Transvaginal ultrasound with bowel preparation versus transvaginal ultrasound with bowel preparation and water contrast for diagnosing Recto-Sigmoid endometriosis. A systematic review and Meta-Analysis.

Transvaginal ultrasound is effective in diagnosing endometriosis involving the rectosigmoid bowel. Some authors suggest enhanced detection of rectosigmoid involvement with bowel preparation. Conversely, conflicting views argue that bowel preparation may not improve diagnostic precision, yielding similar results to rectal water contrast. No existing meta-analysis compares these approaches. Our study aims to conduct a meta-analysis to evaluate the diagnostic performance of transvaginal ultrasound with bowel preparation, with and without rectal water contrast. Studies published between 2000 and 2023 were searched in PubMed, Scopus, Cochrane and Web of Science. From 561 citations, we selected nine studies to include in this meta-analysis. The study quality was assessed using QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2). The mean prevalence of endometriosis rectosigmoid was 43.6% (range 17,56-76,66%) in the group with bowel preparation and 64,80% (50,0-83,60%) for the group with bowel preparation and rectal water contrast. Pooled sensitivity and specificity were 93% and 94% for bowel preparation and 92% and 95% and for bowel preparation with water contrast. We conclude that, there was no significant difference between performing transvaginal ultrasound with intestinal preparation with and without water contrast. In clinical practice, the absence of a significant difference between these methods should be taken into account when making recommendations.

Effect of ischemic compressions versus extracorporeal shockwave therapy on myofascial trigger points: A protocol of a randomized controlled trial.

INTRODUCTION: The myofascial trigger points (MTrPs) are hyperirritable nodules present in a tight muscle band. Among the symptoms, pain is one of the most common, but the individuals may have other sensory, motor, and autonomic changes. Athletes can have MTrPs more intensely due to the high physical and emotional demand. There are a variety of treatments, but not all have strong or moderate evidence of their effectiveness. Thus, the aim of this study is to compare the effects of ischemic compression (IC) and extracorporeal shockwave therapy (ESWT) on pressure pain threshold immediately after the intervention and after 48h. METHODS: This randomized clinical trial was registered in the Brazilian Registry of Clinical Trial (RBR-6wryhb9) and was approved by the Research Ethics Committee (CAAE 46682921.9.0000.5406). Forty participants will be randomized to receive IC or ESWT treatment once in each MTrPs. The protocol will consist of evaluations before (T0), immediate after (T1), and after forty-eight hours (T2) of the intervention. The primary outcome will be pressure pain threshold and the secondary outcomes will be jump height, muscle strength, dorsiflexion range of motion (ROM), the correlation between MTrPs and temperature and participant's satisfaction. CONCLUSIONS: The IC and ESWT have been shown to be efficient in decreasing pain, however, the studies that compare the efficiency of these two treatments are limited in the literature, mainly in the muscles of the lower limbs, which are of great importance and are commonly injured. This study will provide evidence of the IC and ESWT in the triceps surae muscles, assisting in a better treatment for the individual with MTrPs.

Percepção dos docentes sobre as dificuldades de ensinar e formar um profissional em meio a pandemia / Teachers' perception on the difficulties of teaching and training a professional in the midst of the pandemic / Percepción de los profesores sobre las dificultades de enseñar y formar un profesional en medio a la pandemia

Objetivo: verificar na percepção dos docentes as dificuldades de ensinar e formar um profissional em meio a pandemia por COVID-19 e como isso poderá impactar na formação profissional dos acadêmicos. Método: pesquisa de abordagem qualitativa, realizada com 90 docentes de uma Universidade Estadual localizada na região no Sul do Brasil, que desenvolveram atividades de ensino remoto durante o ano letivo de 2020. A coleta de dados ocorreu no mês de junho de 2020 por meio de um questionário semiestruturado aplicado pelo GoogleForms®. Para as respostas foi utilizada a análise lexicográfica com o software "Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires - IRaMuTeQ® a partir do mecanismo de análise de Classificação Hierárquica Descendente. Resultados: O dendograma resultante da análise do corpus deste estudo foi composto por cinco classes: Fragilidade de comunicação professor-aluno e em relação a métodos de ensino adotados; Ausência de acesso dos alunos à internet e as diversas plataformas que são utilizadas para o ensino remoto; Impacto no ensino-aprendizado após a pandemia do COVID-19; Avaliação do processo de aprendizado do aluno e ausência de envolvimento do mesmo nas atividades remotas; Saúde mental dos acadêmicos em tempos de pandemia do COVID-19. Considerações finais: existem fragilidades e dificuldades no processo de ensino e aprendizagem remoto durante este período de distanciamento social devido a Pandemia por COVID-19. Os docentes acreditam que estas dificuldades podem refletir e impactar na formação profissional dos acadêmicos e se preocupam com a saúde mental dos alunos devido ao cenário complexo vivenciado atualmente.

Objective: to verify the perception of professors about the difficulties of learning and training a professional in the best possible way in the pandemic due to COVID-19 and how it is possible to impact the professional training of academics. Method: research with a qualitative approach, carried out with 90 professors from a State University in southern Brazil, who develop distance learning activities during the year 2020. applied by GoogleForms®. For the answers, lexicographical analysis was used with the software "Interface de R pour les Analysis Multidimensionnelles de Textes et de Questionnaires - IRaMuTeQ® from the analysis mechanism of Descending Hierarchical Classification. Results: The dendrogram resulting from the analysis of the corpus of this study was composed of five classes: Fragility of teacher-student communication and in relation to the teaching methods adopted; Lack of access by students to the internet and to the different platforms that are used for distance learning; Impact on teaching-learning after the COVID-19 pandemic; Validation of the student's learning process and assistance in their involvement in remote activities; Mental health of academics in times of the COVID-19 pandemic. Final considerations: there are weaknesses and difficulties in the distance teaching and learning process in this period of social distancing due to the COVID-19 pandemic. Professors recognize that these difficulties can reflect and impact the professional training of academics and are concerned with the mental health of students residing in the centenary complex they currently live in.

Objetivo: verificar la percepción de los profesores sobre las dificultades de enseñar y formar un profesional de la mejor forma posible en plena pandemia debido al COVID-19 y como es posible impactar en la formación profesional de los académicos. Método: investigación con abordaje cualitativo, realizada con 90 profesores de una Universidad Estadual del sur de Brasil, que desarrollan actividades de educación a distancia durante el año 2020. aplicado por GoogleForms®. Para las respuestas se utilizó análisis lexicográfico con el software "Interface de R pour les Analysis Multidimensionnelles de Textes et de Questionnaires - IRaMuTeQ® a partir del mecanismo de análisis de Clasificación Jerárquica Descendente. Resultados: El dendrograma resultante del análisis del corpus de este estudio estaba compuesto por cinco clases: Fragilidad de la comunicación profesor-alumno y en relación a los métodos de enseñanza adoptados; Falta de acceso de los alumnos a internet y a las diferentes plataformas que se utilizan para la enseñanza a distancia; Impacto en la enseñanza- aprendizaje después de la pandemia del COVID-19; Validación del proceso de aprendizaje del alumno y asistencia en su participación en actividades a distancia; Salud mental de los académicos en tiempos de la pandemia del COVID-19. Consideraciones finales: existen debilidades y dificultades en el proceso de enseñanza y aprendizaje a distancia en este período de distanciamiento social debido a la pandemia del COVID-19. Los profesores reconocen que estas dificultades pueden reflejar e impactar en la formación profesional de los académicos y están preocupados con la salud mental de los estudiantes que residen en el complejo centenario en el que viven actualmente.

Segurança do paciente na hemodiálise: uma perspectiva sociodemográfica, laboratorial e farmacológica / Patient safety in hemodialysis: a sociodemographic, laboratory and pharmacological perspective / Seguridad del paciente en hemodiálisis: una perspectiva sociodemográfica, de laboratorio y farmacológica

O objetivo deste estudo é analisar as características sociodemográficas, laboratoriais e farmacológicas de indivíduos que sofreram complicações e eventos adversos durante a hemodiálise. Trata-se de estudo descritivo, transversal e documental. Realizado em uma clínica de terapia renal substitutiva de uma regional de saúde do noroeste do Paraná. A população foi composta de 151 portadores de doença renal crônica em estágio 5 hemodialítico e seus respectivos prontuários, e que faziam tratamento financiado pelo Sistema Único de Saúde. A coleta de dados ocorreu por meio de um questionário semiestruturado nos meses de junho e julho de 2019. A análise dos dados foi por meio de estatística descritiva. Entre os resultados, evidenciou-se que dos 151 participantes, todos tiveram alguma complicação/eventos durante a hemodiálise. Destacaram-se o sexo masculino (61%), idosos (46,4%), residentes no Noroeste do Paraná (46%), trabalhador rural (23%), pardos (46,4%) e renda de até dois salários mínimos (53%). Foram identificados dados de 37 tipos de exames nos prontuários, com predominância (100%) de ureia, hemoglobina e hematócrito. 44 participantes relataram uso regular de medicação, os medicamentos mais utilizados são a eritropoietina humana recombinante (89%), anti-hipertensivos (70%), sacrato de hidróxido férrico (68%) e cloridrato de sevelâmer (n=98; 65%). Conclui-se que as características que contemplaram o estudo permitiu a identificação ampliada de complicações e eventos que comprometem a segurança do paciente. Assim, destaca-se a importância de compreender os fatores de risco e planejar ações para a melhoria do cuidado.

The objective of this study is to analyze the sociodemographic, laboratory and pharmacological characteristics of individuals who suffered complications and adverse events during hemodialysis. This is a descriptive, cross-sectional and documentary study. Performed at a renal replacement therapy clinic in a health district in northwestern Paraná. The population consisted of 151 patients with chronic kidney disease undergoing hemodialysis stage 5 and their respective medical records, who were receiving treatment financed by the Unified Health System. Data collection took place through a semi-structured questionnaire in June and July 2019. Data analysis was through descriptive statistics. Among the results, it was evidenced that of the 151 participants, all had some complication/events during hemodialysis. Males (61%), elderly (46.4%), residents of Northwest Paraná (46%), rural workers (23%), browns (46.4%) and income of up to two minimum wages stood out. (53%). Data from 37 types of tests were identified in the medical records, with a predominance (100%) of urea, hemoglobin and hematocrit. 44 participants reported regular use of medication, the most used drugs are recombinant human erythropoietin (89%), antihypertensives (70%), ferric hydroxide sacrate (68%) and sevelamer hydrochloride (n=98; 65%). It is concluded that the characteristics that contemplated the study allowed the expanded identification of complications and events that compromise patient safety. Thus, the importance of understanding risk factors and planning actions to improve care is highlighted.

El objetivo de este estudio es analizar las características sociodemográficas, de laboratorio y farmacológicas de individuos que sufrieron complicaciones y eventos adversos durante la hemodiálisis. Se trata de un estudio descriptivo, transversal y documental. Realizado en una clínica de terapia de reemplazo renal en un distrito de salud en el noroeste de Paraná. La población estuvo conformada por 151 pacientes con enfermedad renal crónica en hemodiálisis estadio 5 y sus respectivas historias clínicas, quienes recibían tratamiento financiado por el Sistema Único de Salud. La recolección de datos se realizó a través de un cuestionario semiestructurado en junio y julio de 2019. El análisis de datos se realizó mediante estadística descriptiva. Entre los resultados, se evidenció que, de los 151 participantes, todos tuvieron alguna complicación/eventos durante la hemodiálisis. Se destacaron hombres (61%), ancianos (46,4%), residentes en el Noroeste de Paraná (46%), trabajadores rurales (23%), pardos (46,4%) e ingresos de hasta dos salarios mínimos (53%). Se identificaron datos de 37 tipos de pruebas en las historias clínicas, con predominio (100%) de urea, hemoglobina y hematocrito. 44 participantes informaron el uso regular de medicamentos, los medicamentos más utilizados son la eritropoyetina humana recombinante (89%), los antihipertensivos (70%), el sacrato de hidróxido férrico (68%) y el clorhidrato de sevelámero (n=98; 65%). Se concluye que las características que contempló el estudio permitieron la identificación

Educação permanente em Saúde: Design Thinking para planejamento e construção de diretrizes / Educación permanente en salud: Design Thinking para planificar y construir lineamientos / Permanent education in health: Design Thinking for planning and constructing guidelines

Resumo Objetivo analisar o percurso do planejamento e construção de diretrizes de Educação Permanente em Saúde em uma regional de saúde. Método pesquisa participativa, desenvolvida pelo Design Thinking como estratégia colaborativa para o planejamento e construção de diretrizes de Educação Permanente em Saúde em uma Regional de Saúde do estado do Paraná-Brasil. Participaram gestores municipais, profissionais de saúde e representantes da Regional de Saúde, totalizando 32 participantes. Realizaram-se análise documental, grupos focais e formulários online para coleta de dados, que foram analisados segundo a Política Nacional de Educação Permanente em Saúde e a concepção dialógica problematizadora do percurso colaborativo. Resultados apontaram que o planejamento regional descreve ações de educação em saúde majoritariamente generalistas e quantificáveis, e que suscitaram inquietudes quando refletidas coletivamente. A atividade colaborativa oportunizou espaços de problematização do planejamento de Educação Permanente em Saúde, relações dialógicas, construção de conhecimento ancorado na ressignificação das práticas e elaboração coparticipativa de diretrizes qualitativas de educação permanente pautadas na reflexão da realidade vivenciada. Considerações finais implicações para prática o Design Thinking promoveu protagonismo e transformação de saberes e gestão por meio do diálogo emancipatório. O estudo corrobora de forma significativa a adoção do planejamento coparticipativo e regional de Educação Permanente em Saúde pela ressignificação das práticas.

Resumen Objetivo analizar el curso de planificación y construcción de directrices para la Educación Permanente en Salud en una regional de salud. Método investigación participativa, desarrollada por Design Thinking como estrategia colaborativa para la planificación y construcción de directrices para la Educación Permanente en Salud en una Regional de Salud del estado de Paraná, Brasil. Participaron gestores municipales, profesionales de la salud y representantes de la Región Sanitaria, totalizando 32 participantes. Se realizaron análisis documentales, grupos focales y formularios en línea para la recolección de datos, los cuales fueron analizados de acuerdo con la Política Nacional de Educación Permanente en Salud y la concepción dialógica problematizadora del camino colaborativo. Resultados señalaron que la planificación regional describe mayoritariamente acciones de educación en salud generalistas y cuantificables, y que suscitó preocupación cuando se reflexiona colectivamente. La actividad colaborativa brindó espacios para cuestionar la planificación de la Educación Permanente en Salud, las relaciones dialógicas, la construcción de saberes anclados en la redefinición de prácticas y la elaboración coparticipativa de lineamientos cualitativos para la educación permanente a partir del reflejo de la realidad vivida. Consideraciones finales e implicaciones para la práctica el Design Thinking promovió el protagonismo y la transformación del conocimiento y la gestión a través del diálogo emancipador. El estudio corrobora significativamente la adopción de la planificación coparticipativa y regional para la Educación Permanente en Salud por medio de la redefinición de prácticas.

Abstract Objective to analyze the course of planning and construction of guidelines for Permanent Education in Health in a health regional. Method participatory research, developed by Design Thinking as a collaborative strategy for the planning and construction of guidelines for Permanent Education in Health in a Health Region in the state of Paraná, Brazil. Municipal managers, health professionals, and representatives of the Health Region participated, totaling 32 participants. Documentary analysis, focus groups and online forms for data collection were carried out, which were analyzed according to the Brazilian National Policy on Permanent Education in Health and the problematizing dialogic conception of collaborative path. Results they pointed out that regional planning describes mostly generalist and quantifiable health education actions, and that raised concerns when collectively reflected. The collaborative activity provided spaces for questioning the planning of Permanent Health Education, dialogical relationships, construction of knowledge anchored in the re-signification of practices and co-participatory elaboration of qualitative Permanent Health Education guidelines based on the reflection of experienced reality. Final considerations and implications for practice Design Thinking promoted leading role and transformation of knowledge and management through emancipatory dialogue. The study significantly corroborates the adoption of co-participatory and regional planning for Permanent Education in Health by redefining practices.

Promoção da saúde e prevenção de doenças: perspectivas de enfermeiros da atenção básica / Promoción de la salud y prevención de enfermedades: perspectivas de enfermería de la atención básica / Health promotion and disease prevention: perspectives of nurses of basic care

Objetivo: verificar as percepções e as práticas de enfermeiros atuantes na atenção primária à saúde acerca das ações de promoção da saúde e prevenção de doenças e agravos. Método:pesquisa qualitativa, realizada com 15 enfermeiros coordenadores de equipes da saúde da família. As entrevistas foram processadas pelo software IRaMuTeQ® e submetidas à técnica de análise de conteúdo. Resultados: cinco classes emergiram: Público envolvido, gama de atividades desenvolvidas e suas periodicidades; Adversidades para a realização de ações de promoção à saúde e prevenção de agravos; Perspectiva dos usuários quanto a Educação em Saúde; Práticas de Educação Permanente em Saúde e Mudança comportamental dos usuários a partir da promoção da saúde e avaliação dos resultados. Conclusão: para os enfermeiros, ações de promoção e prevenção são positivas para a comunidade, otimizando o autocuidado. Adversidades como falta de tempo, déficitno quadro profissional e sobrecarga foram relatadas

Objective:to check the perception of nurses working in primary health care about health promotion and disease prevention actions. Method:qualitative research, was carried out with 15 nurses coordinating teams of the family health. The declarations were processed by the IRaMuTeQ® software and submitted to the content analysis technique. Results:five classes emerged: Public, range of activities developed and their periodicity; Adversities for carrying out health promotion and disease prevention actions; Users' perspective on Health Education; Permanent Health Education Practices and Behavioral change of users based on health promotion and evaluation of results. Conclusion:in the perception of nurses, the promotion and prevention actions are positive for the community, optimizing self-care. Adversities such as lack of time, deficit in the professional framework and overload were reported

Objetivo:verificar la percepción de los enfermeros que trabajan en la atención primaria sobre las acciones de promoción de la salud y prevención de enfermedades. Método:investigación cualitativa, realizada con 15 enfermeros coordinadores de la salud de familia. Las declaraciones fueron procesadas por el softwareIRaMuTeQ® y sometidas a la técnica de análisis de contenido. Resultados:surgieron cinco clases: Público involucrado, abanico de actividades desarrolladas y su periodicidad; Adversidades para la realizaciónde acciones de promoción de la salud y prevención de enfermedades; Perspectiva de los usuarios sobre educación para salud; Prácticas de educación permanente para salud y Cambio de comportamiento de los usuarios basado en la promoción de la salud y evaluación de resultados. Conclusión:para las enfermerías, acciones son positivas para la comunidad, optimizando el autocuidado. Informaron adversidades como falta de tiempo, escasez de profesionales y sobrecarga

Evaluation of peripheral neuropathy in lower limbs of patients with rheumatoid arthritis and its relation to fall risk.

BACKGROUND: Rheumatoid Arthritis (RA) is a chronic disabling systemic disease characterized by joint inflammation, and extra-articular manifestations, including peripheral neuropathy, a condition that can be associated with changes in muscle strength, proprioception and postural balance contributing for the risk of falls. The objective of this study is to analyze the incidence of peripheral neuropathy in patients with RA and its association with the occurrence of falls. METHODS: Patients were assessed by an electroneuromyography (ENMG) exam and by a questionnaire on accidental falls occurrence in the previous 12 months. They were also assessed on balance by the Short Physical Performance Battery (SPPB), functionality by the Health Assessment Questionnaire (HAQ), disease activity by the Disease Activity Score (DAS-28), neuropathic pain by the Questionnaire for the Diagnosis of Neuropathic Pain (DN4), and cutaneous sensitivity of the feet by the monofilament testing of Semmes-Weinstein. Monthly calls on falls were made in the subsequent six months. Data analysis was performed using the Shapiro-Wilk test for normality and Spearman, Chi-square, and T-student correlation tests, with a significant P level ≤ 0.05. RESULTS: A sample of 33 patients were evaluated. The incidence of peripheral neuropathy was 48.5%, of which 68.7% were axonal and 31.3% myelinic. The sensorimotor type was present in 64.7%, motor in 17.6%, and sensorial in 11.7% of the cases. Neuropathy was associated to balance (P = 0.026), neuropathic pain (P = 0.016), deep tendon reflexes absence (P = 0,049), altered skin sensitivity of the feet (P = 0.029) and fear of falling (P = 0.001). No association was found between peripheral neuropathy and age, gender, disease activity, or functionality. No significant association was found between peripheral neuropathy and occurrence of falls, in a 12-month retrospective and 6-month prospective evaluation. CONCLUSION: Peripheral neuropathy has a high incidence in patients with RA, and is related to neuropathic pain, altered postural balance, but not to the occurrence of falls.

Direct-acting antivirals for chronic hepatitis C treatment: The experience of two tertiary university centers in Brazil.

BACKGROUND: Hepatitis C virus (HCV) treatment has undergone major changes in recent years. Previous interferon-based therapies have been replaced by oral direct-acting antivirals (DAA) regimens, with high sustained virologic response (SVR) rates, and a lower incidence of adverse events (AEs). AIM: To evaluate the efficacy and safety of DAAs for HCV treatment in subjects from two tertiary university centers in Brazil. METHODS: This is a multicenter retrospective cohort study of 532 patients with chronic hepatitis C (CHC), undergoing treatment with interferon-free regimens from November 2015 to November 2019. The therapeutic regimen was defined by the current Brazilian guidelines for HCV management at the time of treatment. Demographic, anthropometric, clinical, and laboratory variables were evaluated. SVRs were assessed at 12 to 24 wk after therapy by intention-to-treat (ITT), and modified ITT (m-ITT) analysis. AEs and serious adverse events (SAEs) were registered. In the statistical analysis, a P value of < 0.05 was considered significant. RESULTS: The mean age was 56.88 years, with 415 (78.5%) being HCV genotype 1, followed by genotype 3 (20.1%). Moreover, 306 (57.5%) subjects had cirrhosis, and a third of them had decompensated cirrhosis. Sofosbuvir (SOF) plus daclatasvir ± ribavirin was the most frequently used treatment (66.9%), followed by SOF plus simeprevir (21.2%). The overall ITT SVR was 92.6% (493/532), while the m-ITT SVR was 96.8% (493/509). Variables associated with treatment failure via ITT evaluation were hepatic encephalopathy (OR: 4.320; 95%CI: 1.920-9.721, P = 0.0004), presence of esophageal varices (OR: 2.381; 95%CI: 1.137-4.988, P = 0.0215), previous portal hypertensive bleeding (OR: 2.756; 95%CI: 1.173-6.471, P = 0.02), higher model for end-stage liver disease scores (OR: 1.143, 95%CI: 1.060-1.233, P = 0.0005), lower serum albumin levels (OR: 0.528, 95%CI: 0.322-0.867, P = 0.0115), higher serum creatinine (OR: 1.117, 95%CI: 1.056-1.312, P = 0.0033), and international normalized ratio (INR) levels (OR: 5.542, 95%CI: 2.023-15.182, P = 0.0009). AEs were reported in 41.1% (211/514) of patients, and SAEs in 3.7%. The female gender, higher body mass index, esophageal varices, higher INR values, and longer treatment duration were independently associated with AE occurrence. CONCLUSION: Treatment with oral DAAs attains a high SVR rate, with fewer SAEs in a real-life cohort of subjects with CHC, from two tertiary university centers in Brazil.

Early liver function improvement following successful treatment of chronic hepatitis C in patients with decompensated cirrhosis: a real-life study.

OBJECTIVES: Despite higher rates of sustained virologic response (SVR), important concerns remain when patients with decompensated cirrhosis due to hepatitis C virus (HCV) are treated with direct-acting antiviral agents (DAA). Questions include efficacy, safety, and the magnitude of liver function improvement. Here, we aimed to evaluate HCV treatment data in this specific population in Brazil. METHODS: We included 85 patients with decompensated cirrhosis submitted to HCV therapy with DAA followed at two academic tertiary centers in the southeastern region of Brazil. RESULTS: Seventy-nine patients (92.9%) were Child-Pugh (CP) score B, and six (7.1%) were CP score C. The mean MELD score was 12.86. The most common treatment was sofosbuvir plus daclatasvir±ribavirin for 24 weeks. The overall intention-to-treat (ITT) SVR rate was 87.4% (74/85) and modified-ITT 96.1% (74/77). ITT SVR was associated with lower baseline INR values (p=0.029). Adverse events (AE) occurred in 57.9% (44/76) of patients. Serious AE were reported in 12.8% (10/78), and were related to the presence of hepatic encephalopathy (p=0.027). SVR was associated with improvement in CP (p<0.0001) and MELD scores (p=0.021). Among baseline CP score B patients with SVR, 46% (29/63) regressed to CP score A. Ascites was independently associated with no improvement in liver function in patients who achieved SVR (p=0.001; OR:39.285; 95% CI:4.301-258.832). CONCLUSIONS: Patients with decompensated HCV cirrhosis showed a high SVR rate with interferon-free therapy. Early liver function improvement occurred after successful HCV eradication. However, long-term follow-up of these patients after SVR remains strongly advised.

Early liver function improvement following successful treatment of chronic hepatitis C in patients with decompensated cirrhosis: a real-life study

OBJECTIVES: Despite higher rates of sustained virologic response (SVR), important concerns remain when patients with decompensated cirrhosis due to hepatitis C virus (HCV) are treated with direct-acting antiviral agents (DAA). Questions include efficacy, safety, and the magnitude of liver function improvement. Here, we aimed to evaluate HCV treatment data in this specific population in Brazil. METHODS: We included 85 patients with decompensated cirrhosis submitted to HCV therapy with DAA followed at two academic tertiary centers in the southeastern region of Brazil. RESULTS: Seventy-nine patients (92.9%) were Child-Pugh (CP) score B, and six (7.1%) were CP score C. The mean MELD score was 12.86. The most common treatment was sofosbuvir plus daclatasvir±ribavirin for 24 weeks. The overall intention-to-treat (ITT) SVR rate was 87.4% (74/85) and modified-ITT 96.1% (74/77). ITT SVR was associated with lower baseline INR values (p=0.029). Adverse events (AE) occurred in 57.9% (44/76) of patients. Serious AE were reported in 12.8% (10/78), and were related to the presence of hepatic encephalopathy (p=0.027). SVR was associated with improvement in CP (p<0.0001) and MELD scores (p=0.021). Among baseline CP score B patients with SVR, 46% (29/63) regressed to CP score A. Ascites was independently associated with no improvement in liver function in patients who achieved SVR (p=0.001; OR:39.285; 95% CI:4.301-258.832). CONCLUSIONS: Patients with decompensated HCV cirrhosis showed a high SVR rate with interferon-free therapy. Early liver function improvement occurred after successful HCV eradication. However, long-term follow-up of these patients after SVR remains strongly advised.

A saúde mental infantojuvenil sob a ótica de gestores da Atenção Básica à Saúde: possibilidades e desafios / Child and adolescent mental health from the perspective of Primary Health Care managers: possibilities and challenges

Resumo Este estudo objetivou identificar a compreensão de gestores de Unidades de Saúde da Família de municípios que não contam com CAPSij (Centro de Atenção Psicossocial Infanto-juvenil), sobre saúde mental infantojuvenil, assim como a sua percepção sobre o entendimento que as equipes têm da saúde mental infantojuvenil. Trata-se de pesquisa descritivo-exploratória de caráter qualitativo, aportada no referencial teórico das Políticas Públicas de Saúde, Saúde Mental, Atenção Psicossocial para Infância e Adolescência e Atenção Básica (ABS). Participaram 21 profissionais da ABS, gestores de Unidades de Saúde da Família vinculadas a três municípios do Estado de São Paulo, de diferentes dimensões. Os participantes concederam entrevistas a partir de roteiros semiestruturados. As entrevistas foram gravadas, transcritas e analisadas com a técnica do Discurso do Sujeito Coletivo (DSC). Os resultados indicaram, entre outros: (a) a crença dos participantes de que as experiências familiares, econômicas e sociais vivenciadas por crianças e adolescentes em seus contextos de vida têm impacto direto em sua saúde mental; (b) a não identificação de casos de saúde mental infantojuvenil pelos gestores das Unidades participantes; (c) a percepção divergente dos gestores quanto à compreensão das equipes sobre saúde mental infantojuvenil. Com base nos resultados, sinaliza-se que o fortalecimento das estratégias de matriciamento e/ou formação continuada, se planejados de forma contextualizada em função dos territórios, podem ser efetivos para apoiar as ações de cuidado em saúde mental na ABS para aqueles municípios com menos recursos humanos e institucionais.

Abstract This study aimed to identify the understanding of managers of family health units that do not count on CAPSij (Child and Youth Psychosocial Care Center), about child and adolescent mental health, and their perception of the understanding of the team about child and adolescent mental health. This is qualitative descriptive-exploratory research, based on the theoretical reference of Public Health Policies, Mental Health, Psychosocial Care for Children and Adolescents, and Primary Health Care (PHC). Twenty-one Primary Care professionals participated, who were managers of Family Health Units linked to three municipalities in the State of São Paulo, of different dimensions. Participants were interviewed based on semi-structured scripts. The interviews were recorded, transcribed, and analyzed with a technique of the Collective Subject Discourse (CSD). Some of the results showed: (a) the belief of the participants that the family, economic and social experiences of children and adolescents in their life contexts directly affected their mental health; (b) the failure to identify cases of child and adolescent mental health by the managers of the participating units; (c) managers' divergent perception of the team's understanding of the child and adolescent mental health. Based on the results, it is suggested that if the strengthening of matriculation and/or continuing education strategies are planned in a contextualized way according to the territories can be effective to support mental health care actions in PHC for those municipalities with less human and institutional resources.

Giant serous adenofibroma of the fallopian tube.

Serous adenofibroma of the fallopian tube is a rare, benign tumour of the female genital tract. They are usually small, asymptomatic and incidentally diagnosed during a surgery for another gynaecological condition. This report presents an atypical case of a 17-year-old girl with a tubal serous adenofibroma that presented with a palpable mass occupying the entire abdomen accompanied by urinary symptoms. She underwent a laparoscopic surgery with drainage of 1800 mL of yellow, citrine liquid from the cyst and left salpingectomy with no complications.

Development of novel Ti-Mo-Mn alloys for biomedical applications.

Due to excellent biocompatibility and corrosion resistance, the application of titanium alloys in orthopedic and dental implants has been increasing since the 1970s. However, the elasticity of these alloys as measured by their Young's modulus is still about two to four times higher than that of human cortical bone. The most widely used titanium alloy for biomedical applications is Ti-6Al-4V, however, previous studies have shown that the vanadium used in this alloy causes allergic reactions in human tissue and aluminum, also used in the alloy, has been associated with neurological disorders. To solve this problem, new titanium alloys without the presence of these elements and with the addition of different elements, usually beta-stabilizers, are being developed. Manganese is a strong candidate as an alloying element for the development of new beta-type titanium alloys, due to its abundance and low cytotoxicity. In this study, Ti-10Mo-5Mn, Ti-15Mo-2.5Mn and Ti-15Mo-5Mn alloys were prepared in an arc furnace, which resulted in an alloy structure clearly showing the predominance of the beta phase with a body-centered cubic crystalline structure. The observed microstructure confirmed the results on the structural characterization of alloys. Measurement of the indirect cytotoxicity of the alloys showed that the extracts of the studied alloys are not cytotoxic for fibroblastic cells.

Análise eletromiográfica dos músculos tibial anterior e sóleo em pacientes hemiparéticos nos ambientes aquático e terrestre / Electromyographic analysis of the anterior tibialis and soleus muscle in hemiparetic patients in the aquatic and land environment

O objetivo deste trabalho foi verificar a ativação dos músculos tibial anterior e sóleo em pacientes hemiparéticos e indivíduos hígidos, em bipedestação no ambiente aquático em comparação ao solo e verificar se há correlação entre ativação muscular e medidas funcionais. Trata-se de um estudo transversal, no qual foram incluídos 6 indivíduos hígidos no grupo controle (GC) e 6 hemiparéticos no grupo estudo (GE). Os participantes foram caracterizados por meio dos instrumentos Mini-Exame do Estado Mental (MEEM), Escala de Equilíbrio de Berg (EEB), Medida da Independência Funcional (MIF) e eletromiografia (EMG) de superfície dos músculos tibial anterior e sóleo em diferentes posturas de bipedestação, nos ambientes terrestre e aquático em dois níveis de imersão, sendo eles processo xifoide (PX) e crista ilíaca ântero superior (CIAS). Como resultados, o GE obteve pontuação média de 24±6,7 no MEEM, sem perdas cognitivas, 80,8±2,7 na MIF, com dependência modificada e independência completa e 48,5±7,1 na EEB, sem riscos de quedas. A EMG evidenciou maior ativação do músculo sóleo no GE quando comparado ao GC, bem como maior ativação no lado hemiparético quando comparado ao lado não afetado. Constatou-se uma correlação inversamente proporcional entre a EMG e a EEB no GE. Com esse estudo foi possível compreender o comportamento dos músculos tibial anterior e sóleo de indivíduos hemiparéticos no ambiente aquático quando comparado ao solo, em posturas comumente utilizadas na reabilitação aquática. Esse melhor entendimento pode possibilitar uma intervenção mais adequada, com repercussões na prática clínica e de atividade física realizadas no ambiente aquático com indivíduos hemiparéticos....(AU)

The purpose of this present trial was to evaluate the activation of the tibialis anterior and soleus muscles in hemiparetics and health individuals, in a standing position performed in aquatic environment and compared to activation of this muscles on the land and verify if there is correlation between muscular activation and functional measures. In this cross-sectional study were included six health individuals in the control group (CG) and six hemiparetics individuals in the experimental group (EG). Participants were characterized by Mini Mental State Exam (MMSE), Berg Balance Scale (BBS), Functional Independence Measure (FIM) and surface electromyography (EMG) of the tibialis anterior and soleus muscles in different stand positions in aquatic environment and on the land in a two-step immersion to the xiphoid process and anterior superior iliac spine. As a result, the EG obtained a mean score of 24 ± 6.7 in the MMSE, without cognitive losses, 80.8 ± 2.7 in the FIM, with modified dependence and complete independence, and 48.5 ± 7.1 in BBE, without risks of falls. The surface EMG showed greater activation of the soleus muscle in the EG when compared to the CG, as well as greater activation on the hemiparetic side when compared to the unaffected side. An inverse proportional relationship between surface EMG and BBE in the EG was found. With this study it was possible to understand the behavior of the tibialis anterior and soleus muscles in hemiparetic individuals in the aquatic environment when compared to land, in postures commonly used in aquatic rehabilitation. This better understanding may allow a more adequate intervention, with repercussions in clinical practice and physical activity performed in the aquatic environment with hemiparetic individuals....(AU)

Adesão aos equipamentos de proteção individual entre trabalhadores de saúde que sofreram acidentes com material biológico / Adherence to standard precautions among health care workers exposed to accidents with biological material

Objetive:To analyze the adhesion to Individual Protection Equipment among health workers who have suffered accidents with biological material. Method:This is a retrospective, quantitative epidemiological study carried out in a hospital of medium complexity between October 2010 and December 2013. Results:The inadequacy of the use of the Individual Protection Equipment during the procedure was more prevalent in people aged up to 29 years-old and inprofessionals of the nursing team. Misuse of equipment was also more prevalent among people who suffered accidents during invasive and bloody procedures. Conclusion:The low adherence or inadequacy of the use of Personal Protective Equipment has been observed and can be linked to both individual and related aspects of employers' institutions.

Objetivo: Analisar a adesão aos Equipamentos de Proteção Individual entre trabalhadores de saúde que sofreram acidentes com material biológico. Método: Trata-se de um estudo epidemiológico, retrospectivo, quantitativo, realizado em um hospital de média complexidade, no período de outubro de 2010 a dezembro de 2013. Resultados: A inadequação do uso dos Equipamentos de Proteção Individual durante a realização do procedimento foi mais prevalente em pessoas com idade até 29 anos e em profissionais da equipe de enfermagem. O uso incorreto dos equipamentos também foi mais prevalente entre as pessoas que sofreram acidentes durante os procedimentos invasivos e com sangue. Conclusão: A baixa adesão ou a inadequação na utilização dos Equipamentos de Proteção Individual foi observada e pode estar vinculada tanto a aspectos individuais como a relacionados as instituições empregadoras.

Mental health care practices in Primary Health Care: identifying researches in the brazilian context / Práticas de cuidado em saúde mental na Atenção Básica: identificando pesquisas no contexto brasileiro

Abstract Introduction: National and international debates point to the importance and necessity of mental health care in primary health care and discuss the main challenges and propositions. Objective: The aim of the present study was to identify and analyze what has been produced in the national scientific literature on mental health care practices in primary health care from a systematic literature review. Method: The review was carried out in the Latin American and Caribbean Literature in Health Sciences database (LILACS), of which 19 articles were eligible to be included in the study, according to the inclusion criteria adopted. Results: Six themes that were most frequently addressed in studies were identified: professional training and qualification; Biomedical model, medicalizing and excluding; Specialty of care; User, family and support network; Powers in the territory; Possibilities and challenges. From the results presented, the difficulties that permeate the care practices in Mental Health in Primary Health Care offered to users in psychological distress are evident. Conclusion: These results, in addition to causing concern, reveal the need for investment in effective and comprehensive care practices, supported by Mental Health and Primary Health Care Public Policies.

Resumo Introdução: Debates nacionais e internacionais apontam para a importância e necessidade de um cuidado em saúde mental na atenção básica e discutem os principais desafios e proposições. Objetivo: O presente estudo tem por objetivo identificar e analisar o que tem sido produzido na literatura científica nacional sobre as práticas de cuidado em saúde mental na atenção básica à saúde, de acordo com uma revisão integrativa de literatura. Método: A revisão foi realizada na base de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), tendo 19 artigos sido elegíveis para integrar o estudo, conforme os critérios de inclusão adotados. Resultados: Identificaram-se seis temáticas abordadas com mais frequência nos estudos: formação e capacitação profissional; modelo biomédico, medicalizante e excludente; especialidade do cuidado; usuário, família e rede de apoio; potencias-práticas no território; possibilidades e desafios. Com base nos resultados apresentados, evidenciaram-se as dificuldades que permeiam as práticas de cuidado em Saúde Mental na Atenção Básica oferecidas ao usuário em sofrimento psíquico. Conclusão: Tais resultados, além de causarem preocupação, revelam a necessidade de investimento em práticas de cuidado efetivas e integrais, respaldadas pelas Políticas Públicas de Saúde Mental e de Atenção Básica.

Multiple hepatic metastases of cardiac angiosarcoma

The differential diagnosis of hepatic focal lesions is challenging because the etiology can be inflammatory, infectious, and even neoplastic. A rare cause of metastatic liver nodules is cardiac angiosarcoma. We report a case of this tumor, which was diagnosed only after autopsy. A 26-year-old Caucasian man was admitted for progressive dyspnea and cough over the past 3 weeks. Physical examination showed only hypophonetic heart sounds. Laboratory analysis demonstrated anemia and elevated inflammatory markers, despite normal biochemical parameters and liver function. Transthoracic echocardiography revealed massive pericardial effusion. Abdomen computed tomography (CT) showed multiple hepatic nodules, the largest of which measured 3 cm, but the percutaneous biopsy revealed only lobular necrosis and perisinusoidal fibrosis without granulomas or neoplastic cells. During hospitalization, the patient had fever and night sweats with weight loss, and empiric treatment for extrapulmonary tuberculosis associated with corticosteroids was initiated. The outpatient follow-up revealed complete improvement of the pericardial effusion, but maintenance of the liver lesions. After 2 months of hospital discharge, the patient was readmitted with hemorrhagic shock due to bleeding liver lesions, which were evidenced by CT. Embolization of the right hepatic artery was performed, but the patient soon died. The autopsy revealed a primary cardiac angiosarcoma with multiple hepatic metastases, rupture of the Glisson's capsule and laceration of the liver. The case shows how important and difficult the diagnosis of focal liver lesions is, since it may result in an unexpected fatal outcome.

Effect of Feeding Bacillus subtilis Spores to Broilers Challenged with Salmonella enterica serovar Heidelberg Brazilian Strain UFPR1 on Performance, Immune Response, and Gut Health.

Salmonellosis is a poultry industry and public health concern worldwide. Recently, Salmonella enterica serovar Heidelberg (SH) has been reported in broilers in Brazil. The effect of feeding a blend of three strains of Bacillus subtilis (PRO) was studied in broilers orally challenged (107 CFU/chick) or not with a SH isolated in south of Brazil (UFPR1 strain). Twelve male Cobb 500 broilers per pen were randomly assigned to six treatments in a 3 × 2 factorial experiment where PRO was added at 0, 250, or 500 g/ton of broiler feed and fed to either SH-challenged (SH Control, SH + PRO 250, and SH + PRO 500) or non-challenged birds (Control, PRO 250, and PRO 500). Broiler performance, histologic alterations in intestinal morphology, Salmonella quantification and immune cells counts in liver (macrophages, T CD4+ and T CD8+) were analyzed. Changes in the intestinal microbiota of broilers were also studied by metagenomics for Control, SH Control, SH + PRO 250, and SH + PRO 500 only. Feeding PRO at 250 or 500 g/ton reduced SH counts and incidence in liver and cecum at 21 days of age. It was observed that PRO groups increased the macrophage mobilization to the liver in SH-challenged birds (P < 0.05) but reduced these cells in the liver of non-challenged birds, showing an interesting immune cell dynamics effect. PRO at 250 g/ton did not affect gut histology, but improved animal performance (P < 0.05) while PRO at 500/ton did not affect animal performance but increased histologic alteration related to activation of the defense response in the ileum in SH challenged birds compared to control birds (P < 0.05). SH + PRO 500 group presented a more diverse cecal microbiota (Shannon-Wiener index; P < 0.05) compared to Control and SH Control groups; while SH + PRO 250 had greater ileal richness (JackkNife index) compared to Control (P < 0.05). PRO was effective in reducing Salmonella colonization in liver and cecum when fed at 250 or 500 g/ton to broilers inoculated with SH strain UFPR1. PRO promotes positive alterations in performance (at 250 g/ton), immune modulatory effect in the gastrointestinal tract, SH reduction, and intestinal microbiota modulation.

Hand strength in patients with RA correlates strongly with function but not with activity of disease.

BACKGROUND: Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by chronic inflammation of the joints, especially of the hands. The evaluation of handgrip strength (HS) and pinch strength can be useful to detect reduction in hand function in RA patients. The aim of the study was to compare HS and pinch strength between RA patients (RA Group - RAG) and a non-RA control group (CG) and to relate HS and pinch strength to functional capacity, duration and disease activity in the RAG. METHODS: A cross-sectional case control study. The RAG was assessed for disease activity by the Disease Activity Score (DAS-28); for functional capacity by the Health Assessment Questionnaire (HAQ), the Cochin Hand Functional Scale (CHFS) questionnaire, and the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire; and for HS and pinch strength (2-point tip-to-tip, lateral or key, and 3-point) using Jamar® and pinch gauge dynamometers, respectively. Associations were analyzed by Pearson and Spearman tests, and groups were compared by the independent samples t test, with a significance level of P <  0.05. RESULTS: The convenience sample included 121 rheumatoid patients and a control group matched by age, sex, and body mass index. The RAG showed lower strength values compared with the CG in all measurements (P <  0.01, 95% CI) and these values were associated with worse performance in the functional questionnaires and greater disease activity and duration. There was a strong correlation among the functional assessment instruments. CONCLUSIONS: The decrease in grip and pinch strength, easily measured by portable dynamometers, is a strong indicator of functional disability in RA patients.