Evaluation of intravascular contrast media transit times in coronary computed tomography angiography.

Objective: To measure the transit times (TTs) of contrast agents among the injection site (antecubital vein), superior vena cava, pulmonary trunk, and ascending aorta, in coronary computed tomography angiography (CTA) examinations of outpatients with no history of cardiovascular or lung disease, thus defining reference values for those TTs. Materials and Methods: The contrast TTs from the injection site (antecubital vein) to the superior vena cava, from the superior vena cava to the pulmonary trunk, and from the pulmonary trunk to the ascending aorta were measured by monitoring contrast enhancement in real time (bolus tracking). Cardiac output was measured by the geometric method during the CTA examination and was correlated with the contrast TT. Results: Forty-three individuals were analyzed. The mean contrast TT was 13.1 s overall (from the antecubital vein to the ascending aorta), 3.0 s from the superior vena cava to the pulmonary trunk, and 7.2 s from the pulmonary trunk to the ascending aorta. There was a tendency toward a correlation between contrast TT and cardiac output (p = 0.055). Conclusion: The reference values established here for contrast TTs among the superior vena cava, pulmonary trunk, and ascending aorta will serve as a basis for clinical evaluation.

Objetivo: Mensurar os tempos de trânsito de contraste (TTCs) entre o sítio de injeção em veia antecubital e a veia cava superior, tronco arterial pulmonar e aorta ascendente em exames de tomografia computadorizada de artérias coronárias de pacientes sem história de doenças cardiovasculares ou pulmonares, definindo padrões de normalidade para esses tempos de circulação. Materiais e Métodos: Os TTCs entre o sítio de injeção e a veia cava superior, tronco arterial pulmonar e aorta ascendente foram medidos com base nas imagens de monitoração (bolus tracking). O débito cardíaco foi calculado com base nas imagens de angiotomografia computadorizada pelo método geométrico e correlacionado com os TTCs. Resultados: Foram analisados 43 pacientes. O TTC médio entre o tronco arterial pulmonar e a aorta ascendente foi de 7,2 s, entre a veia cava superior e o tronco arterial pulmonar foi de 3 s e entre a veia antecubital e a aorta ascendente foi de 13 s. Houve tendência a correlação entre o TTC e o débito cardíaco, com valor de p de 0,055. Conclusão: Os valores de normalidade do TTC entre a veia cava superior, tronco arterial pulmonar e aorta ascendente foram estabelecidos, servindo de base para avaliação clínica.

Risks and Benefits of Breastfeeding in COVID-19: Integrative Literature Review / Riscos e benefícios da amamentação na COVID-19: Revisão integrativa da literatura

Abstract Objective The present article seeks to consolidate existing knowledge on breastfeeding during the SARS-CoV-2 pandemic. Data source Articles from 2020 and 2021 collected from the PubMed, CAPES, Virtual Health Library, Google Scholar, SciELO, and UpToDate databases were analyzed. Books and government documents published in the last decade (2010-2020) were also consulted. Study Selection Sixteen works were used in the present study. The date of publication and discussion of SARS-CoV-2 transmission through breastmilk were the inclusion criteria. Thus, articles containing repeated information or with no relevance to add to the production were excluded. Data collection comprised critical reading and synthesis of the main information obtained on the subject, which were performed for the preparation of the present study. The research took place in the period from March 27 to April 2, 2021. Synthesis of the data Breast milk has diverse benefits for both the nursing mother and the infant. The presence of viral RNA by real-time polymerase chain reaction (RTPCR) in milk from disease-positive mothers has been detected in a few cases, and infant infections in these conditions suggest oral transmission of maternal or third-party origin. The virulence of the novel coronavirus in human milk is not confirmed, while significant amounts of exclusive antibodies are. Conclusion Lactation in the context of COVID-19 has shown greater benefits than risks of vertical transmission. Therefore, it should be encouraged when possible.

Resumo Objetivo O presente artigo procura consolidar os conhecimentos existentes sobre o aleitamento materno durante a pandemia do SARS-CoV-2. Fonte de dados Foram analisados os artigos de 2020 e 2021 recolhidos dos bancos de dados PubMed, CAPES, Biblioteca Virtual de Saúde, Google Scholar, SciELO e bases de dados UpToDate. Livros e documentos governamentais publicados na última década (2010-2020) também foram consultados. Seleção de estudos Dezesseis obras foram utilizadas no presente estudo. A data de publicação e discussão sobre a transmissão do SARS-CoV-2 através do leite materno foram os critérios de inclusão. Assim, foram excluídos os artigos que continham informações repetidas ou sem relevância para a produção. Coleta de dados Para a preparação do presente estudo, foram realizadas leituras críticas e síntese das principais informações obtidas sobre o tema. A pesquisa ocorreu no período de 27 de março a 2 de abril de 2021. Síntese dos dados O leite materno tem diversos benefícios tanto para a mãe quanto para o lactente. A presença de RNA viral por reação em cadeia de polimerase em tempo real (RT-PCR, na sigla em inglês) no leite de mães positivas foi detectada em alguns casos, e as infecções infantis nestas condições sugerem transmissão oral de origem materna ou de terceiros. A virulência do novo coronavírus no leite humano não está confirmada, enquanto quantidades significativas de anticorpos exclusivos sim. Conclusão A lactação no contexto da COVID-19 mostroumaiores benefícios do que os riscos de transmissão vertical. Por conseguinte, deve ser encorajada sempre que possível.

Avaliação de diferentes tempos de trânsito do meio de contraste intravascular em exames de tomografia computadorizada coronariana / Evaluation of intravascular contrast media transit times in coronary computed tomography angiography

Resumo Objetivo: Mensurar os tempos de trânsito de contraste (TTCs) entre o sítio de injeção em veia antecubital e a veia cava superior, tronco arterial pulmonar e aorta ascendente em exames de tomografia computadorizada de artérias coronárias de pacientes sem história de doenças cardiovasculares ou pulmonares, definindo padrões de normalidade para esses tempos de circulação. Materiais e Métodos: Os TTCs entre o sítio de injeção e a veia cava superior, tronco arterial pulmonar e aorta ascendente foram medidos com base nas imagens de monitoração (bolus tracking). O débito cardíaco foi calculado com base nas imagens de angiotomografia computadorizada pelo método geométrico e correlacionado com os TTCs. Resultados: Foram analisados 43 pacientes. O TTC médio entre o tronco arterial pulmonar e a aorta ascendente foi de 7,2 s, entre a veia cava superior e o tronco arterial pulmonar foi de 3 s e entre a veia antecubital e a aorta ascendente foi de 13 s. Houve tendência a correlação entre o TTC e o débito cardíaco, com valor de p de 0,055. Conclusão: Os valores de normalidade do TTC entre a veia cava superior, tronco arterial pulmonar e aorta ascendente foram estabelecidos, servindo de base para avaliação clínica.

Abstract Objective: To measure the transit times (TTs) of contrast agents among the injection site (antecubital vein), superior vena cava, pulmonary trunk, and ascending aorta, in coronary computed tomography angiography (CTA) examinations of outpatients with no history of cardiovascular or lung disease, thus defining reference values for those TTs. Materials and Methods: The contrast TTs from the injection site (antecubital vein) to the superior vena cava, from the superior vena cava to the pulmonary trunk, and from the pulmonary trunk to the ascending aorta were measured by monitoring contrast enhancement in real time (bolus tracking). Cardiac output was measured by the geometric method during the CTA examination and was correlated with the contrast TT. Results: Forty-three individuals were analyzed. The mean contrast TT was 13.1 s overall (from the antecubital vein to the ascending aorta), 3.0 s from the superior vena cava to the pulmonary trunk, and 7.2 s from the pulmonary trunk to the ascending aorta. There was a tendency toward a correlation between contrast TT and cardiac output (p = 0.055). Conclusion: The reference values established here for contrast TTs among the superior vena cava, pulmonary trunk, and ascending aorta will serve as a basis for clinical evaluation.

Risks and Benefits of Breastfeeding in COVID-19: Integrative Literature Review.

OBJECTIVE: The present article seeks to consolidate existing knowledge on breastfeeding during the SARS-CoV-2 pandemic. DATA SOURCE: Articles from 2020 and 2021 collected from the PubMed, CAPES, Virtual Health Library, Google Scholar, SciELO, and UpToDate databases were analyzed. Books and government documents published in the last decade (2010-2020) were also consulted. STUDY SELECTION: Sixteen works were used in the present study. The date of publication and discussion of SARS-CoV-2 transmission through breast milk were the inclusion criteria. Thus, articles containing repeated information or with no relevance to add to the production were excluded. Data collection comprised critical reading and synthesis of the main information obtained on the subject, which were performed for the preparation of the present study. The research took place in the period from March 27 to April 2, 2021. SYNTHESIS OF THE DATA: Breast milk has diverse benefits for both the nursing mother and the infant. The presence of viral RNA by real-time polymerase chain reaction (RT-PCR) in milk from disease-positive mothers has been detected in a few cases, and infant infections in these conditions suggest oral transmission of maternal or third-party origin. The virulence of the novel coronavirus in human milk is not confirmed, while significant amounts of exclusive antibodies are. CONCLUSION: Lactation in the context of COVID-19 has shown greater benefits than risks of vertical transmission. Therefore, it should be encouraged when possible.

OBJETIVO: O presente artigo procura consolidar os conhecimentos existentes sobre o aleitamento materno durante a pandemia do SARS-CoV-2. FONTE DE DADOS: Foram analisados os artigos de 2020 e 2021 recolhidos dos bancos de dados PubMed, CAPES, Biblioteca Virtual de Saúde, Google Scholar, SciELO e bases de dados UpToDate. Livros e documentos governamentais publicados na última década (2010­2020) também foram consultados. SELEçãO DE ESTUDOS: Dezesseis obras foram utilizadas no presente estudo. A data de publicação e discussão sobre a transmissão do SARS-CoV-2 através do leite materno foram os critérios de inclusão. Assim, foram excluídos os artigos que continham informações repetidas ou sem relevância para a produção. COLETA DE DADOS: Para a preparação do presente estudo, foram realizadas leituras críticas e síntese das principais informações obtidas sobre o tema. A pesquisa ocorreu no período de 27 de março a 2 de abril de 2021. SíNTESE DOS DADOS: O leite materno tem diversos benefícios tanto para a mãe quanto para o lactente. A presença de RNA viral por reação em cadeia de polimerase em tempo real (RT-PCR, na sigla em inglês) no leite de mães positivas foi detectada em alguns casos, e as infecções infantis nestas condições sugerem transmissão oral de origem materna ou de terceiros. A virulência do novo coronavírus no leite humano não está confirmada, enquanto quantidades significativas de anticorpos exclusivos sim. CONCLUSãO: A lactação no contexto da COVID-19 mostrou maiores benefícios do que os riscos de transmissão vertical. Por conseguinte, deve ser encorajada sempre que possível.

Importance of computed tomography angiography in acute/hyperacute ischemic stroke.

OBJECTIVE: To evaluate the importance of computed tomography and computed tomography angiography (CTA) in stroke protocols, as well as their impact on endovascular treatment and on the determination of the etiology. MATERIALS AND METHODS: Were evaluated 28 patients with acute/hyperacute stroke in the anterior circulation who underwent intracranial and cervical CTA between April 2018 and August 2019. The parameters evaluated were the degree of stenosis, plaque characteristics, type of infarct, treatment, etiology, and the Alberta Stroke Program Early CT Score (ASPECTS). RESULTS: Of the 28 patients evaluated, 16 (57.1%) had an ASPECTS of 10 (the maximum score, indicative of normality). Four patients (14.3%) underwent thrombolytic treatment, and seven (25.0%) underwent mechanical thrombectomy. The etiology was atherosclerosis in 32.1% of the patients, cerebral small-vessel disease in 7.1%, cardioembolic in 7.1%, and undetermined in 53.6%. Regarding plaque, 17.9% of the patients presented stenosis ≥ 50%, 21.4% presented stable plaques, and 42.9% presented vulnerable plaques. Patients with a lower ASPECTS were more likely to have relevant stenosis and were more likely to have a total infarct. CONCLUSION: In the evaluation of patients with acute/hyperacute strokes, CTA provides important information, identifying occlusion, as well as helping define the etiology and inform decisions regarding treatment.

OBJETIVO: Avaliar a importância da tomografia computadorizada e angiotomografia computadorizada (ATC) no protocolo de acidente vascular encefálico (AVE) e o seu impacto no tratamento endovascular e na determinação da etiologia.Materiais e Métodos: Foram avaliados 28 pacientes com AVE agudo/hiperagudo da circulação anterior que realizaram ATC intracraniana e cervical, no período de abril de 2018 a agosto de 2019. Os parâmetros avaliados foram grau de estenose, placa, tipo do infarto, tratamento, etiologia e classificação Alberta Stroke Program Early CT Score (ASPECTS). RESULTADOS: A maioria dos casos (16; 57,1%) apresentou ASPECTS de 10. Quatro pacientes (14,3%) realizaram tratamento trombolítico e sete (25%) foram submetidos a trombectomia mecânica. A etiologia foi aterosclerose em 32,1% dos pacientes, doença de pequenas artérias em 7,1%, cardioembólico em 7,1% e indeterminada em 53,6%. Em relação à placa, 17,9% apresentaram estenose maior que 50%, 21,4% apresentaram placas estáveis e 42,9%, placas instáveis. Pacientes com ASPECTS mais baixo apresentavam maior probabilidade de ter estenose relevante e apresentavam maior chance de ocorrência de infarto total. CONCLUSÃO: A ATC fornece informações importantes na avaliação do paciente com AVE agudo/hiperagudo, identificando a oclusão e auxiliando na definição da etiologia e no direcionamento do tratamento.

Importance of computed tomography angiography in acute/hyperacute ischemic stroke / Importância da angiotomografia computadorizada no acidente vascular encefálico isquêmico agudo/hiperagudo

Abstract Objective: To evaluate the importance of computed tomography and computed tomography angiography (CTA) in stroke protocols, as well as their impact on endovascular treatment and on the determination of the etiology. Materials and Methods Were evaluated 28 patients with acute/hyperacute stroke in the anterior circulation who underwent intracranial and cervical CTA between April 2018 and August 2019. The parameters evaluated were the degree of stenosis, plaque characteristics, type of infarct, treatment, etiology, and the Alberta Stroke Program Early CT Score (ASPECTS). Results: Of the 28 patients evaluated, 16 (57.1%) had an ASPECTS of 10 (the maximum score, indicative of normality). Four patients (14.3%) underwent thrombolytic treatment, and seven (25.0%) underwent mechanical thrombectomy. The etiology was atherosclerosis in 32.1% of the patients, cerebral small-vessel disease in 7.1%, cardioembolic in 7.1%, and undetermined in 53.6%. Regarding plaque, 17.9% of the patients presented stenosis ≥ 50%, 21.4% presented stable plaques, and 42.9% presented vulnerable plaques. Patients with a lower ASPECTS were more likely to have relevant stenosis and were more likely to have a total infarct. Conclusion: In the evaluation of patients with acute/hyperacute strokes, CTA provides important information, identifying occlusion, as well as helping define the etiology and inform decisions regarding treatment.

Resumo Objetivo: Avaliar a importância da tomografia computadorizada e angiotomografia computadorizada (ATC) no protocolo de acidente vascular encefálico (AVE) e o seu impacto no tratamento endovascular e na determinação da etiologia. Materiais e Métodos: Foram avaliados 28 pacientes com AVE agudo/hiperagudo da circulação anterior que realizaram ATC intracraniana e cervical, no período de abril de 2018 a agosto de 2019. Os parâmetros avaliados foram grau de estenose, placa, tipo do infarto, tratamento, etiologia e classificação Alberta Stroke Program Early CT Score (ASPECTS). Resultados: A maioria dos casos (16; 57,1%) apresentou ASPECTS de 10. Quatro pacientes (14,3%) realizaram tratamento trombolítico e sete (25%) foram submetidos a trombectomia mecânica. A etiologia foi aterosclerose em 32,1% dos pacientes, doença de pequenas artérias em 7,1%, cardioembólico em 7,1% e indeterminada em 53,6%. Em relação à placa, 17,9% apresentaram estenose maior que 50%, 21,4% apresentaram placas estáveis e 42,9%, placas instáveis. Pacientes com ASPECTS mais baixo apresentavam maior probabilidade de ter estenose relevante e apresentavam maior chance de ocorrência de infarto total. Conclusão: A ATC fornece informações importantes na avaliação do paciente com AVE agudo/hiperagudo, identificando a oclusão e auxiliando na definição da etiologia e no direcionamento do tratamento.

Memória e arte na velhice: o caso das "Meninas de Sinhá" / Memory and art in aging: the case of the "Meninas de Sinhá"

Buscamos compreender a relação entre a prática artística do grupo "Meninas de Sinhá" e a memória, como processo cognitivo e cultural vivenciado na velhice. A memória das brincadeiras de roda da infância constitui-se como matéria-prima de criações artísticas coletivas do grupo. Realizamos uma abordagem qualitativa, com revisão bibliográfica e observação participante registrada em diário de campo. Discutimos os conceitos apropriados pela revisão bibliográfica a partir das vivências do "Meninas de Sinhá". Concluímos que, o processo de criação pode ser um recurso para que, na velhice, perdure a escrita autoral da vida. E que, nesta escrita, a memória e outros elementos da cognição sejam preservados e estimulados. O processo de criação demanda alta atividade cognitiva, e no caso da criação coletiva, amplia a participação social e cultural, a troca de sensibilidades e cuidados.

We sought to understand the relationship between the community artistic practice of the group "Meninas de Sinhá" and memory, as a cognitive and cultural process experienced in old age. The memory of children's wheel games constitutes the raw material of collective artistic creations of the group. We performed a qualitative approach, with bibliographic review and participant observation recorded in field diaries. We discuss the concepts appropriated by the bibliographical review from the experiences of the "Meninas de Sinhá". We conclude that, the process of creation can be a resource so that, in old age, the authorial writing of life lasts. And that in this writing, memory and other elements of cognition are preserved and stimulated. The process of creation demands high cognitive activity, and in the case of collective creation, it increases social and cultural participation, the exchange of sensibilities and care.

O lazer como afirmação da identidade no timing da finitude / Leisure as an affirmation of identity in the timing of end of life

Este trabalho é fruto de uma pesquisa do Programa de Pós-Graduação em Estudos do lazer e visa apresentar sua fundamentação teórica para um campo etnográfico referente a pessoas no timing da finitude da vida. Para tanto, apresenta as contribuições de importantes pensadores sobre o tema morte e atividade cotidiana/habituais como afirmação da identidade tais como Morin, Giddens e Kellehear. Propõe uma reflexão sobre o lazer dentro da perspectiva da filosofia existencial e investiga a possibilidade do lazer ser manifesto com um forte sentido de identidade e alinhado aos desejos mais autênticos no tempo da finitude. Mas também busca avançar para reflexões sobre o ser morrente, como um sujeito social e passível de interferências do mercado de consumo e da cultura de massa nas escolhas de atividades de lazer, além de outros determinantes como a condição sociocultural.

This work is the result of a research of the Postgraduate Program in Studies on leisure and aims to present its theoretical foundation for an ethnographic field referring to people in the timing of the finitude of life. For that, it presents the contributions of important thinkers on the subject of death and activity as affirmation of identity such as Morin, Giddens and Kellehear. It proposes a reflection on leisure within the perspective of the existential philosophy and investigates the possibility of leisure to be manifest with a strong sense of identity and aligned with the most authentic desires in the time of finitude. But it also seeks to advance to reflections on being dead, as a social subject and susceptible to interference from the consumer market and mass culture in the choices of leisure activities, as well as other determinants such as sociocultural condition.

Saúde, lazer e envelhecimento: uma análise sobre a brincadeira de dança de roda das Meninas de Sinhá / Health, leisure, and aging: an analysis of Meninas de Sinhá's circle game / Salud, ocio y envejecimiento: un análisis sobre el juego de danza circular de las "Meninas de Sinhá"

O grupo artístico Meninas de Sinhá teve como princípio um encontro de mulheres idosas em situação de vulnerabilidade que utilizam a brincadeira da dança de roda como uma potência curativa, capaz de torná-las mais saudáveis. Investigamos a atribuição de sentidos pelo grupo, no campo da saúde e do lazer, ao longo de sua formação estabelecida nos espaços/tempos de brincar de roda. Analisamos os estados corporais revelados nos depoimentos das mulheres que constam em documentos produzidos sobre o grupo e nas suas músicas autorais. Explicitamos esses estados na passagem da condição de adoecimento para a vida de artistas. Percebemos que, como prática comunitária, a brincadeira de roda constituiu-se como uma necessidade social específica para fruição da experiência do lazer, para mobilizar uma rede de encontros e cuidados (na troca e no autocuidado) e para o empoderamento dessas idosas.(AU)

The artistic group Meninas de Sinhá started as a meeting of elderly women in vulnerable situation who used the circle game as a healing power to become healthier. We investigated the group's attribution of senses in the health and leisure areas throughout its establishment in spaces/times of playing circle. We analyzed the body states revealed in the women's testimonies in documents related to the group and in their own songs. We explained these states in the "transition" from a sick condition to their artistic life. We realized that, as a community practice, the circle game represented a specific social need for enjoying a leisure experience, mobilizing a network of meetings and care (in exchange and selfcare), and empowering these elderly women.(AU)

El grupo artístico Meninas de Sinhá tuvo como principio un encuentro de mujeres ancianas en situación de vulnerabilidad que utilizaron el juego de la ronda como una potencia curativa, capaz de hacerlas más saludables. Investigamos la atribución de sentidos por parte del grupo, en el campo de la salud y del ocio, a lo largo de su formación establecida en los espacios/tiempos de jugar a la ronda. Analizamos los estados corporales revelados en las declaraciones de las mujeres que constan en documentos producidos sobre el grupo y en las canciones de su autoría. Explicamos estos estados en el "pasaje" de la condición de enfermedad para la vida de artistas. Percibimos que, como práctica comunitaria, el juego de la ronda se constituyó como una necesidad social específica para aprovechar la experiencia del ocio, para movilizar una red de encuentros y cuidados (en el intercambio y en el autocuidado) y para el empoderamiento de estas ancianas.(AU)

As Artes na Educação Médica: Revisão Sistemática da Literatura / Arts in Medical Education: a Systematic Literature Review

RESUMO Introdução A introdução das artes no currículo médico tem despertado interesse crescente, uma vez que estas apresentam qualidades únicas que podem auxiliar no desenvolvimento dos aspectos sociais da prática médica, oferecendo maneiras novas e distintas de exploração do conhecimento e da identidade profissional. Objetivo Avaliar a eficácia da utilização das artes no currículo médico por meio de uma revisão bibliográfica. Metodologia As bases de dados Lilacs, SciELO, PubMed e Eric foram pesquisadas para artigos publicados sobre estudos que tentaram avaliar a eficácia de uma abordagem baseada em artes na educação médica de graduação. Outros artigos foram identificados por meio de busca ativa. Foram utilizados os seguintes descritores (art or visual arts or paintings or literature or narrative or poetry or theatre or movies or films or cinema) AND (medical education or medical student or medical curriculum). Foram incluídos somente os artigos cujo estudo foi realizado com estudantes de Medicina e cuja eficácia da intervenção foi avaliada por comparação entre grupos (estudos quantitativos) ou pela satisfação do estudante de Medicina por questionário (estudos qualitativos). Os artigos selecionados foram lidos na íntegra por dois pesquisadores, de modo a identificar o tipo de arte utilizada na intervenção, o autor, a amostra, a metodologia e a conclusão sobre a atividade relatada. Resultados Foram incluídos 28 artigos no estudo, distribuídos de acordo com o tipo de arte utilizada: (n = 16) artes visuais; (n = 6) literatura; (n = 3) teatro; (n = 3) cinema. As competências educacionais sensíveis às artes relatadas nos estudos avaliados foram: habilidades de observação diagnóstica, trabalho em equipe, reflexão e argumentação; facilitar o aprendizado cognitivo; aspectos humanísticos da medicina (empatia/relação médico-paciente); profissionalismo. Alguns estudos afirmam que as intervenções baseadas em artes são eficazes na alteração de atitudes, entretanto não definiram como esse sucesso foi medido. Nenhum estudo considera os efeitos sobre o comportamento. As evidências para o uso de intervenções baseadas em artes para promover habilidades de observação diagnóstica mostraram ser mais fortes. No entanto, seu efeito em outras habilidades clínicas não foi estudado. Conclusão A arte pode ser uma estratégia facilitadora do aprendizado, uma vez que auxilia o estudante a lidar com a complexidade do ser humano e da saúde humana. Este conhecimento mais amplo sobre a saúde e a doença pode levar à melhoria da relação médico-paciente na prática clínica. Entretanto, devido à natureza qualitativa da maioria dos estudos, baseados principalmente na opinião do estudante sobre as modificações ocorridas em suas atitudes, a eficácia das intervenções nem sempre foi efetivamente demonstrada.

ABSTRACT Introduction The introduction of the arts into the medical curriculum has sparked increasing interest since they present unique qualities that can aid in the development of the social aspects of medical practice, offering new and distinctive ways of exploring knowledge and professional identity. Objective To evaluate the effectiveness of the use of the arts in the medical curriculum, through a bibliographical review. Methodology The Lilacs, Scielo, PubMed and Eric databases were searched for published articles on studies that attempt to evaluate the effectiveness of an arts-based approach in undergraduate medical education. Other articles were identified through active searching. The following descriptors (art or visual arts or paintings or literature or narrative or poetry or theatre or movies or films or cinema) AND (medical education or medical student or medical curriculum) were used. We included only articles related to studies that were conducted with medical students and which evaluated the effectiveness of the intervention by comparison between groups (quantitative studies) or by medical student satisfaction by questionnaire (qualitative studies). The selected articles were read in full in order to identify the type of art used in the intervention, the author, the sample, the methodology and the conclusion about the reported activity. Results A total of 28 articles were included in the study, distributed according to the type of art used: (n = 16) visual arts; (n = 6) literature; (n = 3) theater; (n = 3) cinema. The arts-sensitive educational skills reported in the studies evaluated were: skills diagnostic observation, teamwork, reflection and argumentation; facilitating cognitive learning; humanistic aspects of medicine (empathy / patient medical relationship); professionalism. Some studies state that arts-based interventions are effective at changing attitudes; however, they did not define how this success was measured. No study considers the effects on behavior. Evidence for the use of arts-based interventions to promote diagnostic observation skills has been shown to be stronger. However, its effect on other clinical skills has not been studied. Conclusion Art can represent a strategy to facilitate learning, since it helps the student to deal with human complexity and health. This broader understanding of health and illness can lead to improved physician-patient relationships in clinical practice. However, due to the qualitative nature of most of the studies, based mainly on the student's opinion of the changes in their attitudes, the effectiveness of the interventions has not always been effectively demonstrated.

Partial characterization of ethanolic extract of Melipona beecheii propolis and in vitro evaluation of its antifungal activity

ABSTRACT The ethanolic extract of Melipona beecheii Bennett 1831, propolis from Yucatán Mexico was evaluated in vitro for the determination of its phenolic compound content, antioxidant capacity and antifungal activity. The results were compared against those of the ethanolic extract of Apis mellifera propolis. The total phenolic content, flavonoid content and flavanones-dihydroflavonols content were assessed by colorimetric methods. The antifungal activity was assessed in vitro against Candida albicans. For the ethanolic extract of M. beecheii propolis; total phenolic content, was 263.25 ± 8.78 µg/ml, total flavonoid content was 768 ± 204 µg/ml and flavanones-dihydroflavonols content was 335.42 ± 15.08 µg/ml. For antioxidant activity assessed as DPPH scavenging and iron reducing power ethanolic extract of M. beecheii propolis reported IC50 of 32.47 and 1.60 µg/ml of gallic acid equivalent respectively. Regarding antifungal activity against C. albicans, the minimal inhibitory concentration and minimal fungicidal concentration for ethanolic extract of M. beecheii propolis were 1.62 ± 0.33 and 2.50 ± 0.22 µg/ml of dry extract; For both minimal inhibitory concentration and minimal fungicidal concentration, ethanolic extract of M. beecheii propolis required 30% less concentration of dry extract than ethanol extract of A. mellifera propolis to exert the same antifungal actions against C. albicans. To the best of our knowledge, this is the first report about the flavonoid and flavanones-dihydroflavonols content of M. beecheii propolis. Due to the lack of information available about the stingless bee's honeycomb products, the study and conservation of endemic honeybees should remain as an active focus of research.

Costs and emissions assessment of a Blue Corridor in a Brazilian reality: The use of liquefied natural gas in the transport sector.

Technical, economic, social and environmental conditions are turning natural gas into a feasible solution for sustainable transportation systems in the State of São Paulo (Brazil). Blue Corridors are routes that aim to enable the use of liquefied natural gas (LNG) for heavy vehicles as a substitute to Diesel oil. Therefore, this work proposes four scenarios for a Blue Corridor in the State of São Paulo and analyzes its environmental and economic impacts. The results are presented in cartographical figures and show that LNG costs up to 40% less than diesel, while reducing CO2 equivalent emissions by up to 5.2%. Particulate matter (PM) emissions are reduced by 88%, nitrogen oxides (NOx) by 75% and hydrocarbon emissions are eliminated. However, despite the economic and environmental advantages presented in the results of this study, LNG still faces regulatory barriers that must be addressed in order to allow its widespread use in the transportation sector.

Brazilian red propolis attenuates hypertension and renal damage in 5/6 renal ablation model.

The pathogenic role of inflammation and oxidative stress in chronic kidney disease (CKD) is well known. Anti-inflammatories and antioxidant drugs has demonstrated significant renoprotection in experimental nephropathies. Moreover, the inclusion of natural antioxidants derived from food and herbal extracts (such as polyphenols, curcumin and lycopene) as an adjuvant therapy for slowing CKD progression has been largely tested. Brazilian propolis is a honeybee product, whose anti-inflammatory, antimicrobial and antioxidant effects have been widely shown in models of sepsis, cancer, skin irritation and liver fibrosis. Furthermore, previous studies demonstrated that this compound promotes vasodilation and reduces hypertension. However, potential renoprotective effects of propolis in CKD have never been investigated. The aim of this study was to evaluate the effects of a subtype of Brazilian propolis, the Red Propolis (RP), in the 5/6 renal ablation model (Nx). Adult male Wistar rats underwent Nx and were divided into untreated (Nx) and RP-treated (Nx+RP) groups, after 30 days of surgery; when rats already exhibited marked hypertension and proteinuria. Animals were observed for 90 days from the surgery day, when Nx+RP group showed significant reduction of hypertension, proteinuria, serum creatinine retention, glomerulosclerosis, renal macrophage infiltration and oxidative stress, compared to age-matched untreated Nx rats, which worsened progressively over time. In conclusion, RP treatment attenuated hypertension and structural renal damage in Nx model. Reduction of renal inflammation and oxidative stress could be a plausible mechanism to explain this renoprotection.

The innovative moments coding system and the assimilation of problematic experiences scale: a case study comparing two methods to track change in psychotherapy.

The Assimilation of Problematic Experiences Scale (APES) and the Innovative Moments Coding System were applied to transcripts of a successful case of linguistic therapy of evaluation independently by different research groups. Assimilation theory and research suggest that higher APES scores reflect therapeutic gains, with a level of approximately 4.0 separating good from poor outcome cases. The innovative moments (IMs) model suggests that IMs classified as reconceptualization and performing change occur mainly in good outcome cases, whereas action, reflection and protest occur in both good and poor outcome cases. Passages coded as reconceptualization and performing change were rare in this case, but 100% of them were rated at or above APES 4. By contrast, 63% passages coded as action, reflection or protest were rated below APES 4 (Chi-square = 28.62, p < .001). Implications for research are discussed.

Avaliação do eletrocardiograma de pacientes com leishmaniose tegumentar americana tratados com antimonial pentavalente (glucantime) / Electrocardiographic assessment of patients with american cutaneous leihmaniasis treated with pentavalent antimonial (glucantime)

Os antimoniais pentavalentes (Antimoniato de N-metilglumina – Glucantime®) são fármacosde primeira escolha no tratamento da leishmaniose tegumentar americana (LTA). Apresentama cardiotoxicidade como importante efeito adverso e é evidenciada por alterações noeletrocardiograma de repouso (ECG). O alargamento do intervalo QT corrigido (QTc) é a principale potencialmente mais grave delas. O presente estudo teve como objetivo avaliar as alteraçõesno ECG e sua frequência nos pacientes com LTA tratados com Glucantime® no Serviço deDermatologia de nossa instituição. Para isso, um cardiologista avaliou os ECGs de 15 pacientes entre 18 e 59 anos de idade diagnosticados com LTA. Os exames foram realizados imediatamenteantes, no 7º, 14º e 21º dias do tratamento. Desses pacientes, cinco (33 por cento) desenvolveram algumdistúrbio no eletrocardiograma, cuja frequência foi diretamente proporcional ao tempo de uso dofármaco. Bradicardia sinusal nova foi o mais comum (5/15 pacientes), seguida por alargamento dointervalo QTc (2/15 pacientes, os quais também apresentaram bradicardia). Não houve registro decomplicações graves e nenhum paciente desenvolveu sintomatologia cardiovascular. Em apenasum caso foi necessária a interrupção do tratamento. A frequência de alterações no ECG observada écompatível com a relatada por estudos anteriores sobre o tema. Concluímos que a cardiotoxicidadedos antimoniais pentavalentes se manifestou de forma insidiosa, cumulativa, em proporçãocompatível com os relatos da literatura e sem repercussões clínicas.

The pentavalent antimonial compounds (Meglumine Antimoniate – Glucantime®) are thecornerstone for the treatment of American Cutaneous Leishmaniasis (ACL). Cardiotoxicity is theirprincipal adverse effect, which becomes evident as abnormalities in the resting Electrocardiogram(ECG), the prolongation of the corrected QT interval (QTc) being the most important and potentiallyhazardous of them. The purpose of this study was to evaluate the disturbances on ECG and theirfrequency in patients diagnosed with ACL and treated with Glucantime® at our Institution. Fifteenpatients between 18 and 59 years had their ECGs assessed by a senior cardiologist. The tests wereperformed prior to treatment, as well as on its 7th, 14th and 21st day. Five patients (33 percent) developed anabnormality not previously observed, and frequency correlated with the duration of the treatment.The most common was sinus bradycardia (5 of 15 patients), followed by prolongation of the QTcinterval (2 of 15 patients; both also had sinus bradycardia). No major cardiovascular symptomsor complications were reported. Only one patient had to interrupt the treatment. This proportionof ECG disturbances is consistent with previous studies on the subject. We conclude that thecardiotoxicity of the pentavalent antimonial drugs occurred insidiously in a percentage of patientscompatible with the literature, and was not associated with major clinical complications.

Supercapacitor operating at 200 degrees celsius.

The operating temperatures of current electrochemical energy storage devices are limited due to electrolyte degradation and separator instability at higher temperatures. Here we demonstrate that a tailored mixture of materials can facilitate operation of supercapacitors at record temperatures, as high as 200°C. Composite electrolyte/separator structures made from naturally occurring clay and room temperature ionic liquids, with graphitic carbon electrodes, show stable supercapacitor performance at 200°C with good cyclic stability. Free standing films of such high temperature composite electrolyte systems can become versatile functional membranes in several high temperature energy conversion and storage applications.

NF-κB activation mediates crystal translocation and interstitial inflammation in adenine overload nephropathy.

Adenine overload promotes intratubular crystal precipitation and interstitial nephritis. We showed recently that these abnormalities are strongly attenuated in mice knockout for Toll-like receptors-2, -4, MyD88, ASC, or caspase-1. We now investigated whether NF-κB activation also plays a pathogenic role in this model. Adult male Munich-Wistar rats were distributed among three groups: C (n = 17), receiving standard chow; ADE (n = 17), given adenine in the chow at 0.7% for 1 wk and 0.5% for 2 wk; and ADE + pyrrolidine dithiocarbamate (PDTC; n = 14), receiving adenine as above and the NF-κB inhibitor PDTC (120 mg·kg⁻¹·day⁻¹ in the drinking water). After 3 wk, widespread crystal deposition was seen in tubular lumina and in the renal interstitium, along with granuloma formation, collagen accumulation, intense tubulointerstitial proliferation, and increased interstitial expression of inflammatory mediators. Part of the crystals were segregated from tubular lumina by a newly formed cell layer and, at more advanced stages, appeared to be extruded to the interstitium. p65 nuclear translocation and IKK-α increased abundance indicated activation of the NF-κB system. PDTC treatment prevented p65 migration and normalized IKK-α, limited crystal shift to the interstitium, and strongly attenuated interstitial fibrosis/inflammation. These findings indicate that the complex inflammatory phenomena associated with this model depend, at least in part, on NF-κB activation, and suggest that the NF-κB system may become a therapeutic target in the treatment of chronic kidney disease.

Efeitos da participação em um Grupo de Coluna sobre as dores musculoesqueléticas, qualidade de vida e funcionalidade dos usuários de uma Unidade Básica de Saúde de Porto Alegre - Brasil / Effects of participation in a Back School on musculoskeletal pain, quality of life andfunctionality of users of a Unidade Básica de Saúde from Porto Alegre- Brazil

O objetivo deste estudo foi avaliar a eficácia do Grupo de Coluna ministrado em uma Unidade Básica de Saúde de Porto Alegre. Foram avaliados e reavaliados 29 usuários, os quais participaram do Grupo de Coluna. Foi utilizada a Escala Visual Analógica para avaliar a intensidade da dor, o questionário Oswestry Disability Índex para avaliar a capacidade funcional, e o questionário Short-Form Health Survey -SF-36 para avaliar a qualidade de vida. Os resultados, obtidos a partir do teste de Wilcoxon (=0,05),demonstraram a eficácia do Grupo de Coluna na melhora da intensidade das dores musculoesqueléticas (p<0,05), na capacidade funcional (p=0,005), e na qualidade de vida nos domínios capacidade funcional (p=0,001), limitações por aspectos físico (p=0,001), dor (p=0,001), vitalidade (p=0,004), limitação emocional (p=0,026) e saúde mental (p=0,010). Conclui-se que o Grupo de Coluna foi eficaz na melhora da dor, funcionalidade e qualidade de vida dos usuários.

This study was carried out in order to evaluate the effectiveness of the Back Group project, in a Porto Alegre’s Basic Health Unit. We evaluated and re-evaluated 29 users before and after the participated in a Back Group. It’s were used the Visual Analogue Scale to assess pain, the Oswestry Disability Index to assess the functionality, and the questionnaire Item Short-Form Health Survey-SF-36 to assess the quality of life. The results, obtained from the Wilcoxon test (=0.05), demonstrated the effectiveness of the Back Group in the improvement of the intensity of musculoskeletal pain (p<0.05), in the physical functioning(p=0.005), in the quality of life in the functional capacity (p=0.001), by the physical limitations (p=0.001), pain (p=0.001), vitality (p=0.004), emotional limitation (p=0.026) and mental health (p=0.010) dominions. It is concluded that the Back Group was effectiveness in the improved of the pain, function and quality of life’s users.

Prevalence and monthly distribution of head lice using two diagnostic procedures in several age groups in Uberlândia, State of Minas Gerais, Southeastern Brazil.

Some epidemiological characteristics of head lice, Pediculus capitis, were studied using two procedures: cut hair analysis and head inspection. Higher prevalence rates were observed in the middle and at the end of the school terms. Both procedures indicated that children were the main reservoir for this type of pediculosis in Uberlândia.

Prevalence and monthly distribution of head lice using two diagnostic procedures in several age groups in Uberlândia, State of Minas Gerais, Southeastern Brazil

Some epidemiological characteristics of head lice, Pediculus capitis, were studied using two procedures: cut hair analysis and head inspection. Higher prevalence rates were observed in the middle and at the end of the school terms. Both procedures indicated that children were the main reservoir for this type of pediculosis in Uberlândia.

Alguns aspectos da epidemiologia do piolho da cabeça, Pediculus capitis, foram estudados usando dois procedimentos: análise de cabelos cortados e inspeção das cabeças. As mais altas prevalências foram observadas no meio e no final dos semestres escolares. Ambos os procedimentos apontaram as crianças como o principal reservatório desta pediculose em Uberlândia.