Reconstrução total da cobertura cutânea do pênis com retalho miocutâneo: relato de caso / Total reconstruction of the skin coverage of the penis with myocutaneous flap: case report

Introdução: O pênis é uma importante estrutura do corpo masculino, sendo sua reconstrução um desafio. Existem diversas doenças e deformidades que acometem este órgão, sendo necessário, em certos casos, a reconstrução total da cobertura cutânea do pênis, tendo já sido descritas na literatura diversas técnicas, tais como o uso de enxertos totais, retalho escrotal, retalhos miocutâneos da fáscia lata e outros. Relato de Caso: Neste relato é apresentada uma reconstrução da cobertura total do pênis por meio do uso de retalho miocutâneo do músculo cremaster com pele da bolsa escrotal, conseguindo prover uma boa vascularização e mantendo a permeabilidade uretral. Conclusão: Tal técnica não foi encontrada em nenhuma das bases de dados pesquisadas no trabalho, apenas semelhantes, e mostrouse como uma boa opção para a reconstrução total da cobertura cutânea peniana.

Introduction: The penis is an important structure of the male body, and its reconstruction is a challenge. Several diseases and deformities affect this organ, being necessary, in certain cases, for the total reconstruction of the cutaneous coverage of the penis, having already been described in the literature several techniques, such as the use of total grafts, scrotal flap, myocutaneous flaps of the fasciae latae and others. Case Report: In this report, a reconstruction of the total coverage of the penis is presented using a myocutaneous flap of the cremaster muscle with skin from the scrotum, achieving good vascularization and maintaining urethral permeability. Conclusion: This technique was not found in any of the databases researched in this study, only similar ones, and it proved to be a good option for the total reconstruction of penile skin coverage.

The assistance gaps in combating COVID-19 in Brazil: for whom, where and when vaccination occurs.

BACKGROUND: Following the emergence of the COVID-19 pandemic, the number of infected Brazilian people has increased dramatically since February 2020, with Brazil being amongst the countries with the highest number of cases and deaths. Brazilian vaccination began in January 2021, aimed at priority groups. This study analysed the spatial and temporal evolution of vaccination in Brazil between the 3rd and 21st epidemiological weeks (EW) of 2021. METHODS: Spatial and temporal analyses were performed comprising 19 EW. Cases were structured into priority groups-elderly population (EP); healthcare workers (HW); indigenous and quilombola populations (I/Q), dose, vaccine (CoronaVac or AstraZeneca), and place of vaccination. A sweep test was performed to identify vaccination rate clusters. Vaccination rates (VR) were calculated according to a spatial window for each Health Region, indicating clusters above/below expected VR. Based on the discrete Poisson probability model, spatial analysis was performed to detect high/low VR clusters, which were converted into Kernel maps. Points were generated from SaTScan analyses associated with Health Region centroids. Temporal analysis of VR was carried out to identify significant trends, and results were converted into temporal cluster graphs. P-value ≤ 0.05 was adopted. RESULTS: Southeast region concentrated most of the vaccines of EP and HW, followed by the Northeast. The latter region had the largest contingent of I/Q vaccinated. In all priority age groups and all regions, a higher percentage of complete CoronaVac vaccination schedules were observed compared with AstraZeneca. The temporal analysis identified high VR clusters of CoronaVac first and second dose in the early weeks, except for the EP; of AstraZeneca first dose, only for HW in the early weeks, and for EP and I/Q in the final weeks; of AstraZeneca second dose for all priority groups in the final weeks. I/Q populations had the lowest general VR. The spatial profile of VR indicated significant regional cluster differences between the priority groups. CONCLUSION: This study highlights the importance of establishing vaccination priority groups, considering the asymmetries that a pandemic can trigger, notably in vast geographic areas, to contemplate the main objective of vaccination: to prevent casualties.

O ensino remoto no curso de Medicina de uma universidade brasileira em tempos de pandemia / Remote education at Brazilian university medical school during the pandemic

Resumo: Introdução: O processo de ensino-aprendizagem passou por grandes mudanças tecnológicas ao longo das décadas, com importante impacto nos cursos de Medicina. Uma dessas mudanças foi o uso dos ambientes virtuais de aprendizagem (AVA). Objetivo: Este estudo teve como objetivo avaliar a qualidade do processo de ensino-aprendizagem remoto no curso de Medicina durante a pandemia da Covid-19. Método: É um estudo de caráter descritivo com abordagem quantitativa e qualitativa. Seu desenvolvimento foi dividido em quatro fases: revisão da literatura, desenvolvimento do protocolo de avaliação, coleta e análise dos dados. A coleta de dados foi realizada por meio de um formulário on-line, e a análise dos dados, por análise estatística em três eixos: a avaliação do perfil tecnológico, a avaliação da aceitação da tecnologia e a experiência do usuário. Resultado: Foi constatado que a maioria dos estudantes (65%) e docentes (88.2%) possuía infraestrutura para participar do semestre suplementar. A maior parte dos alunos relatou sentir segurança em utilizar as ferramentas tecnológicas e estava satisfeita com o ensino remoto, porém 53% dos alunos relataram não ter um rendimento tão grande quanto teriam em um período presencial comum, além de terem mencionado dificuldades na adaptação ao ensino remoto, e 40,2% citaram uma alta taxa de problemas psicológicos entre eles. Os docentes em sua maioria se sentiam seguros em lecionar on-line e também tiveram uma avaliação em geral bastante positiva do semestre remoto, tendo apenas algumas discordâncias em relação ao tempo para preparação das aulas e da criação de materiais didáticos para seus alunos. Conclusão: Os diversos fatores relacionados à tecnologia, organização e saúde mental dos estudantes e docentes devem ser levados em consideração no planejamento dos próximos semestres, pois, até que a situação de saúde volte ao normal, os próximos semestres letivos terão todos os componentes teóricos do curso de Medicina trabalhados remotamente, ao menos com a maioria na modalidade híbrida. É provável que alunos e professores desenvolvam uma curva de aprendizagem e consequente adaptação, o que pode atenuar algumas das dificuldades observadas. É preciso que o processo de adaptação seja catalisado por normas, orientações e também inovações da universidade.

Abstract: Introduction: Introduction: The teaching-learning process has undergone major technological changes over the decades, with a significant impact on medical courses. One of these changes has been the use of virtual learning environments (VLEs). Objective: to evaluate the quality of the remote teaching-learning process in the medical course during the COVID-19 pandemic. Method: This is a descriptive study with a quantitative and qualitative approach. Its development was divided into 4 phases: literature review, development of the assessment protocol, data collection and analysis. Data collection was through an online form and data analysis was by statistical analysis on three axes: assessment of the technological profile, assessment of the acceptance of the technology and the user experience. Result: It was found that most students (65%) and teachers (88.2%) had the infrastructure to participate in the supplementary semester. Most students reported feeling safe in using technological tools and were satisfied with the remote teaching, however, 53% of students reported underachievement in relation to their performance in an ordinary classroom period and reported difficulties in adapting to remote learning, and 40.2% reported a high rate of psychological problems. Most teachers felt secure in teaching online and had a very positive overall evaluation of the remote semester, with only a few disagreements regarding the time to prepare classes and create teaching materials for their students. Conclusion: The various factors related to technology, organization and mental health of students and teachers must be taken into account in the planning of the next semesters, because until the health situation returns to normal, the forthcoming academic semesters will provide all the theoretical components of the medical course remotely, or at least the majority provided in a hybrid modality. It is likely that students and teachers will develop a learning curve and consequent adaptation, which may alleviate some of the difficulties observed. The adaptation process needs to be catalyzed by standards, guidelines and innovations from the university.