Cirurgia bariátrica: complexidades e caminhos para a atenção da obesidade no SUS / Bariatric surgery: complexities and pathways to care for obesity in the SUS

RESUMO Este ensaio objetivou analisar como o Sistema Único de Saúde (SUS) tem lidado com o aumento da obesidade com indicação para cirurgia bariátrica no Brasil e apontar caminhos para a atenção à saúde integral dessa população. Fez-se um resgate do momento político-histórico de transformação epistemológica da obesidade e suas repercussões para indivíduos, sociedade, sistema de saúde e outros setores; expuseram-se alguns ataques sofridos pelo SUS, em especial os mais recentes, que afetam o já dificultoso acesso à cirurgia bariátrica; e refletiu-se sobre estratégias que buscam garantia da atenção à essa população e a sustentabilidade do sistema de saúde. Destacam-se os documentos produzidos pelo próprio Ministério da Saúde para a orientação do cuidado da obesidade, haja vista sua consonância com as evidências científicas mais atuais e sua utilização por outros países na construção de suas políticas. Ademais, reforça-se a importância do compartilhamento de responsabilidades entre todos os atores envolvidos; a regulamentação da publicidade voltada ao público que possui obesidade; o mandatório aumento de financiamento do SUS; e a utilização da avaliação em saúde de políticas, serviços e ações, para que se façam os ajustes necessários em tempo oportuno, garantindo uma melhor gestão do cuidado em saúde.

ABSTRACT This essay aims to analyze how the Unified Health System (SUS) has dealt with the increase in obesity with indication for bariatric surgery in Brazil, and to point out pathways to provide comprehensive health care for such population. There was a rescue of the political-historic moment of epistemological transformation of obesity and its repercussions for individuals, society, the health system, and other sectors; some attacks suffered by the SUS were exposed, especially the most recent ones, which affect the already difficult access to bariatric surgery; and it reflect on strategies that seek to guarantee care for that population and the sustainability of the health system. The documents produced by the Ministry of Health to guide obesity care stand out, given their consonance with the most current scientific evidence, and their use by other countries in the construction of their policies. Furthermore, it is reinforced the importance of sharing responsibilities among all the actors involved; the regulation of advertising aimed at the public with obesity; the mandatory increase in SUS funding; and the use of health evaluation of policies, services, and actions, so that the necessary adjustments are made in a timely manner and guarantee a better management of health care.

Diagnostic features of low- and high-grade mucinous neoplasms in pancreatic cyst FNA cytology.

BACKGROUND: Pancreatic cyst cytology evaluates for neoplastic mucin and epithelial grade. This study describes cytological features of low- and high-grade mucinous neoplasms (MNs) using gastrointestinal contaminants for comparison. METHODS: Histologically confirmed pancreatic cystic neoplasms were reviewed by a panel of cytopathologists to identify which, among 26 selected cytologic features, correlate significantly with low- and high-grade MN. A test for greater than or equal to four of eight high-grade features (three-dimensional architecture, high nuclear:cytoplasmic ratio, moderate nuclear membrane abnormalities, loss of nuclear polarity, hyperchromasia, >4:1 nuclear size variation in one cluster, karyorrhexis, and necrosis) was assessed for identifying a high-grade neoplasms. Additional characteristics of the cohort such as cyst fluid carcinoembryonic antigen results, molecular testing, Papanicolaou Society of Cytopathology classification, and select high-risk clinical features are described. RESULTS: Endoscopic ultrasound fine-needle aspirations from 134 MN and 17 serous cystadenomas containing gastrointestinal contaminants were included. The MN consisted of 112 (84%) intraductal papillary MNs (low-grade = 69, 62%; high-grade = 24, 21%; and invasive = 19, 17%) and mucinous cystic neoplasms (low-grade = 20, 90%; high-grade = 2, 10%). Half had greater than five clusters of epithelium for analysis. Compared with gastrointestinal contaminants, mucin from MN was thick and colloid-like (40% vs. 6%, p < .01), covered >20% of the smear area (32% vs. none, p < .01), and contained histiocytes (46% vs. 18%, p = .04). Greater than or equal to four of eight select high-grade features was present in 36% of high-grade MN with sensitivity 37% and 98% specificity. CONCLUSION: Colloid-like features, >20% of smear, and histiocytes correlated with MN. Testing for greater than or equal to four high-grade features had low sensitivity and high specificity for high-grade MN.

Promovendo saúde e segurança de enfermeiros intensivistas na pandemia por Covid-19 / Promoting health and safety of intensive care nurses in the pandemic by Covid-19 / Promoción de la salud y la seguridad de las enfermeras de cuidados intensivos en la pandemia por Covid-19

Objetivo: analisar produções científicas a respeito da promoção da saúde de enfermeiros intensivistas no período da pandemia por COVID-19. Método: trata-se de revisão integrativa da literatura, descritiva, exploratória e qualitativa, realizada em agosto de 2022.Foram utilizadas as bases de dados da área da saúde: Literatura Latino-Americana e do Caribe em Ciências da Saúde, Medical Literature Analysis and Retrievel System Online, Google acadêmico e Scientific Electronic Library Online. Resultados: Foram analisados 09 artigos sobre o tema, no qual o ano de 2021 foi predominante, com quatro publicações. Os estudos apontam o uso da humanização, empatia, relações interpessoais, atividades de educação em saúde e o desenvolvimento das práticas integrativas, como formas de promover a saúde na UTI, dentre os profissionais. Conclusão: observa-se incremento na melhoria da promoção à saúde direcionada a esses profissionais e prevenção de agravos relacionados a saúde mental no âmbito da assistência intensiva ao paciente crítico vítima de COVID-19.

Objective: to analyze scientific productions regarding the health promotion of intensive care nurses in the period of the pandemic by COVID-19. Method: this is an integrative review of the literature, descriptive, exploratory and qualitative, conducted in August 2022.The databases of the health area were used: Latin American and Caribbean Literature in Health Sciences, Medical Literature Analysis and Retrievel System Online, Google Academic and Electronic Library Online. Results: We analyzed 09 articles on the subject, in which 2021 was predominant, with four publications. The studies point to the use of humanization, empathy, interpersonal relationships, health education activities and the development of integrative practices, as ways to promote health in the ICU, among professionals. Conclusion: there is an increase in the improvement of health promotion directed to these professionals and prevention of mental health-related injuries in the context of intensive care to critically ill patients who are victims of COVID-19.

Objetivo: analizar las producciones científicas sobre la promoción de la salud de los enfermeros intensivistas en el período de la pandemia por COVID-19. Método: se trata de una revisión integradora de la literatura, descriptiva, exploratoria y cualitativa, realizada en agosto de 2022.Se utilizaron las bases de datos del área de salud: Literatura Latinoamericana y del Caribe en Ciencias de la Salud, Análisis de Literatura Médica y Sistema Recuperador en Línea, Google Académico y Biblioteca Electrónica en Línea. Resultados: Se analizaron 09 artículos sobre el tema, en los que predominó 2021, con cuatro publicaciones. Los estudios apuntan al uso de la humanización, la empatía, las relaciones interpersonales, las actividades de educación para la salud y el desarrollo de prácticas integradoras, como formas de promover la salud en la UTI, entre los profesionales. Conclusión: hay un aumento en la mejora de la promoción de la salud dirigida a estos profesionales y la prevención de lesiones relacionadas con la salud mental en el contexto de cuidados intensivos a pacientes críticos que son víctimas de COVID-19.

Discordant DNA mismatch repair protein status between synchronous or metachronous gastrointestinal carcinomas: frequency, patterns, and molecular etiologies.

The widespread use of tumor DNA mismatch repair (MMR) protein immunohistochemistry in gastrointestinal tract (GIT) carcinomas has unveiled cases where the MMR protein status differs between synchronous/metachronous tumors from the same patients. This study aims at examining the frequency, patterns and molecular etiologies of such inter-tumoral MMR discordances. We analyzed a cohort of 2159 colorectal cancer (CRC) patients collected over a 5-year period and found that 1.3% of the patients (27/2159) had ≥ 2 primary CRCs, and 25.9% of the patients with ≥ 2 primary CRCs (7/27) exhibited inter-tumoral MMR discordance. We then combined the seven MMR-discordant CRC patients with three additional MMR-discordant GIT carcinoma patients and evaluated their discordant patterns and associated molecular abnormalities. The 10 patients consisted of 3 patients with Lynch syndrome (LS), 1 with polymerase proofreading-associated polyposis (PAPP), 1 with familial adenomatous polyposis (FAP), and 5 deemed to have no cancer disposing hereditary syndromes. Their MMR discordances were associated with the following etiologies: (1) PMS2-LS manifesting PMS2-deficient cancer at an old age when a co-incidental sporadic MMR-proficient cancer also occurred; (2) microsatellite instability-driven secondary somatic MSH6-inactivation occurring in only one-and not all-PMS2-LS associated MMR-deficient carcinomas; (3) "compound LS" with germline mutations in two MMR genes manifesting different tumors with deficiencies in different MMR proteins; (4) PAPP or FAP syndrome-associated MMR-proficient cancer co-occurring metachronously with a somatic MMR-deficient cancer; and (5) non-syndromic patients with sporadic MMR-proficient cancers co-occurring synchronously/metachronously with sporadic MMR-deficient cancers. Our study thus suggests that inter-tumoral MMR discordance is not uncommon among patients with multiple primary GIT carcinomas (25.9% in patients with ≥ 2 CRCs), and may be associated with widely varied molecular etiologies. Awareness of these patterns is essential in ensuring the most effective strategies in both LS detection and treatment decision-making. When selecting patients for immunotherapy, MMR testing should be performed on the tumor or tumors that are being treated.

Cytotoxic effect of protic ionic liquids in HepG2 and HaCat human cells: in vitro and in silico studies.

Protic ionic liquids (PILs) are innovative chemical compounds, which due to their peculiar nature and amazing physico-chemical properties, have been studied as potential sustainable solvents in many areas of modern science, such as in the industrial fields of textile dyeing, pharmaceuticals, biotechnology, energy and many others. Due to their more than probable large-scale use in a short space of time, a wider analysis in terms of ecotoxicity and biological safety to humans has been attracting significant attention, once many ionic liquids were found to be "a little less than green compounds" towards cells and living organisms. The aim of this study is to investigate the cytotoxicity of 13 recently synthesized PILs, as well as to reinforce knowledge in terms of key thermodynamic magnitudes. All the studied compounds were tested for their in vitro toxic activities on two human cell lines (normal keratinocytes HaCaT and hepatocytes HepG2). In addition, due to the enormous number of possible combinations of anions and cations that can form ionic liquids, a group contribution QSAR model has been tested in order to predict their cytotoxicity. The estimated and experimental values were adequately correlated (correlation coefficient R 2 = 0.9260). The experimental obtained results showed their remarkable low toxicity for the studied in vitro systems.

Processo de trabalho em unidade de saúde da família e a educação permanente / Work process at a family health unit and continuing education / Proceso de trabajo en unidad de salud de la familia y la educación permanente

Resumo A educação permanente em saúde propõe a criação de espaços coletivos com a finalidade de levar os trabalhadores da saúde à reflexão e avaliação de seus atos produzidos no cotidiano, a fim de buscar a transformação das práticas de saúde e de educação. Este artigo propôs a discussão da educação permanente com base nas ponderações feitas pelos trabalhadores da Estratégia Saúde da Família quanto aos processos de sua atividade profissional. Para isso, desenvolveu-se um estudo qualitativo, com a utilização da técnica de grupo focal. Como resultado, verificou-se que a reflexão dos profissionais de saúde sobre a realidade do próprio cotidiano de trabalho permitiu uma discussão acerca da educação permanente e, em consequência, o início de um processo de mudança de suas práticas.

Abstract Continuing education in health proposes the creation of collective spaces to lead health workers to reflect on and evaluate their actions in daily life in order to seek the transformation of health and education practices. This article proposes a discussion on continuing education based on the considerations made by the Family Health Strategy workers with regard to the processes of their professional activity. A qualitative study using the focal group technique was developed for the discussion. As a result, it was found that the health professionals' reflection about the reality of their own daily work allowed for a discussion on continuing education and, thus, the onset of a process of changing their practices.

Resumen La educación permanente en salud propone la creación de espacios colectivos con la finalidad de llevar a los trabajadores de la salud a la reflexión y evaluación de sus actos producidos en quehacer cotidiano, a fin de buscar la transformación de las prácticas de salud y de educación. Este artículo propuso la discusión de la educación permanente con base en las ponderaciones realizadas por los trabajadores de la Estrategia Salud de la Familia, en cuanto a los procesos de su actividad profesional. Para ello, se desarrolló un estudio cualitativo, con utilización de la técnica de grupo focal. Como resultado, se observó que la reflexión de los profesionales de salud sobre la realidad del propio cotidiano de trabajo permitió una discusión acerca de la educación permanente y, en consecuencia, el inicio de un proceso de cambio de sus prácticas.

Comunicação entre trabalhadores de saúde e usuários no cuidado à criança menor de dois anos no contexto de uma unidade de saúde da família / Communication of healthcare workers and users in caring for children under two years old in the context of a family health unit / Comunicación entre trabajadores de la salud y usuarios en el cuidado a niños menores de dos años en el contexto de una unidad de salud de la familia

O estudo teve como objetivo conhecer a concepção que trabalhadores de saúde e usuários possuem sobre a comunicação no cuidado à criança menor de dois anos, adotando a Teoria da Ação Comunicativa de Habermas. Trata-se de estudo qualitativo que teve como técnica de coleta entrevistas semiestruturadas com trabalhadores de saúde e cuidadoras de crianças menores de dois anos, de modo a obter subsídios para o estudo da comunicação. Os dados foram submetidos à analise de conteúdo temática. Identificaram-se duas categorias temáticas, a partir do referencial teórico proposto: uma instrumental, por suas características voltadas ao domínio e repasse de informações; e outra, denominada compartilhada, por ser entendida como comunhão de saberes entre o trabalhador de saúde e usuário, contendo aproximações aos pressupostos da Teoria da Ação Comunicativa. Sugerem-se mudanças no contexto estudado, na perspectiva de construção de práticas comunicativas dialógicas.

The study aimed to ascertain the conceptions that health workers and users have regarding communication in caring for children under two years old using the Habermas Communicative Action Theory. This was a qualitative study in which the data-gathering technique consisted of semi-structured interviews with healthcare workers and the caregivers of children under two years old in order to obtain support for studying communication. The data were subjected to thematic content analysis. Two thematic categories were identified an instrumental category, given that its characteristics were geared to the domain and information transfers; and another one called the shared category, since it was understood as communion of knowledge between healthcare workers and users, containing approximations to the assumptions of Communicative Action Theory. It was suggested that changes to the context studied should be made, from the perspective of constructing of communicative dialogue practices.

El objetivo del estudio fue conocer la concepción que trabajadores de la salud y usuarios tienen sobre la comunicación en el cuidado a los niños menores de dos años, adoptando la Teoría de la Acción Comunicativa de Habermas. Estudio cualitativo que tuvo, como técnica de colecta, entrevistas semi-estructuradas con trabajadores de la salud y cuidadoras de niños menores de dos años, para obtener subsidios para el estudio de la comunicación. Los datos se sometieron a análisis de contenido temático. Se identificaron dos categorías temáticas: una instrumental, por sus características enfocadas en el dominio y traspaso de informaciones y la otra denominada compartida, por entenderse como comunión de saberes entre el trabajador de la salud y el usuario, conteniendo aproximaciones a los supuestos de la Teoría de la Acción Comunicativa. Se sugieren cambios en el contexto estudiado, en la perspectiva de construcción de prácticas comunicativas dialógicas.