Efeitos adversos às drogas antituberculose: hepatotoxicidade / Adverse effects to antituberculosis drugs: hepatotoxicity

Objetivo: Verificar a frequência de efeitos adversos em pacientes em uso de drogas antituberculose de primeira linha, além dos fatores de risco associados aos efeitos adversos e à hepatotoxicidade. Métodos: Estudo transversal, envolvendo 196 pacientes portadores de tuberculose em Maceió (AL), de agosto de 2017 a junho de 2018. Os efeitos adversos foram classificados de acordo com o Manual de Recomendações para Controle da Tuberculose de 2011, do Ministério da Saúde, em efeitos menores (queixas gastrintestinais, cutâneos, articulares e neurológicos) e maiores (psicose e hepatotoxicidade). Os fatores de risco avaliados foram: idade superior a 40 anos, etilismo, sexo feminino, anemia, doença hepática anterior, diabetes e infecção por HIV. Resultados: Foram observados efeitos adversos às drogas antituberculose em 85 pacientes (43,4%); destes, 40,8% eram menores e 8,2%, maiores. Os mais frequentes foram distúrbios gastrintestinais (25,5%) e cutâneos (15,3%). Identificaram-se como fatores de risco anemia, diabetes e doença hepática anterior. Hepatotoxicidade foi diagnosticada em 15 pacientes (10,6%), dos quais 80% eram sintomáticos, sendo fatores de risco doença hepática anterior e diabetes. Houve suspensão da terapia em todos os casos de hepatotoxicidade com modificação do esquema em 80% dos casos. Conclusão: Demonstrou-se frequência elevada de efeitos adversos às drogas antituberculose, associada à doença hepática anterior e ao diabetes. A hepatotoxicidade representou o efeito adverso mais grave, responsável pela suspensão e pela adequação do esquema terapêutico.

Objective: To determine the adverse effects frequency in patients on first-line antituberculosis drugs, as well as the risk factors associated with adverse effects and hepatotoxicity. Methods: Cross-sectional study, involving 196 tuberculosis patients in Maceió (AL), from August 2017 to June 2018. Adverse effects were classified according to the Manual de Recomendações para Controle da Tuberculose, of the Brazilian Health Ministry, in minor effects (gastrointestinal, cutaneous, articular, neurologic complaints) and major effects (psychosis and hepatotoxicity). The risk factors evaluated were age over 40 years, alcoholism, female sex, anemia, previous hepatic disease, diabetes, and infection by HIV. Results: Adverse effects to the antituberculosis drugs were observed in 85 patients (43.4%) and, among those, 40.8% were minor and 8.2% were major effects. The most frequent were gastrointestinal (25.5%) and skin (15.3%) disorders. Risk factors were identified as anemia, diabetes, and previous hepatic disease. Hepatotoxicity was diagnosed in 15 patients (10.6%), from which 80% were symptomatic, with previous hepatic disease and diabetes being the risk factors. Therapy was discontinued in all cases of hepatotoxicity with regimen modification in 80% of cases. Conclusion: An elevated frequency of adverse effects to antituberculosis drugs was demonstrated. Hepatotoxicity represented the most severe adverse effect, being responsible for the discontinuation and adaptation of the therapeutic regimen.

Anxiety-related psychological impacts in the COVID-19 pandemic on cardiovascular diseases and diabetes

Patients and the general public are under insurmountable psychological pressure which may lead to various psychological problems, such as anxiety, fear, depression, and insomnia, causing, consequently, the impaired quality of life. Psychological crisis intervention plays a pivotal role in the overall deployment of health-related quality of life and disease control. A novel Severe Acute Respiratory Syndrome Coronavirus-2 (SARSCoV-2), a pathogen of the new coronavirus disease (COVID-19), has affected several sector activities, including people's health. To enhance infection control methods, appropriate interventions, and public health policies, the present study aims to assess the fear and peri-traumatic stress during the Covid-19 in Brazil. Method: A cross-sectional survey has been conducted from April 12th to 18th using the Peri-Traumatic Distress Scale (CPDI) and the Fear Scale (FCV-19S) aiming to measure the peri-traumatic stress and fear as psychological reactions during the COVID-19 pandemic. For that purpose, an online spreadsheet was used to send the questionnaire and scales to a sample of 1844 participants as a collecting information tool. After the data analysis, the individuals were separated into 4 groups: Group 1 (1232) population without chronic health conditions; group 2 (298) patients with previous psychological suffering, group 3 (229) patients with cardiovascular diseases, group 4 (71) patients with diabetes. For analysis, G1 and were considered control for comparison with groups 2, 3 and 4 in accordance with One-Way Anova followed by Bonferroni test. Results: All the groups showed the CPDI and FCV-19S increased in comparison with the G1 group. Concerning CPDI, the G 3 was increased when compared to G1, G2 and G4. The G3 had the FCV-19S higher in comparison with G1, G2 and G4. The Wilcoxon-Mann-Whitney test showed a statistical difference between the control group in comparison with 2 and 3 groups (Mann-Whitney p< 0.05). Conclusion: The COVID-19 pandemic had a significant impact on the Brazilian population, with patients with heart disease and hypertension presenting the highest numbers of stress and fear, with numbers comparable and even higher than those who reported previous psychological distress.

How reliable is online diffusion of medical information targeting patients and families?

AIM: To determine whether online diffusion of the "Ten Warning Signs of Primary Immunodeficiency Diseases (PID)'' adheres to accepted scientific standards. METHODS: We analyzed how reproducible is online diffusion of a unique instrument, the "Ten Warning Signs of PID", created by the Jeffrey Modell Foundation (JMF), by Google-assisted searches among highly visited sites from professional, academic and scientific organizations; governmental agencies; and patient support/advocacy organizations. We examined the diffusion, consistency of use and adequate referencing of this instrument. Where applicable, variant versions of the instrument were examined for changes in factual content that would have practical impact on physicians or on patients and their families. RESULTS: Among the first 100 sites identified by Google search, 85 faithfully reproduced the JMF model, and correctly referenced to its source. By contrast, the other 15 also referenced the JMF source but presented one or more changes in content relative to their purported model and therefore represent uncontrolled variants, of unknown origin. Discrepancies identified in the latter included changes in factual content of the original JMF list (C), as well as removal (R) and introduction (I) of novel signs (Table 2), all made without reference to any scientific publications that might account for the drastic changes in factual content. Factual changes include changes in the number of infectious episodes considered necessary to raise suspicion of PID, as well as the inclusion of various medical conditions not mentioned in the original. Together, these changes will affect the way physicians use the instrument to consult or to inform patients, and the way patients and families think about the need for specialist consultation in view of a possible PID diagnosis. CONCLUSION: The retrieved adaptations and variants, which significantly depart from the original instrument, raise concerns about standards for scientific information provided online to physicians, patients and families.

Contribution of audiovestibular tests to the topographic diagnosis of sudden deafness

Sudden hearing loss (SHL) is an ENT emergency defined as sensorineural hearing loss (SNHL) > 30 dB HL affecting at least 3 consecutive tonal frequencies, showing a sudden onset, and occurring within 3 days. In cases of SHL, a detailed investigation should be performed in order to determine the etiology and provide the best treatment. Otoacoustic emission (OAE) analysis, electronystagmography (ENG), bithermal caloric test (BCT), and vestibular evoked myogenic potential (VEMP) assessments may be used in addition to a number of auxiliary methods to determine the topographic diagnosis. OBJECTIVE: To evaluate the contribution of OAE analysis, BCT, VEMP assessment, and magnetic resonance imaging (MRI) to the topographic diagnosis of SHL. METHOD: Cross-sectional and retrospective studies of 21 patients with SHL, as defined above, were performed. The patients underwent the following exams: audiometry, tympanometry, OAE analysis, BCT, VEMP assessment, and MRI. Sex, affected side, degree of hearing loss, and cochleovestibular test results were described and correlated with MRI findings. Student's t-test was used for analysis of qualitative variables (p < 0.05). RESULTS: The mean age of the 21 patients assessed was 52.5 ± 15.3 years; 13 (61.9%) were women and 8 (38.1%) were men. Most (55%) had severe hearing loss. MRI changes were found in 20% of the cases. When the audiovestibular test results were added to the MRI findings, the topographic SHL diagnosis rate increased from 20% to 45%. CONCLUSION: Only combined analysis via several examinations provides a precise topographic diagnosis. Isolated data do not provide sufficient evidence to establish the extent of involvement and, hence, a possible etiology...

Contribution of audiovestibular tests to the topographic diagnosis of sudden deafness.

INTRODUCTION: Sudden hearing loss (SHL) is an ENT emergency defined as sensorineural hearing loss (SNHL) ≥ 30 dB HL affecting at least 3 consecutive tonal frequencies, showing a sudden onset, and occurring within 3 days. In cases of SHL, a detailed investigation should be performed in order to determine the etiology and provide the best treatment. Otoacoustic emission (OAE) analysis, electronystagmography (ENG), bithermal caloric test (BCT), and vestibular evoked myogenic potential (VEMP) assessments may be used in addition to a number of auxiliary methods to determine the topographic diagnosis. Objective To evaluate the contribution of OAE analysis, BCT, VEMP assessment, and magnetic resonance imaging (MRI) to the topographic diagnosis of SHL. Method Cross-sectional and retrospective studies of 21 patients with SHL, as defined above, were performed. The patients underwent the following exams: audiometry, tympanometry, OAE analysis, BCT, VEMP assessment, and MRI. Sex, affected side, degree of hearing loss, and cochleovestibular test results were described and correlated with MRI findings. Student's t-test was used for analysis of qualitative variables (p < 0.05). Results The mean age of the 21 patients assessed was 52.5 ± 15.3 years; 13 (61.9%) were women and 8 (38.1%) were men. Most (55%) had severe hearing loss. MRI changes were found in 20% of the cases. When the audiovestibular test results were added to the MRI findings, the topographic SHL diagnosis rate increased from 20% to 45%. Conclusion Only combined analysis via several examinations provides a precise topographic diagnosis. Isolated data do not provide sufficient evidence to establish the extent of involvement and, hence, a possible etiology.

Occurrence of the Indo-Pacific freshwater prawn Macrobrachium equidens Dana 1852 on the coast of Brazilian Amazonia, with notes on its reproductive biology.

The freshwater prawn Macrobrachium equidens, which is native species of the Indo-Pacific Region, was recorded for the first time on the Amazon coast of Brazil. This species was found to inhabit the same environment as two native Macrobrachium species, M. amazonicum and M. acanthurus, and is morphologically very similar to the latter. The identification of the species was confirmed by the genetic analysis of sequences of the mitochondrial Cytochrome Oxidase (COI) gene. A detailed description of the morphological features and reproductive biology of M. equidens in this new environment is presented.

Occurrence of the Indo-Pacific freshwater prawn Macrobrachium equidens Dana 1852 (Decapoda, Palaemonidae) on the coast of Brazilian Amazonia, with notes on its reproductive biology

The freshwater prawn Macrobrachium equidens, which is native species of the Indo-Pacific Region, was recorded for the first time on the Amazon coast of Brazil. This species was found to inhabit the same environment as two native Macrobrachium species, M. amazonicum and M. acanthurus, and is morphologically very similar to the latter. The identification of the species was confirmed by the genetic analysis of sequences of the mitochondrial Cytochrome Oxidase (COI) gene. A detailed description of the morphological features and reproductive biology of M. equidens in this new environment is presented.

O camarão de água doce Macrobrachium equidens, nativo da região do Indo-Pacífico, foi registrada pela primeira vez na costa da Amazônia Brasileira. Esta espécie foi encontrada habitando o mesmo ambiente que duas espécies nativas do gênero Macrobrachium: M. amazonicum e M. acanthurus, e é morfologicamente muito similar à última. A identificação dessa espécie foi confirmada pela análise da seqüência genética do gene mitocondrial Citocromo Oxidase (COI). Uma descrição detalhada das características morfológicas e biologia reprodutiva de M. equidens neste novo ambiente é apresentada.

Rapid determination of tartaric acid in wines.

A flow-spectrophotometric method is proposed for the routine determination of tartaric acid in wines. The reaction between tartaric acid and vanadate in acetic media is carried out in flowing conditions and the subsequent colored complex is monitored at 475 nm. The stability of the complex and the corresponding formation constant are presented. The effect of wavelength and pH was evaluated by batch experiments. The selected conditions were transposed to a flow-injection analytical system. Optimization of several flow parameters such as reactor lengths, flow-rate and injection volume was carried out. Using optimized conditions, a linear behavior was observed up to 1000 microg mL(-1) tartaric acid, with a molar extinction coefficient of 450 L mg(-1) cm(-1) and +/- 1 % repeatability. Sample throughput was 25 samples per hour. The flow-spectrophotometric method was satisfactorily applied to the quantification of TA in wines from different sources. Its accuracy was confirmed by statistical comparison to the conventional Rebelein procedure and to a certified analytical method carried out in a routine laboratory.

Educação sexual: uma metodologia alternativa / Sexual education: some alternative methodology

O crescimento

Expectativa de inserção profissional: análise de relatos verbais

Diagnóstico das dificuldades que o concluinte do curso de Psicologia na Universidade Federal do Pará, espera encontrar para se engajar no mercado de trabalho. As análises dos relatos verbais permitiram caracterizar a conclusão do curso como um momento de 'crise'. O procedimento de coleta recorreu ao uso de entrevistas longas; no tratamento do material, o pesquisador fazia inferências e classificava os conteúdos das mesmas, agrupando-as em classes de conteúdo verbal. As inferências eram comunicadas ao informante a cada entrevista, constituindo-se em material para uso em nova sessão de entrevista. Os resultados levaram âs seguintes hipóteses de trabalho: - 'crise' é sinônimo de indefinição de interesses, de uma visão obscura de suas dificuldades, e uma diminuta planificação para superá-las e de um sentimento negativo em relação a este estado de coisas. A re-exposição sistemática dos concluintes às suas próprias falas produziu uma reflexão sobre seus interesses, maior explicitação das dificuldades e busca de explicação para as mesmas; bem como um planejamento de ações apropriadas para solucioná-las e uma redução de seu 'mal-estar' (AU)

Ensino Prático Integrado de Obstetrícia e Neonatologia em Maternidade: Relato da Experiência da UFPE / Integrated Practical Training in Obstetrics and Neonatology in a Maternity Hospital: A Case Report from Federal University in Pernambuco

Resumo: A atenção à saúde materno-infantil no período neonatal exige dos profissionais uma compreensão integral do binômio mãe-filho. Os conhecimentos estudados pela Obstetrícia e pela Neonatologia são intimamente relacionados e devem ser abordados de forma integrada, sobretudo durante a graduação médica, quando o futuro médico constrói a base de seus raciocínio clínico. Os alunos do 6o período do curso médico da UFPE realizam as atividades práticas de Obstetrícia e Neonatologia integradas em maternidades-escola, acompanhadas de monitores. A concepção teórica e a concretização prática deste ensino integrado contaram com algumas dificuldades no início de seu funcionamento. A dificuldade de compreensão da importância da prática integrada e a falta de motivação de alguns professores foram relatadas como dificuldades menores. O maior problema desde o início tem sido a infra-estrutura e demanda de pacientes atendidos nas maternidades. O trabalho democrático e participativo de construção coletiva do projeto de ensino realizado por alunos, monitores e a coordenação do estágio tem-se mostrado uma estratégia eficiente para a superação das dificuldades.

Abstract: Mother-child health care during the prenatal period demands that health care professionals have an integral understanding of the mother-child dyad. The bodies of knowledge studied by Obstetrics and Neonatology are intimately related and should receive an integrated approach, especially during basic medical training, when future physicians build the basis for their clinical reasoning. Sixth-semester students in the school of Medicine at UFPE perform integrated practical activities in Obstetrics and Neonatology at teaching maternity hospitals, accompanied by monitors. The theoretical concept and practical implementation of the integrated teaching process enconuntered several difficulties in its early stages. Difficulty in understanding the importance of integrated practice and lack of motivation on the part of some professors were reported as minor problems. The greatest problems have been with the infrastructure and patient demand served at the maternity hospitals. A democratic and participatory work process involving collective development of teaching proposal by students, monitors, and the rotation coordinators has proven be an efficient strategy for overcoming difficulties.

Desmoid tumor of the mediastinum

A desmoid tumor of the mediastinum was diagnosed and terated in a 35 year-old white male who presented with a right supraclavicular mass. He was treated with resection, which involved several vascular structures, requiring multiple vascular reconstructions followed by postoperative radiotherapy. The authors concluded that, when located in tha mediastinum, the invasive character of such tumors and its tendency to recur may pose a considerable surgical challenge, requiring careful preoperative planing and postoperative planning follow-up. The role of radiation therapy is limited to the control of local recurrences

Diagnóstico das dificuldades que o aluno concluinte de psicologia espera encontrar para se engajar no mercado de trabalho

Neste trabalho, procuramos diagnosticar as dificuldades que o concluinte espera encontrar para se enganjar no mercado de trabalho, através de seus relatos verbais, desta forma o problema foi caracterizado considerando- se: a conclusão do curso como um momento de 'crise' (crise = estado de dúvidas e incertezas, fase difícil, grave na evolução das coisas, dos fatos e das idéias - Dicionário Aurélio da Língua Potuguesa). A inexistência de trabalhos focalizando este momento, bem como a inexistência de estudos na área, utilizando relatos verbais longos. Tendo em vista que somente através dos relatos dos informantes poderíamos alcançar o objetivo proposto; o procedimento de coleeta envolveu entrevistas do tipo oral, longa, de modo a permitir que as informações fossem relatadas. A partir dos relatos, o pesquisador fazia inferências e classificava os conteúdos dos mesmos, agrupando-os em classes de conteúdo verbais. As inferências feitas pelo pesquisador eram comunicadas ao informante a cada entrevista, constituindo-se em estímulo discriminativo para o informante poder refletir sobre suas dificuldades e relatar com mais exatidão sobre as mesmas. Optou-se por uma segunda etapa de trabalho, utilizando-se como dado complementar as entrevistas dos supervisores de estágio em uma situação de Seminário de Avaliação. Os resultados levaram às seguintes hipóteses de trabalho: - A 'crise' porque passa o aluno concluinte em Psciologia, caracteriza-se por uma indefinição de interesses, uma visão obscura de suas dificuldades, uma quase ausência de planos para superá-las e um sentimento negativo em relação a este estado de coisas. - A re-exposição sistemática dos concluintes às suas próprias falas produziu uma reflexão sobres interesses; maior explicitação das dificuldades e busca de explicações para as mesmas; bem como um planejamento de ações apropriadas para solucioná-las e uma redução de seu 'mal-estar'. - Tais alterações nos relatos dos informantes não podem ser explicadas simplesmente pela re-exposição dos mesmos a suas falas, devido ao fato dos mesmos estarem também vivenciando experiências importantes para seu engajamento profissional, destacando-se os estágios supervisionados; tornando-se importante os dados coletados com os supervisores cujos resultados levaram a algumas considerações mais gerais sobre as relações entre as dificuldades descritas pelos dois grupos de informantes, e as deficiências do curso, destacando-se o controvertido 'dilema: teoria x prática' (AU)