Do steroid abusers have more temporomandibular joint symptoms? A study with 97 bodybuilders.

OBJECTIVES: Anabolic androgenic steroids (AAS) are derivatives of testosterone, used to treat gonadal disturbances, performance enhancement, and aesthetic purposes. AAS abuse can lead to side effects, including androgenic, cardiovascular, and liver disturbances, effects on libido, gynecomastia, and behavioral effects. There is a hypothesis that some joint tissues may be targets for sex hormones, and the use of AAS without medical follow-up may exacerbate temporomandibular joint problems in patients seeking performance and aesthetics. METHODS: In this study, a cross-sectional survey was conducted on AAS abusers who voluntarily presented themselves for clinical evaluation. Patients were subdivided by sex and age group, and the length of AAS use and symptoms such as headache, tinnitus, and temporomandibular joint pain were evaluated. RESULTS: It was observed that drug usage is related to symptoms. CONCLUSION: The results suggest that AAS use without medical follow-up may exacerbate temporomandibular joint problems, especially in patients with low estrogen levels.

Intracerebral hemorrhage after deep brain stimulation surgery guided with microelectrode recording: analysis of 297 procedures.

OBJECTIVES: Report the incidence of symptomatic and asymptomatic intracerebral hemorrhage (ICH) in patients submitted to deep brain stimulation (DBS) guided with microelectrode recording (MER) with further analysis of potential risk factors, both inherent to the patient and related to the pathology and surgical technique. METHODS: We performed a retrospective observational study. 297 DBS procedures were concluded in 277 patients in a single hospital centre between January 2010 and December 2020. All surgeries were guided with MER. We analysed the incidence of symptomatic and asymptomatic ICH and its correlation to age, sex, diagnosis, hypertension and perioperative hypertension, diabetes, dyslipidaemia, antiplatelet drugs, anatomic target, and number of MER trajectories. RESULTS: There were a total of 585 electrodes implanted in 277 patients. 16 ICH were observed, of which 6 were symptomatic and 10 asymptomatic, none of which incurred in permanent neurological deficit. The location of the hemorrhage varied between cortical and subcortical plans, always in relation with the trajectory or the final position of the electrode. The incidence of symptomatic ICH per lead-implantation was 1%, and the CT-scan demonstrated asymptomatic ICH in 1.7% more patients. Male patients or with hypertension are 2.7 and 2.2 times more likely to develop ICH, respectively. However, none of these characteristics has been shown to have a statistically significant association with the occurrence of ICH, as well as age, diagnosis, diabetes, dyslipidaemia, antiplatelet drugs, anatomic target, number of MER trajectories and perioperative hypertension. CONCLUSIONS: MER-guided DBS is a safe technique, with low incidence of ICH and no permanent deficits in our study. Hypertension and male sex seem to be risk factors for the development of ICH in this surgery. Nevertheless, no statistically significant factors were found for the occurrence of this complication.

Practical guidelines of the EOTTD for pathological and genetic diagnosis of hydatidiform moles.

Hydatidiform moles are rare and thus most pathologists and geneticists have little experience with their diagnosis. It is important to promptly and correctly identify hydatidiform moles given that they are premalignant disorders associated with a risk of persistent gestational trophoblastic disease and gestational trophoblastic neoplasia. Improvement in diagnosis can be achieved with uniformization of diagnostic criteria and establishment of algorithms. To this aim, the Pathology and Genetics Working Party of the European Organisation for Treatment of Trophoblastic Diseases has developed guidelines that describe the pathological criteria and ancillary techniques that can be used in the differential diagnosis of hydatidiform moles. These guidelines are based on the best available evidence in the literature, professional experience and consensus of the experts' group involved in its development.

Association between rectal diameter and response to treatment with parasacral transcutaneous electrical nerve stimulation and behavioral changes in children and adolescents with bladder and bowel dysfunction

ABSTRACT Purpose: Parasacral Transcutaneous Electrical Stimulation (TENS) is one of the treatments for children with Bladder and Bowel Dysfunction (BBD). Some studies showed that children with increased Rectal Diameter (RD) have more Functional Constipation (FC). However, RD prediction in maintenance of BBD after treatment was never evaluated. Our aim is to evaluate the association between RD and response to treatment in children and adolescents with BBD. Materials and Methods: This study evaluated patients from 5-17 years old with BBD. Dysfunctional Voiding Scoring System (DVSS), Rome IV criteria, and the Constipation Score were used. RD was measured using abdominal ultrasound before treatment according to the technique established by Klijn et al. and was considered enlarged when >3cm. No laxatives were used during treatment. Descriptive analysis and binary regression were performed and the area under the ROC curve was calculated. Results: Forty children were included (mean age 8.4±2.8 years, 52.5% male). Before treatment, RD was enlarged in 15 children (37.5%) (mean diameter 3.84±0.6cm), with FC persisting post-treatment in 11/15(73.3%). Those patients also required more laxatives following treatment and had more severe FC. Binary regression showed pretreatment RD to be an independent predictor of the persistence of FC post-treatment (OR=9.56; 95%CI:2.05-44.60). In ROC curve analysis, the sensitivity was 100% (95%CI: 0.49-1.0) and specificity 77.14% (95%CI:0.60-0.90) for rectal diameter >3 cm. The likelihood ratio was 4.38 (95%CI:2.40-8.0) for the persistence of BBD following treatment. Conclusion: RD appears to be relevant in the evaluation of children with BBD, not only as a diagnostic tool but also as a predictor of treatment outcome.

Ovarian clear cell carcinoma arising in a large endometrioma - A case report with pathological correlation and literature review.

Endometriosis-associated ovarian cancer represents the most common form of malignancy associated with this benign disease. It has a better prognosis than most types of ovarian cancer, with endometrioid adenocarcinoma and clear cell carcinoma as the main histological types. Clinical presentation is usually nonspecific and tumor biomarkers can be misleading, since they can also be elevated in the presence of benign ovarian endometriosis. We report a case of a 52-year-old woman with known ovarian and deep pelvic endometriosis, who developed ovarian clear cell carcinoma within a large endometrioma. The imaging findings highlight the key role of magnetic resonance imaging in detecting suspicious features such as loss of the "T2 shading" sign, loss of high T1 signal of an endometrioma, or the presence of mural nodules. Early detection of these malignancies is fundamental for adequate surgical treatment and overall outcome.

Propriedades Psicométricas da Frost Multidimensional Perfectionism Scale para adultos brasileiros / Propiedades psicométricas da Frost Multidimensional Perfectionism Scale para adultos brasileños / Psychometric properties of the Frost Multidimensional Perfectionism Scale for Brazilian adults

O objetivo do presente estudo foi investigar a estrutura interna da Frost Multidimensional Perfectionism Scale (FMPS) para adultos brasileiros, além de averiguar também a sua confiabilidade e estabilidade temporal. Participaram 1.222 indivíduos, com média de idade 26,57 anos (dp = 9,03), sendo que 618 participaram presencialmente e 604 por meio de coleta online. A escala foi reaplicada em 10% da amostra do grupo presencial para avaliar estabilidade temporal. Os resultados da análise fatorial confirmatória apontam que o modelo de seis dimensões, conforme proposta original dos autores da escala, apresentou os melhores índices de ajuste. A estrutura interna avaliada para os dois formatos de aplicação apresentou invariância estrutural, métrica e de configuração limítrofe, apontando para necessidade de ser mais bem investigada em estudos futuros. Tanto os índices de consistência interna quanto a estabilidade temporal são satisfatórios e corroboram os demais achados da literatura com a escala para outros idiomas. Conclui-se que a FMPS possui adequada validade de estrutura interna e confiabilidade para uso no Brasil.(AU)

The aim of this study was to examine the internal structure, reliability, and temporal stability of the Frost Multidimensional Perfectionism Scale (FMPS) for Brazilian adults. The sample included 1222 participants, with a mean age of 26.57 years (SD=9.03). Half of the sample completed the online version of the instrument, while the other half answered the paper-and-pencil version. To check temporal stability, the instrument was reapplied with 10% of the presential sample. The results from the confirmatory factorial analysis indicated that the original six-dimension model was the best fit for the scale. The internal structure evaluated for the two application formats showed only borderline structural, metric and configuration invariance, highlighting the need for future studies. Both the internal consistency and the temporal stability indices were satisfactory and corroborate the literature findings for the scale in other languages. In conclusion, the FMPS has adequate structural validity and reliability for use in the Brazilian context.(AU)

El objetivo del presente estudio fue investigar la estructura interna de la Frost Multidimenrsional Perfectionism Scale (FMPS) para adultos brasileños, además de averiguar también su confiabilidad y estabilidad temporal. Participaron 1.222 individuos, con media de edad 26,57 años (DS=9,03), siendo que 618 participaron presencialmente y 604 por medio de colecta online. La escala fue reaplicada en 10% de la muestra del grupo presencial para evaluar la estabilidad temporal. Los resultados del análisis factorial confirmatorio indicaron que el modelo de seis dimensiones, conforme la propuesta original de los autores de la escala, presentaron los mejores índices de ajuste. La estructura interna evaluada para los dos formatos de aplicación presentó invarianza estructural, métrica y de configuración limítrofe, apuntando para la necesidad de ser mejor investigada en estudios posteriores. Los índices de consistencia interna y estabilidad temporal son satisfactorios y corroboran los demás encontrados en la literatura con la escala para otros idiomas. Se concluye que la FMPS dispone de adecuada validez de estructura interna y confiabilidad para la utilización en Brasil.(AU)

Can spines tell a story? Investigation of echidna spines as a novel sample type for hormone analysis in monotremes.

The short-beaked echidna (Tachyglossus aculeatus) is a monotreme endemic to Australia and New Guinea, and is the most widespread native mammal in Australia. Despite its abundance, there are considerable gaps in our understanding of echidna life history such as reproductive cycles in both sexes, patterns of stress physiology, and possible seasonal changes in metabolism. Slow-growing integumentary sample types comprised of keratin (hair, claw, etc.) have been used in other wildlife to assess these questions via analysis of longitudinal patterns in steroid and thyroid hormones that are deposited in these tissues as they grow. Hairs and spines comprise the pelage of echidnas, the spines being keratinized structures homologous to hair. Thus, echidna spines could be a viable sample type for hormone analysis contributing to a better understanding of the biology of echidnas. The aim of this work was to determine whether steroid hormones are detectable in echidna spines, to perform assay validations, and to establish a protocol for extracting and quantifying hormones in echidna spines using commercially available assay kits. We also inspected cross-sectioned spines using light and electron microscopy for any evidence of annual growth markers that might enable inferences about spine growth rate. Corticosterone, progesterone, estradiol, and testosterone were detectable in all samples, and echidna spine extract passed standard assay validations (parallelism and accuracy), indicating that commercially available assay kits can quantify hormones accurately in this sample type. No visible growth marks were identified in the spines and thus spine growth rate is currently unknown. Echidna spines show promise as a novel matrix from which hormones can be quantified; next steps should involve determination of spine annual growth rate, possible seasonal changes in growth rate, and persistence of spines over time in order to perform physiological validations, i.e., relationship between physiological status and hormone concentrations in spines.

Antioxidant, anti-inflammatory and beneficial metabolic effects of botryosphaeran [(1→3)(1→6)-ß-d-glucan] are responsible for its anti-tumour activity in experimental non-obese and obese rats bearing Walker-256 tumours.

Botryosphaeran, a (1→3)(1→6)-ß-d-glucan, presents several beneficial activities, such as antiproliferative, hypoglycemic and antitumoural activities. This study evaluated the effects of botryosphaeran on oxidative stress, inflammation and metabolic activities in Walker-256 tumour-bearing non-obese and obese rats. Wistars rats were divided into four groups: control tumour (CT); control tumour + botryosphaeran (CTB); obese tumour (OT), and obese tumour + botryosphaeran (OTB). In ninth week, obese and non-obese rats were inoculated with 1 × 107 Walker-256 tumour cells and treated with botryosphaeran (30 mg/kg/d for 15 days). In 11th week, the following parameters were evaluated glycogen, glucose and lactate levels, pro-oxidant (TBARS) and antioxidant markers (superoxide dismutase [SOD]; catalase [CAT]; glutathione-S-transferase [GST]; reduced glutathione [GSH]; vitamin C) and cytokines. Obesity presented oxidative stress and inflammation, as demonstrated by high levels of TBARS, SOD and TNF-α, and lower levels of CAT, GSH and interleukin-10 (IL-10). Botryosphaeran significantly decreased TBARS and TNF-α and increased GST, GSH, vitamin C and IL-10 in the liver; increased SOD and vitamin C in tumour tissue; decreased TBARS in adipose tissue, and notably decreased the levels of glycogen and lactate in the tumour of CTB rats. Botryosphaeran promoted significant antioxidant, anti-inflammatory, and beneficial metabolic effects in Walker-256 tumour-bearing non-obese and obese rats, which contributed to its antitumour activity.

LIECHTENSTEIN VERSUS LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL (TAPP) HERNIA REPAIR: A PROSPECTIVE COMPARATIVE STUDY FOCUSED ON POSTOPERATIVE OUTCOMES IN A GENERAL SURGERY UNIT. / LIECHTENSTEIN VERSUS CORREÇÃO DE HÉRNIA LAPAROSCÓPICA TRANSABDOMINAL PRÉ-PERITONEAL (TAPP): UM ESTUDO COMPARATIVO PROSPECTIVO COM FOCO NOS RESULTADOS PÓS-OPERATÓRIOS EM UMA UNIDADE DE CIRURGIA GERAL.

AIM: Three surgical techniques for inguinal hernia repair are currently validated. Few studies have compared results among Lichtenstein and transabdominal preperitoneal (TAPP) laparoscopic approach obtained at an early step of the learning curve. This study aims to compare the early treatment results between the Liechtenstein technique and the laparoscopic TAPP approach to provide a basis for the surgeon's decision-making. METHODS: Patients were divided into two groups: those who underwent laparoscopic TAPP approach (114 patients), and those who underwent open Lichtenstein repair (35 patients). Data were collected from the medical records during the evolution of the immediate postoperative period and by telephone contact after hospital discharge. For the analysis of the variables, the chi-square test of independence was implemented, with a level of significance set at a p-value of 0.05. RESULTS: There was a strong association between laparoscopy, less postoperative pain, and longer operative time. In addition, a preference for the technique in cases of recurrence, bilaterality, associated umbilical hernia, or obesity was noticed. In this study, the Lichtenstein technique was associated with a shorter time to return to work and was the treatment of choice for elderly patients. CONCLUSION: TAPP laparoscopic herniorrhaphy should be the first choice in cases of bilaterality, associated umbilical hernia, obesity, and recurrence to a previous anterior repair. The surgical risk is adequate for the procedure, even at early stages of the learning curve.

OBJETIVO: Três técnicas cirúrgicas para correção de hérnia inguinal estão atualmente validadas. Poucos estudos compararam os resultados entre Lichtenstein e a abordagem laparoscópica transabdominal pré-peritoneal obtidos em uma etapa inicial da curva de aprendizado. Comparar os resultados iniciais do tratamento entre a técnica de Liechtenstein e a abordagem pré-peritoneal transabdominal laparoscópica para fornecer uma base para a tomada de decisão do cirurgião. MÉTODO: Os pacientes foram divididos em grupo 1: aborgadem laparoscópica transabdominal pré-peritoneal (114 pacientes), e grupo 2: reparo aberto de Lichtenstein (35 pacientes). Os dados foram coletados em prontuários médicos durante a evolução do pós-operatório imediato e por contato telefônico após a alta hospitalar. Para a análise das variáveis, foi implementado o teste de independência Qui-Quadrado, com nível de significância estabelecido em p-valor = 0,05. RESULTADOS: Houve forte associação entre laparoscopia, menos dor pós-operatória e maior tempo operatório. Além disso, notou-se preferência pela técnica nos casos de recorrência, bilateralidade, hérnia umbilical associada ou obesidade. Neste estudo, a técnica de Lichtenstein foi associada a um menor tempo de retorno ao trabalho e foi o tratamento de escolha para pacientes idosos. CONCLUSÃO: A herniorrafia laparoscópica transabdominal pré-peritoneal deve ser a primeira escolha em casos de bilateralidade, hérnia umbilical associada, obesidade e recorrência para reparo anterior. O risco cirúrgico é adequado para o procedimento, mesmo nos estágios iniciais da curva de aprendizado.

Another casualty of the SARS-CoV-2 pandemic-the environmental impact.

Cemetery leachate generated by the process of cadaveric decomposition is a significant contaminant of several matrices in the cemetery environment (soil, groundwater, and surface water). The biogenic amines cadaverine and putrescine stand out among the cemetery leachate contaminants, since they are potentially carcinogenic compounds. This review article presents a discussion of possible environmental impacts caused by the increase in deaths resulting from COVID-19 as its central theme. The study also aims to demonstrate the importance of considering, in this context, some climatic factors that can alter both the time of bodily decomposition and the longevity of the virus in the environment. Additionally, some evidence for the transmission of the virus to health professionals and family members after the patient's death and environmental contamination after the burial of the bodies will also be presented. Several sources were consulted, such as scientific electronic databases (NCBI), publications by government agencies (e.g., ARPEN, Brazil) and internationally recognized health and environmental agencies (e.g., WHO, OurWorldInData.org), as well as information published on reliable websites available for free (e.g., CNN) and scientific journals related to the topic. The data from this study sounds the alarm on the fact that an increase in the number of deaths from the complications of COVID-19 has generated serious environmental problems, resulting from Cemetery leachate.

Parasacral transcutaneous electrical nerve stimulation in children with overactive bladder: comparison between sessions administered two and three times weekly

ABSTRACT Purpose: This study compares the results achieved following parasacral TENS administered using two different weekly schedules. Materials and Methods: Children of at least four years of age with a diagnosis of pure overactive bladder were included in this randomized clinical trial and treated with parasacral TENS (2 versus 3 sessions per week). All the participants also underwent standard urotherapy. Results: Sixteen children were included in the twice-weekly group and eighteen in the three times weekly group. There were no statistically significant differences between the two groups with respect to sex; however, there was a difference in age. There were no significant differences regarding complete resolution of urinary symptoms, with 8 children (50%) in the twice-weekly group and 11 children (61%) in the three times weekly group having their symptoms completely resolved (p=0.73). There was a significant difference in the DVSS score in both groups following TENS treatment compared to baseline (p=0.0001 for both groups), but not between groups. Evaluation of the bladder diary showed no difference between the groups before or after treatment. Conclusion: For children with overactive bladder who are unable to undergo parasacral TENS treatment three times weekly, the method can be administered successfully at twice-weekly sessions.

Liechtenstein versus correção de hérnia laparoscópica transabdominal pré-peritoneal (tapp): um estudo comparativo prospectivo com foco nos resultados pós-operatórios em uma unidade de cirurgia geral / Liechtenstein versus laparoscopic transabdominal preperitoneal (tapp) hernia repair: a prospective comparative study focused on postoperative outcomes in a general surgery unit

RESUMO - RACIONAL: Três técnicas cirúrgicas para correção de hérnia inguinal estão atualmente validadas. Poucos estudos compararam os resultados entre Lichtenstein e a abordagem laparoscópica transabdominal pré-peritoneal obtidos em uma etapa inicial da curva de aprendizado. OBJETIVO: Comparar os resultados iniciais do tratamento entre a técnica de Liechtenstein e a abordagem pré-peritoneal transabdominal laparoscópica para fornecer uma base para a tomada de decisão do cirurgião. MÉTODO: Os pacientes foram divididos em grupo 1: aborgadem laparoscópica transabdominal pré-peritoneal (114 pacientes), e grupo 2: reparo aberto de Lichtenstein (35 pacientes). Os dados foram coletados em prontuários médicos durante a evolução do pós-operatório imediato e por contato telefônico após a alta hospitalar. Para a análise das variáveis, foi implementado o teste de independência Qui-Quadrado, com nível de significância estabelecido em p-valor = 0,05. RESULTADOS: Houve forte associação entre laparoscopia, menos dor pós-operatória e maior tempo operatório. Além disso, notou-se preferência pela técnica nos casos de recorrência, bilateralidade, hérnia umbilical associada ou obesidade. Neste estudo, a técnica de Lichtenstein foi associada a um menor tempo de retorno ao trabalho e foi o tratamento de escolha para pacientes idosos. CONCLUSÃO: A herniorrafia laparoscópica transabdominal pré-peritoneal deve ser a primeira escolha em casos de bilateralidade, hérnia umbilical associada, obesidade e recorrência para reparo anterior. O risco cirúrgico é adequado para o procedimento, mesmo nos estágios iniciais da curva de aprendizado.

ABSTRACT - BACKGROUND: Three surgical techniques for inguinal hernia repair are currently validated. Few studies have compared results among Lichtenstein and transabdominal preperitoneal (TAPP) laparoscopic approach obtained at an early step of the learning curve. AIM: This study aims to compare the early treatment results between the Liechtenstein technique and the laparoscopic TAPP approach to provide a basis for the surgeon's decision-making. METHODS: Patients were divided into two groups: those who underwent laparoscopic TAPP approach (114 patients), and those who underwent open Lichtenstein repair (35 patients). Data were collected from the medical records during the evolution of the immediate postoperative period and by telephone contact after hospital discharge. For the analysis of the variables, the chi-square test of independence was implemented, with a level of significance set at a p-value of 0.05. RESULTS: There was a strong association between laparoscopy, less postoperative pain, and longer operative time. In addition, a preference for the technique in cases of recurrence, bilaterality, associated umbilical hernia, or obesity was noticed. In this study, the Lichtenstein technique was associated with a shorter time to return to work and was the treatment of choice for elderly patients. CONCLUSION: TAPP laparoscopic herniorrhaphy should be the first choice in cases of bilaterality, associated umbilical hernia, obesity, and recurrence to a previous anterior repair. The surgical risk is adequate for the procedure, even at early stages of the learning curve.

O fazer dos estágios curriculares na formação em psicologia: uma experiência coletiva / The making of curricular internships in psychology training: a collective experience

O presente trabalho apresenta a concepção e o fazer dos estágios básicos e específicos do curso de Psicologia da Escola Bahiana de Medicina e Saúde Pública (EBMSP), instituição vocacionada para a saúde. Em seguida, descreve o funcionamento das referidas práticas, apresentando o contexto na qual elas estão inseridas e o processo de gestão do processo. Os estágios ocupam um lugar diferenciado na organização curricular do curso de Psicologia da EBMSP, pois oferecem aos discentes possibilidades de articulação entre teoria e prática de maneira crítica e reflexiva, conforme orientação das Diretrizes Curriculares Nacionais para os Cursos de Graduação de Psicologia. Os componentes fazem parte do eixo pré-profissionalizante e possibilitam a experiência em espaços e processos diversos de trabalho, nas duas ênfases do curso, Saúde e Trabalho. As atividades acontecem ao longo do quarto e quinto ano e são mediadas por vários participantes: corpo discente, corpo docente, coordenação e supervisor de campo. É a organização acadêmica e pedagógica dos estágios que permite a oferta de experiências práticas diferenciadas para o desenvolvimento de competências relacionadas ao fazer do Psicólogo. Observa-se que ao longo dos 20 anos do curso de Psicologia da EBMSP, os estágios estão em aprimoramento contínuo com foco na construção da identidade profissional do discente. Evidenciase, a partir da avaliação dos discentes, docentes e dos supervisores de campo que o egresso do curso de Psicologia da EBMSP, apresenta uma formação generalista, com competências práticas adquiridas para atuarem nos campos da saúde e trabalho com elevado nível técnico, integrados de forma crítica à sociedade, à realidade e ao mundo de trabalho.

This work presents the conception and implementation of basic and specific internships in the Psychology course at the Bahiana School of Medicine and Public Health (EBMSP), an institution dedicated to health. Then, it describes the functioning of these practices, presenting the context in which they are inserted and the process management process. The internships occupy a different place in the curricular organization of the Psychology course at EBMSP, as they offer students possibilities of articulation between theory and practice in a critical and reflective way, as guided by the National Curricular Guidelines for Psychology Undergraduate Courses. The components are part of the pre-professional axis and enable the experience in different work spaces and processes, in the two emphases of the course, Health and Work. The activities take place over the fourth and fifth year and are mediated by several participants: student body, faculty, coordination and field supervisor. It is the academic and pedagogical organization of the internships that allows the offering of different practical experiences for the development of skills related to the Psychologist's work. It is observed that throughout the 20 years of the Psychology course at EBMSP, the internships are in continuous improvement with a focus on building the student's professional identity. It is evident from the evaluation of students, teachers and field supervisors that the graduate of the Psychology course at EBMSP, presents a generalist training, with practical skills acquired to work in the fields of health and work with high technical level, integrated critically to society, reality and the world of work.

Perdas físicas de imunobiológicos no estado do Ceará, 2014-2016 / Pérdidas físicas de inmunobiológicos en el estado de Ceará, Brasil, 2014-2016 / Physical wastage of immunobiological products in the state of Ceará, Brazil, 2014-2016

Objetivo: descrever as perdas físicas, por descarte, dos imunobiológicos fornecidos pelo Programa Nacional de Imunizações (PNI) ao estado do Ceará no período 2014-2016, e os custos das doses perdidas. Métodos: estudo descritivo, com dados dos formulários de avaliação de imunobiológicos sob suspeita e dos pareceres favoráveis de descarte. Resultados: foram incluídos 317 formulários, dos quais 72,0% obtiveram parecer de descarte; foram identificadas 160.767 doses perdidas, totalizando um custo de R$ 1.834.604,75; as perdas representaram 0,45%, 0,93% e 0,53% do custo total das vacinas nos anos de 2014, 2015 e 2016, respectivamente; o principal motivo das perdas físicas identificadas foi a falta de energia elétrica (54,9%). Conclusão: identificou-se grande número de doses descartadas por perdas físicas, com elevado custo absoluto; faz-se necessário um controle mais rigoroso, pois falhas na dinâmica de conservação podem interferir na oferta dos imunobiológicos.

Objetivo: describir las pérdidas físicas por eliminación de inmunobiológicos proporcionados por el Programa Nacional de Inmunización (PNI) al estado de Ceará, en el periodo 2014-2016, y los costos de las dosis omitidas. Métodos: estudio descriptivo, con datos de formula-rios de evaluación de los inmunobiológicos sospechosos y de las opiniones favorables de descarte. Resultados: se incluyeron un total de 317 formularios, de los cuales el 72,0% obtuvo una opinión de descarte, y se identificaron 160.767 dosis omitidas, con un costo total de R$ 1.834.604,75; las pérdidas representaron el 0,45%, el 0,93% y el 0,53% del costo total de las vacunas en 2014, 2015 y 2016, respectivamente; la razón principal de las pérdidas físicas identificadas fue la falta de electricidad (54,9%). Conclusión: iden-tificamos un gran número de dosis descartadas por pérdidas físicas, con un alto costo absoluto; es necesario un control más estricto, ya que las fallas en la dinámica de conser-vación pueden interferir con el suministro de inmunobiológicos.

Objective: to describe discarded wasted immunobiological products provided by the National Im-munization Program (PNI) to the State of Ceará between 2014 and 2016, and the costs of discarded doses. Methods: this was a descriptive study using data from suspect im-munobiological product evaluation forms and data from disposal approval forms. Results: a total of 317 forms were included, 72.0% of which had a disposal approval form, and 160,767 discarded doses were identified, at a total cost of BRL 1,834,604.75; wastage accounted for 0.45%, 0.93% and 0.53% of the total cost of vaccines in 2014, 2015 and 2016, respectively; the main reason for the wastage identified was electric power shortage (54.9%). Conclusion: we identified a large number of discarded wasted doses, with high absolute cost; tighter control is necessary, as failures in conservation dynamics may interfere with the supply of immunobiologicals.

Produção científica em cuidados paliativos e terapia ocupacional: revisão de escopo / Scientific production in palliative care and occupational therapy: a scoping review / Producción científica en cuidados paliativos y terapia ocupacional: revisión de alcance

Objective: The study's main purpose has been to characterize the scientific production addressing palliative care and occupational therapy published in peer-reviewed open access journals available online, as well as identify the approaches used by such publications selected for this work. Methods: This is a scoping review, which performed a thorough search in the following databases: MEDLINE, LILACS, IBECS and INDEX PSI. Furthermore, it considered articles published over the period from 2000 to July 2019, eventually obtaining a sample of 29 studies. Results: The analysis resulted in six categories that addressed subjects on the profile, role, interventions, difficulties, information technology and home care of the occupational therapy in palliative care, where a predominance of English written articles was observed. Conclusion: The study findings have revealed rather small evidences on the occupational therapists' profile and their big challenges - such as updates related to the current practice and the educational curriculum. Hence, it is essential to promote new investigations aimed at demonstrating the effectiveness of interventions focused on improving the occupational therapists' performance and the patient's quality of life

Objetivo: Caracterizar a produção científica sobre os cuidados paliativos e a terapia ocupacional publicada em periódicos online, e identificar os enfoques abordados nas publicações selecionadas para o estudo. Método: Trata-se de uma revisão de escopo, cuja pesquisa foi realizada nas bases de dados MEDLINE, LILACS, IBECS e INDEX PSI, em artigos publicados entre 2000 e julho de 2019, cujas amostras contemplaram 29 estudos. Resultado: Da análise, resultaram seis categorias que contemplam temas sobre o perfil, papel, intervenções, dificuldades, tecnologia da informação e atenção domiciliar da terapia ocupacional em cuidados paliativos, com predominância de artigos em inglês. Conclusão: Os achados desta pesquisa revelam poucas evidências sobre o perfil dos terapeutas ocupacionais e grandes desafios ­ como atualizações na prática atual e no currículo educacional, sendo fundamental o desenvolvimento de novas pesquisas voltadas a demonstrar a eficácia das intervenções, à melhoria do desempenho ocupacional e à qualidade de vida do paciente

Objetivo: Caracterizar la producción científica sobre los cuidados paliativos y la terapia ocupacional publicada en periódicos online y identificar las perspectivas abordadas en las publicaciones seleccionadas para el estudio. Método: Se trata de una revisión de alcance, cuya investigación fue realizada en las bases de datos MEDLINE, LILACS, IBECS y INDEX PSI, en artículos publicados entre 2000 y julio de 2019, de cuales las muestras contemplaron 29 estudios. Resultado: Del análisis, resultaron seis categorías que contemplan temas sobre el perfil, papel, intervenciones, dificultades, tecnología de la información y atención domiciliar de la terapia ocupacional en cuidados paliativos, con predominancia de artículos en inglés. Conclusión: Los hallados de esta investigación revelan pocas evidencias sobre el perfil de los terapeutas ocupacionales y grandes desafíos ­ como actualizaciones en la práctica actual y en el currículo educacional, siendo fundamental el desarrollo de nuevas pesquisas destinadas a demostrar la eficacia de las intervenciones dirigidas a la mejoría del desempeño ocupacional y a la calidad de vida del paciente

Long-term follow-up after EMR of large colorectal lesions: metachronous lesions, predictors and surveillance timing.

Background: Endoscopic mucosal resection (EMR) is the first-line approach to large colorectal sessile lesions. These patients have been associated with high rates of metachronous lesions (ML), but long-term follow-up (LtFU) data are lacking. We aimed at evaluating the efficacy of an LtFU protocol and analyse the development and risk factors for ML.Methods: A prospectively collected database was analysed. Seventy-six patients submitted to EMR of large colorectal sessile lesions between 2007 and 2013 complied with a specific endoscopic surveillance, consisting of two protocols - initial follow-up (iFU) and LtFU. iFU intended to inspect the mucosectomy scars twice (at 3-6 and 12 months) and remove synchronous lesions (SL). Protocol examinations of LtFU were carried out at the first- and fourth-year post-iFU, aiming to remove ML. Statistical analysis included variables related to patient, index lesion, SL and ML characteristics.Results: Rates of ML were 39.5% and 20.4% at the first- and fourth-year of LtFU, and respectively 11.8% and 3.7% of them were advanced ML. All ML were endoscopically resectable. At univariate analysis, male gender (OR: 2.91; p=.029), the presence of SL (OR 3.86, p=.010) and advanced SL (OR 4.25, p=.006) were risk factors for ML. At multivariate analysis, male gender (p=.031) and advanced SL (p=.006) were significant predictors of ML development.Conclusions: We confirmed the increased risk of ML in patients with large colorectal lesions. A significant number of advanced ML was removed at the first LtFU colonoscopy, probably it should be carried out earlier than currently recommended.

Gerenciamento de resíduos em laboratórios de uma universidade pública brasileira: um desafio para a saúde ambiental e a saúde do trabalhador / Waste management in laboratories of a Brazilian public university: a challenge for environmental health and occupational health

RESUMO As instituições de ensino superior, enquanto geradoras e difusoras de conhecimento, precisam cada vez mais assumir seu papel no contexto regional, especialmente na criação de políticas sustentáveis e de preservação do meio ambiente. Neste sentido, o presente artigo objetiva compreender as práticas de gerenciamento de resíduos de serviços de saúde nos laboratórios de ensino-pesquisa do Instituto de Ciências Agrárias da Universidade Federal de Minas Gerais - campus Montes Claros. Trata-se de uma pesquisa com abordagem qualitativa e quantitativa, realizada mediante a aplicação de questionário com os trabalhadores inseridos em atividades dos laboratórios de ensino. Para a análise, foram utilizadas as frequências absolutas e relativas, medidas de posição, tendência central e dispersão. Entre os problemas identificados, ressaltam-se: as não conformidades com a legislação vigente, em relação ao gerenciamento de resíduos nos laboratórios; a ausência relatada pelos trabalhadores, de capacitações para a realização de suas funções, como também de treinamentos para a prevenção de riscos e para o manejo adequado de resíduos; e a cobertura vacinal baixa contra hepatite B e tétano. Apesar de os locais pesquisados realizarem o gerenciamento dos seus resíduos, constata-se que muitas práticas estão em desacordo com a legislação vigente e precisam ser adequadas.

ABSTRACT Higher education institutions, as generators and disseminators of knowledge, are increasingly in need to assume their roles in regional context, especially in the creation of sustainable and environment preservation public policies. In this sense, the aim of this article was to understand the management of health care waste practices in teaching and research laboratories of the Institute of Agrarian Sciences of the Federal University of Minas Gerais - Montes Claros campus. It is a research with quantitative and qualitative approaches, carried out through survey application with workers engaged in the activities of the teaching labs. For the analysis, absolute and relative frequencies, position measurements, central tendency and dispersion were used. Among the problems detected, it should be highlighted: non-compliance with current legislation, concerned to laboratories waste management; absence reported by workers, of training for the accomplishment of their functions, as well as education for risk prevention and proper waste management; insufficient immunization coverage against hepatitis B and tetanus. Although the places researched manage their waste, this work concludes that many practices are at odds with the current legislation and need to be adequate.

Association between stress and lower urinary tract symptoms in children and adolescents

ABSTRACT Introduction: Lower urinary tract dysfunction (LUTD) is a common clinical condition. Emotional and behavioral issues are increasing among children and adolescents, with stress indicating difficulties in personal and social functioning. This study evaluated whether urinary tract symptoms (LUTS) is associated with stress. Materials and Methods: A cross-sectional, analytical study with 6-14-year-old patients with LUTS and no anatomical/neurogenic urinary tract abnormalities was conducted using the Dysfunctional Voiding Scoring System, a psychological assessment and the Child Stress Scale. The overall stress score was analyzed in relation to the psychological assessment data. Answers to the seven specific DVSS urinary questions were compared with those for the four Child Stress Scale domains. Univariate and multivariate analyses were performed. The chi-square test and Pearson's correlation were used to determine associations. Significance was defined as p <0.05. Results: Most children were male (56%). Mean age was 9.0±2.25 years. Stress was detected in 20 out of 98 patients (20.4%; 95% CI: 13-30%). Of these, 90% were born from unplanned pregnancies and 67% were upset about their disorder. All the Child Stress Scale domains were significantly associated with urinary dysfunction, with dysuria being significantly associated with all four domains. In the multivariate analysis, dysuria was the only symptom that remained associated with stress. Associations with stress strengthened as the frequency of dysuria increased: physical reactions (p <0.01), emotional reactions (p <0.05), psychological reactions with a depressive component (p <0.01) and psychophysiological reactions (p <0.05). Conclusion: Stress levels are higher in children and adolescents with LUTS who have more severe symptoms. Dysuria was the symptom most associated with stress, both in the physical reactions domain, in the psychological reactions domains with or without a depressive component and in the psychophysiological reactions domain.