Epidemiological profile of hospitalized human metapneumovirus in a capital of central-west of Brazil from 2017 to 2019: high lethality at extremes of age

Human metapneumovirus (hMPV) is a paramyxovirus that causes airway infections. hMPV symptoms range from mild infections of the upper respiratory tract to infections as serious as bronchiolitis and pneumonia. From 2018 to 2019, there was a high incidence of severe acute respiratory syndrome (SARS) in the State of Goiás with a relative increase in hMPV incidence. This study aimed to assess the hMPV epidemiology of cases treated at tertiary hospitals of Goiás, as there are not significant published data from hMPV infection in Brazil. We performed a retrospective and descriptive analysis of a case series of patients infected with hMPV diagnosed by PCR (16 individuals), through medical records review from 2017 to 2019. The observed age distribution was bimodal, with the disease affecting individuals at extremes of age (median of 3.5 years old in the first stratum and median of 52 years in the second stratum). The time between the onset of flu-like symptoms and the first medical assessment had an average of 5 days. The most frequent severe symptoms were respiratory distress/dyspnea and oxygen saturation <95% (93.7% as media), even in patients without comorbidities. The most frequent complications were acute renal failure (18.7%) and healthcare-associated infections (43.7%). Death occurred in 37.5% of patients. hMPV may cause upper and lower respiratory tract infections in patients of all age groups, but the symptomatic disease occurs more frequently at extremes of age. In the pandemic caused by a new coronavirus (SARS-CoV-2), which is known to lead to influenza-like and SARS, the differential diagnosis of the etiologic agent becomes paramount.

Hypothalamic-pituitary-adrenal axis responsivity to an acute novel stress in female rats subjected to the chronic mild stress paradigm.

The chronic mild stress (CMS) paradigm is the most frequently investigated animal model for major depression. The hypothalamic-pituitary-adrenal (HPA) axis participates in the generation of depressive symptomatology. We examined whether the depression-like state induced by CMS is associated with immediate changes in HPA axis activation in response to a novel acute stress and whether this response could be modified by hormonal status. Adult female Wistar rats were ovariectomized and received estrogen or vehicle pellets. After 2 weeks, rats were subjected to CMS (or control) conditions for 2.5 or 4.5 weeks. Rats were subsequently subjected to restraint stress for 1 h, and plasma corticosterone (CT) levels were determined before (2:00 p.m.) and after acute stress induction (3:00 and 4:00 p.m.). CT levels and FOS expression were measured in the medial parvocellular subdivision of the PVN (PaMP), central (CeA) and medial amygdala (MeA) and ventral subiculum of the hippocampus (vSub). Plasma CT levels in animals treated with 6.5 weeks of estrogen were elevated before and 1 h after restraint stress induction. Results indicate that the estrogen chronicity and CMS exposure impacted CT secretion. Neuronal PaMP, CeA, MeA and vSub activity decreased after 4.5 weeks of CMS in all groups. No differences were detected between CMS and non-CMS groups. These data suggest that the HPA central hyporesponsiveness observed in the experimental groups subjected to a longer protocol period was independent to CMS paradigm and estrogen treatment restored partially its activity. These data suggest that additional stressors could be responsible for the observed alterations of the HPA axis.

Percepções de alunos de medicina sobre marketing médico / Undergraduate medical student's perceptions regarding professional marketing

INTRODUÇÃO: Marketing médico é um assunto controverso, principalmente no que concerne a princípios éticos. Portanto, frente à competição acirrada de mercado, é necessário o preparo profissional. Conhecer a percepção dos alunos de Medicina pode auxiliar na estruturação de alternativas de capacitação. METODOLOGIA: Inicialmente, identificaram-se crenças sobre marketing médico através de grupo focal composto por 12 alunos. Com base nesses dados, dez afirmações para avaliar atitudes foram aplicadas aos alunos de uma Faculdade de Medicina pública brasileira. RESULTADOS: Observou-se falta de clareza sobre o conceito de marketing, preocupação com princípios éticos e necessidade de marketing no mercado competitivo. Na fase de aplicação, foram obtidas 280 respostas de diversos estágios do curso. Apenas 16,8% admitiram contato com o tema. Houve clareza sobre ética em relação ao paciente, influenciada positivamente pela progressão no curso, mas houve divergência na ética entre profissionais. CONCLUSÕES: Marketing médico é uma área pouco compreendida e relegada ao currículo oculto, sendo influenciada por transposições inadequadas de métodos didáticos destinados à comunicação profissional para a população leiga. Novos métodos de ensino, como a educação tutorial, podem ser uma alternativa para lidar com essas situações.

BACKGROUND: Professional marketing is a controversial topic, mainly regarding ethical principles. Therefore, increasing market competion turns professional capacitation mandatory. To know under graduation medical student's perceptions could help to develop educational alternatives to face this problem. METODOLOGY: First, professional marketing believes were identified through focus group methodology including twelve students. Based on these results, ten affirmatives were constructed to evaluate attitudes and applied to the students of a Brazilian public medicine school. RESULTS: It was observed lack of a clear definition of marketing, preoccupation regarding ethical principles and need to employ marketing strategies in a competitive market. At the survey stage, 280 answers from different stages of the course were obtained. Only 16.8% admitted to have had previous contact with the topic. Clear ethical standards for medical-patient relationship were determined, increasing with course progression. However inter-professional ethical principles was more subject to confusion. CONCLUSION: Professional marketing is poorly understood and it is relegated to the occult curricula, being influenced by didactic methods inadequately transposed for marketing strategies. Newer educational methods, like mentoring, could be an alternative to deal with these situations.Tutoria.