Heavy menstrual bleeding in women with inherited bleeding disorders in use of LNG-IUS: A systematic review and single-arm meta-analysis.

OBJECTIVES: Inherited bleeding disorders may cause heavy menstrual bleeding in women, impacting quality of life and impairing daily and social activities. The levonorgestrel-releasing intrauterine system is a potential treatment for these women, which might reduce menstrual blood loss. STUDY DESIGN: We performed a systematic review and single-arm meta-analysis to examine the levonorgestrel-releasing intrauterine system in women with inherited bleeding disorders and heavy menstrual bleeding. RESULTS: A systematic search on PubMed, Embase and Cochrane yielded 583 results, of which six observational studies (n = 156) met inclusion criteria. Levonorgestrel-releasing intrauterine system use in patients with inherited bleeding disorders and heavy menstrual bleeding was associated with amenorrhea in 60% of patients and a significant increase of 1.40 g/dL in hemoglobin and of 19.75 ng/mL in ferritin levels when comparing post- and pre-treatment levels. The post-treatment mean hemoglobin was 13.32 g/dL and the mean ferritin was 43.22 ng/dL. The rate of intrauterine device expulsion or removal due to mal position was low (13%), as was the need for intrauterine device removal due to lack of efficacy (14%). CONCLUSION: The levonorgestrel-releasing intrauterine system may improve bleeding patterns and quality of life in patients with inherited bleeding disorders and heavy menstrual bleeding. IMPLICATIONS: Women with inherited bleeding disorders could benefit from levonorgestrel-releasing intrauterine system, so its use should be an option for this women.

The role of the visceral adiposity index in the assessment of metabolic syndrome of polycystic ovary syndrome patients: a new anthropometric index.

PURPOSE: Polycystic ovary syndrome (PCOS) is a common endocrine disorder often linked to metabolic syndrome (MS), raising the risk of cardiovascular disease and type II diabetes. Certain indicators, such as the lipid accumulation product (LAP) and homeostatic model assessment for insulin resistance (HOMA-IR), can predict MS in PCOS patients. This study aimed to assess the predictive power of the visceral adiposity index (VAI) in comparison to LAP and HOMA-IR as predictors of MS in PCOS patients. METHODS: In this cross-sectional observational study, data from 317 diagnosed PCOS women were analyzed. VAI, LAP, and HOMA-IR were computed as indexes. Participants were categorized into two groups for index accuracy comparison: PCOS patients with and without MS. The data were assessed using a ROC curve. RESULTS: Among PCOS women with MS, 92.3% had abnormal VAI results, 94.5% had abnormal LAP results, and only 50.5% had abnormal HOMA-IR results. Conversely, the majority of PCOS women without MS had normal HOMA-IR (64.6%). When comparing these indexes using the ROC curve, VAI displayed the highest accuracy, followed by LAP and HOMA-IR. CONCLUSION: The VAI index proved to be a superior predictor of metabolic MS in PCOS women when compared to other indexes.

The Influence of IL-11 on Cardiac Fibrosis in Experimental Models: A Systematic Review.

Fibrosis is one of the main factors that impair the function of many organs. In the heart, fibrosis leads to contractile dysfunction and arrhythmias, which are important in the development of heart failure. Interleukin (IL)-11 is regulated in various heart diseases and has recently been reported to be an important cytokine in fibrosis in this organ. However, this topic has been little explored, and many questions persist. Thus, this systematic review aimed to report on possible IL-11 therapies evaluated in rodent model-induced cardiac fibrosis. Inclusion criteria were experimental in vivo studies that used different rodent models for cardiac fibrosis associated with IL-11 interventions, without year and language restrictions. The search in PubMed, Web of Science, and Embase databases was performed in October 2022. The risk of bias assessment of the studies was based on the guidelines of the SYRCLE tool, and data from the selected articles were also presented in a table as a narrative description. This review was based on eight studies in which five different interventions were used: recombinant human IL-11 (rhIL-11), anti-IL11 (X203), recombinant mouse IL-11 (rmIL-11), lentivirus (LV)-IL-11 + lutein, and anti-IL11RA (X209). Based on the included studies, the results were variable, with IL-11 overexpression inducing cardiac fibrosis, while inhibition protected against this process, preserving the function of this organ. Therefore, IL-11 stands out as a promising therapeutic target for cardiac fibrosis. However, further studies are needed to understand the mechanisms triggered by each treatment, as well as its safety and immunogenicity.

In-hospital breastfeeding and predictive factors during the SARS-CoV-2 pandemic: A retrospective cohort study - Aleitamento materno hospitalar e fatores preditores durante a pandemia pelo SARS-CoV-2: Coorte retrospectiva.

PURPOSE: To analyze breastfeeding and the factors that positively influence the first hour of life, during hospitalization, and at discharge during the SARS-CoV-2 pandemic. DESIGN AND METHOD: This is a retrospective cohort study, with data collected from medical records. Consisting of 225 mother-newborn dyads with deliveries between 2020 and 2021. Breastfeeding in the first hour of life, during hospitalization, and at discharge was considered as the outcome variable. The independent variables were sociodemographic, obstetric, and neonatal data. The analysis was performed with bivariate and multivariate regression through a generalized linear model (Poisson family), with a 5% significance level. It was approved by the Institutional Review Board (IRB), under approval number 4,911,317. RESULT: Newborns of women without COVID-19 suspicion or diagnosis and who had skin-to-skin contact with their mother at birth are twice as likely to be breastfed in the first hour of life. Absence of complications in the newborn during hospitalization and no COVID-19 suspicion or diagnosis double the exclusive breastfeeding rate during hospitalization. Newborns exclusively breastfed during hospitalization present 1.6 times more chances of being exclusively breastfeeding at hospital discharge. CONCLUSION: It was evidence that women who gave birth without COVID-19 suspicion, and newborns who had skin-to-skin contact with their mother at birth represented a predictive factor for favoring exclusive breastfeeding. PRACTICE IMPLICATIONS: This research contributes to the innovation of evaluating breastfeeding in the newborn's first hour of life, during hospitalization, and at discharge in a pandemic context.

Menadione and protocatechuic acid: A drug combination with antitumor effects in murine osteosarcoma cells.

Osteosarcoma (OS) is a primary malignant bone tumor that has an abnormal expression of oncogenesis and tumor suppressors and causes dysregulation of various signaling pathways. Thus, novel therapeutic strategies for OS are needed to overcome the resistance of traditional treatments. This study evaluated the cytotoxic and anticancer effects of the association between menadione (MEN) and protocatechuic acid (PCA) in murine OS cells (UMR-106). The concentrations were 3.12 µM of isolated MEN, 500 µM of isolated PCA, and their associations. We performed cell viability assays, morphology modification analysis, cell migration by the wound-healing method, apoptosis by flow cytometry, reactive oxygen species (ROS) production, gene expression of NOX by RT-qPCR, and degradation of MMP-2 and 9 by zymography. Our results showed that the association of MEN+PCA was more effective in OS cells than the compounds alone. The association decreased cell viability, delayed cell migration, and decreased the expression of NOX-2 and ROS. In addition, the MEN+PCA association induced a slight increase in the apoptotic process. In summary, the association can enhance the compound's antitumor effects and establish a higher selectivity for tumor cells, possibly caused by significant mitochondrial damage and antioxidant properties.

O isolamento social no contexto da pandemia covid-19 e a saúde mental: perspectivas de idosos institucionalizados / Social isolation amid the COVID-19 pandemic and mental health: perspectives of institutionalized older adults

Resumo Objetivo Compreender a repercussão do isolamento social durante a pandemia da covid-19 na saúde mental de idosos institucionalizados, sob a óptica dos idosos institucionalizados. Método Estudo exploratório-descritivo com abordagem qualitativa, em duas ILPI's do município de Divinópolis, MG, Brasil, por meio de um questionário de identificação e, para análise dos dados qualitativos, um roteiro semiestruturado com questões norteadoras sobre a autopercepção do isolamento social durante a pandemia. Utilizou-se análise de conteúdo, à luz da teoria de Dorothea Orem. Resultados Participaram 13 idosos e foram levantadas as seguintes categorias temáticas: Sentimentos dos idosos institucionalizados frente ao isolamento social da pandemia; Ações dos residentes para preservar a saúde mental e física durante o período do isolamento social da pandemia; O isolamento social e a inatividade física como parte da vida dos idosos institucionalizados; A covid-19 encarada como algo trivial. Conclusão O isolamento social causado pela pandemia repercutiu negativamente na saúde mental dos idosos institucionalizados e trouxe à tona o fato do isolamento social já fazer parte do cotidiano desses idosos.

Abstract Objective To understand the impact of social isolation during the COVID-19 pandemic on the mental health of institutionalized older adults, from the perspective of these residents. Method An exploratory-descriptive study with a qualitative approach was conducted in two LTCFs in the city of Divinópolis, Minas Gerais State, Brazil. A questionnaire was applied for identification, whereas for qualitative data analysis, a semi-structurednscript with guiding questions about self-perceptions of social isolation during the pandemic was employed. Content analysis was used, drawing on Dorothea Orem's theory. Results Thirteen older adults participated and the following thematic categories were identified: Feelings of the residents about social isolation amid the pandemic; Actions by residents to preserve mental and physical health during pandemic social isolation; Social isolation and physical inactivity as part of the lives of residents; COVID-19 viewed as trivial. Conclusion Social isolation caused by the pandemic had a negative impact on the mental health of the institutionalized older adults and revealed the fact that social isolation was already part of their daily lives.

Infected Spinal Hematoma After Accidental Exteriorization of an Epidural Catheter: A Case Report.

Optimal treatment and outcome after spinal hematoma remain unclear. Close neurological monitoring is the key to successful treatment. Here, we present a case of an infected spinal hematoma management. We report the case of a 51-year-old male patient, American Society of Anesthesiologists physical status I, admitted to a level I hospital due to right lower limb necrotizing fasciitis. A lumbar epidural catheter was placed for pain control without complications. On the 26th day of hospitalization, three hours after the accidental exteriorization of the epidural catheter, the patient developed severe back pain not relieved by systemic analgesia. Prophylactic low-molecular-weight heparin had been administered less than six hours before. The patient had inflammatory signs and digital pressure pain at the catheter insertion site and a positive Brudzinski sign. Sensory-motor deficits were never felt. An urgent dorsolumbar MRI exhibited a significant hematic collection at the subdural and anterior epidural level, and an infected epidural hematoma was assumed. Empirical antibiotics and hourly monitoring of sensory-motor deficits, meningeal signs, and fever were initiated. The patient remained on absolute bed rest. Low-molecular-weight heparin was stopped. The pain disappeared on the third day after the MRI. Citrobacter koseri was isolated. A re-evaluation CT scan did not show spinal compression. The patient was discharged on the 27th day after an MRI in an asymptomatic condition and was referred to acute pain consultation. Neurological deficits are usually expected at the time of spinal hematoma diagnosis. However, the classic triad of pain, sensory deficits, and motor deficits is only seen in less than half of patients. Our patient only developed severe lumbar pain. In selected cases, diagnostic MRI associated with tight monitoring and conservative management can be applied.

Symptoms of Depression in the Postpartum Period: Targeting Maternal Mental Health in the Perinatal Period.

This cross-sectional study aimed to examine the relationship between postpartum depression symptoms, anxiety, and stress during the postpartum period. A total of 101 women were assessed using the Depression, Anxiety and Stress Scale (DASS-21) and the Edinburgh Postnatal Depression Scale (EPDS) within 14 days after delivery. Multivariate regression analysis revealed that paid work, tobacco use, and stress symptoms were significantly associated with a higher incidence of postpartum depression symptoms. These results underscore the importance of comprehensive prenatal care and effective postpartum follow-up to address maternal mental health and prevent adverse outcomes for both mothers and children.

Repercussões do isolamento social na pandemia em pessoas idosas assistidas pela atenção primária à saúde / Repercussions of social isolation during the pandemic on elderly people assisted by primary health care

Objetivo: Conhecer as repercussões do isolamento social no período da pandemia no contexto de vida e de saúde das pessoas idosas. Métodos: Estudo com abordagem qualitativa, com 16 idosos da Atenção Primária à Saúde. Os dados foram coletados por meio de entrevistas semiestruturadas gravadas e analisados segundo a análise temática de conteúdo, em 2022. Resultados: Emergiram cinco unidades temáticas: Banalização da COVID e do isolamento social; Saúde mental e o isolamento social; Pensamentos/ações positivas para o enfrentamento do isolamento social; O isolamento social como parte da vida dos idosos; Afastamento das atividades cotidianas e das relações interpessoais. Conclusão: O isolamento social repercutiu na saúde mental e no bem-estar biopsicossocial dos idosos, por meio da exacerbação de sentimento de tristeza, solidão, ansiedade, angustia, bem como dificuldades na adaptação do novo cotidiano com interrupção de atividades físicas, de lazer e de interação social entre amigos e familiares.(AU)

Objective: To understand the repercussions of social isolation during the pandemic in the context of life and health of older adults. Methods: A study with a qualitative approach, with 16 older adults from Primary Health Care. Data were collected through semi-structured interviews recorded and analyzed according to thematic content analysis in 2022. Results: Five thematic units emerged: Trivialization of COVID and social isolation; Mental health and social isolation; Positive thoughts/actions for coping with social isolation; Social isolation as part of the lives of older adults; Removal from daily activities and interpersonal relationships. Conclusion: Social isolation had repercussions on the mental health and biopsychosocial well-being of the elderly, through the exacerbation of feelings of sadness, loneliness, anxiety, anguish, as well as difficulties in adapting the new daily life with interruption of physical activities, leisure and social interaction between friends and family.(AU)

Objetivo: Conocer las repercusiones del aislamiento social durante la pandemia en el contexto de vida y salud de los adultos mayores. Método: Estudio con abordaje cualitativo, con 16 adultos mayores de Atención Primaria de Salud. Los datos se recogieron mediante entrevistas semiestructuradas grabadas y analizadas según análisis de contenido temático en 2022. Resultados: Emergieron cinco unidades temáticas: Trivialización del COVID y aislamiento social; Salud mental y aislamiento social; Pensamientos/acciones positivas para enfrentar el aislamiento social; Aislamiento social como parte de la vida de los adultos mayores; Alejamiento de las actividades cotidianas y de las relaciones interpersonales. Conclusión: El aislamiento social repercutió en la salud mental y en el bienestar biopsicosocial de los ancianos, a través de la exacerbación de sentimientos de tristeza, soledad, ansiedad, angustia, así como dificultades de adaptación a la nueva vida cotidiana con interrupción de las actividades físicas, de ocio y de interacción social entre amigos y familiares.(AU)

Educational intervention improves knowledge and adherence to treatment amongst puerperal women with syphilis: randomized clinical trial.

BACKGROUND: Gestational syphilis requires early detection and proper treatment to prevent negative maternal-fetal outcomes. This study aimed to evaluate the effectiveness of an educational intervention on treatment adherence and knowledge about syphilis in postpartum women with positive Treponema pallidum results. METHODS: A randomized, parallel, and open clinical trial was conducted with 64 postpartum women who tested positive for T. pallidum, assigned to two groups (1:1 ratio). The Intervention Group (IG) received an educational intervention on syphilis, including an explanatory leaflet and hands-on demonstrations, along with standard guidelines. The Control Group (CG) received standard guidelines alone. Pre-test and post-test assessments were conducted to measure knowledge and treatment adherence. Statistical analyses included descriptive and inferential methods, assessing group homogeneity using the Chi-square or Fishers exact test. The interventions effectiveness was determined using relative risk, and pre- and post-test scores were compared using the independent t test. RESULTS: The post-test revealed improvements in knowledge scores for general knowledge, treatment, and prevention domains (p < .05). The IG demonstrated an increase in post-test knowledge scores (p = .001), with association between post-test scores and treatment adherence (p = .001). CONCLUSION: The educational intervention on syphilis improved knowledge and treatment adherence in postpartum women with syphilis.

The Multifarious Functions of Leukotrienes in Bone Metabolism.

Leukotrienes (LTs) are derived from arachidonic acid metabolism by the 5-lipoxygenase (5-LO) enzyme. The production of LTs is stimulated in the pathogenesis of rheumatoid arthritis (RA), osteoarthritis, and periodontitis, with a relevant contribution to bone resorption. However, its role in bone turnover, particularly the suppression of bone formation by modulating the function of osteoclasts and osteoblasts, remains unclear. We investigated the effects of LTs on bone metabolism and their impact on osteogenic differentiation and osteoclastogenesis using a 5-LO knockout (KO) mouse model. Results from micro-computed tomography (µCT) analysis of femur from 8-week-old 5-LO-deficient mice showed increased cortical bone and medullary region in females and males and decreased trabecular bone in females. In the vertebra, we observed increased marrow area in both females and males 5-LO KO and decreased trabecular bone only in females 5-LO KO. Immunohistochemistry (IHC) analysis showed higher levels of osteogenic markers tissue-nonspecific alkaline phosphatase (TNAP) and osteopontin (OPN) and lower expression of osteoclastogenic marker tartrate-resistant acid phosphatase (TRAP) in the femurs of 5-LO KO mice versus wild-type (WT). Alkaline phosphatase activity and mineralization assay results showed that the 5-LO absence enhances osteoblasts differentiation and mineralization but decreases the proliferation. Alkaline phosphatase (ALP), Bglap, and Sp7 gene expression were higher in 5-LO KO osteoblasts compared to WT cells. Eicosanoids production was higher in 5-LO KO osteoblasts except for thromboxane 2, which was lower in 5-LO-deficient mice. Proteomic analysis identified the downregulation of proteins related to adenosine triphosphate (ATP) metabolism in 5-LO KO osteoblasts, and the upregulation of transcription factors such as the adaptor-related protein complex 1 (AP-1 complex) in long bones from 5-LO KO mice leading to an increased bone formation pattern in 5-LO-deficient mice. We observed enormous differences in the morphology and function of osteoclasts with reduced bone resorption markers and impaired osteoclasts in 5-LO KO compared to WT osteoclasts. Altogether, these results demonstrate that the absence of 5-LO is related to the greater osteogenic profile. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Sexual dysfunction in Brazilian patients with multiple sclerosis.

BACKGROUND: People with multiple sclerosis (PwMS) show an increased risk of sexual dysfunction (SD), both in women and men. OBJECTIVE: The aim of the present study was to apply the Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19) and evaluate our results by comparing them with those in in the literature, as well as to assess the ease of applying the scale and the engagement of the patients in discussing the topic of sexuality. METHODS: We developed and applied a web-based Google form questionnaire that the respondents completed online, which included the MSISQ-19, for the assessment of sexual function. Baseline characteristics were reported as proportions and mean ± standard deviation (SD) or median ± interquartile range (IQR) as appropriate according to data distribution. Categorical variables were stratified by sex and compared with chi-squared tests. Statistical analyses were performed using STATA v. 16 (StataCorp., College Station, TX, USA). RESULTS: Of the 621 respondents, 541 were included in the analysis. Among the patients with MS, a total of 347 (64.14%) exhibited SD. When stratified by gender, the frequencies of SD were not significantly different. CONCLUSION: There is a high incidence of sexual dysfunction among PwMS and we need to identify the reasons for this and implement strategies to treat and counsel our patients. The MSISQ-19 can be used to help clinicians to assess sexual functioning in a quick and easy way and give patients the possibility to address this topic and receive appropriate help and support.

ANTECEDENTES: Pacientes com esclerose múltipla apresentam altas taxas de disfunção sexual em diversos estudos. OBJETIVO: Avaliar a aplicação e resultados da ferramenta para avaliação de disfunção sexual em pacientes com Esclerose Multipla, Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19), bem como comparar os resultados encontrados com a literatura já existente e ter a percepção do engajamento dos pacientes sobre o tema. MéTODOS: Realizado através de questionário on-line na plataforma Google Forms, composto por questões sobre perfil demográfico e relacionadas à doença e o questionário MSISQ-19. Os dados demográficos e sobre a doença foram descritos como proporções e média ± desvio padrão (DP) ou mediana ± intervalo interquartil (IIQ). As variáveis categóricas foram estratificadas por sexo e comparadas com testes de qui-quadrado. As análises estatísticas foram realizadas no programa STATA v. 16 (StataCorp., College Station, TX, EUA). RESULTADOS: Um total de 621 pacientes responderam ao questionário, sendo inclusos na análise 541 respostas, após a aplicação dos critérios de elegibilidade. Um total de 347 (64,14%) pacientes apresentaram disfunção sexual, sem diferença entre os gêneros. CONCLUSãO: Disfunção sexual apresenta alta prevalência no grupo estudado, sendo necessário identificar as causas e implementar estratégias de tratamento. O MSISQ-19 é uma ferramenta fácil e rápida de ser aplicada, podendo ser utilizada para facilitar a comunicação com os pacientes sobre o tema, possibilitando assim o tratamento das disfunções sexuais nessa população.

Dentoalveolar Alterations in an Adenine-Induced Chronic Kidney Disease Mouse Model.

Chronic kidney disease (CKD) is characterized by kidney damage and loss of renal function. CKD mineral and bone disorder (CKD-MBD) describes the dysregulation of mineral homeostasis, including hyperphosphatemia and elevated parathyroid hormone (PTH) secretion, skeletal abnormalities, and vascular calcification. CKD-MBD impacts the oral cavity, with effects including salivary gland dysfunction, enamel hypoplasia and damage, increased dentin formation, decreased pulp volume, pulp calcifications, and altered jaw bones, contributing to clinical manifestations of periodontal disease and tooth loss. Underlying mechanisms are not fully understood, and CKD mouse models commonly require invasive procedures with high rates of infection and mortality. We aimed to characterize the dentoalveolar effects of an adenine diet (AD)-induced CKD (AD-CKD) mouse model. Eight-week-old C57BL/6J mice were provided either a normal phosphorus diet control (CTR) or adenine and high-phosphorus diet CKD to induce kidney failure. Mice were euthanized at 15 weeks old, and mandibles were collected for micro-computed tomography and histology. CKD mice exhibited kidney failure, hyperphosphatemia, and hyperparathyroidism in association with porous cortical bone in femurs. CKD mice showed a 30% decrease in molar enamel volume compared to CTR mice. Enamel wear was associated with reduced ductal components, ectopic calcifications, and altered osteopontin (OPN) deposition in submandibular salivary glands of CKD mice. Molar cusps in CKD mice were flattened, exposing dentin. Molar dentin/cementum volume increased 7% in CKD mice and pulp volume decreased. Histology revealed excessive reactionary dentin and altered pulp-dentin extracellular matrix proteins, including increased OPN. Mandibular bone volume fraction decreased 12% and bone mineral density decreased 9% in CKD versus CTR mice. Alveolar bone in CKD mice exhibited increased tissue-nonspecific alkaline phosphatase localization, OPN deposition, and greater osteoclast numbers. AD-CKD recapitulated key aspects reported in CKD patients and revealed new insights into CKD-associated oral defects. This model has potential for studying mechanisms of dentoalveolar defects or therapeutic interventions. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Acesso avançado na atenção primária

Acesso Avançado na Atenção Primária - Produção do Curso de Mestrado Profissional da EEUSP - 2023

Sexual dysfunction in Brazilian patients with multiple sclerosis / Disfunção sexual em pacientes brasileiros com esclerose múltipla

Abstract Background People with multiple sclerosis (PwMS) show an increased risk of sexual dysfunction (SD), both in women and men. Objective The aim of the present study was to apply the Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19) and evaluate our results by comparing them with those in in the literature, as well as to assess the ease of applying the scale and the engagement of the patients in discussing the topic of sexuality. Methods We developed and applied a web-based Google form questionnaire that the respondents completed online, which included the MSISQ-19, for the assessment of sexual function. Baseline characteristics were reported as proportions and mean ± standard deviation (SD) or median ± interquartile range (IQR) as appropriate according to data distribution. Categorical variables were stratified by sex and compared with chisquared tests. Statistical analyses were performed using STATA v. 16 (StataCorp., College Station, TX, USA). Results Of the 621 respondents, 541 were included in the analysis. Among the patients with MS, a total of 347 (64.14%) exhibited SD. When stratified by gender, the frequencies of SD were not significantly different. Conclusion There is a high incidence of sexual dysfunction among PwMS and we need to identify the reasons for this and implement strategies to treat and counsel our patients. The MSISQ-19 can be used to help clinicians to assess sexual functioning in a quick and easy way and give patients the possibility to address this topic and receive appropriate help and support.

Resumo Antecedentes Pacientes com esclerose múltipla apresentam altas taxas de disfunção sexual em diversos estudos. Objetivo Avaliar a aplicação e resultados da ferramenta para avaliação de disfunção sexual em pacientes com Esclerose Multipla, Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19), bem como comparar os resultados encontrados com a literatura já existente e ter a percepção do engajamento dos pacientes sobre o tema. Métodos Realizado através de questionário on-line na plataforma Google Forms, composto por questões sobre perfil demográfico e relacionadas à doença e o questionário MSISQ-19. Os dados demográficos e sobre a doença foram descritos como proporções e média ± desvio padrão (DP) ou mediana ± intervalo interquartil (IIQ). As variáveis categóricas foram estratificadas por sexo e comparadas com testes de qui-quadrado. As análises estatísticas foram realizadas no programa STATA v. 16 (StataCorp., College Station, TX, EUA). Resultados Um total de 621 pacientes responderam ao questionário, sendo inclusos na análise 541 respostas, após a aplicação dos critérios de elegibilidade. Um total de 347 (64,14%) pacientes apresentaram disfunção sexual, sem diferença entre os gêneros. Conclusão Disfunção sexual apresenta alta prevalência no grupo estudado, sendo necessário identificar as causas e implementar estratégias de tratamento. O MSISQ-19 é uma ferramenta fácil e rápida de ser aplicada, podendo ser utilizada para facilitar a comunicação com os pacientes sobre o tema, possibilitando assim o tratamento das disfunções sexuais nessa população.

O cuidado do idoso com alzheimer e a resiliência do cuidador informal / El cuidado de los mayores con alzheimer y la resiliencia del cuidador informal / The care of the elderly with Alzheimer and the resilience of the informal caregiving

Objetivo:compreender o cuidado com o idoso com a doença de Alzheimer e a resiliência do cuidador informal. Método:pesquisa qualitativa com 20 cuidadores de idosos realizada de agosto a dezembro de 2019 através de um roteiro sociodemográfico-econômico e questões norteadoras analisadas pela Análise de conteúdo e Teoria das Representações Sociais. Resultados:foi observada a complexidade, singularidade e dualidade de sentimentos no cuidado com o idoso com a doença de Alzheimer. Apesar dos cuidadores não compreenderem o significado de resiliência, existe o desenvolvimento de habilidades para o enfrentamento do cotidiano de cuidados. Conclusões:o cuidador convive com a ambivalência de sentimentos e experiências, de caráter semelhante ou oposto, que interferem inteiramente no cuidado prestado e que contribuem na construção do processode resiliência deste cuidador informal familiar.

Objective: to understand the care of the elderly with Alzheimer's disease and the resilience of the informal caregiver. Method: qualitative research with 20 caregivers of the elderly carried out from August to December 2019 through a sociodemographic-economic script and guiding questions that were analyzed by Content Analysis and Theory of Social Representations. Results: the complexity, uniqueness and duality of feelings in the care of the elderly with Alzheimer's disease were observed. Although caregivers do not understand the meaning of resilience, there is the development of skills to cope with daily care. Conclusions: the caregiver lives with the ambivalence of feelings and experiences, of a similar or opposite nature, that interfere entirely in the care provided and that contribute to the construction of the resilience process of this informal family caregiver.

Objetivo: comprender el cuidado del anciano con enfermedad de Alzheimer y la resiliencia del cuidador informal. Método: investigación cualitativa con 20 cuidadores de ancianos realizada de agosto a diciembre de 2019 a través de un guión sociodemográfico-económico y preguntas orientadoras que fueron analizadas por Análisis de Contenido y Teoría de las Representaciones Sociales. Resultados: se observó la complejidad, singularidad ydualidad de sentimientos en el cuidado de ancianos con enfermedad de Alzheimer. Aunque los cuidadores no comprendan el significado de resiliencia, existe el desarrollo de habilidades para afrontar el cuidado diario. Conclusiones: el cuidador vive con la ambivalencia de sentimientos y vivencias, de naturaleza análoga o contraria, que interfieren totalmente en el cuidado prestado y que contribuyen a la construcción del proceso de resiliencia de este cuidador familiar informal.

Influence of simulation design on stress, anxiety and self-confidence of nursing students: Systematic review with meta-analysis.

AIM: To evaluate the simulation design characteristics that may influence the stress, anxiety and self-confidence of undergraduate nursing students during learning. DESIGN: Systematic review with meta-analysis. DATA SOURCES: Searchers were conducted in October 2020 and updated in August 2022 in the databases CENTRAL, CINAHL, Embase®, ERIC, LILACS, MEDLINE, PsycINFO®, Scopus and Web of Science, PQDT Open (ProQuest), BDTD, Google Scholar and specific journals on simulation. REVIEW METHODS: This review was conducted according to the recommendations of Cochrane Handbook for Systematic Reviews and reported according to the PRISMA Statement. Experimental and quasi-experimental studies that compared the effect of simulation on stress, anxiety and self-confidence of nursing students were included. The selection of studies and data extraction was performed independently by two reviewers. Simulation information was collected as prebriefing, scenario, debriefing, duration, modality, fidelity and simulator. Data summarization was performed by qualitative synthesis and meta-analytical methods. RESULTS: Eighty studies were included in the review, and most reported in detail the structure of the simulation, contemplating prebriefing, scenario, debriefing and the duration of each step. In subgroup meta-analysis, the presence of prebriefing, duration of more than 60 min and high-fidelity simulations helped reduce anxiety, while the presence of prebriefing and debriefing, duration, immersive clinical simulation modalities and procedure simulation, high-fidelity simulations and use of mannequins, standardised patients and virtual simulators, contributed to greater students' self-confidence. CONCLUSIONS: Different modulations of simulation design components imply reduction of anxiety and increased self-confidence in nursing students, especially highlighting the quality of the methodological report of simulation interventions. RELEVANCE TO CLINICAL PRACTICE: These findings help to support the need of more rigorous methodology in simulation designs and research methods. Consequently, impact on the education of qualified professionals prepared to work in clinical practice. No Patient or Public Contribution.

[Hereditary bradykinin angioedema. Case report]. / Angioedema hereditario por bradicinina. Reporte de Caso.

INTRODUCTION: Hereditary angioedema is an autosomal dominant genetic disease, associated with increased levels of bradykinin. It is classified into 3 types according to the C1-INH enzyme. The diagnosis is clinical and laboratory. Its treatment is divided into short- and long-term and crisis prophylaxis. CASE REPORT: 40-year-old female patient who came to the emergency service for labial edema without resolution with corticosteroids. The tests for IgE, C4 and C1 esterase inhibitors had a low result. She currently uses danazol prophylactically and fresh frozen plasma in crises. CONCLUSIONS: Since it is a disease that considerably affects the quality of life, hereditary angioedema must be diagnosed and an effective treatment plan made to prevent or reduce its complications.

INTRODUCCIÓN: El angioedema hereditario es una enfermedad genética autosómica dominante, asociada con aumento de las concentraciones de bradicinina. Se clasifica en tres tipos, de acuerdo con la enzima C1-INH. El diagnóstico se establece por las manifestaciones clínicas y los estudios de laboratorio. El tratamiento consiste profilaxis a corto y largo plazo, y protocolo para el control de las crisis. REPORTE DEL CASO: Paciente femenina de 40 años, que acudió al servicio de Urgencias por edema labial, sin reacción al tratamiento con corticosteroides. Se detectaron concentraciones bajas de IgE, C4 e inhibidores de la esterasa C1. Se estableció el diagnóstico de angioedema hereditario. Actualmente se mantiene en tratamiento profiláctico con danazol y plasma fresco congelado para el control de las crisis. CONCLUSIONES: El angioedema hereditario es una enfermedad que afecta considerablemente la calidad de vida; por tanto, debe diagnosticarse de forma oportuna y establecer un plan de tratamiento eficaz, con la intención de prevenir o reducir las complicaciones.

A regulação jurídica brasileira do exercício da telemedicina no contexto da pandemia do COVID-19 / La regulació jurídica brasilera de l'exercici de la telemedicina en el context de la pandèmia de COVID-19 / La regulación jurídica brasileña del ejercicio de la telemedicina en el contexto de la pandemia de COVID-19 / The Brazilian legal regulation of the exercise of telemedicine in the context of the COVID-19 pandemic

O presente artigo tem como tema central a regulação jurídica do exercício da telemedicina, especialmente a partir do contexto criado na pandemia do COVID-19. Neste sentido, o estudo aborda os mecanismos legais e as orientações dadas pelo Conselho Federal de Medicina (CFM) para adoção da prática. Surgem, em virtude disso, diversos questionamentos referentes à situação trabalhista dos profissionais de saúde que utilizam a telemedicina como mecanismo de trabalho. O artigo, portanto, explanará a importância da adoção da telemedicina, como também as problemáticas oriundas de sua utilização.(AU)

L'article té com a tema central la regulaciójurídica de l'exercici de la telemedicina, especialment des del context creat en la pandèmia COVID-19. L'article aborda els mecanismes legals i les directrius donades pel Consell Federal de Medicina (CFM) per a l'adopció de la pràctica. Com a conseqüència, sorgeixen diverses preguntes sobre la situació laboral dels professionals sanitaris que utilitzen la telemedicina com a mecanisme de treball. L'article, per tant, explicarà la importància d'adoptar la telemedicina, així com els problemes derivats del seuús.(AU)

El artículo tiene como tema central la regulación jurídica del ejercicio de la telemedicina, especialmente desde el contexto creado en la pandemia COVID-19. El artículo aborda los mecanismos legales y las directrices dadas por el Consejo Federal de Medicina (CFM) para la adopción de la práctica. Como consecuencia, surgen varias preguntas sobre la situación laboral de los profesionales sanitarios que utilizan la telemedicina como mecanismo de trabajo. El artículo, por tanto, explicará la importancia de adoptar la telemedicina, así como los problemas derivados de su uso.(AU)

This article has as its central theme the legal regulation of the exercise of telemedicine, especially from the context created in the COVID-19 pandemic. In this sense, the study addresses the legal mechanisms and guidelines given by the Federal Council of Medicine (CFM) for the adoption of the practice. As a result, several questions arise regarding the work situation of health professionals who use telemedicine as a work mechanism. The article, therefore, will explain the importance of adopting telemedicine, as well as the problems that arise through it.(AU)

Reliability and Validity of UNESP-Botucatu Cattle Pain Scale and Cow Pain Scale in Bos taurus and Bos indicus Bulls to Assess Postoperative Pain of Surgical Orchiectomy.

Pain assessment guides decision-making in pain management and improves animal welfare. We aimed to investigate the reliability and validity of the UNESP-Botucatu cattle pain scale (UCAPS) and the cow pain scale (CPS) for postoperative pain assessment in Bos taurus (Angus) and Bos indicus (Nelore) bulls after castration. METHODS: Ten Nelore and nine Angus bulls were anaesthetised with xylazine-ketamine-diazepam-isoflurane-flunixin meglumine. Three-minute videos were recorded at -48 h, preoperative, after surgery, after rescue analgesia and at 24 h. Two evaluators assessed 95 randomised videos twice one month apart. RESULTS: There were no significant differences in the pain scores between breeds. Intra and inter-rater reliability varied from good (>0.70) to very good (>0.81) for all scales. The criterion validity showed a strong correlation (0.76-0.78) between the numerical rating scale and VAS versus UCAPS and CPS, and between UCAPS and CPS (0.76). The UCAPS and CPS were responsive; all items and total scores increased after surgery. Both scales were specific (81-85%) and sensitive (82-87%). The cut-off point for rescue analgesia was >4 for UCAPS and >3 for CPS. CONCLUSIONS: The UCAPS and CPS are valid and reliable to assess postoperative pain in Bos taurus and Bos indicus bulls.