A fermented milk drink with Umbu (Spondias tuberosa) pulp and whey is effective for weight gain and re-nutrition in malnourished: An in vivo study in mice and children.

Malnutrition is considered one of the major public health problems worldwide and negatively affects the growth, development and learning of schoolchildren. This study developed and evaluated a fermented milk drink with added Umbu (Spondias tuberosa) pulp in the weight gain and renutrition of mice submitted to malnutrition by calorie restriction, and in malnourished children. The supplementation with this fermented milk drink contributed to an increase of 7.2 % in body weight, and 64.3 % in albumin, and a reduction of 35 % in cholesterol in malnourished mice. In humans, a group of nine malnourished children consumed a daily 200 mL serving of the milk drink (for 60 days). For humans, the fermented milk drink allowed an increase of 16.5 % in body weight, and 20.9 % in body mass index in malnourished children. In conclusion, fermented milk drink has a positive effect on the re-nutrition of malnourished mice and helps to improve the nutritional status of malnourished children.

Impact of COVID-19 pneumonia on pulmonary vascular volume.

Background: Pulmonary manifestations of COVID-19 pneumonia are well known. However, COVID-19 is also associated with a range of vascular manifestations such as embolism, congestion, and perfusion changes. Regarding congestion, research from different groups has suggested arteriovenous anastomosis dysregulation as a contributing factor. In this study, we aim to better describe the changes in vascular volume in affected lung zones and to relate them to pathophysiological hypotheses. Methods: We performed automatic vascular volume extraction in 10 chest CTs of patients, including 2 female and 8 male with a mean age of 63.5 ± 9.3 years, diagnosed with COVID-19 pneumonia. We compared the proportion of vascular volumes between manually segmented regions of lung parenchyma with and without signs of pneumonia. Results: The proportion of vascular volume was significantly higher in COVID (CVasc) compared to non-COVID (NCVasc) areas. We found a mean difference (DVasc) of 5% and a mean ratio (RVasc) of 3.7 between the two compartments (p < 0.01). Conclusion: Vascular volume in COVID-19 affected lung parenchyma is augmented relative to normal lung parenchyma, indicating venous congestion and supporting the hypothesis of pre-existing intra-pulmonary arteriovenous shunts.

EUS-guided choledochoduodenostomy for malignant biliary obstruction: A multicenter comparative study between plastic and metallic stents.

Background and Objectives: EUS-guided choledochoduodenostomy (EUS-CDS) is commonly employed to address malignant biliary obstruction (MBO) after a failed ERCP. In this context, both self-expandable metallic stents (SEMSs) and double-pigtail stents (DPSs) are suitable devices. However, few data comparing the outcomes of SEMS and DPS exist. Therefore, we aimed to compare the efficacy and safety of SEMS and DPS at performing EUS-CDS. Methods: We conducted a multicenter retrospective cohort study between March 2014 and March 2019. Patients diagnosed with MBO were considered eligible after at least one failed ERCP attempt. Clinical success was defined as a drop of direct bilirubin levels ≥ 50% at 7 and 30 postprocedural days. Adverse events (AEs) were categorized as early (≤7 days) or late (>7 days). The severity of AEs was graded as mild, moderate, or severe. Results: Forty patients were included, 24 in the SEMS group and 16 in the DPS group. Demographic data were similar between the groups. Technical success rates and clinical success rates at 7 and 30 days were similar between the groups. Similarly, we found no statistical difference in the incidence of early or late AEs. However, there were two severe AEs (intracavitary migration) in the DPS group and none in the SEMS cohort. Finally, there was no difference in median survival (DPS 117 days vs. SEMS 217 days; P = 0.99). Conclusion: EUS-guided CDS is an excellent alternative to achieve biliary drainage after a failed ERCP for MBO. There is no significant difference regarding the effectiveness and safety of SEMS and DPS in this context.

Sebaceous Carcinoma of the Vulva: An Unexpected Diagnosis and Literature Review.

Sebaceous carcinoma of the vulva is a rare malignancy of the sebaceous glands, with potentially aggressive behaviour, that is usually found in the peri-ocular area. Nonetheless, there are sebaceous glands in the vulva and this diagnosis is especially rare, with only ten cases described in the literature. We report a case of 78-year-old female patient who presented with vulvar pruritus, previously treated with topical steroid and antifungal treatments, without improvement. The vulvar examination showed a visible yellow papule, 12 x 10 mm on the right major labia, which was biopsied and the microscopic examination revealed an invasive sebaceous carcinoma of the vulva, with an in situ component. We performed an uneventful excisional biopsy, followed by a subsequent margin widening. Three months after the diagnosis, she presented with the first recurrence. Two and half years after the diagnosis, she recurred with a larger lesion (13 mm) in the upper half of small right lip, more than 10 mm away from the midline. In a multidisciplinary meeting it was decided that the patient should undergo partial right vulvectomy with homolateral inguino-femoral sentinel node biopsy (one negative node). There was no evidence of recurrence one-year post-surgery.

O carcinoma sebáceo da vulva é uma neoplasia maligna rara das glândulas sebáceas com comportamento potencialmente agressivo, mais comummente encontrada na área periocular. Este diagnóstico é particularmente raro nas glândulas sebáceas da vulva, com apenas dez casos previamente descritos na literatura. Relatamos o caso de uma paciente de 78 anos que se apresentou com prurido vulvar, anteriormente tratado com corticóides tópicos e antifúngicos, sem melhoria evidente. Ao exame objetivo apresentava uma pápula amarela visível, com cerca de 12 x 10 mm no grande lábio direito, que foi biopsada. O exame microscópico revelou um carcinoma sebáceo invasivo da vulva, com componente in situ. Posteriormente, foi realizada uma biópsia excisional, com alargamento de margens, sem intercorrências. Três meses após o diagnóstico, surgiu a primeira recidiva, pelo que foi realizada uma nova biópsia excisional. Dois anos e meio após o diagnóstico, a doente apresentava uma lesão com 13 mm, na metade superior do pequeno lábio direito, mais de 10 mm afastada da linha mediana. Em reunião multidisciplinar decidiu-se que deveria ser submetida a uma vulvectomia parcial direita, com pesquisa de gânglio sentinela inguino-femoral homolateral (um gânglio negativo). Um ano após a cirurgia, a doente encontra-se sem evidência de recorrência.

In vitro anti-trypanosomal potential of kaurane and pimarane semi-synthetic derivatives.

As part of the search for anti-trypanosomal agents, this work presents the production of sixteen derivatives. All of them were obtained from two natural diterpenes, one with kaurane skeleton (ent-kaurenoic acid) and other with a pimarane skeleton (ent-pimaradienoic acid). Then, the eighteen compounds were assayed against epimastigote form of Trypanosoma cruzi, with the derivatives showing increase of activity in relation to their precursors. Moreover, the most active derivative presented an IC50 <12.5 µM (estimated 0.8 µM), lower than Benznidazole (IC50 = 9.8 µM), used as control. The esterification of acid diterpenes showed to be an interesting way in the search for anti-trypanosomal agents.

Disfunção sexual percebida e fatores atribuídos por mulheres com hanseníase / Perceived sexual dysfunction and factors attributed by women with leprosy

A hanseníase é uma doença infectocontagiosa de evolução lenta, alta infectividade e baixa patogenicidade, que apresenta sinais e sintomas dermatoneurológicos. A alteração no padrão sexual ocasionada pela disfunção sexual feminina é uma complicação que pode ser vivenciada por mulheres com hanseníase, causando um impacto negativo na qualidade de vida. O objetivo desta pesquisa foi identificar a função sexual percebida e fatores atribuídos por mulheres com hanseníase. Estudo descritivo, transversal desenvolvido em dois ambulatórios de referência em dermatologia do município de Fortaleza, Ceará, com 76 mulheres com hanseníase. Foi utilizado formulário de entrevista com variáveis socioeconômicas e clínicas, e aplicação do Female Sexual Function Index. Prevaleceu a idade adulta jovem, com condições socioeconômicas desfavoráveis, e formas multibacilares. A percepção da disfunção sexual foi predominante entre as entrevistadas (60,5%), que citaram como fatores relacionados a autoimagem (26,0%) e alteração no desejo sexual (26,0%). Os domínios com maior alteração foram: satisfação (R=3,06), excitação (R=3,78), desejo (R=3,79) e orgasmo (R=3,79). A abordagem sobre a função sexual de mulheres com hanseníase deve ser realizada por profissionais de saúde, de forma a promover uma maior satisfação sexual e pessoal para a paciente.

Leprosy is an infectious disease of slow evolution, high infectivity and low pathogenicity, which presents dermato-neurological signs and symptoms. The change in the sexual pattern caused by female sexual dysfunction is a complication that can be experienced by women with leprosy, causing a negative impact on quality of life. The objective of this study was to identify the perceived sexual function and factors attributed by women with leprosy. This descriptive, cross-sectional study was carried out in two dermatology outpatient clinics in the city of Fortaleza, Ceará, with 76 women with leprosy. An interview form was used with socioeconomic and clinical variables, and application of the Female Sexual Function Index. Young adulthood prevailed, with unfavorable socioeconomic conditions, and multibacillary forms. The perception of sexual dysfunction was predominant among the interviewees (60.5%), who cited as factors related to self-image (26.0%) and changes in sexual desire (26.0%). The domains with the greatest change were: satisfaction (R=3.06), arousal (R=3.78), desire (R=3.79), and orgasm (R=3.79). The approach to the sexual function of women with leprosy should be carried out by health professionals, in order to promote greater sexual and personal satisfaction for the patient.

Nocebo effect in health communication: how to minimize it? / Efeito nocebo na comunicação em saúde: como minimizá-lo?

ABSTRACT Purpose: to describe the strategies used to minimize the nocebo effect in health communication. Methods: an integrative review of the literature. The keywords "nocebo effect" and "health communication" and their combinations were used in English, Portuguese, and Spanish to search publications from 2011 to 2021 in MEDLINE, Latin American and Caribbean Health Sciences Literature (LILACS), Cochrane Library, EMBASE, and Web of Science/ISI. The following research question was used: "Which strategies have been used to minimize the nocebo effect in health communication?". Literature Review: altogether, 77 articles were found, although only six met the inclusion criteria and comprised the review sample. Their year of publication ranged from 2015 to 2021. Positive framing, assertive communication, and contextual factors were the strategies used to minimize the nocebo effect. Conclusion: the strategies used to minimize the nocebo effect were contextual factors, motivational talk, positive framing, assertive communication, and empathetic communication. These communication techniques are seemingly effective, though still little known by health professionals. This knowledge is important as it helps develop communicative skills aiming at humanized patient care.

RESUMO Objetivo: descrever as estratégias para minimizar o efeito nocebo na comunicação em saúde. Métodos: trata-se de uma revisão integrativa da literatura. Os descritores utilizados foram: "Efeito nocebo" e "comunicação em saúde", em inglês, português e espanhol e suas combinações, no período de 2011 a 2021, nas bases de dados da Medline, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Cochrane Library, Embase e Web of Science/ISI. A pergunta de investigação para esse estudo foi: Quais as estratégias utilizadas para minimizar o efeito nocebo na comunicação em saúde? Revisão da Literatura: foram encontrados 77 artigos. Apenas seis preencheram os critérios de inclusão e compuseram a amostra da revisão. Os anos de publicação dos artigos variaram entre 2015 e 2021. As estratégias definidas para minimizar o efeito nocebo foram: enquadramento positivo, comunicação assertiva e utilização de fatores contextuais. Conclusão: as estratégias encontradas para minimizar o efeito nocebo foram fatores contextuais, conversa motivacional, enquadramento positivo, comunicação assertiva e comunicação empática. Essas técnicas de comunicação parecem ser efetivas, mas ainda são pouco conhecidas pelos profissionais em saúde. Esse conhecimento se faz importante, pois auxilia no desenvolvimento de habilidades comunicativas que visam à humanização do cuidado ao paciente.

Prevalence of kinesiophobia and catastrophizing in patients with temporomandibular disorders / Prevalência de cinesiofobia e catastrofização em pacientes com disfunção temporomandibular

ABSTRACT Purpose: to identify the frequency and levels of kinesiophobia and catastrophizing in patients with temporomandibular disorders who had been submitted to speech-language-hearing therapy. Methods: the sample comprised patients with myogenous (predominantly) and mixed temporomandibular disorders in the study group and healthy individuals in the control group. The instruments used were the Diagnostic Criteria for Temporomandibular Disorders, Tampa Scale for Kinesiophobia, and Pain Catastrophizing Scale. Statistical analyses were performed with the Mann-Whitney test (to compare the means on each scale between the groups) and the Spearman's correlation coefficient test (to analyze the correlation between the scales in each group and its significance). Results: the study group had a higher pain catastrophizing index than the control group. Likewise, the study group had greater kinesiophobia positive indices, whereas the control group had lower ones. A moderate positive correlation was also identified between kinesiophobia and catastrophizing in the study group. Conclusion: patients presented with temporomandibular disorders have higher levels of kinesiophobia and catastrophizing than subjects not diagnosed with the disorder.

RESUMO Objetivo: identificar a frequência e os níveis de cinesiofobia e catastrofização em pacientes com Disfunção Temporomandibular que realizaram terapia fonoaudiológica. Métodos: a amostra compreendeu pacientes com Disfunção Temporomandibular muscular e mista com predominância muscular, grupo de estudo e adultos saudáveis, o grupo controle. Os instrumentos utilizados foram: Diagnostic Criteria for Temporomandibular Disorders, Escala Tampa para Cinesiofobia e Escala de Catastrofização da Dor. A análise estatística foi composta do Teste de Mann-Whitney para comparar as médias entre os grupos de cada escala e o teste de Coeficiente de Correlação de Spearman para analisar a correlação entre as escalas em cada grupo e sua significância. Resultados: foi identificado um alto índice de catastrofização da dor no grupo de estudo em comparação ao grupo controle. Quanto à cinesiofobia, houve maior índice positivo para essa variável no grupo de estudo e menor para o grupo controle. Além disso, identificou-se correlação moderada e positiva entre a cinesiofobia e catastrofização no grupo de estudo. Conclusão: Pacientes com Disfunção Temporomandibular possuem níveis de cinesiofobia e catastrofização mais altos que pacientes que não foram diagnosticados com o distúrbio.

Triagem biológica de inibidores de sirtuína 2 (TcSir2rp1) candidatos a antichagásicos / Biological screening of sirtuin 2 inhibitors (TcSir2rp1) antichagasic candidates

A doença de Chagas é causada pelo Trypanosoma cruzi, e atualmente, acomete entre 6 a 7 milhões de pessoas em todo o mundo. A quimioterapia disponível para seu o tratamento se baseia apenas em dois fármacos, nifurtimox e benznidazol, com mais de 50 anos de descoberto. Estes fármacos apresentam eficácia limitada, pois são pouco efetivos na fase crônica e apresentam alta toxicidade, resultando em efeitos adversos graves. Esse panorama mostra a necessidade de novas abordagens terapêuticas contra essa doença. Nesse sentido, a inibição de vias bioquímicas essencias para o parasita se mostram como uma boa sugestão para identificação de compostos promissores candidatos a novos agentes quimioterápicos. A sirtuína 2 (Sir2) são enzimas reguladoras que participam de mecanismos epigenéticos em tripanossomatídeos, e no T. cruzi possuem um papel fundamental em todos os seus estágios evolutivos, devido a este fato, se apresentam como um alvo promissor na busca por novos fármacos contra a doença de Chagas. Neste sentido propomos a busca de inibidores da Sir2 proteína 1 do T. cruzi (TcSir2rp1) que é geneticamente validada como alvo farmacológico, por meio da estratégia de triagem biológica. Realizou-se a expressão da enzima recombinante por biologia molecular em um sistema de transformação utilizando cepa de Escherichia coli Artic Express (DE3). Foi feita a purificação e a confirmação da obtenção da proteína recombinante se deu por gel SDS-PAGE. Após a obtenção da enzima os parâmetros cinéticos foram determinados por experimentos de fluorimetria. A triagem foi realizada para um conjunto de 82 compostos, previamente sintetizados pelo nosso grupo de pesquisa, como inibidores da TcSir2p1 em dose única de 100 µM. Os ensaios foram realizados em triplicata e em experimentos independentes. Dentre os 82 compostos testados, 20 apresentaram inibições maior que 50% contra a enzima TcSir2rp1, na dose de 100 µM. Dentre estes, se destacaram 3 compostos derivados de chalconas, para os quais foi determinada a potência. O composto 1 foi o que mais potente, apresentando valor de IC50 de 11,65 µM, já os compostos 3 e 5 foram menos potentes (IC50= 38,50 µM e 19,85 µM, respectivamente). Diante dos resultados obtidos, pode-se concluir que a estratégia de triagem biológica é promissora na identificação de inibidores da TcSir2p1 candidatos a agentes anti- T. cruzi

Chagas disease is caused by Trypanosoma cruzi, and currently affects 6 to 7 million people worldwide. The chemotherapy available for its treatment is based on only two drugs, nifurtimox and benznidazole, with more than 50 years of discovery. These drugs have limited efficacy, as they are ineffective in the chronic phase and have high toxicity, resulting in serious adverse effects. This panorama shows the need for new therapeutic approaches against this disease. In this sense, the inhibition of essential biochemical pathways for the parasite proves to be a good suggestion for the identification of promising compounds candidates for new chemotherapeutic agents. Sirtuin 2 (Sir2) are regulatory enzymes that participate in epigenetic mechanisms in trypanosomatids, and in T. cruzi they have a fundamental role in all their evolutionary stages, due to this fact, they present themselves as a promising target in the search for new drugs against Chagas disease. In this sense, we propose the search for inhibitors of Sir2 protein 1 of T. cruzi (TcSir2rp1) which is genetically validated as a pharmacological target, through the biological screening strategy. The expression of the recombinant enzyme was performed by molecular biology in a transformation system using strain of Escherichia coli Artic Express (DE3). Purification was performed and confirmation of obtaining the recombinant protein was performed by SDS-PAGE gel. After obtaining the enzyme, the kinetic parameters were determined by fluorimetry experiments. Screening was performed for a set of 82 compounds, previously synthesized by our research group, as TcSir2p1 inhibitors in a single dose of 100 µM. Assays were performed in triplicate and in independent experiments. Among the 82 compounds tested, 20 showed inhibitions greater than 50% against the enzyme TcSir2rp1, at a dose of 100 µM. Among these, 3 compounds derived from chalcones stood out, for which the potency was determined. Compound 1 was the most potent, with an IC50 value of 11.65 µM, while compounds 3 and 5 were less potent (IC50= 38.50 µM and 19.88 µM, respectively). In view of the results obtained, it can be concluded that the biological screening strategy is promising in the identification of TcSir2p1 inhibitors candidates for anti-T. cruzi agents

Diagnostic Properties of Three SARS-CoV-2 Antibody Tests.

Serological assays emerged as complementary tools to RT-PCR in the diagnosis of SARS-CoV-2 as well as being needed for epidemiological studies. This study aimed to assess the performance of a rapid test (RT) compared to that of serological tests using finger prick blood samples. A total of 183 samples were evaluated, 88 of which were collected from individuals with negative RT-PCR and 95 from positive RT-PCR individuals. The diagnostic performance of RT (WONDFO®) and LUMIT (PROMEGA®) were compared to that of ELISA (EUROIMMUN®) for detecting antibodies against SARS-CoV-2 according to time from symptoms onset. The IgG antibody tests were detected in 77.4% (LUMIT), 77.9% (RT), and 80.0% (ELISA) of individuals. The detection of antibodies against SARS-CoV-2 increases in accordance with increasing time from symptoms onset. Considering only time from symptoms onset >21 days, the positivity rate ranged from 81.8 to 97.0% between the three tests. The RT and LUMIT showed high agreement with ELISA (agreement = 91.5%, k = 0.83, and agreement = 96.3%, k = 0.9, respectively) in individuals who had symptoms 15 to 21 days before sample collection. Compared to that of the ELISA assay, our results show sensitivity ranged from 95% to 100% for IgG antibody detection in individuals with symptoms onset between 15 and 21 days before sample collection. The specificity was 100% in individuals with symptoms onset >15 days before serological tests. This study shows good performance and high level of agreement of three immunoassays for the detection of SARS-CoV-2 antibodies.

Parasitic sirtuin 2 as an opportunity in drug discovery.

Infections caused by protozoans remain a public health issue, especially in tropical countries. Serious adverse events, lack of efficacy at the different stages of the infection and routes of administration that have a negative impact on treatment adherence are some of the problems with currently available therapy against these diseases. Here we describe an epigenetic target, sirtuin 2 and its related proteins, that is promising given the results in phenotypic assays and in vivo models against Sir2 of Plasmodium falciparum, Leishmania donovani, Leishmania infantum, Schistosoma mansoni, Trypanosoma brucei and Trypanosoma cruzi parasites. The results we present highlight how this target can be extensively explored and how its inhibitors might be employed in the clinic.

Potencialidades e limitações da visita domiciliar realizada por estudantes de medicina na disciplina de Saúde da Família e Comunidade / Potentialities and limitations of the home visit performed by students of medicine in the course of Family and Community Health

Foram analisadas experiências vivenciadas nas visitas domiciliares realizadas pelos estudantes de Medicina, com objetivo de identificar e discutir as potencialidades e as limitações dessas. A partir disso, são descritas e avaliadas crítica e qualitativamente tais experiências, a fim de demonstrar a sua contribuição na área de atuação. O estudo teve como base a análise temática dos portfólios realizados por estudantes que cursavam a disciplina Saúde da Família e Comunidade, entre agosto de 2015 e outubro de 2016, e que, no presente, são membros da Liga Acadêmica de Atenção Básica à Saúde (LAABS). Diante de tais análises, destacam-se como potencialidades a importância do trabalho em equipe, aproximação entre profissional de saúde e a realidade do paciente, avaliação da situação de saúde e das condições de vida da população, além do desenvolvimento de vínculos com a população, o que facilita a continuidade do cuidado. Por outro lado, o pouco tempo disponível para a visita, o horário inadequado escolhido em algumas situações e a frustração quando o estudante não percebia adesão instantânea à mudança do estilo de vida pelo paciente foram algumas das limitações encontradas. Por fim, diante do exposto, embora a visita domiciliar apresente limitações, as potencialidades superam, visto que por auxiliar concretamente na melhoria da relação médico paciente, ela torna possível a realização de um trabalho contínuo e que propicia um melhor seguimento com a população.

Medical students' practices experienced in home visits were analyzed, aiming to identify and to discuss their potentialities and limitations. From this, these experiences are described and evaluated critically and qualitatively, in order to demonstrate their contribution in the area of performance. The study was based on the thematic analysis of the portfolios carried out by students who attended the Family and Community Health course, between August 2015 and October 2016, and who are currently members of the Academic League for Basic Health Care (ALBHC). Faced with such analyzes, the potentialities and the importance of teamwork are highlighted. as well as the approximation between health professional and patient reality; the evaluation of the health situation and the living conditions of the population and the development of ties with the population, which facilitates the continuity of care. On the other hand, some of the limitations were found like short time available for the visit; the inappropriate time chosen in some situations; the frustration when the student did not notice instant adherence to the lifestyle change by the patient. Finally, as described above, although the home visit presents limitations, the potentialities outweigh them, since they help concretely in the improvement of the patient-doctor relationship, which makes possible the accomplishment of a continuous work and allows a better follow-up with the population.

Case Report: Intrapulmonary Arteriovenous Anastomoses in COVID-19-Related Pulmonary Vascular Changes: A New Player in the Arena?

Up to now, COVID-19-related vascular changes were mainly described as thrombo-embolic events. A handful of researchers reported another type of vascular abnormality referred to as "vascular thickening" or "vascular enlargement," without specifying whether the dilated vessels are arteries or veins nor providing a physiopathological hypothesis. Our observations indicate that the vascular dilatation occurs in the venous compartment, and underlying mechanisms might include increased blood flow due to inflammation and the activation of arteriovenous anastomoses.

Reflexões sobre a quarentena: uma estratégia de acolhimento de discentes em um grupo de mentoring / Reflections about quarantine: a strategy for undergraduate medical student reception in a mentoring group

Resumo: Introdução: Notícias sobre a pandemia de Covid-19 chegam constantemente via meios de comunicação, e, rapidamente, há elevada sobrecarga de informações e inseguranças cotidianas. Para os estudantes de Medicina, essas mudanças podem ter efeito ainda mais significativo, pois já apresentam certo grau de adoecimento e queda da qualidade de vida pelo estresse acadêmico. Nessas situações, estratégias de reflexão, fala e escuta ativa podem ser úteis para a saúde mental. Relato de experiência: Este relato apresenta, de forma descritiva, a análise reflexiva da percepção discente sobre facilidades e adversidades vivenciadas durante o distanciamento social proporcionado pela pandemia de Covid-19, bem como avalia de que modo a participação na mentoria interferiu nesse processo. Os estudantes responderam a um questionário de seis perguntas abertas sobre as experiências e a saúde mental deles. Esse questionário teve como objetivos refletir sobre o momento e compreendê-lo para melhorar a condução dos encontros do mentoring e minimizar um eventual impacto negativo na saúde mental dos discentes. Após a anuência dos participantes, por meio do Termo de Consentimento Livre e Esclarecido (TCLE) aprovado pelo Comitê de Ética em Pesquisa, as respostas foram analisadas em anonimato e coletivamente pelos próprios estudantes, de forma categorial temática, encontrando os núcleos de sentido a partir da leitura do corpus textual para identificação das unidades de análises. Discussão: Houve 12 respondentes, o que representa uma taxa de resposta de 92,3% dos estudantes aos quais foi enviado o questionário, no qual apontaram o impacto da pandemia na saúde mental, fizeram uma reflexão interior, indicaram os mecanismos adaptativos e apresentaram os aspectos da mentoria que a tornaram um ambiente seguro e de suporte. Conclusão: A análise revelou que muitos discentes estão enfrentando dificuldades de adaptação, sobretudo quanto à saúde mental, como instabilidade emocional, revolta e frustração. Todavia, relataram-se positividade, desenvolvimento de hobbies e aumento do autoconhecimento e da comunicação com familiares. Apesar das limitações dos encontros remotos, não houve prejuízos de aproveitamento do programa e alcance de seus objetivos.

Abstract: Introduction: The constant stream of news about the Covid-19 pandemic in the media has contributed to information overload and daily insecurities. For medical students, these changes can have an even more significant effect, as they already suffer a certain degree of illness and their quality of life is impaired by academic stress. In these situations, strategies for reflection, speech and active listening can be useful for mental health. Experience report: This report presents, in a descriptive way, the reflective analysis of the student's perception of the facilities and adversities experienced during the social distancing measures enforced by the Covid-19 pandemic and how participation in mentoring interfered in this process. The students answered a questionnaire of six open-ended questions about their experiences and mental health, to reflect and better understand the current situation and thus enhance the mentoring program meetings, supporting and minimizing any negative impact on the students' mental health. After informed consent was agreed by the participants and approval given by the Ethics Committee, thematic content analysis of the answers was performed anonymously and collectively by the students themselves. The core meanings were sought from reading the textual corpus, thus identifying the units of analysis. Discussion: There were twelve respondents, representing a response rate of 92.3% of the students to whom the questionnaire was sent, reporting the impact on their mental health, their inner reflections and adaptive mechanisms and mentoring as a safe environment of support. Conclusion: The analysis revealed that many students are facing difficulties in adapting, especially regarding mental health, reporting issues such as emotional instability, revolt and frustration. However, positivity, development of hobbies, increased self-knowledge and communication with family members were reported. Despite the limitations presented by the remote meetings, there were no adverse effects of using the program and achieving its objectives.

Maternity during the COVID-19 crises: Content validity of psychoeducational resources to coping with stress from the COVID-19 pandemic / Maternidade em tempos de COVID-19: validade de conteúdo de recursos psicoeducativos para enfrentamento do estresse da pandemia da COVID-19 / Maternidad en tiempos de COVID-19: validez de contenido de recursos psicoeducativos para enfrentar el estrés de la pandemia del COVID-19

The COVID-19 pandemic can lead to stress, especially for pregnant women and mothers of babies. It is important to propose resources for them to cope with specific stressors and promote their health and well-being. Two psychoeducational flyers, based on the Coping Dispositional Theory, on information about the COVID-19 and on Positive Psychology interventions are presented in this article. The content validity of the flyers was analyzed, adopting CVC indexes > 0.80. Five experts evaluated theflyers qualitatively, while nine pregnant women and mothers, evaluated themusing a 5-point Likert scale. They responded to a Google Form, sent via WhatsApp, which included a TCLE, a General data protocol and a Questionnaire about the clarity of language, relevance, pertinence, and presentation of the flyers. Considering the results, we highlight the validity of the flyersfor pregnant women (CVC> 0.93) and for mothers (CVC > 0.86 and 1.0) as useful resources for coping with the COVID-19 pandemic.

A pandemia da COVID-19 resulta em estresse, especialmente para gestantes e mães de bebês. É importante propor recursos para elas lidarem com estressores específicos e, então, promover sua saúde e bem-estar. Dois flyers psicoeducativos, baseados na Teoria Disposicional do Coping, informações sobre a COVID-19 e intervenções da Psicologia Positiva são apresentados neste artigo. A validade de conteúdo dos flyers foi analisada, adotando-se índices CVC > 0.80. Cinco experts avaliaram qualitativamente, enquanto nove participantes, gestantes e mães, avaliaram os flyers usando uma escala Likert de 5 pontos. Elas responderam a um Google Form enviado via WhatsApp, que incluiu TCLE, Protocolo de dados gerais e Questionário sobre clareza da linguagem, pertinência, relevância e apresentação dos flyers. Destaca-se a validade dos flyers para gestantes (CVC> 0.93) e mães (CVC > 0.86 e 1.0) como recursos úteis para enfrentar a pandemia da COVID-19.

La pandemia del COVID-19 produce estrés, especialmente para mujeres embarazadas y madres de bebés. Es importante proponer recursos para que ellas se puedan enfrentar los estresores específicos y luego promover su salud y bienestar. En este artículo se presentan dos folletos psicoeducativos, basados en la Teoría de Afrontamiento Disposiciónal, información sobre el COVID-19 y las intervenciones de la Psicología Positiva. Se analizó la validez de contenido de los folletos, adoptando índices CVC > 0.80. Cinco expertos evaluaron cualitativamente, mientras que nueve participantes, mujeres embarazadas y madres, evaluaron los folletos utilizando una escala Likert de 5 puntos. Ellas respondieron a un formulario de Google, enviado a través de WhatsApp, que incluía el TCLE, Protocolo general de datos y Cuestionario sobre comprensión del lenguaje, relevancia, pertinencia y presentación de los folletos. La validez de los folletos para mujeres embarazadas (CVC > 0.93) y para madres (CVC > 0.86 y 1.0) se destacan como recursos útiles para afrontar la pandemia del COVID-19.

Adolescent gluten intake: population-based study in a brazilian city / Ingestão de alimentos com glúten por adolescentes: estudo de base populacional em município brasileiro

ABSTRACT Objective: To estimate the prevalence of gluten intake according to demographic, socioeconomic, and health-related behavioral variables in adolescents. Methods: This is a population-based cross-sectional study with a two-stage cluster sampling, conducted in Campinas, São Paulo, in 2008-2009. Foods containing gluten were identified using a 24-hour Recall. We calculated the prevalence and adjusted prevalence ratios with multiple Poisson regression. Results: The study had a sample of 924 adolescents aged 10 to 19 years. Among the foods assessed, 26.9% (confidence interval of 95% - 95%CI 25.3-28.6) contained gluten. We found a higher prevalence of gluten intake in younger individuals (10 to 14 years), as well as in subgroups of adolescents who had a higher number of household appliances, attended school, consumed fewer beans and vegetables during the week (<4 times), and whose head of the family had better education level (≥12 years of schooling). The main food sources of gluten in their diet were: bread, cakes, and cereals (30.2%), chocolate milk (14%), chicken nuggets (12.3%), and cookies (11%). Conclusions: The results of the study show the epidemiological profile associated with gluten intake in adolescents and could support actions aimed at promoting healthy eating habits and preventing gluten-related diseases.

RESUMO Objetivo: Estimar a prevalência da ingestão de alimentos com glúten segundo variáveis demográficas, socioeconômicas e de comportamentos relacionados à saúde em adolescentes. Métodos: Trata-se de estudo transversal de base populacional, com amostra por conglomerados e em dois estágios, realizado em Campinas, São Paulo, em 2008-2009. Os alimentos com glúten foram identificados por meio do Recordatório de 24 horas. Calcularam-se prevalências e razões de prevalência ajustadas por meio de regressão múltipla de Poisson. Resultados: Participaram do estudo 924 adolescentes de dez a 19 anos. Entre os alimentos referidos, 26,9% (intervalo de confiança de 95% - IC95% 25,3-28,6) continham glúten. Prevalências superiores de ingestão de glúten foram verificadas nos indivíduos mais jovens (dez a 14 anos), bem como nos subgrupos de adolescentes cujo chefe de família era mais escolarizado (≥12 anos de estudo), nos que possuíam maior número de equipamentos domésticos na residência, nos que frequentavam a escola e naqueles que consumiam menos feijão e hortaliças durante a semana (<4 vezes). As principais fontes alimentares de glúten na dieta foram: pães, bolos e cereais (30,2%), achocolatado (14%), nuggets (12,3%) e biscoitos (11%). Conclusões: Os resultados do estudo mostram o perfil epidemiológico associado ao consumo de glúten em adolescentes e podem subsidiar ações voltadas à promoção de hábitos alimentares saudáveis e de prevenção de doenças relacionadas ao glúten.

ADOLESCENT GLUTEN INTAKE: POPULATION-BASED STUDY IN A BRAZILIAN CITY.

OBJECTIVE: To estimate the prevalence of gluten intake according to demographic, socioeconomic, and health-related behavioral variables in adolescents. METHODS: This is a population-based cross-sectional study with a two-stage cluster sampling, conducted in Campinas, São Paulo, in 2008-2009. Foods containing gluten were identified using a 24-hour Recall. We calculated the prevalence and adjusted prevalence ratios with multiple Poisson regression. RESULTS: The study had a sample of 924 adolescents aged 10 to 19 years. Among the foods assessed, 26.9% (confidence interval of 95% - 95%CI 25.3-28.6) contained gluten. We found a higher prevalence of gluten intake in younger individuals (10 to 14 years), as well as in subgroups of adolescents who had a higher number of household appliances, attended school, consumed fewer beans and vegetables during the week (<4 times), and whose head of the family had better education level (≥12 years of schooling). The main food sources of gluten in their diet were: bread, cakes, and cereals (30.2%), chocolate milk (14%), chicken nuggets (12.3%), and cookies (11%). CONCLUSIONS: The results of the study show the epidemiological profile associated with gluten intake in adolescents and could support actions aimed at promoting healthy eating habits and preventing gluten-related diseases.

Cotyledonoid Dissecting Leiomyoma of the Uterus: An Unexpected Diagnosis After Delivery.

Cotyledonoid dissecting leiomyoma, also known as Sternberg tumor, is a rare benign uterine tumor with a gross and radiological appearance that may suggest the possibility of a malignancy. We report a case of a thirty-eight-year-old female patient who presented with menorrhagia and abdominal pain one month after delivery by cesarean section. An ultrasound scan showed a heterogeneous pelvic mass, near the isthmic region, with 25 x 24 x 23 mm without vascularization so the possibility of placenta accreta could not be excluded. During hysterectomy, we also removed a small grey mass in the right ovary. Microscopic examination revealed a proliferation of a sparsely cellular tissue with extensive hyalinization and coagulative necrosis, composed of spindle shaped muscle cells without cellular atypia or mitoses. The patient is without evidence of recurrence one year and six months post-surgery.

O leiomioma cotiledonóide dissecante, também conhecido como tumor de Sternberg, é uma forma rara de tumor uterino benigno com uma aparência macroscópica e radiológica sugestiva de malignidade. Reportamos o caso de uma doente de trinta e oito anos que se apresentou com menorragia e dor abdominal, um mês após um parto por cesariana. Na ecografia visualizava-se uma massa heterogénea, próxima da região ístmica, com 25 x 24 x 23 mm e sem vascularização, pelo que não foi excluída a possibilidade de placenta acreta. Aquando da histerectomia, foi também excisada uma pequena massa cinzenta do ovário direito. A análise microscópica das peças cirúrgicas, revelou uma proliferação de tecido celular esparso, com extensas áreas de hialinização e necrose coagulativa, compostas por células fusiformes musculares sem atipia ou mitoses. A doente apresenta-se sem evidência de recorrência um ano e meio após a cirurgia.

O trabalho educativo do Agente Comunitário de Saúde nas visitas domiciliares em dois municípios do Brasil / The educational work of community Health Workers in Home visits in two municipalities of Brazil / El trabajo educativo del Agente Comunitario de Salud en las visitas domiciliares en dos municipios de Brasil

Resumo O estudo objetivou descrever e analisar possíveis diferenças nas atividades de educação em saúde realizadas por agentes comunitários de saúde durante a visita domiciliar. Foram analisados os dados de dois estudos transversais no contexto das Unidades Básicas de Saúde da Família dos municípios de Campina Grande (2010) e Queimadas (2011), no estado da Paraíba, Brasil. Em Campina Grande, foram elegíveis mulheres com crianças menores de um ano, selecionadas por sorteio sistemático, de 30% das unidades de saúde (n= 508). Em Queimadas, foram elegíveis todas as mulheres com crianças nascidas durante o ano de 2009, residentes no município e atendidas em todas as 16 unidades de saúde (n= 204). As mães foram questionadas sobre as atividades educativas desenvolvidas pelos agentes durante as visitas domiciliares. Uma maior proporção de mulheres indicou não receber visitas domiciliares no município de Campina Grande, foram encontradas deficiências relacionadas a orientações sobre o cuidado com a saúde da criança nos dois municípios e maior frequência de atividades educativas entre os agentes de Queimadas. As diferenças relativas ao trabalho dos agentes comunitários de saúde podem envolver fatores como desvalorização profissional e precárias condições de trabalho. Destaca-se a importância da capacitação e preparação dos enfermeiros para a supervisão do trabalho dos agentes.

Abstract The study aimed to describe and analyze possible differences in the activities of health education performed by community health workers during a home visit. Data of two transversal studies were analyzed in the context of Family Health Units in the municipalities of Campina Grande (2010) and Queimadas (2011), in the state of Paraíba, Brazil. In Campina Grande, women whose children were younger than one year old were eligible, selected by systematic lottery, from 30% of the health units (n=508). In Queimadas, all women whose children were born within the year of 2009, those who resided in the municipality and those who were treated in any of the 16 health units (n=204) were eligible. The mothers were questioned about the educational activities developed by the agents during the home visits. A larger proportion of women indicated not to receive home visits in the municipality of Campina Grande, and deficiencies were found related to orientation on how to care for children's health in the two municipalities, and there was a higher frequency of educational activities in the agents from Queimadas. The differences related to the work of community health workers may involve elements such as professional devaluation and precarious work conditions. It must be emphasized the importance of the training and preparation of nurses for the supervision of the health workers.

Resumen El estudio objetivó describir y analizar posibles diferencias en las actividades de educación en salud realizadas por agentes comunitarios de salud durante la visita domiciliar. Fueron analizados los datos de dos estudios transversales en el contexto de las Unidades Básicas de Salud de la Familia de los municipios de Campina Grande (2010) y Queimadas (2011), en el estado de Paraíba, Brasil. En Campina Grande, fueron elegibles mujeres con niños menos de un año, seleccionadas por sorteo sistemático, de 30% de las unidades de salud (n=508). En Queimadas, fueron elegibles todas las mujeres con niños nascidos durante el año de 2009, residentes en el municipio y atendidas en todas las 16 unidades de salud (n=204). Las mamas fueron cuestionadas sobre las actividades educativas desarrolladas por los agentes durante las visitas domiciliares. Una mayor proporción de mujeres indicó no recibir visitas domiciliares en el municipio de Campina Grande, fueron encontradas deficiencias relacionadas a orientaciones sobre el cuidado con la salud del niño en los dos municipios y mayor frecuencia de actividades educativas entre los agentes de Queimadas. Las diferencias relativas al trabajo de los agentes comunitarios de salud pueden envolver factores como desvalorización profesional y precarias condiciones de trabajo. Destaca-se la importancia de la capacitación y preparación de los enfermeros para la supervisión del trabajo de los agentes.

Errata de: Índices antropométricos de crianças assistidas em creches e sua relação com fatores socioeconômicos, maternos e infantis / Erratum to: Anthropometric indices of children treated in daycare centers and the relationship with socioeconomic, maternal and child factors

Errata no artigo: Índices antropométricos de crianças assistidas em creches e sua relação com fatores socioeconômicos, maternos e infantis. edição: volume 21 número 7: 2016, p.2219 correção na p.2230 Doi: 10.1590/1413-81232015217.11712015

Errata no artigo: Resolução nº 510 de 7 de abril de 2016 que trata das especificidades éticas das pesquisas nas ciências humanas e sociais e de outras que utilizam metodologias próprias dessas áreas. na edição: volume 21 número 8: 2016, p.2629 DOI: 10.1590/1413-81232015218.17212016

Errata in article: Anthropometric indices of children treated in daycare centers and the relationship with socioeconomic, maternal and child factors.edição: volume 21 número 7: 2016, p.2219 Doi: 10.1590/1413-81232015217.11712015

Errata in article: Approval of the Resolution governing the ethics of research in social sciences, the humanities, and other disciplines that use methodologies characteristic of these areas: challenges and achievements. na edição: volume 21 número 8: 2016, p.2629 DOI: 10.1590/1413-81232015218.17212016