Factors associated with adverse outcomes among patients hospitalized at a COVID-19 treatment center in Herat, Afghanistan.

Though many studies on COVID have been published to date, data on COVID-19 epidemiology, symptoms, risk factors and severity in low- and middle-income countries (LMICS), such as Afghanistan are sparse. To describe clinical characteristics, severity, and outcomes of patients hospitalized in the MSF COVID-19 treatment center (CTC) in Herat, Afghanistan and to assess risk factors associated with severe outcomes. 1113 patients were included in this observational study between June 2020 and April 2022. Descriptive analysis was performed on clinical characteristics, complications, and outcomes of patients. Univariate description by Cox regression to identify risk factors for an adverse outcome was performed. Adverse outcome was defined as death or transfer to a level 3 intensive care located at another health facility. Finally, factors identified were included in a multivariate Cox survival analysis. A total of 165 patients (14.8%) suffered from a severe disease course, with a median time of 6 days (interquartile range: 2-11 days) from admission to adverse outcome. In our multivariate model, we identified male gender, age over 50, high O2 flow administered during admission, lymphopenia, anemia and O2 saturation < = 93% during the first three days of admission as predictors for a severe disease course (p<0.05). Our analysis concluded in a relatively low rate of adverse outcomes of 14.8%. This is possibly related to the fact that the resources at an MSF-led facility are higher, in terms of human resources as well as supply of drugs and biomedical equipment, including oxygen therapy devices, compared to local hospitals. Predictors for severe disease outcomes were found to be comparable to other settings.

The impact of disease-modifying therapies on immunoglobulin blood levels in patients with multiple sclerosis: a retrospective cross-sectional study.

Background: Although disease-modifying therapies (DMTs) in multiple sclerosis (MS) are known to target the immune system, mechanisms of action, efficacy, safety, and tolerability profiles differ. The long-term impact of DMTs on the immune system and its relation to infectious complications is still poorly understood. Objectives: To analyze the effect of DMTs on serum immunoglobulin (Ig) levels under consideration of patient demographics and therapy duration. Design: We included 483 patients on DMTs, 69 patients without DMTs, and 51 controls in this retrospective cross-sectional study. Methods: IgG, IgM, and IgG subclass 1-4 levels of patients with MS under treatment with DMTs were compared with treatment naive MS patients and controls by multivariate linear regression. Further, Ig levels stratified by DMTs were analyzed regarding therapy duration. Results: MS patients treated with fingolimod (FG), natalizumab, and B-cell depleting therapies (BCDT) demonstrated significantly lower IgG and IgM levels than healthy controls after a median treatment of 37, 31, and 23 months, respectively (p < 0.05). Treatment with dimethyl fumarate (DMF) and teriflunomide was associated with lower IgG, but not IgM levels. DMF and BCDT were also associated with lower IgG1 levels, while FG led to a reduction of IgG2. Treatment with interferon-beta (IFN) and glatiramer acetate (GA) had no impact on Ig levels. Analysis of subgroups by linear regression also showed a time-dependent decrease of Igs levels in patients treated with BCDT with a median annual reduction of IgG of 3.2% and IgM of 6.2%. Conclusion: Treatment with DMTs, except GA and IFN, was associated with a decrease in Ig levels. DMTs differed in the extent of decreasing Ig levels but also in their differential effects on Ig subclasses. Monitoring of Ig levels should be considered in patients on long-term treatment with DMTs, particularly those on BCDT, to identify patients at risk of low immunoglobulin levels.

Does the presence of a specialist doctor reduce the burden of disease in people with epilepsy in low-resource settings? A comparison of two epilepsy clinics in rural Tanzania.

BACKGROUND: With an estimated lifetime prevalence of epilepsy of 7.6 per 1,000 people, epilepsy represents one of the most common neurological disorders worldwide, with the majority of people with epilepsy (PWE) living in low-income and middle-income countries (LMICs). Adequately treated, up to 70 % of PWE will become seizure-free, however, as many as 85% of PWE worldwide, mostly from LMICs, do not receive adequate treatment. OBJECTIVE: To assess the impact of the presence of a neurologist on the management of PWE in Tanzania. METHODS: Two epilepsy clinics in rural Tanzania, one continuously attended by a neurologist, and one mainly attended by nurses with training in epilepsy and supervised intermittently by specialist doctors (neurologists/psychiatrists) were comparatively analyzed by multivariable linear and logistic regression models with regard to the outcome parameters seizure frequency, the occurrence of side effects of antiepileptic medication and days lost after a seizure. RESULTS: The presence of a neurologist significantly reduced the mean number of seizures patients experienced per month by 4.49 seizures (p < 0.01) while leading to an increase in the occurrence of reported side effects (OR: 2.15, p = 0.02). CONCLUSION: The presence of a neurologist may play a substantial role in reducing the burden of the disease of PWE in LMICs. Hence, specialist training should be encouraged, and relevant context-specific infrastructure established.

Frequency of myelin oligodendrocyte glycoprotein antibodies in a large cohort of neurological patients.

BACKGROUND: Myelin oligodendrocyte glycoprotein (MOG) antibody disease (MOG-AD) is recognized as a distinct nosological entity. IgG antibodies against MOG (MOG-Ab) overlap with neuromyelitis optica spectrum disorders (NMOSD) phenotype in adults. However, an increasing number of clinical phenotypes have been reported to be associated with MOG-Ab. OBJECTIVE: To investigate the seroprevalence of MOG-Ab under consideration of demographics, disease entities and time course in a large cohort of unselected neurological patients. METHODS: Blood samples of 2.107 consecutive adult neurologic patients admitted to our department between 2016-2017 were tested for MOG-Ab using a cell-based assay. MOG-Ab persistence was analyzed in follow-up samples. External validation was performed in two independent laboratories. RESULTS: We found MOG-Ab in 25 of 2.107 (1.2%) patients. High antibody ratios were mostly associated with NMOSD and MOG-AD phenotype (5/25). Low ratios occurred in a wide range of neurological diseases, predominantly in other demyelinating CNS diseases (5/25) and stroke (6/25). MOG-Ab persistence over time was not confined to NMOSD and MOG-AD phenotype. CONCLUSION: The present study demonstrates the occurrence of MOG-Ab in a wide range of neurological diseases. Only high MOG-Ab ratios were associated with a defined clinical phenotype, but low MOG-Ab ratios were not. The diagnostic value of low MOG-Ab is thus highly limited.

Drug Treatment of Neuromyelitis Optica Spectrum Disorders: Out with the Old, in with the New?

INTRODUCTION: Neuromyelitis optica spectrum disorders (NMOSD) are rare neuroinflammatory demyelinating diseases of the CNS, mainly affecting optic nerves, spinal cord and brainstem regions. The diagnosis depends on clinical symptoms, MRI findings and the detection of autoantibodies against the water channel aquaporin 4 (AQP4-Ab). This autoantibody is particularly important for diagnostic sensitivity and specificity and further sets the course for major therapeutic decisions. Due to a relapsing course with the accumulation of disability, relapse prevention by immunotherapy is crucial in NMOSD. Until recently, disease-modifying agents specific to NMOSD were not available, and patients were treated with various immunosuppressive drugs and regimens - with variable success. Fortunately, since 2019, three new therapeutic antibodies have entered the market. AREAS COVERED: We aim to shortly summarise the pathogenesis and biological targets for acute and preventive therapy of adult NMOSD. We will focus on conventional immunotherapies and the recently approved novel biological drugs satralizumab, eculizumab and inebilizumab, and conclude with a brief outlook on future therapeutic approaches. EXPERT OPINION: Although satralizumab, eculizumab and inebilizumab are a breakthrough concerning short-term efficacy, important questions on their future use remain open. There is no data from head-to-head comparisons, and data on long-term safety and efficacy of the new medicines are pending. Whether any of the biologics are efficacious in AQP4-Ab negative NMOSD patients is not yet known - as is how they will succeed in non-responders to conventional immunotherapies. Further, (autoimmune) comorbidities, affordability, and market availability of drugs may be decisive factors for choosing treatments in the near future. We are fortunate to have these new drugs available now, but they will not immediately supersede established off-label drugs in this indication. It is still too early to definitively revise the treatment algorithms for NMOSD - although we are probably on the way.

Genetic determinants of the humoral immune response in MS.

OBJECTIVE: In this observational study, we investigated the impact of genetic factors at the immunoglobulin heavy chain constant locus on chromosome 14 and the major histocompatibility complex region on intrathecal immunoglobulin G, A, and M levels as well as on B cells and plasmablasts in the CSF and blood of patients with multiple sclerosis (MS). METHODS: Using regression analyses, we tested genetic variants on chromosome 14 and imputed human leukocyte antigen (HLA) alleles for associations with intrathecal immunoglobulins in 1,279 patients with MS or clinically isolated syndrome and with blood and CSF B cells and plasmablasts in 301 and 348 patients, respectively. RESULTS: The minor alleles of variants on chromosome 14 were associated with higher intrathecal immunoglobulin G levels (ß = 0.58 [0.47 to 0.68], lowest adjusted p = 2.32 × 10-23), and lower intrathecal immunoglobulin M (ß = -0.56 [-0.67 to -0.46], p = 2.06 × 10-24) and A (ß = -0.42 [-0.54 to -0.31], p = 7.48 × 10-11) levels. Alleles from the HLA-B*07:02-DRB1*15:01-DQA1*01:02-DQB1*06:02 haplotype were associated with higher (lowest p = 2.14 × 10-7) and HLA-B*44:02 with lower (ß = -0.35 [-0.54 to -0.17], p = 1.38 × 10-2) immunoglobulin G levels. Of interest, different HLA alleles were associated with lower intrathecal immunoglobulin M (HLA-C*02:02, ß = -0.45 [-0.61 to -0.28], p = 1.01 × 10-5) and higher immunoglobulin A levels (HLA-DQA1*01:03-DQB1*06:03-DRB1*13:01 haplotype, ß = 0.40 [0.21 to 0.60], p = 4.46 × 10-3). The impact of HLA alleles on intrathecal immunoglobulin G and M levels could mostly be explained by associations with CSF B cells and plasmablasts. CONCLUSION: Although some HLA alleles seem to primarily drive the extent of humoral immune responses in the CNS by increasing CSF B cells and plasmablasts, genetic variants at the immunoglobulin heavy chain constant locus might regulate intrathecal immunoglobulins levels via different mechanisms.

CSF parameters associated with early MRI activity in patients with MS.

Objective: To identify CSF parameters at diagnosis of clinically isolated syndrome (CIS) and MS that are associated with early inflammatory disease activity as measured by standardized cerebral MRI (cMRI). Methods: One hundred forty-nine patients with newly diagnosed CIS and MS were included in the retrospective study. cMRI at onset and after 12 months was analyzed for T2 and gadolinium-enhancing lesions. CSF was tested for oligoclonal bands and intrathecal synthesis of immunoglobulin G (IgG), A (IgA), and M (IgM) before initiation of disease-modifying therapy (DMT). In a subgroup of patients, CSF and serum samples were analyzed for sCD27, neurofilament light chain, and IgG subclasses 1 and 3. Association between CSF parameters and cMRI activity was investigated by univariable and multivariable regression analysis in all patients, DMT-treated patients, and untreated patients. Results: IgG index, sCD27 levels in CSF, and to a lesser extent IgM index were associated with the occurrence of new cMRI lesions. IgG index and sCD27 levels in CSF were highly correlated. In a multivariable analysis, IgG index and to a lesser extent IgM index together with DMT treatment status and gender were strongest predictors of future cMRI activity. Conclusions: CSF parameters such as IgG and IgM index are independently associated with future MRI activity and thus might be helpful to support early treatment decisions in patients newly diagnosed with CIS and MS.

Dilemas atuais da sociedade brasileira sob as lentes da antropologia: relato de experiência de uma disciplina do curso de graduação em saúde coletiva da UFRJ / Current dilemmas of Brazilian society through the lenses of anthropology: an experience report in a discipline from the UFRJ Collective Health Graduation Course

Resumo A antropologia brasileira tem se debruçado sobre o multiculturalismo, a diversidade social e a desigualdade econômica no país. Os estudos antropológicos sobre essas questões muito contribuíram para inseri-las nos debates mais amplos sobre os problemas sociais brasileiros. Este artigo trata de um relato de experiência de ensino em duas ofertas da disciplina Atividades Integradas em Saúde Coletiva (Aisc) II para bacharelandos do segundo período do curso de graduação em saúde coletiva da Universidade Federal do Rio de Janeiro. A disciplina busca trazer à discussão problemas sociais emergentes da sociedade brasileira, como racismo, intolerância religiosa, saúde da população transexual e violência doméstica. Por meio de rodas de conversa com ativistas e visitas a locais de militância, os alunos realizam observação participante e conhecem suas lutas e reivindicações. Introduzindo conceitos caros à antropologia, como etnocentrismo, relativismo e movimentos sociais, pretende-se estimular nos estudantes uma reflexão crítica sobre dilemas sociais contemporâneos. Os debates, os relatos e as trocas de experiências advindos no decorrer da disciplina mostram que a antropologia tem muito a contribuir para uma formação e atuação mais dialógica desses futuros sanitaristas com as populações às quais prestarão cuidado, além de favorecer uma compreensão mais aplicada do impacto das desigualdades sociais no processo saúde-doença.

Abstract The Brazilian anthropology has focused on multiculturalism, social diversity and economic inequality in the country. Anthropological studies on these issues have greatly contributed to inserting it into broader debates about Brazilian social problems. This article deals with a report taken from two semesters teaching experience of the Integrated Activities of Collective Health II discipline for second period bachelor's degree students of the graduate course in collective health of Universidade Federal do Rio de Janeiro. The discipline aims at discussing emerging social problems in Brazilian society such as racism, religious intolerance, health of the transsexual population and domestic violence. Through conversations with activists and meetings in militance sites, students engage in participant observation and know their struggles and demands. Introducing important concepts to anthropology, such as ethnocentrism, relativism and social movements, it is intended to stimulate a critical reflection on contemporary social dilemmas in the students. The debates, reports and experiences exchanges emerged during the discipline course reveal that anthropology has a lot to contribute to a more dialogical formation and action of these future public health workers among the population of whom they will take care, besides favoring a more applied understanding on the impact of the social inequalities on the health-disease process.

A traição que caiu na rede: sofrimento alheio? / The betrayal that fell on the net: suffering from others?

Partindo da observação de que discussões sobre o tema da traição em tempos de redes sociais tem ganhado visibilidade no facebook, propõe-se aqui uma análise exploratória do tema a partir de uma postagem do Caso Sorocaba. Busca-se atingir os seguintes objetivos: 1) Investigar a traição na rede como um fenômeno da subjetividade contemporânea; 2) Compreender a linguagem da traição: do sofrimento ao ato e 3) Analisar a infidelidade deflagrada a partir do advento das redes sociais para a vida em sociedade. Os resultados desse artigo apontam para o mal estar do sujeito contemporâneo, descritos pelo seus excessos, explosões e desamparo. Portanto, observou-se um cenário de necessidades e de aprendizagens para os relacionamentos amorosos na contemporaneidade.(AU)

Based on the observation that discussions on the theme of betrayal in social networking times have gained visibility on Facebook, it is proposed here an exploratory analysis of the topic from a posting of the Sorocaba Case. It seeks to achieve the following main objectives: 1) Investigate betrayal in the network as a phenomenon of contemporary subjectivity; 2) Understand the language of betrayal: from suffering to act and 3) Analyse infidelity triggered from the advent of social networks to life in society in society. The results of this article point to the malaise of the contemporary subject, described by his excesses, explosions and helplessness. Therefore, a scenario of needs and learning for contemporary love relationships was observed.(AU)

[The "tug of war" in healthcare: psychologists' conception and practice concerning Matrix-Based Support in the Center for Family Health Support]. / O "cabo de força" da assistência: concepção e prática de psicólogos sobre o Apoio Matricial no Núcleo de Apoio à Saúde da Família.

The current study analyzed the conception and practice of matrix-based support among psychologists working at the Center for Family Health Support (NASF in Portuguese) in the city of São Paulo, Brazil. A qualitative methodology was used with semi-structured interviews that were taped, transcribed, and submitted to thematic content analysis. The study revealed dilemmas between the work as prescribed and what is possible to achieve in practice, and between idealization of the collaborative proposal and its implementation. Exchanges of knowledge and training appear as the principal meanings in the matrix-based concept. The practice revealed a complex context with heterogeneous work organization, lack of linkage between management levels and tensions in the execution of shared work, such as unequal division of tasks, in with the family health teams take responsibility for direct care to the population, while the NASF occupies the role of training and supervising, thereby generating conflicts over responsibility for care and creating a context which is hardly conducive to comprehensive, shared, and collaborative care.

O "cabo de força" da assistência: concepção e prática de psicólogos sobre o Apoio Matricial no Núcleo de Apoio à Saúde da Família / The "tug of war" in healthcare: psychologists' conception and practice concerning Matrix-Based Support in the Center for Family Health Support / El "cable de alimentación" de la asistencia: concepción y práctica de psicólogos sobre el Apoyo Matricial en el Núcleo de Apoyo a la Salud de la Familia

O presente estudo analisou a concepção e a prática do matriciamento realizadas por psicólogos que trabalham no Núcleo de Apoio à Saúde da Família (NASF) no Município de São Paulo, Brasil. Foi utilizada a metodologia qualitativa, foram realizadas entrevistas semiestruturadas, gravadas e transcritas, submetidas à análise de conteúdo do tipo temática. Essa pesquisa demonstra dilemas entre a prescrição do trabalho e o que é possível ser realizado na prática, e entre a idealização da proposta colaborativa e sua implantação. A troca de saberes e a capacitação apareceram como principais significados da concepção de matriciamento. A prática revelou um contexto complexo com uma organização de trabalho bastante heterogênea com falta de articulação entre gerências e tensões na execução do trabalho compartilhado, como a divisão desigual de tarefas, em que as equipes de saúde da família devem se responsabilizar pela assistência direta à população enquanto o NASF ocupa o lugar daquele que capacita e supervisiona, gerando conflitos sobre de quem é a responsabilidade da assistência, constituindo um contexto pouco propício ao cuidado integral, compartilhado e colaborativo.

The current study analyzed the conception and practice of matrix-based support among psychologists working at the Center for Family Health Support (NASF in Portuguese) in the city of São Paulo, Brazil. A qualitative methodology was used with semi-structured interviews that were taped, transcribed, and submitted to thematic content analysis. The study revealed dilemmas between the work as prescribed and what is possible to achieve in practice, and between idealization of the collaborative proposal and its implementation. Exchanges of knowledge and training appear as the principal meanings in the matrix-based concept. The practice revealed a complex context with heterogeneous work organization, lack of linkage between management levels and tensions in the execution of shared work, such as unequal division of tasks, in with the family health teams take responsibility for direct care to the population, while the NASF occupies the role of training and supervising, thereby generating conflicts over responsibility for care and creating a context which is hardly conducive to comprehensive, shared, and collaborative care.

El presente estudio analizó la concepción y la práctica de la organización matricial realizadas por psicólogos que trabajan en el Núcleo de Apoyo a la Salud de la Familia (NASF) en el Municipio de Sao Paulo, Brasil. Se utilizó metodología cualitativa, se realizaron entrevistas semiestructuradas, grabadas y transcritas, sometidas al análisis de contenido del tipo de temática. Esta investigación demuestra dilemas entre la prescripción del trabajo y lo que es posible ser realizado en la práctica, y entre la idealización de la propuesta colaborativa y su implantación. El intercambio de saberes y la capacitación aparecieron como los principales significados de la concepción de organización matricial. La práctica reveló un contexto complejo con una organización de trabajo bastante heterogénea, con falta de articulación entre equipos gerentes y tensiones en la ejecución del trabajo compartido, como una división desigual de tareas, donde los equipos de salud de la familia deben responsabilizarse por la asistencia directa a la población, mientras el NASF ocupa el lugar de aquel que capacita y supervisa, generando conflictos sobre de quién es la responsabilidad de la asistencia, constituyendo un contexto poco propicio al cuidado integral, compartido y colaborativo.

Processo de trabalho em reabilitação: a perspectiva do trabalhador e do usuário / Proceso de trabajo en rehabilitación: la perspectiva del trabajador y el usuario / The Working Process during Rehabilitation: From the Standpoint of the Worker and the User

A prevalência das deficiências físicas constitui-se grave problema de saúde nas sociedades contemporâneas, o que demanda um processo longo de cuidados com ênfase na reabilitação. Este é um estudo de caso com abordagem qualitativa realizado em um centro de reabilitação de referência estadual, o qual envolveu 10 usuários e 22 trabalhadores com o objetivo de analisar o processo de trabalho em reabilitação. Foram coletados dados por meio de entrevistas com usuários e trabalhadores, observação sistemática e análise documental de prontuários. Emergiram quatro categorias temáticas: usuários com lesão medular atendidos no centro de reabilitação; equipe profissional que atua junto às pessoas com lesão medular; aspectos do processo de trabalho que favorecem a reabilitação; aspectos do processo de trabalho que a dificultam. Neste, destacaram-se déficits nos instrumentos de trabalho; nos aspectos que facilitam a reabilitação, destacou-se o trabalho em equipe humanizado. Conclui-se que o trabalho multiprofissional facilita o processo de reabilitação, o que traz benefícios aos usuários, e que o trabalho de enfermagem é parte essencial desse processo.

La prevalencia de discapacidades físicas se constituye en un problema de salud en las sociedades contemporáneas, lo que demanda un proceso largo de cuidados con énfasis en la rehabilitación. Este es un estudio de caso con abordaje cualitativo realizado en un centro de rehabilitación de referencia distrital, con 10 usuarios y 22 trabajadores, a fin de analizar el proceso de trabajo en rehabilitación. Se recolectaron datos por medio de entrevistas a usuarios y trabajadores, observación sistemática y análisis documental de historias clínicas. Emergieron cuatro categorías temáticas: usuarios con lesión medular atendidos en el centro de rehabilitación; equipo profesional que actúa junto a las personas con lesión medular; aspectos del proceso de trabajo que favorecen la rehabilitación; aspectos del proceso de trabajo que la dificultan. En esta última, se destacaron los déficits en los instrumentos de trabajos; en los que facilitan la rehabilitación, se destacó el trabajo humanizado en equipo. Se concluye que el trabajo multiprofesional facilita el proceso de rehabilitación, lo que trae beneficios a los usuarios, y que el trabajo de enfermería es parte esencial de este proceso.

The prevalence of physical disabilities is a serious health problem in contemporary societies and one that requires a long process of care with an emphasis on rehabilitation. This is a case study with a qualitative approach. It was conducted at a district rehabilitation center with 10 users and 22 workers to analyze the working process during rehabilitation. The data were collected through interviews with users and workers, systematic observation, and documentary analysis of medical records. Four subject categories emerged: users with spinal cord injury who were being treated at the rehabilitation center; the professional team that works with persons who have spinal cord injuries; aspects of the working process that favor rehabilitation; and aspects of the working process that hamper rehabilitation. As for the latter, shortcomings in the instruments for rehabilitation work and in those facilitating rehabilitation were noted, and the humanized work of the team was highlighted. It was concluded that multidisciplinary work by professionals facilitates the rehabilitation process, which means benefits for users, and nursing work is an essential part of this process.

Use of dermoscopy in the diagnosis of temporal triangular alopecia.

Temporal triangular alopecia, also referred as congenital triangular alopecia, is an uncommon dermatosis of unknown etiology. It is characterized by a non-scarring, circumscribed alopecia often located unilaterally in the frontotemporal region. It usually emerges at ages 2-9 years. Alopecia areata is the main differential diagnosis, especially in atypical cases. Dermoscopy is a noninvasive procedure that helps distinguish temporal triangular alopecia from aloepecia areata. Such procedure prevents invasive diagnostic methods as well as ineffective treatments.

Use of dermoscopy in the diagnosis of temporal triangular alopecia

Temporal triangular alopecia, also referred as congenital triangular alopecia, is an uncommon dermatosis of unknown etiology. It is characterized by a non-scarring, circumscribed alopecia often located unilaterally in the frontotemporal region. It usually emerges at ages 2-9 years. Alopecia areata is the main differential diagnosis, especially in atypical cases. Dermoscopy is a noninvasive procedure that helps distinguish temporal triangular alopecia from aloepecia areata. Such procedure prevents invasive diagnostic methods as well as ineffective treatments.

Humanização e processo de trabalho em reabilitação / Humanization and work process in rehabilitation / Humanización y proceso de trabajo en rehabilitación

A Política Nacional de Humanização é uma prática social ampliadora dos vínculos de solidariedade e compartilhamento de responsabilidades dos diversos atores sociais envolvidos no cuidado. O objetivo foi conhecer se o processo de trabalho num centro referência estadual em reabilitação é humanizado. Tratou-se de estudo de caso, com abordagem qualitativa, realizado no segundo semestre de 2012, em um Centro de Reabilitação referência do estado de Santa Catarina. A coleta de dados foi realizada por meio de entrevista, observação e análise documental dos prontuários dos usuários entrevistados. Utilizou-se a análise temática com base nas categorias prévias relacionadas à humanização ? acolhimento, clínica ampliada e compartilhada; práticas coletivas de gestão e avaliação da assistência. Como resultados evidenciou-se que o processo de trabalho pauta-se no acolhimento, há o trabalho em equipe e não há avaliação da assistência. Concluiu-se que há o acolhimento, o trabalho em equipe e o olhar multiprofissional para a integralidade das pessoas lá atendidas.

The National Policy of Humanization proposes the extension of the solidarity bonds and shared responsibility of the various social actors involved in healthcare. The objective was to understand whether the work process in a state reference center for rehabilitation is humanized, in accordance with the Health Ministry policy. This was a case study with a qualitative approach, conducted in the second half of 2012, in a Rehabilitation Centre of reference in the state of Santa Catarina. Data collection was conducted through interviews, observation and documentary analysis (records of respondent users). In the analysis prior categories related to humanization were used ? reception, extended and shared clinic; collective management practices and evaluation of the assistance. As a result, it was evidenced that the work process is guided by the reception, there is teamwork, but there is no evaluation of the care. It was concluded that the actions developed are still insufficient for the humanization of healthcare.

The National Policy of Humanization proposes the extension of the solidarity bonds and shared responsibility of the various social actors involved in healthcare. The objective was to understand whether the work process in a state reference center for rehabilitation is humanized, in accordance with the Health Ministry policy. This was a case study with a qualitative approach, conducted in the second half of 2012, in a Rehabilitation Centre of reference in the state of Santa Catarina. Data collection was conducted through interviews, observation and documentary analysis (records of respondent users). In the analysis prior categories related to humanization were used ? reception, extended and shared clinic; collective management practices and evaluation of the assistance. As a result, it was evidenced that the work process is guided by the reception, there is teamwork, but there is no evaluation of the care. It was concluded that the actions developed are still insufficient for the humanization of healthcare.

Lobomycosis: epidemiology, clinical presentation, and management options.

Lobomycosis is a subcutaneous mycosis of chronic evolution caused by the Lacazia loboi fungus. Its distribution is almost exclusive in the Americas, and it has a particularly high prevalence in the Amazon basin. Cases of lobomycosis have been reported only in dolphins and humans. Its prevalence is higher among men who are active in the forest, such as rubber tappers, bushmen, miners, and Indian men. It is recognized that the traumatic implantation of the fungus on the skin is the route by which humans acquire this infection. The lesions affect mainly exposed areas such as the auricles and upper and lower limbs and are typically presented as keloid-like lesions. Currently, surgical removal is the therapeutic procedure of choice in initial cases. Despite the existing data and studies to date, the active immune mechanisms in this infection and its involvement in the control or development of lacaziosis have not been fully clarified. In recent years, little progress has been made in the appraisal of the epidemiologic aspects of the disease. So far, we have neither a population-based study nor any evaluation directed to the forest workers.