients with ovarian cancer and brain metastasis and known BRCA status (31 BRCA mutated (BRCAm), 54 BRCA wild-type (BRCAwt)) were analyzed. Twenty-two patients had received PARPi before brain metastases diagnosis (11 BRCAm, 11 BRCAwt) and 12 after (8 BRCAm, 4 BRCAwt). Brain metastases occurred >1 year later in patients who had received previous PARPi. Survival was longer in the BRCAm group (median post-brain metastasis survival: BRCAm 23 months vs BRCAwt 8 months, p=0.0015). No differences were found based on BRCA status analyzing the population who did not receive PARPi after brain metastasis (median post-brain metastasis survival: BRCAm 8 months vs BRCAwt 8 months, p=0.31). In the BRCAm group, survival was worse in patients who had received previous PARPi (median post-brain metastasis survival: PARPi before, 7 months vs no-PARPi before, 24 months, p=0.003). If PARPi was administered after brain metastases, survival of the overall population improved (median post-brain metastasis survival: PARPi after, 46 months vs no-PARPi after, 8 months, p=0.00038).In cases of surgery for brain metastases, the prognosis seemed better (median post-brain metastasis survival: surgery 13 months vs no-surgery 8 months, p=0.036). Three variables were significantly associated with prolonged survival at multivariate analysis: BRCA mutation, multimodal treatment, and ≤1 previous chemotherapy line. CONCLUSIONS: BRCA mutations might impact brain metastasis occurrence and lead to better outcomes. In a multimodal treatment, surgery seems to affect survival even in cases of extracranial disease. PARPi use should be considered as it seems to prolong survival if administered after brain metastasis.

The Role of Uniform Textures in Making Texture Elements Visible in the Visual Periphery.

There are important differences between central and peripheral vision. With respect to shape, contours retain phenomenal sharpness, although some contours disappear if they are near other contours. This leads to some uniform textures to appear non-uniform (Honeycomb illusion, Bertamini et al., 2016). Unlike other phenomena of shape perception in the periphery, this illusion is showing how continuity of the texture does not contribute to phenomenal continuity. We systematically varied the relationship between central and peripheral regions, and we collected subjective reports (how far can one see lines) as well as judgments of line orientation. We used extended textures created with a square grid and some additional lines that are invisible when they are located at the corners of the grid, or visible when they are separated from the grid (control condition). With respects to subjective reports, we compared the region of visibility for cases in which the texture was uniform (Exp 1a), or when in a central region the lines were different (Exp 1b). There were no differences, showing no role of objective uniformity on visibility. Next, in addition to the region of visibility we measured sensitivity using a forced-choice task (line tilted left or right) (Exp 2). The drop in sensitivity with eccentricity matched the size of the region in which lines were perceived in the illusion condition, but not in the control condition. When participants were offered a choice to report of the lines were present or absent (Exp 3) they confirmed that they did not see them in the illusion condition, but saw them in the control condition. We conclude that mechanisms that control perception of contours operate differently in the periphery, and override prior expectations, including that of uniformity. Conversely, when elements are detected in the periphery, we assign to them properties based on information from central vision, but these shapes cannot be identified correctly when the task requires such discrimination.

Health-related quality of life in patients with conditions affecting the hand: meta-analysis.

BACKGROUND: Health state utility values provide the quality component of quality-adjusted life years and are essential for health economic analyses, such as the National Institute for Health and Care Excellence Technology Appraisal. The aims of this systematic review were to: catalogue utility values for health states experienced by patients with hand conditions; provide pooled utility estimates for common hand conditions; and determine how utilities have been estimated. METHODS: A PRISMA-compliant systematic review and meta-analysis was conducted (registered in PROSPERO, the international prospective register of systematic reviews (CRD42021226098)). Five databases were searched from inception until April 2023 (Embase, MEDLINE, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Central Register of Controlled Trials (CENTRAL)). All studies that reported primary utility values for hand health states in adult patients were eligible for inclusion. Pooled utility estimates were determined across conditions and intervention status using random-effects meta-analysis. RESULTS: A total of 10 254 articles were identified; 57 studies met the full inclusion criteria and reported 363 distinct health state utility values. Health state utility values were estimated using a range of methods; the most common measure was the EQ-5D. Pooled utility estimates for carpal tunnel syndrome and hand osteoarthritis before surgical intervention were 0.69 (95% c.i. 0.66 to 0.73) and 0.63 (95% c.i. 0.60 to 0.67) respectively. CONCLUSION: Pooled utility estimates for patients with untreated carpal tunnel syndrome and hand osteoarthritis are 11% and 18% lower than age-matched population norms respectively. Hand conditions have a significant detrimental impact on health-related quality of life and this study provides catalogued utility values for use in future economic analyses to support the delivery of value-based hand surgery.

Taxonomy of Candida parapsilosis complex isolated from neonates and the role of Hsp90 inhibitors to enhanced the antifungal activity of micafungin.

Species from Candida parapsilosis complex are frequently found in neonatal candidemia. The antifungal agents to treat this infection are limited and the occurrence of low in vitro susceptibility to echinocandins such as micafungin has been observed. In this context, the chaperone Hsp90 could be a target to reduce resistance. Thus, the objective of this research was to identify isolates from the C. parapsilosis complex and verify the action of Hsp90 inhibitors associated with micafungin. The fungal identification was based on genetic sequencing and mass spectrometry. Minimal inhibitory concentrations were determined by broth microdilution method according to Clinical Laboratory and Standards Institute. The evaluation of the interaction between micafungin with Hsp90 inhibitors was realized using the checkerboard methodology. According to the polyphasic taxonomy, C. parapsilosis sensu stricto was the most frequently identified, followed by C. orthopsilosis and C. metapsilosis, and one isolate of Lodderomyces elongisporus was identified by genetic sequencing. The Hsp90 inhibitor geladanamycin associated with micafungin showed a synergic effect in 31.25% of the isolates, a better result was observed with radicicol, which shows synergic effect in 56.25% tested yeasts. The results obtained demonstrate that blocking Hsp90 could be effective to reduce antifungal resistance to echinocandins.

Danish translation and validation of the Parotidectomy Outcome Inventory 8.

INTRODUCTION: Complications and recurrence within benign salivary gland surgery are not systematically registered in Denmark. Patient-reported outcome measures are increasingly included in clinical and health policy decision-making, and therefore it is crucial that this type of data is valid. A patient-reported questionnaire regarding outcome after benign parotid gland surgery has been developed and implemented in a national German database. We aimed to translate the Parotidectomy Outcome Inventory 8 (POI-8) into Danish and validate it. METHODS: The questionnaire was translated. The study population was recruited from a single centre from 6 December 2019 to 1 June 2022. Patients > 18 years of age who had undergone their first parotid salivary gland surgery for a benign tumour were included. The questionnaire underwent pilot-testing and test-retesting; it was sent to respondents twice at a 14-day interval. For the categorical variables, the reliability of the items was tested using the weighted kappa-coefficient. RESULTS: A weighted kappa coefficient of 0.74 and Cronbach's alpha of 0.78 were found. No significant difference was found between testing at day 0 and 14. CONCLUSIONS: We have translated and validated the Danish version of the POI-8, finding acceptable levels of the weighted kappa coefficient and Cronbach's alpha. We suggest the systematic use of PROMs in Danish healthcare and specifically in parotidectomy for benign neoplasms. FUNDING: No funding. TRIAL REGISTRATION: Not relevant.

On the relationship between foveal mask interference and mental imagery in peripheral object recognition.

A delayed foveal mask affects perception of peripheral stimuli. The effect is determined by the timing of the mask and by the similarity with the peripheral stimulus. A congruent mask enhances performance, while an incongruent one impairs it. It is hypothesized that foveal masks disrupt a feedback mechanism reaching the foveal cortex. This mechanism could be part of a broader circuit associated with mental imagery, but this hypothesis has not as yet been tested. We investigated the link between mental imagery and foveal feedback. We tested the relationship between performance fluctuations caused by the foveal mask-measured in terms of discriminability (d') and criterion (C)-and the scores from two questionnaires designed to assess mental imagery vividness (VVIQ) and another exploring object imagery, spatial imagery and verbal cognitive styles (OSIVQ). Contrary to our hypotheses, no significant correlations were found between VVIQ and the mask's impact on d' and C. Neither the object nor spatial subscales of OSIVQ correlated with the mask's impact. In conclusion, our findings do not substantiate the existence of a link between foveal feedback and mental imagery. Further investigation is needed to determine whether mask interference might occur with more implicit measures of imagery.

Foveal feedback in perceptual processing: Contamination of neural representations and task difficulty effects.

Visual object recognition was traditionally believed to rely on a hierarchical feedforward process. However, recent evidence challenges this notion by demonstrating the crucial role of foveal retinotopic cortex and feedback signals from higher-level visual areas in processing peripheral visual information. The nature of the information conveyed through foveal feedback remains a topic of debate. To address this, we conducted a study employing a foveal mask paradigm with varying stimulus-mask onset asynchronies in a peripheral same/different task, where peripheral objects exhibited different degrees of similarity. Our hypothesis posited that simultaneous arrival of feedback and mask information in the foveal cortex would lead to neural contamination, biasing perception. Notably, when the two peripheral objects were identical, we observed a significant increase in the number of "different" responses, peaking at approximately 100 ms. Similar effect was found when the objects were dissimilar, but with an overall later timing (around 150 ms). No significant difference was found when comparing easy (dissimilar objects) and difficult trials (similar objects). The findings challenge the hypothesis that foveation planning alone accounts for the observed effects. Instead, these and previous observations support the notion that the foveal cortex serves as a visual sketchpad for maintaining and manipulating task-relevant information.

European Respiratory Society short guidelines for the use of as-needed ICS/formoterol in mild asthma

Recent clinical trials of as-needed fixed-dose combination of inhaled corticosteroid (ICS)/formoterol have provided new evidence that may warrant a reconsideration of current practice. A Task Force was set up by the European Respiratory Society to provide evidence-based recommendations on the use of as-needed ICS/formoterol as treatment for mild asthma. The Task Force defined two questions that were assessed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach. The Task Force utilised the outcomes to develop recommendations for a pragmatic guideline for everyday clinical practice. The Task Force suggests that adults with mild asthma use as-needed ICS/formoterol instead of regular ICS maintenance treatment plus as-needed short-acting ß2-antagonist (SABA) and that adolescents with mild asthma use either as-needed ICS/formoterol or ICS maintenance treatment plus as-needed SABA (conditional recommendation; low certainty of evidence). The recommendation for adults places a relatively higher value on the reduction of systemic corticosteroid use and the outcomes related to exacerbations, and a relatively lower value on the small differences in asthma control. Either treatment option is suggested for adolescent patients as the balance is very close and data more limited. The Task Force recommends that adult and adolescent patients with mild asthma use as-needed ICS/formoterol instead of as-needed SABA (strong recommendation; low certainty of evidence). This recommendation is based on the benefit of as-needed ICS/formoterol in mild asthma on several outcomes and the risks related to as-needed SABA in the absence of anti-inflammatory treatment. The implementation of this recommendation is hampered in countries (including European Union countries) where as-needed ICS/formoterol is not approved for mild asthma.

Neonatal fungemia caused by Lodderomyces elongisporus: first case report in Latin America.

Premature hospitalized neonates have a greater risk for candidemia, however, fungemia due to rare opportunistic yeasts have been recently reported and is associated with high mortality rates. We herein report the first case in Latin America of Lodderomyces elongisporus fungemia in a premature neonate with a fatal outcome.

European Respiratory Society short guidelines for the use of as-needed ICS/formoterol in mild asthma.

Recent clinical trials of as-needed fixed-dose combination of inhaled corticosteroid (ICS)/formoterol have provided new evidence that may warrant a reconsideration of current practice. A Task Force was set up by the European Respiratory Society to provide evidence-based recommendations on the use of as-needed ICS/formoterol as treatment for mild asthma. The Task Force defined two questions that were assessed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach. The Task Force utilised the outcomes to develop recommendations for a pragmatic guideline for everyday clinical practice. The Task Force suggests that adults with mild asthma use as-needed ICS/formoterol instead of regular ICS maintenance treatment plus as-needed short-acting ß2-antagonist (SABA) and that adolescents with mild asthma use either as-needed ICS/formoterol or ICS maintenance treatment plus as-needed SABA (conditional recommendation; low certainty of evidence). The recommendation for adults places a relatively higher value on the reduction of systemic corticosteroid use and the outcomes related to exacerbations, and a relatively lower value on the small differences in asthma control. Either treatment option is suggested for adolescent patients as the balance is very close and data more limited. The Task Force recommends that adult and adolescent patients with mild asthma use as-needed ICS/formoterol instead of as-needed SABA (strong recommendation; low certainty of evidence). This recommendation is based on the benefit of as-needed ICS/formoterol in mild asthma on several outcomes and the risks related to as-needed SABA in the absence of anti-inflammatory treatment. The implementation of this recommendation is hampered in countries (including European Union countries) where as-needed ICS/formoterol is not approved for mild asthma.

Multiparametric Flow Cytometry for Determination of Viability, Caspase 3 and 7 Activity, and Lipid Peroxidation Adduct (4-Hydroxynonenal) in Equine Spermatozoa.

Flow cytometry is a powerful tool for the analysis of cell samples formed of multipopulations, such as spermatozoa. In recent years, multiparametric cytometers have evolved, allowing the study of different cellular characteristics, such as protein expression, DNA analysis, or mitochondrial activity. Whether using traditional fluorescent dyes or fluorophore-conjugated antibodies, each cell or cellular component is individually stained, the sample is analyzed at high velocities, and then is displayed and interpreted in a dot-plot. We hereby describe the procedure to perform a multiparametric flow cytometry analysis in equine spermatozoa using three sources of excitation and polychromatic flow cytometry for the detection of 4HNE, a lipid peroxidation adduct (by anti-4HNE antibody), apoptotic markers (by caspases 3 and 7 activity), and live/dead spermatozoa (by ethidium-homodimer) excluding the debris with Hoechst 33342 staining and gating. This multiparametric analysis allows the simultaneous detection of different spermatic parameters, providing useful information for the characterization of a seminal sample and fertility estimation. © 2023 Wiley Periodicals LLC. Basic Protocol: Determination of viability, caspase 3 and 7 activity, and 4-hydroxynonenal in equine spermatozoa by flow cytometry.

Bronchogenic Cyst: Lessons Learned in 20 Years of Experience at a Tertiary Pediatric Center.

BACKGROUND: Bronchogenic cysts are benign congenital malformations of the primitive ventral foregut. The aim of this study is to analyze and report 20 years of experience in the diagnosis and treatment of bronchogenic cysts at a tertiary pediatric center. METHODS: A retrospective review was conducted of all patients diagnosed with a bronchogenic cyst between 2000-2020. Presence of symptoms, cyst location, surgical technique, postoperative complications, need for pleural drainage, and recurrence were reviewed. RESULTS: Forty-five children were included in the study. In 37 patients a partial resection of the cyst was done, followed by cauterization or chemical obliterateration with iodopovidone of the mucosa of the remaining cyst wall that was adherent to the airway. A lobectomy was done in patients who had intrapulmonary cysts (n = 8). Cyst location was subcarinal in 23 (51.1%), paratracheal in 14 (31.1%), and intrapulmonary in eight patients (17.8%). The majority of subcarinal and paratracheal cysts (90%) were approached by thoracoscopy. Complications occurred in seven patients (15%): subcutaneous emphysema after pleural drain removal in one, extubation failure in two, reoperation due to bleeding in one, surgical site infection in one, bronchopleural fistula in one, and pneumothorax in one. Reoperation due to cyst recurrence was necessary in two patients (4.4%). Mean follow-up was 56 months (range, 0-115). CONCLUSION: A minimally invasive approach is a safe option for the management of paratracheal and subcarinal bronchogenic cysts with no history of infection in specialized pediatric surgery center. Thoracoscopic partial resection is a feasible option in most patients with subcarinal and paratracheal bronchogenic cysts with a low complication and reoperation rate. LEVEL OF EVIDENCE: IV.

Factors associated with severe acute respiratory syndrome in pregnant/postpartum women with COVID-19 receiving care at referral centers in northeastern Brazil: Secondary analysis of a cohort study.

Background: At the beginning of the COVID-19 pandemic, the greater risks associated with the new SARS-CoV-2 pathogen in pregnant women were as yet unclear. This study analyzed factors associated with severe acute respiratory syndrome (SARS) in pregnant/postpartum women with COVID-19. Methods: A prospective and retrospective cohort study was conducted in eight referral centers in northeastern Brazil between April 2020 and December 2021 involving pregnant/postpartum women with a positive COVID-19 RT-PCR test. A multivariate analysis was then conducted using a hierarchical logistic regression model to evaluate the association between the independent variables and the presence of SARS. Findings: Of 611 patients included, 522 were pregnant and 83 were postpartum, at the time of admission. Criteria for SARS were present in 215 patients (35·2%). Factors associated with SARS included overweight and/or obesity (adjusted odds ratio/AOR: 1·95; 95%CI: 1·21-3·12; p = 0·0054), parity ≥2 (AOR: 1·72; 95%CI: 1·21-2·45; p = 0·0025), gestational age <34 weeks (AOR: 3·54; 95%CI: 2·47-5·07; p < 0·0001) and duration of symptoms >7 days (AOR: 1·97; 95%CI: 1·35-2·89; p = 0·0004). SARS increased the likelihood of requiring oxygen therapy (RR = 8·80; 95%CI: 6·25-12·40; p = 0·0000), mechanical ventilation (RR = 8·15; 95%CI: 4·67-14·21; p = 0·0000), and admission to an ICU (RR = 6·54; 95%CI: 4·70-9·11; p = 0·0000), and of maternal near miss (RR = 10·82; 95%CI: 1·20-22·47; p = 0·0000) and maternal death (RR = 8·12; 95%CI: 3·11-21·09; p = 0·0000). Interpretation: In patients with COVID-19, parity ≥2, overweight/obesity, gestational age <34 weeks and duration of symptoms >7 days increased the risk of SARS. Cesarean sections, oxygen therapy, and mechanical ventilation were more common in patients with SARS.

Reconstruction of the nasal columella using bilateral nasolabial flaps: case report / Reconstrução da columela nasal com utilização de retalhos nasolabiais bilaterais: relato de caso

Introduction: The columella is an important subunit of the nose, essential for nasal architecture and facial aesthetics. The total reconstruction of the nasal columella becomes a great challenge after repairing trauma, carcinomas, and necrosis in this region. There are descriptions in the literature of numerous reconstruction techniques using different flaps, such as a frontal region flap, an infraclavicular region flap, and a unilateral and bilateral nasolabial flap. Case Report: A total reconstruction of the nasal columella after resection of basal cell carcinoma (BCC) using a bilateral nasolabial flap is reported. Conclusion: The technique proved effective for correcting the complex defect after BCC resection, with technical ease for resolution and good aesthetic and functional results.

Introdução: A columela é uma importante subunidade do nariz, sendo essencial para a arquitetura nasal e estética facial. A reconstrução total da columela nasal torna-se, portanto, um grande desafio após reparação de traumas, carcinomas e necroses nesta região. Há na literatura a descrição de inúmeras técnicas de reconstrução com uso de diferentes retalhos, como retalho da região frontal, retalho da região infraclavicular, retalho nasolabial unilateral e bilateral. Relato de Caso: Reporta-se uma reconstrução total da columela nasal pós-ressecção de carcinoma basocelular (CBC) utilizando retalho nasolabial bilateral. Conclusão: A técnica utilizada mostrou-se eficaz para correção do defeito complexo pós-ressecção de CBC, apresentando facilidade técnica para resolução e bom resultado estético-funcional.

Cutaneous traction as a complement to the parascapular flap in major cancer loss: case report / Tração cutânea como complemento ao retalho paraescapular em grande perda oncológica: relato de caso

Introduction: Squamous cell carcinoma (SCC) is a malignant epidermal keratinocyte tumor closely related to sun exposure. When diagnosed, through biopsy, its staging, tumor resection with oncological safety margins must be performed, and lymph node dissection and treatment of metastases, if present, may be performed. Case Report: Skin traction is reported as a complement to the parascapular flap, used reconstructively after the excision of a large SCC in the left shoulder. Conclusion: The technique used proved effective for the satisfactory correction of large dehiscence in the postoperative period of the parascapular flap, promoting partial closure of the defect, reduced time to perform, and correction of the residual defect in a single step.

Introdução: O carcinoma espinocelular (CEC) é um tumor maligno dos queratinócitos epidérmicos e está intimamente relacionado à exposição solar. Quando diagnosticado, por meio de biópsia, deve ser realizado seu estadiamento, ressecção tumoral com margens de segurança oncológica, podendo ser feito esvaziamento ganglionar e tratamento de metástases, caso presentes. Relato de Caso: Reporta-se a utilização da tração cutânea como complemento ao retalho paraescapular, utilizado reconstrutivamente pós excisão de CEC de grande dimensão em ombro esquerdo. Conclusão: A técnica utilizada mostrou-se eficaz para correção satisfatória de grandes deiscências em pós-operatório de retalho paraescapular, promovendo fechamento parcial do defeito, tempo reduzido para realização e correção do defeito residual em tempo único.

[Celestina, SUS and Sertão: a therapy clown experiment in popular education in health]. / Celestina, SUS e Sertão: uma experiência de palhaçaria na educação popular em saúde.

The scope of this paper is to elicit reflection on therapy clowns in the realm of Popular Education in Health. It describes and analyzes interventions conducted between October 2020 and December 2021 between civil service workers and patients in the Sertão Central hinterlands. Therapy clowning paved the way as a potent technology for humanized care treatment by the resident nurse. As an intermediary between scientific and popular knowledge, in its scenopoetic approach, it dealt creatively and humorously with taboo subjects for community health, promoting a light-hearted interaction experience with its audience. The experience revealed some points about the scarcity of investment to make projects like this viable, thereby empowering the institutionalization of Popular Education in Health. For this reason, we advocate the implementation of training sessions and workshops on concepts, challenges, and potentialities in Popular Education in Health. Therapy clowning, as a proposed action, is a transformative technology that inspires a proactive approach in the community through knowledge, loving care, and art.

Objetivo de promover reflexão sobre a palhaçaria, à luz da Educação Popular em Saúde. Descreve e analisa intervenções realizadas entre outubro de 2020 e dezembro de 2021, com usuários e servidores públicos no Sertão Central. A palhaça abriu alas para a territorialização e se mostrou potente tecnologia para uma atuação humanizada da enfermeira residente. Como interlocutora entre o saber científico e o popular, em sua corporalidade cenopoética, lidava de forma criativa e leve com assuntos tabus para a saúde comunitária, promovendo uma educação problematizadora e dialógica com seu público. A experiência fez-nos refletir nas lacunas de investimentos para viabilizar projetos como esse, fortalecendo a institucionalização da Educação Popular em Saúde. Assim, defendemos a implementação de formações e oficinas sobre conceitos, desafios e potencialidades da Educação Popular em Saúde. A palhaçaria, como proposta de atuação, é tecnologia transformadora que inspira o protagonismo à comunidade por meio de conhecimento, cuidado amoroso e arte.

Celestina, SUS e Sertão: uma experiência de palhaçaria na educação popular em saúde / Celestina, SUS and Sertão: a therapy clown experiment in popular education in health

Resumo Objetivo de promover reflexão sobre a palhaçaria, à luz da Educação Popular em Saúde. Descreve e analisa intervenções realizadas entre outubro de 2020 e dezembro de 2021, com usuários e servidores públicos no Sertão Central. A palhaça abriu alas para a territorialização e se mostrou potente tecnologia para uma atuação humanizada da enfermeira residente. Como interlocutora entre o saber científico e o popular, em sua corporalidade cenopoética, lidava de forma criativa e leve com assuntos tabus para a saúde comunitária, promovendo uma educação problematizadora e dialógica com seu público. A experiência fez-nos refletir nas lacunas de investimentos para viabilizar projetos como esse, fortalecendo a institucionalização da Educação Popular em Saúde. Assim, defendemos a implementação de formações e oficinas sobre conceitos, desafios e potencialidades da Educação Popular em Saúde. A palhaçaria, como proposta de atuação, é tecnologia transformadora que inspira o protagonismo à comunidade por meio de conhecimento, cuidado amoroso e arte.

Abstract The scope of this paper is to elicit reflection on therapy clowns in the realm of Popular Education in Health. It describes and analyzes interventions conducted between October 2020 and December 2021 between civil service workers and patients in the Sertão Central hinterlands. Therapy clowning paved the way as a potent technology for humanized care treatment by the resident nurse. As an intermediary between scientific and popular knowledge, in its scenopoetic approach, it dealt creatively and humorously with taboo subjects for community health, promoting a light-hearted interaction experience with its audience. The experience revealed some points about the scarcity of investment to make projects like this viable, thereby empowering the institutionalization of Popular Education in Health. For this reason, we advocate the implementation of training sessions and workshops on concepts, challenges, and potentialities in Popular Education in Health. Therapy clowning, as a proposed action, is a transformative technology that inspires a proactive approach in the community through knowledge, loving care, and art.

Correlação entre o escore SAME-TT2R2 e o polimorfismo VKORC1: C. 174-136C>T (RS9934438) como preditores da qualidade da anticoagulação entre pacientes idosos brasileiros usuários de varfarina / Correlation between the SAME-TT2R2 score and the VKORC1:C.174-136C>T (RS9934438) polymorphism as predictors of anticoagulation quality among elderly Brazilian patients using warfarin

INTRODUÇÃO: A varfarina é um anticoagulante utilizado na prevenção e tratamento de doenças tromboembólicas. Nos idosos, a principal indicação é fibrilação atrial. O exame mais utilizado para controle da anticoagulação é o tempo de protrombina, através do cálculo da razão normalizada internacional (RNI), na faixa 2-3, que requerem um monitoramento especial devido a idade, dificuldades na adesão, polimedicação ou comorbidades. Embora seja conhecido que os fatores genéticos influenciam na resposta terapêutica, na maioria dos hospitais a farmacogenética ainda não é considerada no cálculo de ajuste de dose. Portadores do genótipo rs9934438 AA requerem menor dose comparado com genótipo AG ou GG. O escore SAMe- -TT2R2 obtido por meio de algumas variáveis visa predizer quais os pacientes em uso de varfarina atingirão taxas de INR aceitáveis e, por consequência, um tempo na faixa terapêutica (TFT) adequado. Apostolakis, propuseram e validaram o escore SAMe-TT2R2 (S=sexo; A =idade OBJETIVO: Visando estabelecer uma conduta terapêutica personalizada, o presente estudo tem como objetivo avaliar correlação entre o polimorfismo rs9934438 do gene VKORC1 e correlaciona-lo com o escore SAME-TT2R2 na predição da qualidade da anticoagulação em uso de varfarina. MÉTODOS e RESULTADOS: Foram incluídos 29 pacientes, idade de 81,72 (±4,07), de ambos os sexos e em uso de varfarina. A análise do polimorfismofoi realizada através da PCR em tempo real utilizando os reagentes do kit TaqMan™ Sample-to-SNP™ e o sistema de detecção TaqMan® SNP Genotyping Assay. As análises estatísticas foram realizadas utilizando o pacote SPSS v. 16.0 e nível de significância adotado foi de 5% e o Escore SAME-TT2R2 foi calculado após entrevista. Os Escores Chadsvasc2 = 4,34 (±1,17), Hasbled = 2,24 (±0,68) e SAME-TT2R2 = 2,31(±1,28), a dose semanal variou de 10 a 55 mg. Apesar de ser um estudo piloto, com baixo amostra, a distribuição dos genótipos está em equilíbrio gênico, segundo Hardy-Weinberg (AA=24,3%, AG=41,3%, GG= 34,4%). Os portadores do genótipo AA necessitaram de menor dose para atingir a TFT quando comparados aos portadores do genótipo GG: 26,6 versus 39,7 mg/semana, corroborando o resultado do SAME-TT2R2 = 2 no grupo AA comparado ao GG que foi de 3. CONCLUSÃO: Os resultados mostram que o polimorfismo rs9934438 está associado com a dose semanal de varfarina administrada aos pacientes idosos de pelo menos 30% e com correspondência ao Escore SAME-TT2R2 que demostrou um índice menor.