'Scorched Earth: The portrait of health in Brazil after the Bolsonaro's administration and the first 100 days of the Lula Government in health'.

This article is a rejoinder to the rebuttal letter authored by Jair Bolsonaro's former Minister of Health and Secretary of Primary Care to our initial article, 'From Bolsonaro to Lula: The opportunity to rebuild universal healthcare in Brazil during the government transition,' published in the International Journal of Health Planning and Management. We aim to refute the claims that we consider unsubstantiated and disconnected from reality, while reiterating the risks posed by authoritarian and antidemocratic far-right governments, such as Bolsonarism in Brazil, to the sustainability and resilience of universal health systems. This political threat is gaining momentum across several countries worldwide, thereby endangering the Democratic Rule of Law, institutions, and social policies. Furthermore, we emphasise the significant actions implemented during the first 100 days of President Lula's government, which align with the priorities established during the governmental transition process and strengthen the prospects of reconstructing and fortifying the Brazilian universal health system.

From Bolsonaro to Lula: The opportunity to rebuild universal healthcare in Brazil in the government transition.

This paper takes the government transition that took place between 2022 and 2023 in Brazil as a case study and aims to analyse how a cycle of radical right-wing populist government acted to dismantle Brazil's national health system foundations. It describes how governance was built based on political-clientelism and market-privatising interests and on the adoption of long-term fiscal austerity policies, whose results are public defunding and weakening and disorganisation of the country's national health system, with a significant worsening of health indicators and the capacity to respond to the population health needs. The lessons from recent experience in Brazil should serve as learning and a source of academic and political reflection, since there is an ongoing international movement and signs of rise of radical right-wing populist regimes in several countries, which endanger the Democratic Rule of Law, institutions, and social policies. It allows putting into perspective how political cycles of this nature can affect national universal health systems, including those that have experienced substantial progress towards universal access and universal health coverage. Keeping in mind the Brazilian experience, it was possible to observe the progressive structuring of a radical right-wing neo-populism and in the sanitarian.

Indirect Calorimetry as an Instrument of Research to Identify the Effect of Hypermetabolism in Critical Patients' Prognosis.

BACKGROUND: Energy expenditure (EE) evaluation in Intensive Care Unit (ICU) patients can be very challenging. Critical illness is characterized by great variability in EE, which is influenced by the disease itself and the effects of treatment. Indirect calorimetry (IC) is currently the gold standard to measure EE in Intensive Care Unit (ICU) patients. However, calorimeters are not widely available, and predictive formulas (PF) are still commonly used, leading to under or overfeeding and deleterious consequences.Important metabolic changes occur and catabolism becomes prominent in critically ill patients.Both hyper and hypometabolism can be observed, but hypermetabolic patients appear to have higher mortality rates compared to metabolically normal patients. This study aimed to assess hypermetabolism incidence and compare clinical outcomes between hypermetabolic and normometabolic patients in ICU. METHODS: A single-center, retrospective, and observational study was conducted in the ICU of the Hospital do Divino Espírito Santo in Ponta Delgada, between August 2018 and February 2021. Only invasively mechanically ventilated patients were included. Resting energy expenditure (REE) was predicted by 25 kcal/kg/day formula to obtain predicted resting energy expenditure (PREE), and REE was measured by IC to obtain measured resting energy expenditure (MREE). According to their metabolic state (PREE/MREE), patients were divided into hypermetabolic (≥1.3) and normometabolic (<1.3). To determine the limits of agreement between PREE and MREE, we performed a Bland-Altman (BA) analysis. Baseline characteristics, severity criteria, nutritional status, and main diagnosis on admission were compared. The primary outcome considered was 30-day mortality. Other outcomes such as the ICU length of stay (LOS), in-hospital LOS, and length of invasive ventilation were also evaluated. RESULTS: Among the 80 ICU patients included in the final analysis, 67 patients were normometabolic (83.4%). Patients admitted due to pneumonia were more hypermetabolic, 8 (61.5%) vs. 10 (14.9%); p<0.001. Hypermetabolism was found also in patients admitted due to sepsis/septic shock, 7 (53.8%) vs. 16 (23.9%); p=0.029. Hypermetabolic patients had lower body mass index (22.5 [interquartile range (IQR): 21.5-24.9] vs. 27.7 [IQR: 25.0-32.4] kg/m2; p=0.001) and higher MREE (2715.0 [2399.0-3090.0] vs. 1690.0 [1410.0-2190.0] kcal/day; p<0.001). Bland-Altman analysis showed a mean difference of -5.6 ± 744.7 Kcal/day between the PREE and MREE by IC. No statistically significant difference was found between the two groups, neither in 30-day mortality nor in the other outcomes considered. CONCLUSIONS: Hypermetabolism was not seen to present a greater risk of death in mechanically ventilated patients in ICU. Lower BMI, sepsis/septic shock, and pneumonia appear to be associated with a hypermetabolic state.

Functional outcomes of the anterior subcutaneous internal pelvic fixator (INFIX) technique for pelvic ring injuries: A case series.

INTRODUCTION: Anterior external fixation is a well-established technique for treating pelvic ring injuries, but many complications are associated with it. The subcutaneous anterior internal fixator (INFIX) technique is associated with reduced complication rates and is less uncomfortable for patients. OBJECTIVE: This study evaluated functional outcomes among patients with pelvic ring injuries treated using the INFIX method. PATIENTS AND METHODS: In this retrospective case series, patients treated using the INFIX technique were reviewed for functional outcomes, using the Iowa Pelvic Score (IPS). Thirty-four patients, of mean age 39.2 years, were evaluated after a mean follow-up of 1.2 years. RESULTS: Twenty-three of the 34 patients experienced reduction classified as excellent, and eleven as good, with no instances of moderate or poor reduction. One patient developed implant exposure and infection during follow-up. Twenty-six ultimately experienced an excellent or good functional result. The average final IPS was 79.4 (range: 48-100). CONCLUSION: Our results reinforce prior evidence that the INFIX method is safe for fixating pelvic ring lesions. Most of our patients also experienced excellent or good functional recovery, suggesting that this technique is a viable option for treating certain pelvic ring injuries.

Kounis syndrome. Apropos of a clinical case. / Síndrome de Kounis. A propósito de um caso clínico.

Kounis syndrome, while an acute coronary syndrome, occurs in the context of a hypersensitivity reaction, allergies, or anaphylaxis and is subdivided into three types: coronary spasm in normal arteries, instability of plaques in atherosclerotic coronary arteries, and thrombosis of coronary stents. Herein, the case of a 73-year-old patient who, after administration of amoxicillin/clavulanic acid, went into cardiorespiratory arrest with evidence of ST-T segment elevation on electrocardiogram is reported. Coronarography revealed no obstructive lesions, and spontaneous resolution of electrocardiographic abnormalities was observed. A review of anamnesis with the family revealed a previous allergy to penicillin. The tryptase dosage was strongly positive. Kounis syndrome type 2 was diagnosed, and the clinical outcome was good.

Síndrome de Kounis. A propósito de um caso clínico / Kounis syndrome. Apropos of a clinical case

RESUMO A síndrome de Kounis, enquanto síndrome coronária aguda, ocorre em um contexto de reação de hipersensibilidade, alergia ou anafilaxia, e subdivide-se em três tipos: o espasmo coronário em artérias normais, a instabilidade de placas em artérias coronárias ateroscleróticas e a trombose de stent coronário. Apresenta-se o caso de uma doente de 73 anos que, após administração de amoxicilina/ácido clavulânico, entra em parada cardiorrespiratória, com evidência de supradesnivelamento do segmento ST-T em eletrocardiograma. Realiza coronariografia com ausência de lesões obstrutivas, verificando-se resolução espontânea das alterações eletrocardiográficas. Revisão da anamnese com a família documenta alergia prévia à penicilina. O doseamento de triptase foi fortemente positivo. Foi admitida provável síndrome de Kounis tipo 2, com boa evolução clínica posterior.

ABSTRACT Kounis syndrome, while an acute coronary syndrome, occurs in the context of a hypersensitivity reaction, allergies, or anaphylaxis and is subdivided into three types: coronary spasm in normal arteries, instability of plaques in atherosclerotic coronary arteries, and thrombosis of coronary stents. Herein, the case of a 73-year-old patient who, after administration of amoxicillin/clavulanic acid, went into cardiorespiratory arrest with evidence of ST-T segment elevation on electrocardiogram is reported. Coronarography revealed no obstructive lesions, and spontaneous resolution of electrocardiographic abnormalities was observed. A review of anamnesis with the family revealed a previous allergy to penicillin. The tryptase dosage was strongly positive. Kounis syndrome type 2 was diagnosed, and the clinical outcome was good.

Estratégias para o fortalecimento de redes sociais comunitárias: a experiência dos bairros Tupi e Lajedo em Belo Horizonte/MG / Strategies for strengthening community social networks: the experience of the Tupi and Lajedo neighborhoods in Belo Horizonte/MG / Estrategias para el fortalecimiento de redes sociales comunitarias: la experiencia de los barrios Tupi y Lajedo en Belo Horizonte/MG

A pesquisa objetivou sistematizar estratégias para o fortalecimento de uma rede comunitária localizada em Belo Horizonte, desmobilizada em decorrência de conflitos existentes entre suas lideranças e pela forte presença de viés político-partidário nas relações comunitárias. Buscou-se elucidar os fatores que influenciavam no engajamento, motivação e participação política da comunidade nas ações em rede para, a partir daí, propor estratégias para o seu fortalecimento. Foi utilizada a pesquisa participante como método, tendo sido realizada observação participante e um grupo focal como instrumentos de coleta de dados. Repensar a própria rede, seus objetivos e funcionamento, e realizar ações que digam respeito à comunidade e sua história, para que os moradores se identifiquem e estabeleçam uma relação de afeto com o território, foram algumas das estratégias propostas para a reconfiguração da rede comunitária, com vistas ao aumento da sua força de mobilização e à participação efetiva de seus membros.

The main objective of our research was to systematize strategies for strengthening a community network located in Belo Horizonte, demobilized as a consequence of conflicts between their leaders and by the strong presence of partisan political bias in their community relations. We tried to elucidate the factors influencing the engagement, motivation and political participation of the community in the networked actions in order to, from there, propose strategies for community strengthening. Method used was the participatory survey, with participatory observation and focal group chosen as data collection instruments. Some of the proposed strategies for reconfiguration of community network were to rethink the actual network, its objectives and operation, and to make actions related to the community and its history, in order to make the dwellers identify themselves and establish an emotional/affective relationship with the territory, towards the increase of the mobilization force and the effective participation of the community members.

La investigación objetivó sistematizar estrategias para el fortalecimiento de una red comunitaria ubicada en Belo Horizonte, desmovilizada como consecuencia de conflictos existentes entre sus líderes y por la fuerte presencia de sesgo político-partidario en las relaciones comunitarias. Se buscó elucidar los factores que influían el compromiso, motivación y participación política de la comunidad en las acciones en red para, a partir de ahí, proponer estrategias para su fortalecimiento. Se utilizó la investigación participante como método, habiendo sido realizada observación participante y grupo focal como instrumentos de recolección de datos. Repensar la propia red, sus objetivos y funcionamiento, y realizar acciones que afecten a la comunidad y su historia, para que los habitantes se identifiquen y establezcan una relación de afecto con el territorio, fueron algunas estrategias propuestas para la reconfiguración de la red comunitaria, con vistas al aumento de su fuerza de movilización ya la participación efectiva de sus miembros.

Saúde mental e gênero: facetas gendradas do sofrimento psíquico / Gender and mental health: gendered facets of psychological suffering

A partir das contribuições do estudo de Zanello e Bukowitz (2011) acerca da participação dos valores e ideais de gênero presentes no sofrimento psíquico de pacientes em crise, internados em um hospital psiquiátrico, o presente trabalho teve como escopo investigar o modo como se dava esta participação em usuári@s de um Centro de Atenção Psicossocial em Brasília. A partir da análise de conteúdo de 15 entrevistas semiestruturadas, os resultados apontam que a experiência do adoecimento psíquico é gendrada e coloca em xeque de maneiras distintas homens e mulheres em processo de tratamento em saúde mental: enquanto a fala delas é marcada sobretudo pelo sofrimento em não conseguir maternar e dar conta dos afazeres domésticos, além de um lugar de silenciamento; na deles destacou-se o sofrimento em não poder trabalhar e prover a família, além da importância e dificuldade em se manter em uma sexualidade masculina hegemônica de “comedor”.(AU)

From the contributions of the study of Zanello and Bukowitz (2011) on the participation of gender values and ideals present in psychological suffering of patients in crisis in a psychiatric hospital, the present study aimed to investigate the aspects of this participation in users of a Psychosocial Care Center in Brasilia. From the content analysis of 15 semi-structured interviews the results suggest that the experience of mental illness is gendered and puts in check in distinct ways men and women under mental health treatment: the women’s speech is particularly marked by suffering for not being able to parent and take care of household chores, as well as a place of silencing; in the men’s speech the suffering for not being able to work and provide for the family prevailed, in addition to the importance and difficulty in maintaining an hegemonic male sexuality of “womanizer”.(AU)

Saúde mental e gênero: facetas gendradas do sofrimento psíquico / Gender and mental health: gendered facets of psychological suffering

A partir das contribuições do estudo de Zanello e Bukowitz (2011) acerca da participação dos valores e ideais de gênero presentes no sofrimento psíquico de pacientes em crise, internados em um hospital psiquiátrico, o presente trabalho teve como escopo investigar o modo como se dava esta participação em usuári@s de um Centro de Atenção Psicossocial em Brasília. A partir da análise de conteúdo de 15 entrevistas semiestruturadas, os resultados apontam que a experiência do adoecimento psíquico é gendrada e coloca em xeque de maneiras distintas homens e mulheres em processo de tratamento em saúde mental: enquanto a fala delas é marcada sobretudo pelo sofrimento em não conseguir maternar e dar conta dos afazeres domésticos, além de um lugar de silenciamento; na deles destacou-se o sofrimento em não poder trabalhar e prover a família, além da importância e dificuldade em se manter em uma sexualidade masculina hegemônica de "comedor"

From the contributions of the study of Zanello and Bukowitz (2011) on the participation of gender values and ideals present in psychological suffering of patients in crisis in a psychiatric hospital, the present study aimed to investigate the aspects of this participation in users of a Psychosocial Care Center in Brasilia. From the content analysis of 15 semi-structured interviews the results suggest that the experience of mental illness is gendered and puts in check in distinct ways men and women under mental health treatment: the women's speech is particularly marked by suffering for not being able to parent and take care of household chores, as well as a place of silencing; in the men's speech the suffering for not being able to work and provide for the family prevailed, in addition to the importance and difficulty in maintaining an hegemonic male sexuality of "womanizer"

Sepsis-induced purpura fulminans caused by Pasteurella multocida.

A 52-year-old man was admitted with a cutaneous rash associated with septic shock and multiorganic failure, 6 days after a dog bite. He was started on empiric antibiotherapy and supportive measures. The patient's condition aggravated, with need for invasive mechanical ventilation and intermittent haemodialysis, and evolution from a petechiae-like rash to purpura and gangrene, culminating in bilateral lower limb amputation. The blood cultures revealed only Pasteurella multocida, after 10 days of incubation. P multocida infection is a rare cause of soft tissue infection that subsides with oral antibiotherapy. Infections causing sepsis are rare and appear in immunocompromised patients. Purpura fulminans induced by sepsis is a rare, life-threatening disorder. This syndrome should be recognised promptly, so early treatment is instituted. We found no case reports of purpura fulminans caused by Pasteurella infections in our literature review.

Cutaneous gnathostomiasis: report of 6 cases with emphasis on histopathological demonstration of the larva.

BACKGROUND: Cutaneous gnathostomiasis is an emerging food-borne parasitic zoonosis. Histopathological demonstration of the larva on random biopsy specimen of erythematous plaques is infrequent because of its migrating nature. OBJECTIVE: We sought to determine whether medical treatment with albendazole or ivermectin increases the diagnostic yield of skin biopsy specimen. METHODS: A retrospective chart review was conducted in a private dermatology practice in Lima, Peru. Cases with a clinical diagnosis of nodular migratory panniculitis and pathological diagnosis of eosinophilic panniculitis or gnathostomiasis were reviewed. Only cases with definitive diagnosis confirmed by histopathology or parasite isolation were included in the study. RESULTS: A definitive diagnosis of gnathostomiasis was rendered in 6 of 55 reviewed cases. Histopathological or gross identification of the nematode's larva was made obtaining a biopsy specimen of papules or pseudofuruncles that developed after oral antiparasitic treatment. LIMITATIONS: This is a retrospective case series study and no serologic testing was available. CONCLUSION: Biopsy of a papule or pseudofuruncle subsequent to oral treatment increases the likelihood of demonstrating the larva on skin biopsy specimen, which allows definitive diagnosis and may have therapeutic benefit.

Product evaluation based in the association between intuition and tasks.

This paper explores the importance of researching the intuitiveness in the product use. It approaches the intuitiveness influence for users that already had a visual experience of the product. Finally, it is suggested the use of a table that relates the tasks performed while using a product, the features for an intuitive use and the performance metric "task success".

Possível relação entre estresse ocupacional e síndrome metabólica / Relationship between job stress and the metabolic syndrome

O crescente número de casos de síndrome metabólica está relacionado àa mudanças no estilo de vida e no padrão alimentar das populações e, possivelmente, às situações de estresse cotidiano. O objetivo do presente estudo é investigar a possível relação entre estresse ocupacional e síndrome metabólica. Em estudo transversal foram avaliados 94 indivíduos: 51 agentes penitenciários (Grupo 1) e 43 funcionários da administração pública, que constituíram o grupo controle (grupo 2), submetidos a exame físico, avaliação laboratorial (dosagens de glicose, colesterol total, colesterol HDL, triglicérides e ácido úrico) além da aplicação de questionário para avaliação do grau de estresse no trabalho. O diagnóstico de síndrome metabólica se baseou nos critérios do National Cholesterol Education Program - Adult Treatment Panel III (NCEP-ATPIII). Foi encontrada maior prevalência de obesidade abdominal, hipertensão arterial, hipertrigliceridemia e baixos níveis de colesterol HDL entre os agentes penitenciários, quando comparados ao grupo controle (p<0,05). O diagnóstico de síndrome metabólica foi realizado em 11 (26,2%) indivíduos do grupo 1 e em doi2 indivíduos (5,7%) do grupo 2 (p<0,05). A razão de prevalência do estresse ocupacional para o grupo 1, em relação ao grupo 2 foi de 3,909 (IC de 95%: 0,88 a 17,4, p=0,048). A frequência de síndrome metabólica foi mais elevada entre os indivíduos submetidos à maior demanda psicológica no exercício da profissão sendo provável a relação entre essa entidade clínica e o estresse ocupacional.

The increasing number in the cases of metabolic syndrome is related to changes in the life style and food patterns of the populations and, possibly, to daily stress circumstances. The aim of the present study is to investigate the relationship between work stress and the metabolic syndrome. In a transversal study 94 individuals were evaluated: 51 prison guards (group 1) and 43 civil employees as the control group (group 2), who were submitted to physical examination, laboratory evaluation (fasting plasma glucose, total cholesterol, HDL cholesterol, triglycerides, and uric acid) in addition to a questionnaire to evaluate the level of stress at work. The diagnosis of metabolic syndrome was based on the National Cholesterol Education Program - Adult Treatment Panel III (NCEP-ATPIII) criteria. Prison guards showed greater prevalence of abdominal obesity, hypertension, high triglycerides and low HDL-cholesterol levels when compared to control group (p<0.05). The metabolic syndrome diagnosis was accomplished in 11 (26.2%) individuals, in group 1 and 2 (5.7%) in group 2 (p<0.05). The prevalence ratio of work stress of group 1 vs group 2 was 3.91 (95% CI: 0.88 to 17.4, p=0.048). The metabolic syndrome prevalence was higher among individuals who were submitted to greater psychological demand in the job, and the relationship between this clinical entity and work stress is probable.

Estudo comparativo do desempenho visual e análise de frente de onda entre as lentes intra-oculares multifocais difrativas Tecnis® ZM900 e AcrySof® ResTor® SN60D3 / Comparison between OPD-Scan results and visual outcomes of Tecnis® ZM900 and Restor® SN60D3 diffractive multifocal intraocular lenses

OBJETIVOS: Comparar o desempenho visual e a análise de frente de onda entre as lentes intra-oculares (LIOs) multifocal difrativa Tecnis® ZM900 asférica e AcrySof® Restor® esférica SN60D3. MÉTODOS: Trata-se de estudo prospectivo comparativo que incluiu 78 olhos de 39 pacientes. A avaliação oftalmológica contou com medida da acuidade visual para longe, intermediária e curta distância, sem correção e com a melhor correção óptica, teste de sensibilidade ao contraste e análise de frente de onda por meio do aberrômetro OPD-Scan. RESULTADOS: Acuidade visual para longe e para perto sem correção óptica e análise de aberrometria foram estatisticamente semelhantes em relação a ambas as LIOs; já a visão intermediária e a sensibilidade ao contraste em condições fotópicas revelaram diferença estatisticamente significante entre as duas lentes a favor da Tecnis ZM900. CONCLUSÃO: Ambas as lentes intra-oculares promoveram excelente visão para longe e para perto em situações de alto contraste. A LIO Tecnis multifocal necessita de menos luminosidade para visão em situações de alto contraste, apresenta menos aberrações ópticas e melhor visão intermediária que a LIO ResTor.

PURPOSE: Comparison of the visual performance and wavefront analysis between patients with Tecnis® ZM900 aspheric and AcrySof ReStor® SN60D3 spheric diffractive multifocal intraocular lenses (IOL). METHODS: This prospective comparative study included 78 eyes of 39 patients. The performed ophthalmologic evaluation included near, intermediate and distance corrected and uncorrected visual acuity, contrast sensitivity measurement (under photopic and mesopic conditions) and wavefront analysis with the OPD-Scan aberrometrer. RESULTS: Uncorrected near and distance visual acuity and aberrometry analysis were similar with both intraocular lenses; nevertheless, intermediate visual acuity and contrast sensitivity under photopic conditions were statistically better with Tecnis ZM900. CONCLUSION: Both studied intraocular lenses promoted excellent near and distance postoperative visual acuity, in high contrast situations. Tecnis ZM900 IOL provided good quality of vision with high contrast condition in low luminosity with reduction in spherical aberration and improvements in intermediate visual acuity when compared to Restor IOL.

[Comparison between OPD-Scan results and visual outcomes of Tecnis ZM900 and Restor SN60D3 diffractive multifocal intraocular lenses]. / Estudo comparativo do desempenho visual e análise de frente de onda entre as lentes intra-oculares multifocais difrativas Tecnis ZM900 e AcrySof ResTor SN60D3.

PURPOSE: Comparison of the visual performance and wavefront analysis between patients with Tecnis ZM900 aspheric and AcrySof ReStor SN60D3 spheric diffractive multifocal intraocular lenses (IOL). METHODS: This prospective comparative study included 78 eyes of 39 patients. The performed ophthalmologic evaluation included near, intermediate and distance corrected and uncorrected visual acuity, contrast sensitivity measurement (under photopic and mesopic conditions) and wavefront analysis with the OPD-Scan aberrometrer. RESULTS: Uncorrected near and distance visual acuity and aberrometry analysis were similar with both intraocular lenses; nevertheless, intermediate visual acuity and contrast sensitivity under photopic conditions were statistically better with Tecnis ZM900. CONCLUSION: Both studied intraocular lenses promoted excellent near and distance postoperative visual acuity, in high contrast situations. Tecnis ZM900 IOL provided good quality of vision with high contrast condition in low luminosity with reduction in spherical aberration and improvements in intermediate visual acuity when compared to Restor IOL.

Josué de Castro e o Brasil / Josué de Castro and the Brasil

A fome não se resume aos determinantes previstos numa espécie de ocorrência natural dos fatos. A fome não é do mundo, ela está estranhada aqui por questões que fogem ao campo da fatalidade. Fome não se dissocia de conjuntura socioeconômica, de decisão política, de debate ideológico. Assim provou Josué de Castro. Assim acreditam os organizadores do seminário e de seu desdobramento, registrado neste livro.