Human Papillomavirus and Coronary Artery Disease in Climacteric Women: Is There an Association?

BACKGROUND: Cardiovascular diseases are leading causes of death worldwide. Recent studies suggest that infection by some viruses, including the human papillomavirus (HPV), may increase the risk of developing atheromatous lesions on coronary arteries. However, there is a lack of data regarding the possible association between HPV infection and coronary artery disease (CAD) in women. OBJECTIVE: To investigate whether HPV infection is associated with the occurrence of CAD among climacteric women. METHODS: The presence of CAD and cervical HPV DNA was investigated in 52 climacteric women. Social and demographic variables and metabolic profiles were also investigated. RESULTS: Among 27 women with CAD, 16 were positive for HPV, whereas 11 were negative. The presence of cervical HPV was strongly associated with CAD, after adjusting for demographic variables, health and sexual behaviors, comorbidities, and known cardiovascular risk factors. HPV-positive women showed a greater likelihood of having CAD (odds ratio [OR] = 3.74; 95% confidence interval [CI]: 1.16 to 11.96) as compared with HPV-negative women, particularly those infected with high-risk HPV types (OR = 4.90; 95% CI: 1.26 to 19.08). CONCLUSION: These results support the hypothesis that HPV infection might be associated with CAD among climacteric women, though further studies are needed to investigate the mechanisms involved.

Fatal Myocarditis following COVID-19 mRNA Immunization: A Case Report and Differential Diagnosis Review.

Carditis in childhood is a rare disease with several etiologies. We report a case of infant death due to pericarditis and myocarditis after the mRNA vaccine against COVID-19 (COVIDmRNAV). A 7-year-old male child received the first dose of the COVIDmRNAV and presented with monoarthritis and a fever non-responsive to oral antibiotics. The laboratory investigation showed signs of infection (leukocytosis, high levels of c-reactive protein). His condition rapidly deteriorated, and the patient died. The autopsy identified pericardial fibrin deposits, hemorrhagic areas in the myocardium, and normal valves. A diffuse intermyocardial inflammatory infiltrate composed of T CD8+ lymphocytes and histiocytes was identified. An antistreptolysin O (ASO) dosage showed high titers. The presence of arthritis, elevated ASO, and carditis fulfills the criteria for rheumatic fever. However, valve disease and Aschoff's nodules, present in 90% of rheumatic carditis cases, were absent in this case. The temporal correlation with mRNA vaccination prompted its inclusion as one of the etiologies. In cases of myocardial damage related to COVID-19mRNAV, it appears to be related to the expression of exosomes and lipid nanoparticles, leading to a cytokine storm. The potential effects of the COVID-19mRNAV must be considered in the pathogenesis of this disease, whether as an etiology or a contributing factor to a previously initiated myocardial injury.

Cyclin D1 expression in penile cancer.

The main goal of the present study was to analyze the expression profile of cyclin D1 in patients with PC, and to determine possible correlations with clinical and histopathological features. A survey was conducted with 100 patients diagnosed with PC, who were treated at two reference hospitals in São Luís, Maranhão, Brazil, between 2013 and 2017. A review of clinical, epidemiological, and histopathological data was performed, Human Papillomavírus (HPV) DNA was detected using polymerase chain reaction (PCR) and cyclin D1 expression analysis was performed using immunohistochemical techniques. The data revealed that the absence of cyclin D1 expression was significantly associated with HPV-positive histological subtypes (p = 0.001), while its expression was associated with high-grade tumors (p = 0.014), histological subtype (p = 0.001), presence of sarcomatoid transformation (p = 0.04), and perineural invasion (p = 0.023). Patients with cyclin D1 expression exhibited lower disease-free survival compared to the cyclin D1-negative group, although the difference was not statistically significant. The results suggest that cyclin D1 may be a potential biomarker for PC, especially for poorer prognosis.

What is the role of circRNAs in the pathogenesis of cervical cancer? A systematic literature review.

Cervical Cancer (CC) is one of the most prevalent neoplasms among women, considered the leading cause of gynecological death worldwide, and the fourth most common type of cancer. Regional metastasis is closely related to the low effectiveness of treatment, and validating biomarkers can optimize accuracy in diagnosis and prognosis. Among the potential biomarkers associated with disease metastasis are circular RNAs (circRNAs), whose altered expression has been linked to CC progression. In this context, this systematic review aims to compile information on the clinical-pathological significance and describe the biological function of circRNAs. Inclusion and exclusion criteria were used to include relevant literature, followed by in silico analysis. Additionally, we employed the UALCAN tools to search for host genes of circRNAs and expression data, miRTargetLink 2.0 to predict interactions of microRNA target genes and the Cytoscape software to predict possible interactions of microRNA target genes. According to the research, most circRNAs were found to be overexpressed and described as regulators of processes such as invasion, cell proliferation, apoptosis and migration. They were also implicated in clinical significance, including metastasis, TNM staging and microRNA interactions. CircRNAs may participate in critical processes in tumorigenesis; therefore, understanding the underlying molecular mechanisms of gene regulation in CC can contribute to the accuracy of diagnosis, prognosis and therapy.

Association analysis of human leukocyte antigen class II (DRB1) alleles with leprosy in individuals from São Luís, state of Maranhão, Brazil.

Epidemiological studies have demonstrated that the variability of the clinical response to infection caused by Mycobacterium leprae is associated with host genetic factors. The present study investigated the frequency of human leukocyte antigen (HLA) class II (DRB1) alleles in patients with leprosy from São Luís, Maranhão, Brazil. A case-control study was performed in 85 individuals with leprosy and 85 healthy subjects. All samples were analysed via polymerase chain reaction-sequence specific oligonucleotide probes. The HLA-DRB1*16 allele showed a higher frequency in the group with leprosy [(9.41% vs. 4.12%) odds ratio (OR) = 2.41 95% confidence interval (CI) (0.96-6.08) p = 0.05], whereas the HLA-DRB1*11 allele was less frequent in the group with leprosy [(6.47% vs. 11.76%) OR = 0.51 95% CI (0.23-1.12) p = 0.09]. The frequency of HLA-DRB1* alleles between the control group and leprosy patient subgroups presenting different forms of the disease showed that the HLA-DRB1*16 (16.13% vs. 8.24%, OR = 4.10, CI = 1.27-13.27, p = 0.010) and HLA-DRB1*14 (5% vs. 3.53%, OR = 4.63, CI = 1.00-21.08, p = 0.032) alleles were significantly more frequent in patients with different clinical subtypes of leprosy. The sample size was a limitation in this study. Nevertheless, the results demonstrated the existence of a genetic susceptibility associated with the clinical forms of leprosy. The low frequency of the HLA-DRB1*11 allele should be further studied to investigate the possible protective effect of this allele.

Primary Leiomyosarcoma of the Glans.

Penile leiomyosarcoma isz an extremely uncommon entity that rarely occurs in the glans. Due to the limited number of cases described in literature, guidelines regarding non-surgical treatment, prognosis, and management remain equivocal. Among the mesenchymal tumors of the penis, leiomyosarcoma has the highest propensity for recurrence. It originates in the smooth muscle cells from two distinct locations: superficial and deep. The deep subtype is the most aggressive and has the highest potential for metastasis. Surgical treatment should be implemented early and must be locally aggressive. Herein, we present a rare case of a 54-year-old patient with deep localized leiomyosarcoma of the glans, albeit with superficial characteristics. A review of the main histopathological, clinical, immunohistochemical, and therapeutic aspects of this unusual entity is presented.

Early application of Global Subjective Evaluation Produced by the Patient and survival in patients with cancer.

INTRODUCTION: Introduction: malnutrition is a frequent event in cancer, and unless identified early, it can lead to progressive functional impairment of the organism. Objective: to associate the early application of the Global Subjective Evaluation Produced by the Patient (GSEPP) to the time of hospitalization and death in cancer patients. Methods: a cross-sectional, analytical study carried out between July and September 2014 in patient records (> 20 years) with cancer, with hospitalization for more than three days in a reference cancer hospital. Age, sex, origin, disease location, antineoplastic treatment, length of stay and application of GSEPP, type of discharge, weight loss in one and six months, body mass index (BMI) and GSEPP score were collected. Results: three hundred and sixty-six patients were evaluated: 51.6% women, 54.9% adults, 27.6% tumors of the digestive tract, 11.5% with metastasis, 21.9% of deaths and 40.4% with hospitalization time greater than or equal to ten days. The length of hospital stay was statistically lower in the early application of GSEPP (11.4 ± 1.5 vs 23.3 ± 1.3 days). The delay in the application of GSEPP was positively correlated with the increase in length of hospital stay, the GSEPP score, as well as malnutrition by BMI and weight loss in one and six months. Conclusion: early application of GSEPP was associated with improvements in the parameters of malnutrition, shorter hospitalization time, but not mortality. Measures that abbreviate its application should be taken to awaken the importance and the impact of this instrument in the health of the evaluated patient.

INTRODUCCIÓN: Introducción: la desnutrición es un acontecimiento frecuente en el cáncer. Si no se identifica precozmente puede provocar el compromiso funcional progresivo del organismo. Objetivo: asociar la aplicación precoz de la Evaluación Subjetiva Global Producida por el Paciente (ASGPPP) al tiempo de internación y muerte en pacientes con cáncer. Métodos: estudio transversal, analítico, realizado entre julio y septiembre de 2014 en historiales de pacientes (> 20 años) con cáncer, con ingreso superior a tres días en un hospital de referencia en cáncer. Se recogieron los siguientes datos: edad, sexo, procedencia, localización de la enfermedad, tratamiento antineoplásico, tiempo de internación y de aplicación de la ASGPPP, tipo de alta, pérdida de peso al mes y seis meses, índice de masa corporal (IMC) y puntaje de la ASGPPP. Resultados: trescientos sesenta y seis pacientes: el 51,6% mujeres, el 54,9% adultos, el 27,6% con tumores del tracto digestivo, el 11,5% con metástasis, con un 21,9% de óbitos y un 40,4% de casos con tiempo de internación mayor o igual a diez días. El tiempo de ingreso fue estadísticamente menor en la aplicación precoz de la ASGPPP (11,4 ± 1.5 vs. 23,3 ± 1,3 días). La demora en la aplicación de la ASGPPP se correlacionó positivamente con el aumento del tiempo de internación, la puntuación de la ASGPPP, así como, la desnutrición medida mediante por IMC y la pérdida de peso al mes y a los seis meses. Conclusión: la aplicación precoz de la ASGPPP se asoció con mejoras de los parámetros de desnutrición y menor tiempo de internación, pero no con la mortalidad. Se deben tomar medidas que abrevien su aplicación para reforzar la importancia y el impacto de este instrumento en el pronóstico del paciente evaluado.

Cuidado de Enfermagem e sexualidade em oncologia para o indivíduo penectomizado / Nursing care and sexuality in Oncology for penectomized individuals / Cuidado de Enfermería y sexualidad en oncología para el individuo que sufrió penectomía

Objetivo: proporcionar reflexões sobre o cuidado de enfermagem com abordagem à sexualidade para a saúde do homem penectomizado por câncer de pênis. Conteúdo: corresponde a estudo reflexivo construído a partir de leituras em produções científicas sobre o cuidado de Enfermagem e a sexualidade para o paciente oncológico penectomizado, à luz dos pensamentos e pressupostos ontológicos e teóricos de Martin Heidegger. Considerações finais: as novas condições impostas pelo adoecimento por câncer de pênis e o tratamento mutilador, a penectomia, exigem uma Enfermagem que aborde a sexualidade, considerando o indivíduo em sua totalidade e com ênfase no cuidado com perspectiva na profundidade e subjetividade existenciais humanas(AU)

Objective: to provide reflections on nursing care with an approach to sexuality for the health of men undergoing penectomy for penile cancer. Content: reflective study developed from readings in scientific productions on Nursing care and sexuality for the penectomized cancer patient, in the light of Martin Heidegger's ontological and theoretical thoughts and assumptions. Final considerations: the new conditions imposed by illness from penile cancer and the mutilating treatment, penectomy, require Nursing that addresses sexuality, considering the individual in its entirety and with an emphasis on care with a perspective on human existential depth and subjectivity(AU)

Objetivo: proporcionar reflexiones sobre el cuidado de Enfermería con abordaje a la sexualidad para la salud del hombre que sufrió penectomía por cáncer de pene. Contenido: corresponde a estudio reflexivo construido a partir de lecturas en producciones científicas sobre el cuidado de Enfermería y la sexualidad para el paciente oncológico que sufrió penectomía, a la luz de los pensamientos y presupuestos ontológicos y teóricos de Martin Heidegger. Consideraciones finales: las nuevas condiciones impuestas por la enfermedad por cáncer de pene y el tratamiento mutilador, la penectomía, exigen una Enfermería que aborde la sexualidad, considerando al individuo en su totalidad y con énfasis en el cuidado con perspectiva en la profundidad y subjetividad existenciales humanas(AU)

Hemorragia pós-parto: estratégias para qualificação do cuidado / Postpartum hemorrhage: strategies for qualifying care / Hemorragia posparto: estrategias para la atención calificada

Objetivo: relatar a experiência de construção de um kit emergencial e de um fluxograma que oriente a atuação profissional, como tecnologia em saúde na hemorragia pós-parto. Método: trata-se de um estudo qualitativo, descritivo, a partir de um relato de experiência vivenciado no centro de parto de uma maternidade no Maranhão. Utilizou-se o Arco de Problematização de Maguerez para orientação metodológica. Resultados: a assistência da equipe de saúde se mostrou fragmentada, apontando-se a falta de liderança frente à Hemorragia pós-parto. A elaboração das tecnologias tornou a assistência mais eficaz, e a equipe com maior potencial. Conclusão: tornou-se importante a realização de capacitações e treinamentos para a equipe de saúde com a finalidade de melhorar a qualidade da assistência prestada à mulher e ao recém-nascido.

Objective: to report the experience of building an emergency kit and a flowchart that guides professional action, as a health technology in postpartum hemorrhage. Method: this is a qualitative, descriptive study, based on an experience report at the birth center of a maternity hospital in Maranhão. Maguerez's Problematization Arc was used for methodological guidance. Results: the health team's assistance was fragmented, highlighting a lack of leadership in the face of postpartum hemorrhage. The development of technologies has made assistance more effective and the team with greater potential. Conclusion: it has become important to carry out training and qualifications for the health team in order to improve the quality of care provided to women and newborns.

Objetivo: relatar la experiencia de construcción de un botiquín de emergencia y un diagrama de flujo que orienta la acción profesional, como tecnología de salud en la hemorragia posparto. Método: se trata de un estudio cualitativo, descriptivo, basado en un relato de experiencia en la casa de parto de una maternidad de Maranhão. Se utilizó el Arco de Problematización de Maguerez como guía metodológica. Resultados: la asistencia del equipo de salud fue fragmentada, destacándose falta de liderazgo ante la hemorragia posparto. El desarrollo de las tecnologías ha hecho que la asistencia sea más eficaz y el equipo con mayor potencial. Conclusión: se ha vuelto importante realizar capacitación y capacitación del equipo de salud para mejorar la calidad de la atención brindada a la mujer y al recién nacido.

Association between pathogens from tracheal aspirate and oral biofilm of patients on mechanical ventilation.

The aim of this study was to detect possible associations between respiratory pathogens from tracheal aspirate and oral biofilm samples in intubated patients in an intensive care unit (ICU), and to identify the most common respiratory pathogens in oral biofilm, particularly in patients that developed ventilator-associated pneumonia (VAP). Two oral biofilm samples were collected from the tongue of intubated patients (at admission and after 48 hours) and analyzed by culture with the Antibiotic Sensitivity Test. The results from the tongue biofilm samples were compared with the tracheal secretions samples. A total of 59.37% of patients exhibited the same species of pathogens in their tracheal aspirate and oral biofilm, of which 8 (42.1%) developed VAP, 10 (52.63%) did not develop pneumonia and one (5.26%) had aspiration pneumonia. There was a statistically significant association between presence of microorganisms in the tracheal and mouth samples for the following pathogens: Klebsiella pneumoniae, Candida albicans, Pseudomonas aeruginosa, Enterobacter gergoviae, Streptococcus spp and Serratia marcescens (p < 0.05). Pathogens that are present in tracheal aspirates of intubated patients can be detected in their oral cavity, especially in those who developed VAP or aspiration pneumonia. Thus, the results indicate that an improved oral care in these patients could decrease ICU pneumonia rates.

Knowledge and perceptions on toxoplasmosis among pregnant women and nurses who provide prenatal in primary care.

BACKGROUND: Toxoplasmosis is an infection that affects almost a third of the world population. In adults, it is often asymptomatic, although having important manifestation in children- infected by placental transmission. The prenatal is an important moment, requiring actions in women's care during pregnancy, in order to prevent diseases that could compromise the mother and the child's life. METHODS: This is a descriptive study of qualitative approach aimed to understand the perception of nurses and pregnant women about toxoplasmosis during primary - prenatal care. The study was conducted in five selected primary health care units, in the municipality of São Luis - MA. The sample consisted of 15 nurses working in nursing consultation and 15 pregnant women attended in prenatal care. For data collection, a semi-structured questionnaire and an interview guide covering issues related to knowledge and conduct on toxoplasmosis were used. For analysis, the content analysis technique was used. RESULTS: The answers were transcribed, organized and grouped thematically, where the following categories emerged: knowledge about examination requests; knowledge about toxoplasmosis; guidance during prenatal consultation; knowledge of nurses about the avidity test; procedures and guidelines on reagent cases. Pregnant women showed unawareness about toxoplasmosis and its effects. Nurses, although having basic knowledge about the subject, showed little applicability regarding pregnant women's guidance. CONCLUSION: The nurse plays an important role in educational activities regarding pregnant women, contributing to the quality of prenatal care. Pregnant women were shown to have some knowledge about toxoplasmosis, although they said they did not have assurance about prevention.

Knowledge of adolescents regarding sexually transmitted infections and pregnancy.

OBJECTIVE:: To investigate the knowledge of adolescents related to sexually transmitted infections (STIs), AIDS, and pregnancy, and understand the role of school in sex education. METHOD:: A qualitative descriptive study, developed through a semi-structured interview and a form for participant characterization, with 22 high school students from a public school aged 16 to 19 years. Data were submitted to content analysis. RESULTS:: After analysis, four thematic categories were developed: sexuality and sex education; understanding of risk behaviors; knowledge of STI/AIDS; and knowledge of and practices for prevention. FINAL CONSIDERATIONS:: This study showed the need for preventive educational actions for adolescents, because the lack of information contributes to their vulnerability. The adolescents recognize the importance of sex education; therefore it is important to implement strategies to promote and protect health in the school environment to encourage and strengthen self-care in health. OBJETIVO:: investigar o conhecimento de adolescentes relacionado às Infecções Sexualmente Transmissíveis (IST), AIDS e gravidez, além de conhecer a compreensão sobre o papel da escola na educação sexual. MÉTODO:: estudo qualitativo, descritivo, desenvolvido por meio de entrevista semiestruturada e formulário para caracterização dos participantes, com 22 adolescentes entre 16 e 19 anos de idade, estudantes do Ensino Médio em uma escola pública. Os dados foram submetidos à análise de conteúdo. RESULTADOS:: da análise emergiram quatro categorias temáticas: Sexualidade e educação sexual; Compreensão de comportamentos de risco; Conhecimento de IST/AIDS; Conhecimento e práticas de prevenção. CONSIDERAÇÕES FINAIS:: revelou-se a necessidade de ações educativas de prevenção para os adolescentes, pois a falta de informações contribui para a sua vulnerabilidade. Os adolescentes reconhecem a importância da educação sexual; consequentemente, é importante a implementação de estratégias de promoção e de proteção à saúde no ambiente escolar para contribuir e fortalecer o autocuidado na saúde.

Hanseníase em menores de 15 anos: caracterização sociodemográfica e clínica dos casos em um município hiperendêmico / Hansen`s disease in children under 15 years old: sociodemographic and clinical characterization of the cases in a hyperendemic municipality / La lepra en menores de 15 años: caracterización sociodemográfica y clínica de los casos en un municipio hiperendémico

RESUMO Objetivo: analisar o perfil sociodemográfico e clínico dos casos notificados de hanseníase em menores de 15 anos, no município de São Luís - Maranhão - Brasil. Método: estudo descritivo realizado com 826 casos notificados no Sistema de Informação de Agravos de Notificação, em São Luís - Maranhão, no período de 2010 a 2019. Os dados foram analisados por meio de estatística descritiva e foram expressos em frequências absolutas e relativas. Resultados: faixa etária entre 10 e 14 anos (60,29%), masculino (51,09%), cor parda (69,59%), ensino fundamental incompleto (39,58%), multibacilar (62,71%), forma clínica dimorfa (54,24%), até cinco lesões (74,45%), zero a dois nervos afetados (83,23%), sem baciloscopia (46,28%), casos novos (93,70%), demanda espontânea (46,38%) e grau zero de incapacidade no diagnóstico (78,98%). Conclusão: foram demostrados parâmetros hiperendêmicos com elevado risco para a doença. Destaca-se a importância de criar estratégias de controle e prevenção para reduzir a transmissão da hanseníase em crianças.

ABSTRACT Objective: to analyze the sociodemographic and clinical profile of reported cases of Hansen´s disease in children under 15 years old in the municipality of São Luís - Maranhão - Brazil. Method: descriptive study conducted with 826 cases reported in the Notifiable Diseases Information System, in São Luís - Maranhão, in the period from 2010 to 2019. Data were analyzed using descriptive statistics and were expressed in absolute and relative frequencies. Results: age group between 10 and 14 years (60.29%), male (51.09%), brown (69.59%), incomplete elementary education (39.58%), multibacillary (62.71%), dimorphic clinical form (54.24%), up to five lesions (74.45%), zero to two nerves affected (83.23%), no bacilloscopic (46.28%), new cases (93.70%), spontaneous demand (46.38%) and zero degree of disability at diagnosis (78.98%). Conclusion: hyper-endemic parameters with high risk for the disease were demonstrated. It is important to create control and prevention strategies to reduce Hansen´s disease transmission in children.

RESUMEN Objetivo: analizar el perfil sociodemográfico y clínico de los casos notificados de lepra en niños menores de 15 años, en el municipio de São Luís - Maranhão - Brasil. Método: estudio descriptivo realizado con 826 casos notificados en el Sistema de Información de Enfermedades de Declaración Obligatoria, en São Luís - Maranhão, en el período de 2010 a 2019. Los datos se analizaron mediante estadísticas descriptivas y se expresaron en frecuencias absolutas y relativas. Resultados: edad entre 10 y 14 años (60,29%), sexo masculino (51,09%), color marrón (69,59%), educación elemental incompleta (39,58%), multibacilar (62,71%), forma clínica dimórfica (54,24%), hasta cinco lesiones (74,45%), de cero a dos nervios afectados (83,23%), sin baciloscopia (46,28%), casos nuevos (93,70%), demanda espontánea (46,38%) y cero grado de discapacidad en el momento del diagnóstico (78,98%). Conclusión: se demostraron parámetros hiperendémicos con alto riesgo de enfermedad. Destaca la importancia de crear estrategias de control y prevención para reducir la transmisión de la lepra en los niños.

Temporal relationship between rainfall, temperature and occurrence of dengue cases in São Luís, Maranhão, Brazil.

This study analyzed the relationship between rainfall, temperature and occurrence of dengue cases. Ecological study performed with autochthonous dengue cases reported during 2003 to 2010 in São Luís, Maranhão. Data of rainfall and temperature were collected monthly. The monthly incidence of dengue cases was calculated by year/100,000 inhabitants. In order to identify the influence of climate variables and dengue cases different distributed lag models using negative binomial distribution were considered. Model selection was based on the lowest AIC (Akaike Information Criterion). Thirteen thousand, four hundred forty-four cases of dengue between 2003 and 2010 were reported, with peaks in 2005, 2007 and 2010. The correlation between rainfall and the occurrence of dengue cases showed increase in the first months after the rainy months. Occurrence of dengue cases was observed during all the period of study. Only rainfall-lag per three months showed a positive association with the number of cases dengue. Thus, this municipality is considered as an endemic and epidemic site. In addition, the relation between rainfall and dengue cases was significant with a lag of three months. These results should be useful to the future development of politics healthy for dengue prevention and control.

Cenário da educação superior à distância em saúde no Brasil: a situação da Enfermagem / Escenario de la educación superior a distancia en salud en Brasil: situación de la Enfermería / Scenario of distance higher education in health in Brazil: the situation of Nursing

Resumo Objetivo Analisar a oferta dos cursos de graduação em saúde na modalidade de Ensino a Distância no Brasil, destacando suas principais características para Enfermagem. Método Estudo transversal baseado em dados on line de cursos de graduação em saúde a distância, criados entre 2005 e 2020. Para doze graduações em saúde, destacaram-se características da criação e distribuição do ensino a distância, enfatizando-se a situação da Enfermagem. Realizaram-se testes de significância estatística (α=5%) e mapa. Resultados Verificaram-se 431 cursos de graduação em saúde, sendo a maioria deles criados entre 2017 e 2020 (≥61,4%). Para Enfermagem, o período de maior criação foi anterior (entre 2013 e 2016; 72,7%) (p=0,001). Todos os cursos eram vinculados a instituições privadas, que ofertavam 82.000 vagas, distribuídas em 1.363 Polos por todos os estados. Verificou-se predomínio em São Paulo (23,9%) e nas cidades localizadas no interior dos estados (64,3%) (p=0,001). Conclusão e implicações para prática Houve aumento significativo de cursos de graduação em saúde no ensino a distância no Brasil. Para Enfermagem, estes se caracterizaram por oferta privada e localizada no interior dos estados. Contudo, a distribuição regional ainda é desigual, concentrando Polos nas regiões mais ricas e centrais do país, e longe das áreas com maiores necessidades de saúde.

Resumen Objetivo Analizar la oferta de estudios superiores en salud bajo la modalidad de Educación a Distancia en Brasil, destacando sus principales características para Enfermería. Método Estudio transversal a partir de datos en línea de las carreras de grado en salud a distancia, creadas entre 2005 y 2020. Para doce titulaciones de salud se destacaron características de la creación y distribución de la educación a distancia, destacando la situación de Enfermería. Se realizaron pruebas de significación estadística (α = 5%) y mapa. Resultados Se detectaron 431 carreras de grado en salud, la mayoría de las cuales se crearon entre 2017 y 2020 (≥61,4%). Para Enfermería, el período de mayor creación fue anterior (entre 2013 y 2016; 72,7%) (p = 0,001). Todos los cursos estuvieron vinculados a instituciones privadas, que ofrecieron 82.000 plazas, distribuidas en 1.363 centros en todos los estados. Se registró predominio de cursos en São Paulo (23,9%) y en ciudades del interior de los estados (64,3%) (p = 0,001). Conclusión e implicaciones para la práctica Se advierte un aumento significativo en los cursos de pregrado en salud en educación a distancia en Brasil. Para Enfermería, estos se caracterizaron por una oferta privada ubicada en el interior de los estados. Sin embargo, la distribución regional sigue siendo desigual, concentrada en las regiones más ricas y céntricas del país, y lejos de las áreas con mayores necesidades de salud.

Abstract Objective To analyze the offer of undergraduate health courses in the Distance Learning modality in Brazil, highlighting its main characteristics for Nursing. Method This is a cross-sectional study based on distance health undergraduate courses online data, created between 2005 and 2020. For twelve health degrees, characteristics of the creation and distribution of distance learning were highlighted, emphasizing Nursing courses. Statistical significance tests (α = 5%) and mapping were performed. Results There were 43 undergraduate courses in health, most of which were created between 2017 and 2020 (≥61.4%). For Nursing, most courses were created in earlier years (2013 and 2016; 72.7%) (p = 0.001). The courses were linked to private institutions, which offered 82,000 seats and are distributed in 1,363 hubs across all states. Courses predominated in São Paulo (23.9%) and non-capital cities (64.3%) (p = 0.001). Conclusion and implications for the practice There has been a significant increase in distance education in Brazil's undergraduate health courses. For Nursing, the courses were characterized by private offers located in non-capital cities. However, the regional distribution is still uneven, concentrating hubs in the country's richest and most central regions and away from areas with the greatest health needs.

Aspects of dental care for patients hospitalized in a medical clinic from a university hospital / Aspectos da assistência odontológica a pacientes internados em clínica médica de um hospital universitário

INTRODUCTION: The current context of multiprofessional approach in health is based on quality of care and patient safety, with the key contribution of the dentist in the hospital team to improve the health of hospitalized patients. OBJECTIVE: To characterize the systemic and buccal profile of patients treated in a medical clinic of a University Hospital from the Brazilian Public Health System, aiming to provide information for guiding dental care in the multidisciplinary attendance in the hospital setting. METHODS: Retrospective observational study carried out on 104 clinical records with data collection about general characteristics, systemic alterations, habits, oral situation and dental treatments of hospitalized patients attended by the dentist. RESULTS: There was a high frequency of hypertensive patients (36.5%) and with cardiac problems (33.6%). A significant association between diabetes (60%) and hypertension (50%) in the age group from 60 to 75 years of age was observed. For most patients, the frequency of oral hygiene was less than three times a day (54.3%), without flossing (85.7%). Biofilm (73.3%), dental calculus (70.5%), prosthesis use (25.7%), with poor hygiene (14.3%) and prosthetic stomatitis (8.6%) were recorded. Among the treatments performed by dentist, basic periodontal therapy (71.4%) and exodontia (39%) were noteworthy. CONCLUSION: The high frequency of biofilm presence, dental calculus, prosthesis with poor hygiene and basic periodontal therapy performed during the hospitalization denote the need for dental care with preventive activities.

INTRODUÇÃO: O contexto atual de abordagem multiprofissional em saúde fundamenta-se na qualidade do atendimento e segurança ao paciente, com contribuição importante do cirurgião-dentista na equipe hospitalar para melhoria de saúde dos hospitalizados. OBJETIVO: Caracterizar o perfil sistêmico e bucal de pacientes atendidos em clínica médica de um Hospital Universitário do Sistema de Saúde Pública do Brasil, visando fornecer subsídios no direcionamento da assistência odontológica ao atendimento multidisciplinar em âmbito hospitalar. MÉTODOS: Foi realizado estudo observacional retrospectivo em 104 fichas clínicas com coleta de dados sobre características gerais, alterações sistêmicas, hábitos, situação bucal e tratamentos odontológicos de pacientes internados, atendidos pelo odontólogo. RESULTADOS: Verificou-se alta frequência de pacientes hipertensos (36,5%) e com problemas cardíacos (33,6%). Observou-se associação significativa de diabetes (60%) e hipertensão (50%) na faixa etária de 60 a 75 anos de idade. Para a maioria dos pacientes, a higiene bucal foi realizada menos que três vezes ao dia (54,3%), sem uso de fio dental (85,7%). Biofilme (73,3%), cálculo dental (70,5%), uso de próteses (25,7%), com higiene deficiente (14,3%), e estomatite protética (8,6%) foram registradas. Dentre os tratamentos realizados, destacam-se a terapia básica periodontal (71,4%) e exodontias (39%). CONCLUSÃO: A alta frequência de presença de biofilme, cálculo dental, próteses com higiene deficiente e a terapia básica periodontal executada durante o período de internação denotam a necessidade de atuação odontológica com atividades preventivas.

Perfil clínico-epidemiológico da hanseníase em um município hiperendêmico / Clinical-epidemiological profile of leprosy in a hyperendemic municipality

Objetivo: caracterizar o perfil clínico e epidemiológico dos casos de hanseníase no município hiperendêmico de São Luís do Maranhão, Brasil. Metodologia: estudo epidemiológico, retrospectivo, descritivo e quantitativo. Utilizaram-se dados de pacientes com hanseníase, referentes ao período de 2014 a 2017, obtidos a partir da base de dados do Sistema de Informação de Agravos de Notificação, disponibilizados pelo Departamento de Informática do Sistema Único de Saúde. Resultados: no período analisado, notificaram-se 2.166 casos de hanseníase. Observou-se maior frequência no sexo feminino (53,4%) e na faixa etária de 15-59 anos (69,4%). Quanto aos aspectos clínicos, 62,1% eram da forma dimorfa, 77,8% classificados como multibacilar e 61,8% sem incapacidades físicas. Apresentaram algum grau de incapacidade 694 casos (32,0%). O diagnóstico da hanseníase ainda é realizado tardiamente devido à detecção da classificação multibacilar e forma clínica dimorfa, além da presença de incapacidade física no momento do diagnóstico. Conclusão: os resultados deste estudo sugerem a realização de novas pesquisas que explorem a necessidade de intensificação de estratégias de prevenção e controle da doença visando à eliminação da hanseníase como problema de saúde pública no município.

Objective: to characterize the clinical and epidemiological profile of leprosy cases in the hyperendemic municipality of São Luís do Maranhão, Brazil. Methodology: This is an epidemiological, retrospective, descriptive, and quantitative study. We used data from leprosy patients from 2014 to 2017 obtained from the database of the Information System for Notifiable Diseases, available by the Informatics Department of the Unified Health System. Results: In the analyzed period, we notified 2,166 leprosy cases. A higher frequency was observed in females (53.4%) and the 15-59 age group (69.4%). Regarding the clinical aspects, 62.1% were of the dimorphic form, 77.8% were classified as multibacillary and 61.8% without physical disabilities. In 694 cases (32.0%), there was some degree of disability. The diagnosis of leprosy is still made late, due to the detection of the multibacillary classification and the dimorphic clinical form, and to the presence of a physical disability at the time of diagnosis. Conclusion: the results of this study suggest new research that explores the need to intensify strategies for prevention and control of the disease aiming at the elimination of leprosy as a public health problem in the municipality.

[HLA alleles association and recurrent spontaneous abortion in a São Luis/Maranhão population, in Brazilian Northeastern region]. / Associação de alelos HLA e aborto espontâneo recorrente em uma população de São Luís/Maranhão, na região Nordeste do Brasil.

PURPOSE: To investigate the association of the HLA-A, -B and -DRB1 alleles with the occurrence of Recurrent Spontaneous Abortion. METHODS: A case-control study of 200 women aged 18 to 35 years, consisting of a convenience sample of 100 women who had idiopathic recurrent spontaneous abortion and 100 women without abortion and with two or more children. Peripheral blood genomic DNA was extracted from 500l of Buffy Coat stored at -20°C. HLA typing was performed by the PCR-SSOP method (Polymerase Chain Reaction - Specific Sequence of Oligonucleotides Probes, One Lambda(r), CA, USA). The regions of the amplified DNA were exon 2 and 3 for the A and B loci and only exon 3 for the DRB1 locus. The HLA FUSIONTM program (One Lambda, Canoga Park, CA, USA, version 3.0) was used for HLA-A, HLA-B and HLA-DRB1 genotyping. Absolute frequencies and percentages and calculation of mean and standard deviation were used for standard statistical analysis. The qualitative variables were compared by the χ2 test with Yates correction or by Fisher's exact test. The odds ratio with the 95%CI was used for the comparisons, with the level of significance set at p<0.05. RESULTS: The frequency of the A*34 allele was significantly higher in the case group compared to control (4.0 versus 0.5%; p<0.05). Alleles A*24 (6.0 versus 12.5%; p<0.05) and B*35 (8.0 versus 20.5%; p<0.05) were significantly less frequent in the case group. Among the class II alleles, DRB1*03 showed a slightly higher frequency in the case group (11.0 versus 5.5%, p = 0.056). CONCLUSIONS: It was shown that the HLA-A*34 allele is a risk factor for recurrent spontaneous abortion, while the HLA-A*24 and HLA-B*35 alleles are associated with protection, and no allele of the DRB1 locus was associated with RSA.

Estratégias de controle e vigilância de contatos de hanseníase: revisão integrativa / Strategies for control and surveillance of leprosy contacts: integrative review

RESUMO A pesquisa objetivou analisar as evidências científicas disponíveis sobre controle e vigilância epidemiológica de contatos de hanseníase. Trata-se de uma revisão integrativa norteada pela pergunta: qual a produção científica sobre controle e vigilância epidemiológica de contatos de hanseníase? Incluíram-se estudos primários, publicados em inglês, português ou espanhol nas bases de dados PubMed, Lilacs e Cinahl, entre 2008 e 2018, disponíveis na íntegra. A amostra foi composta por 19 estudos. Identificaram-se três categorias temáticas: fatores de risco para infecção e adoecimento entre os contatos de hanseníase, vigilância ativa de contatos de hanseníase e novas estratégias de controle e vigilância de contatos de hanseníase. Os resultados mostraram estudos voltados à prevenção e controle da hanseníase entre os contatos, entretanto, as evidências apontam novas estratégias que podem ser incorporadas à prática clínica visando à eliminação da hanseníase como problema de saúde pública no País.

ABSTRACT The objective of this research was to analyze the available scientific evidence on control and epidemiological surveillance of leprosy contacts. This is an integrative review guided by the question: what is the scientific production on control and epidemiological surveillance of leprosy contacts? Primary studies published in English, Portuguese, or Spanish in the PubMed, Lilacs, and Cinahl databases from 2008 to 2018, available in full, were included. The sample consisted of 19 studies. Three thematic categories were identified: risk factors for infection and illness among leprosy contacts, active surveillance of leprosy contacts, and new strategies for control and surveillance of leprosy contacts. The results showed studies focused on the prevention and control of leprosy among contacts, however, the evidence points to new strategies that may be incorporated into clinical practice aiming at the elimination of leprosy as a public health problem in the Country.