Utilização das F-Words em serviços de reabilitação fisioterapêutica pediátrica: um estudo observacional / Use of F-Words in pediatric physiotherapeutic rehabilitation services: an observational study

O objetivo deste trabalho foi avaliar o nível de conhecimento de fisioterapeutas que atuam nos serviços públicos e privados de reabilitação pediátrica sobre o conhecimento das F-Words, assim como identificar as principais barreiras de aplicação destas ferramentas na assistência. Trata-se de um estudo transversal, conduzido de acordo com as recomendações do STROBE. A amostra apresentou uma média etária de 28,1 ± 5,8 anos, constituída por 54 fisioterapeutas que atuam nos serviços públicos e privados de reabilitação pediátrica. Foi observado que 55,6% da amostra já ouviram falar nas F-Words; 44,4% não sabiam sobre a importância; 94,4% estabelecem metas terapêuticas em parceria com a família; 57,4% nunca ouviram falar nas F-Words Tools; 77,8% nunca aplicaram essas ferramentas na assistência. Conclui-se que, as F-Words são importantes, mas são pouco utilizadas na assistência em decorrência da falta de conhecimento dos fisioterapeutas em relação à ferramenta e aos instrumentos.

The aim of this study was to assess the level of knowledge of physiotherapists who work in public and private pediatric rehabilitation services about knowledge of F-Words, as well as to identify the main barriers to applying these tools in care. This is a cross-sectional study, conducted in accordance with the STROBE recommendations. The sample had a mean age of 28.1 ± 5.8 years, consisting of 54 physiotherapists who work in public and private pediatric rehabilitation services. It was observed that 55.6% of the sample had already heard about F-Words; 44.4% did not know about the importance; 94.4% establish therapeutic goals in partnership with the family; 57.4% had never heard of F-Words Tools; 77.8% never applied these tools in care. It is concluded that the F-Words are important, but are little used in assistance due to the lack of knowledge of physiotherapists in relation to the tool and instruments.

Prevalence and factors associated with dietary adherence in individuals with type 2 diabetes mellitus in Brazil: a systematic review with meta-analysis / Prevalência e fatores associados à adesão à dieta em indivíduos com diabetes mellitus tipo 2 no Brasil: Uma revisão sistemática com meta-análise

Introduction: Low adherence to the treatment is a major challenge faced by health professionals during the management of type 2 diabetes. Objective: To assess the prevalence and risk factors related to dietary adherence in individuals living with type 2 diabetes in Brazil. Material and Methods: PubMed, Embase, Cochrane Library and SciELO/Lilacs were searched without restriction to a year of publication and language. Results: From 3713 studies, 14 articles involving 2962 individuals living with type 2 diabetes were eligible. The combined proportion of adherence to the diet was 41% (95% CI: 0.267-0.562, p< 0.001; I2= 98.81%, p<0.001), with the highest 78% and lowest 3%. The combined proportion of nonadherence to the diet was 51% (95% CI: 0.268-0.754, p<0.001; I²= 99.25%, p<0.001), with the highest being 98% and the lowest being 9%. The main risk factors for nonadherence to nutritional treatment were low education, low income, and multimorbidity. Conclusion: Low adherence to the diet is a concern during nutritional counseling of individuals living with type 2 diabetes in Brazil.

Introdução: A baixa adesão ao tratamento é um dos principais desafios enfrentados pelos profissionais de saúde durante a gestão da diabetes tipo 2. Objetivo: Avaliar a prevalência e os fatores de risco relacionados à adesão à dieta em indivíduos vivendo com diabetes mellitus tipo 2 no Brasil. Material e Métodos: Foram pesquisadas as bases de dados PubMed, Embase, Cochrane Library e SciELO/Lilacs, sem restrição de ano de publicação e idioma. Resultados: De 3713 estudos, 14 artigos envolvendo 2962 indivíduos vivendo com diabetes mellitus tipo 2 foram elegíveis. A proporção combinada de adesão à dieta foi de 41% (IC 95%: 0,267-0,562, p<0,001; I2= 98,81%, p<0,001), sendo a maior 78% e a menor 3%. A proporção combinada de não adesão à dieta foi de 51% (IC 95%: 0,268-0,754, p<0,001; I²= 99,25%, p<0,001), sendo a mais elevada de 98% e a mais baixa de 9%. Os principais fatores de risco para a não adesão ao tratamento nutricional foram a baixa escolaridade, a baixa renda e a multimorbidade. Conclusão: A baixa adesão à dieta é uma preocupação durante o aconselhamento nutricional de indivíduos vivendo com diabetes mellitus tipo 2 no Brasil.

Clinical manifestations of syphilis in the oral cavity: a review / Manifestações clínicas da sífilis na cavidade oral: uma revisão bibliográfica

Introduction: Syphilis is a sexually transmitted infection caused by Treponema pallidum bacterium, which impact on a significant increase in contagions reported worldwide, bringing up the need of urgent actions to ensure the control, treatment, and diagnosis of the disease. Objective: Given this context, this work presents a bibliographical review on syphilis, aiming to describe the most common oral manifestations that occur on the four stages of this infection. Methods: For the literature review, the searches were carried out in the PubMed, Science Direct, Scientific Electronic Library Online, Latin American and Caribbean Health Sciences Literature and databases of Virtual Health Library. Results: Regarding the primary syphilis, the main clinical manifestations in the oral cavity include chancres in the palate, buccal mucosa, tongue, and lips. In the secondary stage, the presence of diffuse and nonspecific oral lesions was identified. In tertiary syphilis, stomatitis and glossitis are present, being the hard palate and the tongue the main affected regions. In congenital syphilis, the patients are affected with dental and jaw malformations. Conclusion: The clinical manifestations of syphilis in the oral cavity can appear at any stage of the infection, being the oral cavity the second most affected region by this sexually transmitted infection. Therefore, the knowledge regarding this subject is extremely important for health professionals, as well as for the population, being essential to carry out the correct diagnosis and adequate treatment for the rapid cure of this infection (AU)

Introdução: A sífilis é uma infecção sexualmente transmissível oriunda da bactéria Treponema Pallidum, com transmissão através de relações sexuais sem o uso de preservativos ou por contato com lesões contaminadas. Nos últimos anos, diversos novos casos estão sendo reportados de forma alarmante, mostrando uma realidade dura sobre as dificuldades do diagnóstico da doença. Objetivo: Diante desse contexto, este trabalho apresenta uma revisão bibliográfica sobre a sífilis, com o objetivo de descrever as manifestações orais mais comuns nos quatros estágios possíveis da doença. Métodos: Para a revisão de literatura, realizou-se a busca dos artigos nas bases de pesquisas PubMed, Science Direct, Scientific Electronic Library Online, Literatura Latino-Americana e do Caribe em Ciências da Saúde e Biblioteca Virtual em Saúde. Resultados: Observou-se que, na sífilis primária, as principais manifestações clínicas na cavidade oral ocorrem com a presença de cancros no palato, na mucosa jugal, na língua e nos lábios. No estágio secundário, identificou-se a presença de lesões orais difusas e inespecíficas. Na sífilis terciária, podem ocorrer estomatites e glossites, sendo o palato duro e a língua as principais regiões acometidas. Na sífilis congênita, os possíveis sinais clínicos na cavidade oral são malformações dentárias e nos maxilares. Conclusões: As manifestações clínicas da sífilis na cavidade oral podem surgir em qualquer estágio da infecção, sendo a cavidade oral a segunda região com maior acometimento da infecção. Portanto, é de extrema importância o conhecimento das manifestações orais da sífilis pelos profissionais da área da saúde, bem como pela população, sendo fundamental o correto diagnóstico e tratamento rápido para a cura precoce da doença. (AU)

A survey on brazilian dentists' awareness, perception, and knowledge of bisphosphonates

Aim: The purpose of the study was to analyze the knowledge of dentists in Belo Horizonte, Brazil, about bisphosphonates and their clinical implications. Methods: A cross-sectional questionnaire-based study was conducted with a convenience sample of dentists in Belo Horizonte, in a period of 8 weeks. The questionnaire was self-applied and was structured with 10 items about the dentists' demographic characteristics, professional profile, and knowledge about bisphosphonates. Associations in the data were analyzed by with the Fischer's exact test with a significance level of 5%. Results: Of the 214 participating dentists, 163 (76.17%) were women, and 51 (23.83%) were men, with age ranged for 21 to 73 years (mean of 30 years) and mean of 6 years of professional activity. Nearly half (106/49.53%) reported having knowledge about bisphosphonates, and undergraduate courses were the primary source of such information (73/34.11%). Osteoporosis was the most identified indication for use (75/35.04%), although no participants correctly identified all indications. Regarding the drugs' side effects, only three dentists (1.40%) could correctly identify all responses, with bone necrosis being recognized by the majority (88/41.12%). Sodium alendronate (54/25.23%) and sodium ibandronate (15/7.01%) were the most identified examples of bisphosphonates. Last, only nine dentists (4.20%) could identify all examples of the drugs, and their capacity was associated with self-reported knowledge (p<0.05). Conclusions: More information about bisphosphonates should be disseminated in Belo Horizonte, ideally via better approaches in local undergraduate and postgraduate courses. Until then, knowledge of the basic aspects of bisphosphonates will remain limited

ECG Tutor: desenvolvimento e avaliação de um sistema tutor inteligente gamificado para ensino de eletrocardiograma / ECG Tutor: a gamified intelligent tutoring system for electrocardiogram teaching

Resumo: Introdução: Novas abordagens metodológicas têm sido sugeridas na tentativa de aprimorar a aquisição de habilidades em interpretação de eletrocardiograma (ECG), comprovadamente complexa e de difícil assimilação. Diante da expansão das metodologias ativas e do estímulo às inovações tecnológicas para o ensino médico, o uso de tecnologias de internet (e-learning) ganha força, destacando a utilização de plataformas com inteligência artificial, como os sistemas tutores inteligentes (STI), por sua capacidade de promover instrução adaptativa. Pesquisadores têm utilizado gamificação (técnicas de design de jogos) em conjunto com os STI, reportando maior engajamento. Objetivo: Buscando melhorar o desempenho de aprendizagem em ECG entre graduandos de Medicina por meio do desenvolvimento de novas metodologias e considerando os benefícios dos STI e do uso da gamificação na educação médica, o presente estudo objetivou explorar o interesse e a motivação dos acadêmicos de Medicina na utilização conjunta de tais tecnologias para estudar ECG. Método: Trata-se de uma pesquisa exploratória e quantitativa, na qual protótipos do design gráfico de STI gamificado instrutor de ECG foram idealizados por professores do curso médico e avaliados por acadêmicos de Medicina de uma universidade pública e outra particular após aprimoramento para um formato interativo, com a contribuição de uma equipe interdisciplinar. Resultado: No primeiro momento, participaram da pesquisa 53 graduandos do quinto ao 11º período do curso. Reduziu-se esse número para 14 na segunda etapa. A análise mostrou aprovação nos aspectos relacionados à facilidade de uso percebida, à utilidade percebida, à atitude em direção ao uso e à intenção de uso. Evidenciou-se a premência de adaptação também para dispositivos móveis e aperfeiçoamento nos elementos de gamificação e estética. Conclusão: Os resultados obtidos permitem concluir que os alunos de Medicina demonstraram intenção de uso futuro do ECG Tutor, implicando a necessidade de desenvolvimento de uma solução computacional do sistema e mensuração do seu impacto no aprendizado dos estudantes.

Abstract: Introduction: New methodological approaches have been suggested in an attempt to improve the acquisition of skills in electrocardiogram (ECG) interpretation, known to be complex and difficult to assimilate. Considering the expansion of active methodologies and the encouragement of technological innovations for medical education, the use of internet technologies (e-learning) has gained strength, highlighting the use of artificial intelligence platforms, such as intelligent tutoring systems (ITS), for their capacity to promote adaptive instruction. Researchers have used gamification (game design techniques) in conjunction with ITS, reporting greater engagement. Objective: Seeking to improve ECG learning performance among medical students through the development of new methodologies and considering the benefits of ITS and the use of gamification in medical education, the present study aimed to explore the interest and motivation of medical students in the use joint use of these technologies to study ECG. Method: This is an exploratory, quantitative study, in which graphic design prototypes of a gamified ECG instructor ITS were created by teachers of the medical course and evaluated by medical students from a public university and another private university after improvement into an interactive format, with the contribution of an interdisciplinary team. Result: At first, 53 undergraduate students from the 5th to the 11th semesters of the course participated in the study. That number was reduced to 14 in the second stage. The analysis showed approval of aspects related to perceived easy-to-use format, perceived usefulness, attitude towards use and intention to use. On the other hand, an urgent need to adapt to mobile devices and improve gamification and aesthetic elements was observed. Conclusion: The obtained results allowed us to conclude that medical students intend to use the ECG Tutor in the future, implying the need to develop a computational solution for the system and measure its impact on student learning.

Ischemic stroke mortality and time for hospital arrival: analysis of the first 90 days / Mortalidad por accidente cerebrovascular isquémico y tiempo de llegada al hospital: análisis de los primeros 90 días / Mortalidade por acidente vascular cerebral isquêmico e tempo de chegada a hospital: análise dos primeiros 90 dias

ABSTRACT Objective: To analyze the association between time of arrival at a reference hospital and mortality of people with ischemic stroke. Method: Descriptive and inferential statistics were used. Modifying and confounding variables between time of arrival and mortality were observed in the multivariate analysis. The Akaike Information Criterion was used to choose the model. Statistical significance of 5% and risk correction using the Poisson Model were adopted. Results: Most participants arrived within 4.5 hours of symptom onset or wake up stroke to the referral hospital and 19.4% died. The score of the National Institute of Health Stroke Scale was a modifier. In the multivariate model stratified by scale score ≥14, arrival time >4.5h was associated with lower mortality; and age ≥60 years and having Atrial Fibrillation, to higher mortality. In the model stratified by score ≤13, previous Rankin ≥3, and presence of atrial fibrillation were predictors of mortality. Conclusion: The relationship between time of arrival and mortality up to 90 days was modified by the National Institute of Health Stroke Scale. Prior Rankin ≥3, atrial fibrillation, time to arrival ≤4.5h, and age ≥60 years contributed to higher mortality.

RESUMEN Objetivo: Analizar la asociación entre el tiempo de llegada a un hospital de referencia y la mortalidad de las personas con accidente cerebrovascular isquémico. Método: Fueron usadas estadísticas descriptivas e inferenciales. En el análisis multivariado se verificaron variables modificadoras y confusoras entre el tiempo de llegada y la mortalidad. Para la elección del modelo se utilizó el Criterio de Información de Akaike. Se adoptó la significación estadística del 5% y la corrección del riesgo mediante el Modelo de Poisson. Resultados: La mayoría de los participantes llegaron dentro de las 4,5 horas posteriores al inicio de los síntomas o wake up stroke al hospital de referencia y el 19,4% fallecieron. La puntuación de la escala National Institute of Health Stroke Scale fue un modificador. En el modelo multivariante estratificado por puntaje de escala ≥14, el tiempo de llegada >4,5 h se asoció con una menor mortalidad; y edad ≥60 años y con Fibrilación Auricular a mayor mortalidad. En el modelo estratificado por puntaje ≤13, Rankin previo ≥3 y tener fibrilación auricular fueron predictores de mortalidad. Conclusión: La relación entre tiempo de llegada y mortalidad hasta los 90 días fue modificada por puntaje de la escala National Institute of Health Stroke Scale. Rankin previo ≥3, fibrilación auricular, tiempo hasta la llegada ≤4,5 h y la edad ≥60 años contribuyeron a una mayor mortalidad.

RESUMO Objetivo: Analisar a associação entre tempo de chegada a hospital de referência e mortalidade de pessoas com Acidente Vascular Cerebral isquêmico. Método: Foram utilizadas estatísticas descritivas e inferenciais. Variáveis modificadoras e confundidoras entre tempo de chegada e mortalidade foram verificadas na análise multivariada. O Critério de Informação de Akaike foi utilizado para escolha do modelo. Adotou-se significância estatística de 5% e correção de risco pelo Modelo de Poisson. Resultados: A maioria dos participantes chegou em até 4,5 horas do início dos sintomas ou wake up stroke ao hospital de referência e 19,4% morreram. A pontuação da National Institute of Health Stroke Scale foi um modificador. No modelo multivariado estratificado por pontuação da escala ≥14, o tempo de chegada >4,5h estava associado a menor mortalidade; e idade ≥60 anos e ter Fibrilação Atrial, a maior mortalidade. No modelo estratificado por pontuação ≤13, Rankin prévio ≥3 e ter fibrilação atrial foram preditores de mortalidade. Conclusão: A relação entre tempo de chegada e mortalidade até 90 dias foi modificada pela pontuação da National Institute of Health Stroke Scale. Rankin prévio ≥3, fibrilação atrial, tempo de chegada ≤4,5h e idade ≥60 anos contribuíram para maior mortalidade.

Adherence to secondary prevention measures after acute coronary syndrome in patients associated exclusively with the public and private healthcare systems in Brazil.

Adherence to secondary prevention measures after acute coronary syndrome (ACS) is essential to prevent disease recurrence. In Brazil, the Brazilian Unified Health System (SUS, in Portuguese), and the private healthcare system (PHCS) coexist. We aimed to evaluate the adherence to secondary prevention in patients with ACS who were assisted by either SUS or PHCS. In this longitudinal prospective study, patients with ACS were admitted to the four cardiological reference hospitals of Sergipe, three of which assisted PHCS users, and one, SUS users. We analyzed the two patient care models with multiple logistic regression models for adherence to physical activity, pharmacotherapy, and smoking cessation. We enrolled 581 volunteers in this study: 44.1 % from SUS and 55.9 % from PHCS. PHCS users showed greater adherence to pharmacotherapy at both 30 and 180 (p = 0.001) days after ACS with better results in all classes of medications (p < 0.05) than SUS users did. They also showed better adherence to physical activity (p = 0.047). There was no distinction between the groups regarding smoking cessation. The secondary prevention measures after ACS were more effective in PHCS users than in SUS users due to better adherence, especially to pharmacotherapy and regular physical activity.

Relationship of Inflammatory Markers and Metabolic Syndrome in Postmenopausal Women.

The increased deposition of visceral fat in the postmenopause period increases the production of inflammatory cytokines and the release of tumor necrosis factor- α (TNF-α), interleukin-6 (IL-6), and decrease in IL-10. This study investigated the relationship between inflammatory biomarkers and metabolic syndrome (MS) in postmenopausal women considering different diagnostic criteria. We conducted a cross-sectional observational study based on STROBE. Data were collected regarding the diagnostic criteria for MS (International Diabetes Federation; NCEP (International Diabetes Federation (IDF), National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III), and Harmonized criteria), body composition, comorbidities, time without menstruation, values of IL-6, IL-10, and TNF-α. ANOVA, Kruskal-Wallis, Levene tests, ROC, and odds ratio were performed to analyze the data. The results showed no significant difference between the methods and no interaction between the method and the presence of MS. However, for the values of WC, body fat percentage, TNF-α, and IL-10/TNF-α ratio, a significant effect of MS was observed. In subjects with MS, lower values of body fat percentage and TNF-α and higher values of the IL-10/TNF-α ratio were also observed. The higher IL-10/TNF-α ratio in the MS group is related to the greater anti-inflationary action of IL-10. The IL-10/TNF-α ratio showed significant accuracy to discriminate patients with MS according to the NCEP-ATP III criteria.

Xylobotryum portentosum (Mont.) Pat. (Xylobotryomycetes, Ascomycota): a rare fungal species newly found in Southeastern Brazil / Xylobotryum portentosum (Mont.) Pat. (Xylobotryomycetes, Ascomycota): uma espécie rara de fungo encontrada na Região Sudeste do Brasil

Abstract Xylobotrum portentosum (Mont.) Pat. is a striking Neotropical fungal species but it has been reported only a few times from Southern Brazil (States of Paraná and Santa Catarina), found in remnants of Atlantic Forest. Herein we report the species for the first time from the Southeastern Region of Brazil (State of São Paulo). A brief description and color photographs of the fresh specimen are presented.

Resumo Xylobotrum portentosum (Mont.) Pat. é uma espécie notável de fungo neotropical que foi registrada apenas poucas vezes para a Região Sul do Brasil (Paraná e Santa Catarina), encontrada em remanescentes de Mata Atlântica. Neste trabalho a espécie é reportada pela primeira vez para a Região Sudeste do Brasil (Estado de São Paulo). São apresentadas uma breve descrição e fotografias coloridas do espécime fresco.

Oculo-auriculo-vertebral spectrum associated with aberrant subclavian artery in an infant with recurrent respiratory distress / Espectro oculoauriculovertebral associado à artéria subclávia aberrante em lactente com desconforto respiratório recorrente

ABSTRACT Objective: To describe an infant with craniofacial microsomia and recurrent respiratory distress associated with aberrant right subclavian artery in order to review its most frequent congenital anomalies and alert the pediatrician to its rarer and more severe complications. Case description: This case report involves an 18-month-old male infant, only son of non-consanguineous parents. At birth, the child presented craniofacial dysmorphisms (facial asymmetry, maxillary and mandibular hypoplasia, macrostomia, grade 3 microtia, and accessory preauricular tag) restricted to the right side of the face. Additional tests showed asymmetric hypoplasia of facial structures and thoracic hemivertebrae. No cytogenetic or cytogenomic abnormalities were identified. The patient progressed to several episodes of respiratory distress, stridor, and nausea, even after undergoing gastrostomy and tracheostomy in the neonatal period. Investigation guided by respiratory symptoms identified compression of the esophagus and trachea by an aberrant right subclavian artery. After surgical correction of this anomaly, the infant has not presented respiratory symptoms and remains under multidisciplinary follow-up, seeking rehabilitation. Comments: Craniofacial microsomia presents a wide phenotypic variability compared to both craniofacial and extracraniofacial malformations. The latter, similarly to the aberrant right subclavian artery, is rarer and associated with morbidity and mortality. The main contribution of this case report was the identification of a rare anomaly, integrating a set of malformations of a relatively common condition, responsible for a very frequent complaint in pediatric care.

RESUMO Objetivo: Descrever lactente com microssomia craniofacial e desconforto respiratório recorrente associado à artéria subclávia direita aberrante, com o intuito de revisar as anomalias congênitas mais frequentes e alertar o pediatra sobre suas complicações mais raras e de maior gravidade. Descrição do caso: Lactente do sexo masculino, 18 meses de idade e filho único de casal não consanguíneo. Ao nascimento, foram observadas dismorfias craniofaciais (assimetria facial, hipoplasia maxilar e mandibular, macrostomia, microtia grau 3 e apêndice na linha trago-oral) restritas ao lado direito da face. Os exames complementares evidenciaram hipoplasia assimétrica da face e hemivértebras torácicas. Não foram identificadas anormalidades citogenéticas ou citogenômicas. O paciente evoluiu com diversos episódios de desconforto respiratório, estridor e náuseas, mesmo tendo realizado gastrostomia e traqueostomia no período neonatal. A investigação direcionada para os sintomas respiratórios identificou a compressão de esôfago e traqueia por uma artéria subclávia direita aberrante. Após a correção cirúrgica dessa anomalia, o lactente não tem apresentado sintomas respiratórios e mantém seguimento multidisciplinar buscando reabilitação. Comentários: A microssomia craniofacial apresenta grande heterogeneidade fenotípica em relação às malformações tanto craniofaciais como extracraniofaciais. Estas últimas, como a artéria subclávia direita aberrante, são mais raras e associadas à morbimortalidade. A principal contribuição deste relato de caso foi o reconhecimento de uma anomalia rara, integrando um conjunto de malformações de uma condição relativamente comum e sendo responsável por uma queixa muito frequente no atendimento pediátrico.

Toxoplasma gondii-Induced Neutrophil Extracellular Traps Amplify the Innate and Adaptive Response.

Toxoplasmosis affects one-third of the human population worldwide. Humans are accidental hosts and are infected after consumption of undercooked meat and water contaminated with Toxoplasma gondii cysts and oocysts, respectively. Neutrophils have been shown to participate in the control of T. gondii infection in mice through a variety of effector mechanisms, such as reactive oxygen species (ROS) and neutrophil extracellular trap (NET) formation. However, few studies have demonstrated the role of neutrophils in individuals naturally infected with T. gondii. In the current study, we evaluated the activation status of neutrophils in individuals with acute or chronic toxoplasmosis and determined the role of T. gondii-induced NET formation in the amplification of the innate and adaptive immune responses. We observed that neutrophils are highly activated during acute infection through increased expression of CD66b. Moreover, neutrophils from healthy donors (HDs) cocultured with tachyzoites produced ROS and formed NETs, with the latter being dependent on glycolysis, succinate dehydrogenase, gasdermin D, and neutrophil elastase. Furthermore, we observed elevated levels of the chemokines (CXC motif) CXCL8 and (CC motif) CCL4 ligands in plasma from patients with acute toxoplasmosis and production by neutrophils from HDs exposed to T. gondii. Finally, we showed that T. gondii-induced NETs activate neutrophils and promote the recruitment of autologous CD4+ T cells and the production of interferon gamma (IFN-γ), tumor necrosis factor (TNF), interleukin 6 (IL-6), IL-17, and IL-10 by peripheral blood mononuclear cells. In conclusion, we demonstrated that T. gondii activates neutrophils and promotes the release of NETs, which amplify human innate and adaptive immune responses. IMPORTANCE Approximately one-third of the human population is estimated to be chronically infected with the obligate intracellular parasite Toxoplasma gondii. Humans are accidental hosts that are infected with T. gondii after consumption of undercooked meat or contaminated water. Neutrophils have been shown to control T. gondii growth by different mechanisms, including neutrophil extracellular traps (NETs). In the current study, we observed that neutrophils are highly activated during acute toxoplasmosis. We also determined that T. gondii-induced NETs are dependent on the energetic profile of neutrophils as well as the production of ROS and gasdermin D (GSDMD) cleavage. In addition, we showed that T. gondii-induced NETs activate neutrophils, promote the recruitment of autologous CD4+ T cells, and induce the production of cytokines by peripheral blood mononuclear cells, amplifying the innate and adaptive immune responses.

Bariatric Surgery: Late Outcomes in Patients Who Reduced Comorbidities at Early Follow-Up.

Backgroundand Objectives: In severe obesity, a relevant weight loss can promote the reduction of comorbidities, such as systemic arterial hypertension (SAH), dyslipidemia, and diabetes mellitus (DM2). Bariatric surgery (BS) has been an essential resource in the therapy of this disease with a short-term reduction of cardiometabolic risk (CR). This study aimed to evaluate the reduction of factors associated with the CR in patients undergoing BS at a 5-year follow-up. Materials and Methods: This is a longitudinal, retrospective study carried out with patients undergoing BS by the Brazilian Public Healthcare System (PHS). Anthropometric and clinical parameters related to the CR (DM2, dyslipidemia, and SAH), quantified by the Assessment of Obesity-Related Comorbidities (AORC) score, were evaluated at the following moments: admission and preoperative and postoperative returns (3 months, 6 months, 1 to 5 years). Results: The sample had a mean age of 44.69 ± 9.49 years and were predominantly in the age group 20-29 years (34.80%) and women (72.46%). At admission to the service, 42.3% had DM2, 50.7% dyslipidemia, and 78.9% SAH. Regarding BS, the gastric bypass technique was used in 92.86% of the sample, and the waiting time for the procedure was 28.3 ± 24.4 months. In the pre- and postoperative period of 3 months, there was a significant reduction in the frequency of DM2 (p < 0.003), dyslipidemia (p < 0.000), and SAH (p < 0.000). However, at postoperative follow-up from 6 months to 5 years, there was no significant reduction in the comorbidities studied. After five years, 35.7% had total remission of DM2 and 2.9% partial remission of DM2, 44.2% had control and remission of dyslipidemia, and 19.6% of SAH (AORC score ≤ 2 for the comorbidities). Conclusion: BS promoted a reduction of the CR in the first three months after BS in severely obese PHS users.

OCULO-AURICULO-VERTEBRAL SPECTRUM ASSOCIATED WITH ABERRANT SUBCLAVIAN ARTERY IN AN INFANT WITH RECURRENT RESPIRATORY DISTRESS.

OBJECTIVE: To describe an infant with craniofacial microsomia and recurrent respiratory distress associated with aberrant right subclavian artery in order to review its most frequent congenital anomalies and alert the pediatrician to its rarer and more severe complications. CASE DESCRIPTION: This case report involves an 18-month-old male infant, only son of non-consanguineous parents. At birth, the child presented craniofacial dysmorphisms (facial asymmetry, maxillary and mandibular hypoplasia, macrostomia, grade 3 microtia, and accessory preauricular tag) restricted to the right side of the face. Additional tests showed asymmetric hypoplasia of facial structures and thoracic hemivertebrae. No cytogenetic or cytogenomic abnormalities were identified. The patient progressed to several episodes of respiratory distress, stridor, and nausea, even after undergoing gastrostomy and tracheostomy in the neonatal period. Investigation guided by respiratory symptoms identified compression of the esophagus and trachea by an aberrant right subclavian artery. After surgical correction of this anomaly, the infant has not presented respiratory symptoms and remains under multidisciplinary follow-up, seeking rehabilitation. COMMENTS: Craniofacial microsomia presents a wide phenotypic variability compared to both craniofacial and extracraniofacial malformations. The latter, similarly to the aberrant right subclavian artery, is rarer and associated with morbidity and mortality. The main contribution of this case report was the identification of a rare anomaly, integrating a set of malformations of a relatively common condition, responsible for a very frequent complaint in pediatric care.

Abundance, distribution, and characteristics of microplastics in coastal surface waters of the Colombian Caribbean and Pacific.

Microplastic pollution has become a global concern due to its distribution, high abundance, and negative impacts on aquatic ecosystems. These particles enter aquatic systems through the inadequate management of solid waste and wastewater generated from socioeconomic and domestic activities. In Colombia, about 65% of the solid waste generated in coastal populations is improperly managed and discharged into natural water bodies, contributing to microplastic pollution. The present study aimed to determine the abundances, distribution, and physical and chemical characteristics of microplastics in coastal surface waters of the Colombian Caribbean and Pacific. Samplings were carried out at 41 stations distributed across nine study areas during the rainy season of 2017, using a 500-µm mesh plankton net. The microplastic abundances ranged from 0.01 to 8.96 items m-3, with the coastal waters of the Caribbean areas being the most polluted. Microplastics with shapes of fragments, filaments, and foams, composed of polyethylene, polypropylene, and polystyrene, were the most common. A baseline of microplastic pollution in Colombian coastal water was generated, which will serve to evaluate the effectiveness of the environmental measures implemented to significantly reduce this pollution type, within the sustainable development goals.

Psicodiagnóstico na unidade de internação psiquiátrica de um hospital público / Psychodiagnosis in a public psychiatric unit of a general hospital

Introdução: Este estudo caracterizou pacientes adultos que tiveram solicitação de psicodiagnóstico enquanto estavam internados em leitos do Sistema Único de Saúde (SUS) em uma unidade psiquiátrica de um hospital geral universitário de Porto Alegre no ano de 2017. Com o intuito de subsidiar o planejamento deste serviço, assim como a discussão com as equipes assistenciais a respeito das indicações para a solicitação, buscou-se conhecer as características tanto dos pacientes beneficiados por este exame como de suas internações. Traçou-se o perfil demográfico, identificou-se as especificidades das internações quanto ao motivo, tempo de permanência e diagnóstico psiquiátrico, e observou-se as características da própria avaliação psicológica. Método: Estudo exploratório, quantitativo e transversal, em que os dados foram resgatados dos prontuários de forma retrospectiva. A análise dos dados foi feita de forma descritiva e inferencial, com auxilio do SPSS versão 16.0. Resultados: Dos 247 pacientes internados, 17,8% tiveram solicitação de psicodiagnóstico, sendo que 93,2% (41) tiveram o processo concluído. A demanda principal foi para pacientes adultos jovens, possivelmente em primeira internação psiquiátrica e em processo de avaliação diagnóstica, um dos possíveis objetivos de uma internação psiquiátrica. Conclusão: O psicodiagnóstico auxilia no entendimento dinâmico do paciente; entretanto, este é um recurso técnico que precisa ser usado de forma estratégica durante a internação psiquiátrica por conta dos fatores que podem envolver desde o funcionamento da própria unidade até o estado mental e emocional do indivíduo em momento de crise. (AU)

Introduction: This study characterized adult patients that had indication for psychodiagnosis while in a public psychiatric unit in a general university hospital in Porto Alegre, southern Brazil, in 2017. With the purposes of encouraging the discussion about psychodiagnosis indication among care teams and planning for this service, this study sought a better comprehension of patients' characteristics and their hospitalizations. Demographics, profile of the period of hospitalization, including reason for admission, length of stay, and psychiatric diagnosis, and characteristics of psychological assessment were described. Methods: This exploratory, quantitative, and cross-sectional study retrieved data from medical records retrospectively. Data were then analyzed descriptively and inferentially with SPSS, version 16.0. Results: Of 247 hospitalized patients, 17.8% had indication for psychodiagnosis, and 93.2% (41) had the procedure completed. The group that demanded most was young adults, possibly in their first psychiatric hospitalization and in the process of psychiatric assessment, one of the main objectives of a psychiatric admission. Conclusion: Psychodiagnosis helps to understand the dynamics of a patient; however, it should be used with caution in psychiatric hospitalization because of factors ranging from the operation of the unit itself to the mental and emotional state of a patient during an acute crisis. (AU)

Estratégias educativas de ressuscitação cardiopulmonar para leigos: revisão integrativa da literatura / Estrategias educativas para la reanimación cardiopulmonar para legos: revisión integrativa de la literatura / Educational cardiopulmonary resuscitation strategies for laypeople: an integrative literature review

RESUMO Objetivo: identificar as estratégias de ensino e aprendizagem da ressuscitação cardiopulmonar voltadas para pessoas leigas. Método: revisão integrativa realizada nas fontes National Library of Medicine; National Institutes of Health; Cumulative Index to Nursing and Allied Health Literature; Literatura Latino-Americana e do Caribe em Ciências da Saúde; Web of Science; e SCOPUS. Resultados: identificaram-se 932 estudos e incluíram-se 11. As estratégias foram: aula expositiva; treinamento com manequim/instrutor; manequim/instrutor/dispositivo de feedback; videoaula e web. Adotou-se, frequentemente, o manequim/instrutor, no entanto, demonstrou-se mais efetivo associar dispositivo de feedback e/ou videoaula. Os estudos foram considerados de boa qualidade pelo instrumento do Instituto Joanna Briggs e de moderada qualidade pelo Medical Education Research Study Quality Instrument. Conclusão: as evidências sobre o ensino da ressuscitação cardiopulmonar para leigos indicaram as principais e mais efetivas estratégias para a adoção de melhores práticas.

RESUMEN Objetivo: identificar estrategias de enseñanza y aprendizaje de la reanimación cardiopulmonar dirigidas a legos. Método: revisión integrativa realizada en fuentes de la National Library of Medicine; National Institutes of Health; Cumulative Index to Nursing and Allied Health Literature; Literatura Latinoamericana y del Caribe en Ciencias de la Salud; Web of Science; y SCOPUS. Resultados: se identificaron 932 estudios y se incluyeron 11. Las estrategias fueron: clase expositiva; entrenamiento con maniquí / instructor; maniquí / instructor / dispositivo de feedback; clase de video y web. El muñeco / instructor se adoptó a menudo, sin embargo, demostró ser más efectivo asociar un dispositivo de feedback y / o una clase de video. Los estudios fueron considerados de buena calidad por el instrumento del Instituto Joanna Briggs y de calidad moderada por el Medical Education Research Study Quality Instrument. Conclusión: la evidencia sobre la enseñanza de la reanimación cardiopulmonar a legos indicó las principales y más efectivas estrategias para la adopción de mejores prácticas.

ABSTRACT Objective: to identify teaching and learning strategies for cardiopulmonary resuscitation aimed at laypeople. Method: integrative review carried out in the National Library of Medicine sources; National Institutes of Health; Cumulative Index to Nursing and Allied Health Literature; Latin American and Caribbean Literature in Health Sciences; Web of Science; and SCOPUS. Results: 932 studies were identified and 11 were included. The strategies were: lecture; training with dummy/instructor; dummy/instructor/feedback device; video class and web. The dummy/instructor was often adopted, however, it proved to be more effective to associate a feedback device and/or video class. The studies were considered of good quality by the Joanna Briggs Institute instrument and of moderate quality by the Medical Education Research Study Quality Instrument. Conclusion: the evidence on the teaching of cardiopulmonary resuscitation to laypeople indicated the main and most effective strategies for the adoption of best practices.

Impact of concurrent epidemics of dengue, chikungunya, zika, and COVID-19

Abstract INTRODUCTION: This study evaluated the epidemiological implications of arbovirus infections and coronavirus disease (COVID-19) co-occurrences in Espírito Santo, Brazil. METHODS: This ecological study of dengue, chikungunya, zika, and COVID-19 was performed from January 1 to July 31, 2020. RESULTS: Espírito Santo registered 44,614, 8,092, 3,138, and 91,483 cases of dengue, chikungunya, zika, and COVID-19, respectively (January-July, 2020). In the 27 and four municipalities with a high incidence of dengue and chikungunya, respectively, the incidence of COVID-19 was 647.0-3,721.7 and 1,787.2-3,403.0 cases per 100,000 inhabitants, respectively. CONCLUSIONS: Espírito Santo experienced an overlap of epidemics, especially in urban areas.

Vigilância Epidemiológica estadual no enfrentamento da pandemia pela COVID-19 no Brasil: um relato de experiência / State Epidemiological Surveillance in combating the COVID-19 pandemic in Brazil: an experience report / Vigilancia Epidemiológica estatal en el combate a la pandemia por COVID-19 en Brasil: informe de experiência

Objetivo: sistematizar a experiência do estado do Espírito Santo no enfrentamento da COVID-19, baseando-se na vivência enquanto equipe gestora e operacional da vigilância epidemiológica estadual, no período de março de 2020 a março de 2021. Método: trata-se de um estudo descritivo, do tipo relato de experiência. Os dados foram obtidos por meio de canais oficiais, alimentados por um sistema de notificação em saúde adotado pelo estado do Espírito Santo e por planilhas enviadas diariamente pelos estabelecimentos de saúde. Resultados: observou-se que a aproximação entre a gestão estadual e municipal facilitou a implementação das orientações instituídas e a consolidação das medidas em todo território capixaba, vale salientar que outros órgãos governamentais auxiliaram nesse processo. Conclusão: os desdobramentos exigidos na gestão da pandemia evidenciam a importância da Vigilância em Saúde e o papel estratégico da Vigilância Epidemiológica no controle da pandemia, e na tomada de decisão e direcionamento de recursos humanos e financeiros.

Objective: to systematize the experience of the state of Espírito Santo in facing COVID-19, based on the experience as a manager and operational team of the state epidemiological surveillance, in the period from March 2020 to March 2021. Method: this is a descriptive study, of the experience report type. The data were obtained through official channels, fed by a health notification system adopted by the State of Espírito Santo and by spreadsheets sent daily by health establishments. Results: it was observed that the approximation between state and municipal management facilitated the implementation of the instituted guidelines and the consolidation of the measures in the entire territory of the state of Espírito Santo. Conclusion: it is concluded that the developments required in the management of the pandemic highlight the importance of Health Surveillance and the strategic role of the Epidemiological Surveillance in the control of the pandemic, and in the decision making and direction of human and financial resources

Objetivo: sistematizar la experiencia de estado de Espírito Santo en el enfrentamiento del COVID-19, a partir de la experiencia como equipo gestora y operacional de la vigilancia epidemiológica estatal, de marzo de 2020 a marzo de 2021. Método: se trata de un estudio descriptivo, tipo relato de experiencia. Los datos se obtuvieron a través de canales oficiales, alimentados por un sistema de notificación sanitaria adoptado por el Estado de Espírito Santo y por planillas enviadas diariamente por los establecimientos de salud. Resultados: se observó que la aproximación entre la gestión estatal y municipal facilitó la implementación de orientaciones instituidas y la consolidación de medidas en todo el territorio del estado de Espírito Santo, cabe mencionar que otras agencias gubernamentales asistieron en este proceso. Conclusión: se concluye que los desdoblamientos exigidos en la gestión de la pandemia evidenciaron la importancia de la Vigilancia en Salud y el rol estratégico de la Vigilancia Epidemiológica en el control de la pandemia y en la toma de decisiones y direccionamiento de recursos humanos y financieros

Segurança dos profissionais de saúde no enfrentamento do novo coronavírus no Brasil / Safety of health professionals in facing the new coronavirus in Brazil / Seguridad de los profesionales de la salud en el enfrentamiento al nuevo coronavirus en Brasil

Objetivos: apresentar o número de profissionais de saúde acometidos pela COVID-19 no Brasil, identificar algumas medidas de controle para redução da vulnerabilidade e as repercussões sobre a saúde desses profissionais no enfrentamento da pandemia COVID-19. Método: implementado estudo descritivo, tendo como fonte boletins epidemiológicos e o Centers for Disease Control and Prevention. Resultados: 22 estados brasileiros informam casos da COVID-19 entre os profissionais de saúde, totalizando 181.886. Dentre todas as capitais do país, 12 trazem informações. Algumas medidas recomendadas são: controle de engenharia, segurança, administrativas, práticas de segurança no trabalho e equipamentos de proteção individual. As repercussões envolvem saúde mental com implicações psíquicas, transtornos psicológicos e psiquiátricos. Conclusão e implicações para a prática: a pandemia desvelou, de forma crua e inequívoca, o retrato das condições de trabalho desigual, segregacionista e nefasto para a saúde humana a que os profissionais de saúde estão expostos, clama por mudanças e reconhecimentos e urge para a valorização desse grupo profissional

Objectives: to present the number of health professionals affected by COVID-19 in Brazil, to identify some control measures to reduce vulnerability and the health repercussions of these professionals in facing the COVID-19 pandemic. Method: a descriptive study was implemented, using epidemiological bulletins and the Centers for Disease Control and Prevention as a source. Results: 22 Brazilian states report cases of COVID-19 among health professionals, totaling 181,886. Among all the capitals of the country, 12 bring information. Some recommended measures are: engineering control, safety, administrative, work safety practices and individual protective equipment. The repercussions involve mental health with psychic implications, psychological and psychiatric disorders. Conclusion and implications for the practice: the pandemic has revealed, in a raw and unequivocal way, the picture of unequal, segregationist and harmful working conditions for human health to which health professionals are exposed, calls for changes and recognition and urge for the valorization of this professional group

Objetivos: presentar el número de profesionales de la salud afectados por COVID-19 en Brasil, identificar algunas medidas de control para reducir la vulnerabilidad y las repercusiones en la salud de estos profesionales en el enfrentamiento a la pandemia del COVID-19. Método: se implementó un estudio descriptivo, utilizando como fuente boletines epidemiológicos y los Centros para el Control y la Prevención de Enfermedades. Resultados: Veintidós estados brasileños informan casos de COVID-19 entre los profesionales de la salud, totalizando 181.886. Entre todas las capitales del país, 12 traen información. Algunas medidas recomendadas son: control de ingeniería, seguridad, administrativas, prácticas de seguridad en el trabajo y equipo de protección individual. Las repercusiones se refieren a la salud mental con implicaciones psíquicas, trastornos psicológicos y psiquiátricos. Conclusión e implicaciones para la práctica: la pandemia ha develado de manera cruda e inequívoca, el retrato de las condiciones laborales desiguales, segregacionistas y nefastas para la salud humana a las que están expuestos los profesionales de la salud y exige cambios y reconocimiento, porque es urgente la valorización de este colectivo profesional

Avaliação do Perfil dos Professores de Medicina de uma Universidade do Interior de Minas Gerais / Assessment of Medical Faculty Profile at a University in Minas Gerais, Brazil

Resumo: Introdução: O ensino médico vem passando por grande reformulação nas últimas décadas, e um dos pontos considerados fundamentais nessa mudança é a atuação docente. Pesquisas indicam que os professores de Medicina usualmente possuem pouca formação didático-pedagógica, dividem-se entre as profissões de médico e professor, colocada em segundo plano, privilegiam a pesquisa em relação ao ensino e são resistentes a mudanças no seu modo de atuação. Segundo a literatura, essas características repercutiriam diretamente no ensino oferecido. Método: A presente pesquisa buscou analisar como características dos professores de Medicina de uma universidade no interior de Minas Gerais repercutem na forma como os alunos avaliam o ensino recebido. Para tanto, levantou-se o perfil dos professores a partir de documentação e entrevista semiestruturada. Posteriormente, os alunos avaliaram os professores participantes por meio de um questionário autoaplicado. Confrontaram-se avaliação e perfil, e utilizaram-se testes estatísticos para a análise da associação entre características e avaliação feita. Participaram 57 professores (83,8% dos elegíveis) e 203 alunos (84,5% dos elegíveis). Resultados: Foi identificado perfil de professores semelhante ao da literatura, com a maioria em dedicação parcial à universidade, renda proporcionada principalmente por outra profissão e preparação didática constituindo parte reduzida da formação. A comparação entre os grupos de características dos professores, com base nas avaliações dos alunos, por sua vez, mostrou resultados que rompem com a bibliografia. Os dados mostraram, com relevância estatística, que no curso professores mais jovens, com menos tempo de graduação, de atuação docente e de experiência em outra profissão, sem mestrado e que possuem como motivação para lecionar prazer e aptidão são mais bem avaliados. Maior tempo de preparação didática, cursos preparatórios, maior dedicação semanal ao ensino e maior identificação com a docência, entre outros aspectos, não se associam à melhor avaliação de forma estatisticamente significativa. Conclusões: A pior avaliação do docente mais experiente, associada a questões como conflitos geracionais e dificuldades de adaptação a novos currículos, mostra a importância de uma preparação docente contínua e reforçada com o tempo. Além disso, o melhor desempenho de professores mais satisfeitos demonstra a importância da valorização da carreira docente. Por fim, constata-se que quantidade de formação não é suficiente sem qualidade nessa formação.

Abstract: Introduction: Medical education has undergone a major overhaul over the last decades and one significant change is related to teaching performance. Research indicates that the medical faculty typically has little training in didactics, split their time between clinical practice and teaching, award less priority to the latter, privileging research to the detriment of teaching, and resist changing their ways. According to the literature, such traits and attitudes would directly affect educational quality. Method: This study assessed how traits and attitudes of the medical faculty at a university in Minas Gerais impact student assessment of the education they receive. For that purpose, teachers were profiled through semi-structured interviews and analysis of relevant documentation. Subsequently, students assessed their teachers' performance through a self-applied questionnaire. Performance and profiles were then compared, and statistical tests were used to analyze the associations between teachers' traits and performance assessment results. Overall, 57 faculty members (83.8% of those eligible) and 203 students (84.5% of those eligible) participated in this study. Results: A faculty profile similar to that found in the literature was identified, with a majority of teachers dedicating only part of their time to the university, and most of their income coming from another occupation and teacher training amounting to a small portion of their overall professional training. The analyses of relationships between groups of traits and teaching performance, however, contradicted the literature. The data showed, with statistical relevance, that younger teachers and those who graduated a shorter time ago, who are less experienced in teaching or have other occupations, who lack a master's degree and whose motivation to teach comes from satisfaction and vocation are better evaluated. Longer didactical training, undergoing training courses, longer weekly dedication and greater identification with the teaching profession are not significantly associated with better evaluation. Conclusion: The worse evaluation of the most experienced faculty, associated with issues such as generational conflicts and difficulties adapting to new curricula, shows the importance of continuous faculty training and updating. Additionally, the better performance of more satisfied teachers, demonstrates the importance of valuing the teaching career and raising its status. Finally, it seems that more teacher training is not enough in itself and more attention must be paid to the training quality.