Comprehensive analysis of gastrointestinal side effects in COVID-19 patients undergoing combined pharmacological treatment with azithromycin and hydroxychloroquine: a systematic review and network meta-analysis.

During the COVID-19 pandemic, several drugs were repositioned and combined to quickly find a way to mitigate the effects of the infection. However, the adverse effects of these combinations on the gastrointestinal tract are unknown. We aimed investigate whether Hydroxychloroquine (HD), Azithromycin (AZ), and Ivermectin (IV) used in combination for the treatment of COVID-19, can lead to the development of gastrointestinal disorders. This is a systematic review and network meta-analysis conducted using Stata and Revman software, respectively. The protocol was registered with PROSPERO (CRD42023372802). A search of clinical trials in Cochrane Library databases, Embase, Web of Science, Lilacs, PubMed, Scopus and Clinicaltrials.gov conducted on November 26, 2023. The eligibility of the studies was assessed based on PICO criteria, including trials that compared different treatments and control group. The analysis of the quality of the evidence was carried out according to the GRADE. Six trials involving 1,686 COVID-19 patients were included. No trials on the association of HD or AZ with IV met the inclusion criteria, only studies on the association between HD and AZ were included. Nausea, vomiting, diarrhea, abdominal pain and increased transaminases were related. The symptoms of vomiting and nausea were evaluated through a network meta-analysis, while the symptom of abdominal pain was evaluated through a meta-analysis. No significant associations with these symptoms were observed for HD, AZ, or their combination, compared to control. Low heterogeneity and absence of inconsistency in indirect and direct comparisons were noted. Limitations included small sample sizes, varied drug dosages, and potential publication bias during the pandemic peak. This review unveils that there are no associations between gastrointestinal adverse effects and the combined treatment of HD with AZ in the management of COVID-19, as compared to either the use of a control group or the administration of the drugs individually, on the other hand, highlighting the very low or low certainty of evidence for the evaluated outcomes. To accurately conclude the absence of side effects, further high-quality randomized studies are needed.

Morphological and molecular data confirm the occurrence of Paramphistomum leydeni (Trematoda: Paramphistomidae) in ruminants from Southern Brazil.

Species belonging to the family Paramphistomidae Fischoeder, 1901, commonly known as "rumen flukes", are a group of parasites frequently related to Brazilian livestock production. They inhabit the digestive tract of ruminants and have recognized pathogenicity during the early stages of infection, which can be responsible for economic losses. These trematodes are often associated with Southern Brazil, a region heavily focused on animal farming, which also makes it ideal for the life cycle of paramphistomes. Despite their aforementioned importance, studies regarding their distribution, molecular taxonomy and biology are still scarce in the country. In the present study, rumen flukes collected from cattle (n = 22) and sheep (n = 3) from 9 batches of ruminants from the cities of Jaguarão, Pelotas and Rio Grande, state of Rio Grande do Sul, Brazil, between May and July 2022, were subjected to morphological and molecular study. The microscopic analysis of histological and manual cuts revealed diagnostical traits compatible with Paramphistomum leydeni Näsmark, 1937, including the presence of tegumental papillae, pharynx of the liorchis type and acetabulum of the leydeni type. Molecular data corroborated the morphological identification, with ITS-2 and cox-1 sequences here obtained presenting 100% and 96.8-99.8% similarity, respectively, to P. leydeni samples previously characterized in different countries from Asia, Europe, and South America. Intensity of infection ranged from 5 to 458 and 1 to3 specimens of P. leydeni in sampled cattle and sheep, respectively. The present study contributes to a better understanding of the taxonomy of the flukes involved in cattle and sheep paramphistomosis in Brazil, suggesting that P. leydeni could be the main paramphistome species found in ruminants in the studied region.

Role of Deep Eutectic Solvent Precursors as Hydrotropes: Unveiling Synergism/Antagonism for Enhanced Kraft Lignin Dissolution.

Lignin holds significant potential as a feedstock for generating valuable aromatic compounds, fuels, and functional materials. However, achieving this potential requires the development of effective dissolution methods. Previous works have demonstrated the remarkable capability of hydrotropes to enhance the aqueous solubility of lignin, an amphiphilic macromolecule. Notably, deep eutectic solvents (DESs) have exhibited hydrotropic behavior, significantly increasing the aqueous solubility of hydrophobic solutes, making them attractive options for lignin dissolution. This study aimed at exploring the influence of hydrogen bond acceptors (HBAs) and hydrogen bond donors (HBDs) on the performance of DESs as hydrotropes for lignin dissolution, while possible dissolution mechanisms in different water/DES compositions were discussed. The capacity of six alcohols (glycerol, ethylene glycol, 1,3-propanediol, 1,4-butanediol, 1,5-pentanediol, and 1,6-hexanediol) and cholinium chloride to enhance the solubility of Kraft lignin in aqueous media was investigated. A correlation between solubility enhancement and the alkyl chain length of the alcohol was observed. This was rationalized upon the competition between hydrotrope-hydrotrope and solute-hydrotrope aggregates with the latter being maximized for 1,4-butanediol. Interestingly, the hydrotropic effect of DESs on lignin solubility is well represented by the independent sum of the dissolving contributions from the corresponding HBAs and HBDs in the diluted region. Conversely, in the concentrated region, the solubility of lignin for a certain hydrotrope concentration was always found to be higher for the pure hydrotropes rather than their combined HBA/HBD counterparts.

Repurposing Kraft black Liquor as Reductant for Enhanced Lithium-Ion Battery Leaching.

The economic advantages of H2SO4 make it the acid of choice for the hydrometallurgical treatment of waste lithium-ion batteries (LIBs). However, to facilitate the full dissolution of the higher valency metal oxides present in the cathode black mass, a suitable reducing agent is required. Herein, the application of industrial black liquor (BL) obtained from the Kraft pulping for papermaking is investigated as a renewable reducing agent for the enhanced leaching of transition metals from LIB powder with H2SO4. The addition of acidified BL to H2SO4 significantly improved the leaching efficiency for a range of LIB cathode chemistries, with the strongest effect observed for manganese-rich active material. Focusing on NMC111 (LiMnxCoyNizO2) material, a linear correlation between the BL concentration and the leaching yield of Mn was obtained, with the best overall leaching efficiencies being achieved for 2.0 mol L-1 H2SO4 and 50 vol % of BL at 353 K. A quasi-total degradation of oxygenated and aromatic groups from the BL during NMC111 dissolution was observed after leaching, suggesting that these chemical groups are essential for LIB reduction. Finally, the leached transition metals could be easily recovered by pH adjustment and oxalic acid addition, closing the resource loop and fostering resource efficiency.

The IMRiS Trial: A Phase 2 Study of Intensity Modulated Radiation Therapy in Extremity Soft Tissue Sarcoma.

PURPOSE: Primary soft tissue sarcoma (STS) is rare, with many tumors occurring in extremities. Local management is limb-sparing surgery and preoperative/postoperative radiation therapy (RT) for patients at high risk of local recurrence. We prospectively investigated late normal tissue toxicity and limb function observed after intensity modulated RT (IMRT) in extremity STS. METHODS AND MATERIALS: Patients with extremity STS, age ≥16 years. Two treatment cohorts: IMRT 50 Gy in 25 × 2 Gy fractions (preoperative) or 60/66 Gy in 30/33 × 2 Gy fractions (postoperative). The primary endpoint was the rate of grade ≥2 late soft tissue fibrosis (subcutaneous tissue) at 24 months after IMRT (Radiation Therapy Oncology Group late radiation morbidity scoring). RESULTS: One hundred sixty-eight patients were registered between March 2016 and July 2017. Of those, 159 (95%) received IMRT (106, 67% preoperative RT; and 53, 33% postoperative RT) with a median follow-up of 35.2 months (IQR, 32.9-36.6); 62% men, median age 58 years. Of 111 patients assessable for the primary endpoint at 24 months, 12 (10.8%; 95% CI, 5.7%-18.1%) had grade ≥2 subcutaneous fibrosis. The overall rate at 24 months of Radiation Therapy Oncology Group late skin, bone, and joint toxicity was 7 of 112 (6.3%), 3 of 112 (2.7%), and 10 of 113 (8.8%), respectively, and for Stern's scale edema was 6 of 113 (5.3%). More wound complications were observed with preoperative than postoperative RT (29.2% vs 3.8%). Overall survival at 24 months was 84.6%, and the local recurrence event rate at 24 months was 10%. CONCLUSIONS: The rate of grade ≥2 subcutaneous fibrosis at 24 months after IMRT was 10.8%, consistent with other recent trials of IMRT and lower than historically reported rates in patients treated with 3-dimensional conformal RT. This trial provides further evidence for the benefits of IMRT in this patient population.

Gastroprotective activity and physicochemical analysis of carboxymethylated gum from Anadenanthera colubrina.

Biotechnological advancements require the physicochemical alteration of molecules to enhance their biological efficacy for the effective treatment of gastric ulcers. The study aimed to produce a polyelectrolytic compound from red angico gum (AG) by carboxymethylation, evaluate its physicochemical characteristics and investigate gastric protection against ethanol-induced ulcers. AG and carboxymethylated angico gum (CAG) were characterized by Fourier transform infrared spectroscopy, determination of the degree of substitution and gel permeation chromatography (GPC) and 13C NMR techniques. The results demonstrated that the modification of the polymer was satisfactory, presenting conformational changes e improving the interaction with the gastric mucosa. AG and CAG reduced macroscopic and microscopic damage such as edema, hemorrhage and cell loss caused by exposure of the mucosa to alcohol. Both demonstrated antioxidant activity in vitro, and in vivo, pretreatment with gums led to the restoration of superoxide dismutase and glutathione levels compared to the injured group. Concurrently, the levels of malondialdehyde and nitrite decreased. Atomic force microscopy showed that CAG presented better conformational properties of affinity and protection with the gastric mucosa compared to AG in the acidic pH. Based on our findings, it is suggested that this compound holds promise as a prospective product for future biotechnological applications.

Geographical and gender differences in the development of motor skills in preschool children / Diferenças geográficas e de género no desenvolvimento das capacidades motoras das crianças em idade pré-escolar

ABSTRACT Motor development during childhood is fundamental for acquiring advanced perceptual and cognitive skills, playing a pivotal role in personal development and skill acquisition later in life. This study aims to investigate differences in the motor skills of children between the ages of 3 to 5, based on their geographic location (urban or rural) and gender. A cohort of 94 Portuguese children between the ages of 3 and 5 years old (comprising 48 boys and 46 girls) were selected for a study. Data collection was conducted within 8 different schools, and motor skills were assessed utilizing the MOBAK-KG test. It was observed that children from urban areas outperformed those from rural areas in motor skills related to body and object control. On the contrary, girls' motor skills did not show significant differences according to their geographical location. Although the geographical environment influences children's motor development, other factors, such as socio-economic and cultural factors, may have a greater impact on girls. These findings emphasise the significance of focusing on the motor development of girls and examining how cultural and gender expectations can impact their motor skills.

RESUMO O desenvolvimento motor durante a infância é fundamental para a aquisição de competências perceptivas e cognitivas avançadas, desempenhando um papel fulcral no desenvolvimento pessoal e na aquisição de competências mais tarde na vida. Este estudo tem como objetivo investigar as diferenças nas capacidades motoras de crianças entre os 3 e os 5 anos de idade, com base na sua localização geográfica (urbana ou rural) e género. Foi selecionada para o estudo uma coorte de 94 crianças portuguesas com idades compreendidas entre os 3 e os 5 anos (48 meninos e 46 meninas). A recolha de dados foi efectuada em 8 escolas diferentes e as capacidades motoras foram avaliadas utilizando o teste MOBAK-KG. Verificou-se que as crianças das zonas urbanas superavam as das zonas rurais nas capacidades motoras relacionadas com o controlo do corpo e dos objectos. Pelo contrário, as capacidades motoras das raparigas não apresentaram diferenças significativas em função da sua localização geográfica. Embora o ambiente geográfico influencie o desenvolvimento motor das crianças, outros factores, tais como os factores socioeconómicos e culturais, podem ter um maior impacto nas raparigas. Estes resultados sublinham a importância de nos concentrarmos no desenvolvimento motor das raparigas e de examinarmos a forma como as expectativas culturais e de género podem ter impacto nas suas capacidades motoras.

Reforming the regulatory reform: general law on independent agencies in Brazil / Reformando la reforma regulatoria: Ley General de Organismos Independientes en Brasil / Reformando a reforma regulatória: Lei Geral das Agências Independentes no Brasil

Abstract This paper addresses the effects of the new general law on independent agencies in Brazil. This regulatory reform sought to increase transparency and accountability, strengthen ex-ante evaluation, and improve decision-making. The research objective was to evaluate the possible organizational and institutional consequences of these changes. The study compared data collected from key actors in the 11 agencies referring to the period before the law with the regulatory scenario one year after the law was enacted. The results allow an unprecedented panoramic view of the agencies' instruments under the inspiration of better regulation, and the new scenario can positively impact these structures' credibility and trust. The study indicates an advance in the Brazilian regulatory governance model and opens space for future research.

Resumen Este artículo investiga los efectos de la nueva Ley General de Organismos Independientes en Brasil. Esta reforma de la reforma regulatoria intentó aumentar la transparencia y la rendición de cuentas, fortalecer la evaluación ex ante y mejorar la toma de decisiones. El objetivo de la investigación fue evaluar las posibles consecuencias organizacionales e institucionales de estos cambios. A partir de la recolección de datos con actores clave de los 11 organismos, se realizó una comparación entre el período previo a la Ley y el escenario regulatorio a un año de su vigencia. Los resultados permiten una panorámica inédita de los instrumentos de los organismos, bajo la inspiración de la better regulation. Este nuevo escenario puede tener un impacto positivo en la credibilidad y confianza de estas estructuras. El estudio indica un avance en el modelo brasileño de gobernanza regulatoria y abre espacio para futuras investigaciones.

Resumo Este trabalho investiga os efeitos da nova Lei Geral das Agências Independentes no Brasil. Essa reforma da reforma regulatória buscou aumentar a transparência e a responsabilidade, fortalecer a avaliação ex ante e melhorar a tomada de decisões. O objetivo da pesquisa foi avaliar possíveis consequências organizacionais e institucionais dessas mudanças. A partir da coleta de dados com atores-chave nas 11 agências, foi feita uma comparação entre o período anterior à Lei e o cenário regulatório após um ano de sua vigência. Os resultados permitem uma visão panorâmica inédita dos instrumentos das agências, sob a inspiração da better regulation. Esse novo cenário pode impactar positivamente na credibilidade e confiança dessas estruturas. O estudo indica um avanço no modelo de governança regulatória brasileiro e abre espaço para futuras pesquisas.

A phase 2 trial of short-course Hyperthermic IntraPeritoneal Chemotherapy (HIPEC) at interval cytoreductive surgery (iCRS) for advanced ovarian cancer / Quimioterapia Intraperitoneal Hipertérmica (HIPEC) de curta duração ao tempo da cirurgia citorredutora de intervalo (iCRS) para câncer de ovário avançado: ensaio clínico de fase 2

ABSTRACT Objective: to report the final analysis of a phase 2 trial assessing the efficacy and safety of short-course hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with advanced epithelial ovarian cancer (EOC). Methods: this was an open-label, multicenter, single-arm trial of HIPEC in patients with advanced EOC who underwent interval cytoreductive surgery (iCRS) after neoadjuvant chemotherapy (NACT). HIPEC was performed as a concentration-based regimen of platinum-based chemotherapy for 30 minutes. Primary endpoint was the rate of disease progression occurring at nine months following iCRS plus HIPEC (PD9). Secondary endpoints were postoperative complications, time to start adjuvant chemotherapy, length of hospital and ICU stay, quality of life (QoL) over treatment, and ultimately 2-year progression-free survival (PFS) and overall survival (OS). Analysis was by intention-to-treat with final database lock for survival outcomes on February 23, 2021. Results: fifteen patients with stage III EOC were enrolled between February 2015 and July 2019, in four centers. The intention to treat PD9 was 6.7%. With a median follow-up of 33 months (IQR, 24.3-46.5), the median PFS was 18.1 months and corresponding 2-year rates of PFS and OS was 33.3% and 93.3%, respectively. Three patients (20%) experienced graded III complications. Median length of hospital and ICU stay was 5 (IQR, 4-6.5) and 1 (IQR, 1-1) days, respectively. Time to restart systemic chemotherapy was 39 (IQR, 35-49.3) days and no significant difference over time in QoL was observed. Conclusions: we demonstrate preliminary efficacy and safety of short-course HIPEC in patient with advanced EOC.

RESUMO Objetivo: apresentar a análise final de ensaio clínico de fase 2 que avaliou a eficácia e a segurança da quimioterapia intraperitoneal hipertérmica (HIPEC) de curta duração em pacientes com câncer epitelial de ovário avançado (EOC). Métodos: estudo aberto, multicêntrico, de braço único avaliando a HIPEC em pacientes com EOC avançado submetidos a cirurgia citorredutora de intervalo (iCRS) após quimioterapia neoadjuvante (NACT). A HIPEC foi realizada como regime baseado na concentração de cisplatina, perfundida por 30 minutos. O desfecho primário foi a taxa de progressão da doença 9 meses após a iCRS com HIPEC (PD9). Os desfechos secundários foram complicações pós-operatórias, tempo para iniciar a quimioterapia adjuvante, tempo de internação e permanência em UTI, qualidade de vida (QoL) ao longo do tratamento e, finalmente, sobrevida cumulativa livre de progressão (PSF) e global (OS) em 2 anos. As análises foram em intenção de tratar (ITT) com fechamento dos dados para análise da sobrevida em 23 de fevereiro de 2021. Resultados: quinze pacientes com EOC em estágio III foram incluídos no estudo entre fevereiro de 2015 e julho de 2019 em quatro centros recrutadores. A PD9 por ITT foi de 6,7%. Com acompanhamento mediano de 33 meses (IQR, 24,3-46,5), a PFS mediana foi de 18,1 meses e as taxas correspondentes de PFS e OS em 2 anos foram 33,3% e 93,3%, respectivamente. Três pacientes (20%) apresentaram complicações grau III. O tempo mediano de internamento hospitalar e em UTI foi de 5 (IQR, 4-6,5) e 1 (IQR, 1-1) dias, respectivamente. O tempo para reinício da quimioterapia sistêmica foi de 39 dias (IQR, 35-49,3) e não foi observada diferença significativa na QoL ao longo do tratamento. Conclusões: demonstrou-se eficácia e segurança preliminares da HIPEC de curta duração em pacientes com EOC avançado.

A aplicação da laserterapia no tratamento de traumas mamilares: revisão de literatura / Application of laser therapy in the treatment of nipple traumas: a literature review / Aplicación de laserterapia en el tratamiento del traumatismo del pezón: revisión de literatura

OBJETIVO: Identificar na literatura científica a aplicação da laserterapia de baixa intensidade no tratamento de traumas mamilares em puérperas. MÉTODO: Trata-se de uma revisão integrativa da literatura. O levantamento das publicações ocorreu no período de setembro a novembro de 2020, utilizando os descritores "low-level light therapy" e "laser therapy", além da palavra-chave: "nipple trauma", nas bases de dados da PubMed, EMBASE, CINAHL, Scopuse Web of Science.Após a leitura e análise dos artigos, 3 artigos foram selecionados para a amostra final. RESULTADOS: Os dados analisados compuseram dois eixos temáticos denominados: "Uso da laserterapia no alívio da dor mamilar" e "Uso da laserterapia na cicatrização de fissuras mamilares". CONCLUSÃO: A aplicação da laserterapia resultou na diminuição da dor e boa regeneração tecidual mamilar, contribuindo para manutenção do aleitamento materno.

OBJECTIVE: To identify in the scientific literature the application of low-level laser therapy in the treatment of nipple traumas in puerperal women. METHOD: This is an integrative literature review.The survey of publications took place from September to November2020, using the descriptors "low-level light therapy" and "laser therapy", in addition to the keyword"nipple trauma", in the PubMed, EMBASE, CINAHL, Scopus and Web of Science databases.After reading and analyzing the articles, 3 were selected for the finalsample. RESULTS: The analyzed data composed two thematic axes, namely: "The use of laser therapy for nipple pain relief" and "The use of laser therapy in the healing of nipple fissures". CONCLUSION: The application of laser therapy resulted in pain reduction and in good nipple tissue regeneration, contributing to the maintenance of breastfeeding.

OBJETIVO: Identificar en la literatura científica la aplicación de laserterapia de baja intensidad en el tratamiento del traumatismo del pezón en mujeres posparto. MÉTODO: Se trata de una revisión integradora de la literatura. El levantamiento de publicaciones se realizó de septiembre a noviembre de 2020, utilizando los descriptores "low-level light therapy" y "laser therapy", además de la palabra clave: "nipple trauma", en las bases de datos de PubMed, EMBASE, CINAHL, Scopus y Web of Science. Después de leer y analizar los artículos, se seleccionaron 3 artículos para la muestra final. RESULTADOS: Los datos analizados comprendieron dos ejes temáticos denominados: "Uso de laserterapia para aliviar el dolor del pezón" y "Uso de laserterapia para la cicatrización de las grietas del pezón". CONCLUSIÓN: La aplicación de laserterapia dio como resultado una disminución del dolor y una buena regeneración del tejido del pezón, contribuyendo al mantenimiento de la lactancia.

Protocol for visits of patients' pets in palliative care in a hospital / Protocolo para la visita de mascotas de pacientes en cuidados paliativos en un hospital / Protocolo para visita do animal de estimação do paciente em cuidados paliativos em um hospital

ABSTRACT Objective To report the experience of the multidisciplinary health team in the construction and implementation of the assistance protocol for pets visiting patients admitted to a palliative care unit. Method This is an experience report about the construction and implementation of a protocol in a university hospital in the South of Brazil by a working group from the multidisciplinary team of the Palliative Care Program and composed of three nurses, a physician, a psychologist, a social worker, a manager, and a nutritionist. The period of construction and implementation of the protocol was from September 2017 to April 2019. Results The construction of the protocol by the multidisciplinary team followed three stages: planning, execution, and implementation, which enabled the release of visits of patients' pets in palliative care. Conclusion The construction of the protocol allowed for the institutionalization of the visit of patients' pets in palliative care in a university hospital, bringing benefits to patients and their families.

RESUMEN Objetivo Informar la experiencia del equipo de salud multiprofesional en la construcción e implementación de un protocolo de atención para visita de mascotas, para los pacientes internados en una unidad de cuidados paliativos. Método Se trata de un informe de experiencia sobre la construcción e implementación de un protocolo en un hospital universitario en el sur de Brasil, realizado por un grupo de trabajo originado a partir del equipo multidisciplinario del Programa de Cuidados Paliativos y compuesto por tres enfermeras, un médico, un psicólogo, un trabajador social, un administrador y un nutricionista. El período de construcción e implementación del protocolo abarca desde septiembre de 2017 hasta abril de 2019. Resultados La construcción del protocolo por la experiencia del equipo multiprofesional siguió tres etapas: planificación, ejecución e implementación, que permitieron la habilitación de las visitas de mascotas de pacientes en cuidados paliativos. Conclusión La construcción del protocolo permitió institucionalizar la visita de mascotas de pacientes en cuidados paliativos en un hospital universitario, brindando beneficios tanto a los pacientes como a sus familias.

RESUMO Objetivo Relatar a experiência da equipe multiprofissional em saúde na construção e implantação do protocolo assistencial para visita dos animais de estimação dos pacientes internados em uma Unidade de Cuidados Paliativos. Método Trata-se de um relato de experiência de uma ação realizada em um hospital universitário do sul do Brasil por um grupo de trabalho originado da equipe multiprofissional do Programa de Cuidados Paliativos, composto por três enfermeiros, um médico, um psicólogo, um assistente social, um administrador e uma nutricionista. O período de construção e implementação do protocolo foi de setembro de 2017 a abril de 2019. Resultados: A construção do protocolo pela equipe multiprofissional seguiu três etapas, planejamento, execução e implementação, e resultou na liberação para visita dos animais de estimação dos pacientes em cuidados paliativos. Conclusão A construção do protocolo permitiu a institucionalização da visita dos animais de estimação dos pacientes em cuidados paliativos em um hospital universitário, trazendo benefícios para os pacientes e seus familiares.

Residência em Medicina de Família e Comunidade para a formação de recursos humanos: o que pensam gestores municipais? / Family and Community Medicine Residency Programs for training the health workforce: what do municipal health managers think?

Resumo Treinamento especializado, provimento e fixação de profissionais na Atenção Primária à Saúde são desafios prementes no Brasil. A recente expansão dos Programas de Residência em Medicina de Família e Comunidade coexiste com lacunas na literatura sobre o efeito deste processo. O objetivo do trabalho é explorar a perspectiva do gestor municipal de saúde acerca das estratégias para o fortalecimento das residências e do papel destas na formação profissional e na qualificação da atenção. Trata-se de um estudo de análise quantitativa e qualitativa, com aplicação de questionário a gestores de municípios cenários destes programas. As respostas de 48 sujeitos foram submetidas a estatística descritiva e análise de conteúdo. Os resultados revelam um esforço em incorporar o Médico de Família e Comunidade na rede de atenção à saúde, uma percepção do potencial das residências no incremento da qualidade da atenção e da formação profissional e fragilidades nas ações para melhoria da estrutura e organização dos serviços com residentes. Vislumbra-se assim o potencial das residências para a superação de problemas históricos da Atenção Primária à Saúde brasileira, se atrelada a ações de fortalecimento do serviço, dos recursos humanos e do próprio programa.

Abstract The training, recruitment and retention of primary care professionals is a constant challenge in Brazil. The recent expansion of family and community medicine residency programs in the country coexists with gaps in the literature on the effects of this process. This article explores municipal health managers' understanding of these programs and the role they play in professional training and improving the quality of health care. We conducted a quantitative and qualitative analysis of the responses to questionnaires answered by 48 health managers working in municipal health services affiliated to residency programs. A descriptive statistical analysis of the quantitative data was performed and the qualitative data were analyzed using thematic analysis. The findings show that efforts were made to incorporate family and community doctors into the health care network and that managers recognized the potential residency program have to improve the quality of care and enhance professional training. Weaknesses were found in actions to improve infrastructure and facilities and the organization of the services affiliated to the programs. This study highlights the potential of residency programs for addressing longstanding problems in primary health care in Brazil when combined with actions to strengthen services, human resources and the programs.

Quality of life in a phase 2 trial of short-course hyperthermic intraperitoneal chemotherapy (HIPEC) at interval debulking surgery for high tumor burden ovarian cancer / Avaliação da qualidade de vida em ensaio clínico de fase 2 envolvendo quimioterapia intraperitoneal hipertérmica (HIPEC) de curta duração no momento da citorredução de intervalo em pacientes com câncer de ovário de grande volume tumoral

ABSTRACT Introduction: to evaluate the effect of short-course (i.e.: 30 minutes) HIPEC on health-related quality of life (HRQoL) in our feasibility study; NCT02249013. Methods: a prespecified secondary end-point of our open-label, multicenter, single-arm, phase 2 trial on safety and efficacy was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30, version 3.0). Patients were required to complete the HRQoL questionnaire at baseline, after HIPEC, and after the end of the treatment. Changes of HRQoL over time were assessed by median scores for each domain and analyzed by Friedman`s test at a significant two-sided level of 0.05. Results: fifteen patients with high tumor burden EOC were recruited from our public health system between February 2015 and July 2019. A baseline EORTC QLQ-C30 questionnaire and at least one follow-up questionnaire was received from all of the patients. No significant difference over time in the QLQC30 summary scores was observed (p>0.05). The transitory impairment on patients HRQoL immediately after the short-course HIPEC trended to return to baseline at the end of the multimodal treatment. Conclusions: we found no significant impairment of short-course HIPEC on patients HRQoL into the context of our comprehensive treatment protocol.

RESUMO Objetivo: avaliar o impacto da quimioterapia intraperitoneal hipertérmica (HIPEC) de curta duração (i.e.: 30 minutos) na qualidade de vida (QoL) relacionada à saúde (HRQoL) no contexto de ensaio clínico terapêutico piloto; NCT02249013. Métodos: avaliou-se o desfecho secundário predeterminado de HRQoL em ensaio clínico de fase 2 de segurança e eficácia, aberto, multicêntrico, de braço único, utilizando-se o questionário European Organization for Research and Treatment of Cancer Quality of Life (EORTC QLQ-C30, versão 3.0). As pacientes foram solicitadas a responder o questionário de HRQoL antes do tratamento, após a HIPEC, e ao fim do tratamento interdisciplinar. As variações da HRQoL ao longo do tempo foram avaliadas pelas medianas dos escores de cada domínio e analisadas pelo teste de Friedman, considerando-se nível de significância estatística bicaudal de 5%. Resultados: quinze pacientes com câncer de ovário de grande volume tumoral foram recrutadas do sistema de saúde pública (i.e.: SUS) entre fevereiro de 2015 e julho 2019. Um questionário basal e pelo menos um questionário de acompanhamento foram coletados de todas as pacientes. Não se observou diferença significativa ao longo do tempo na HRQoL em nenhum dos domínios ou sintomas estudados (p> 0,05). O comprometimento transitório da HRQoL imediatamente após a HIPEC de curta duração tendeu a retornar à linha de base ao final do tratamento multimodal. Conclusões: não se observou impacto significativo da HIPEC de curta duração sobre a HRQoL no contexto deste protocolo de tratamento interdisciplinar.