Frequency of skin diseases in renal transplant recipients and patients with chronic kidney disease in a tertiary center: a cross-sectional study.

BACKGROUND: The prevalence of chronic kidney disease (CKD) has increased in the recent decades, along with the number of patients in the terminal stages of this disease, requiring transplantation. Some skin disorders are more frequent in patients with CKD and in renal transplant recipients (RTR). OBJECTIVES: To evaluate the frequency of skin diseases in RTR and patients with CKD receiving conservative treatment. DESIGN AND SETTING: This observational cross-sectional study recruited consecutive patients with CKD and RTR from a nephrology clinic at a teaching hospital in Brazil between 2015 and 2020. METHODS: Quantitative, descriptive, and analytical approaches were used. The sample was selected based on convenience sampling. Data were collected from dermatological visits and participants' medical records. RESULTS: Overall, 308 participants were included: 206 RTR (66.9%, median age: 48 years, interquartile range [IQR] 38.0-56.0, 63.6% men) and 102 patients with CKD (33.1%, median age: 61.0 years, IQR 50.0-71.2, 48% men). The frequency of infectious skin diseases (39.3% vs. 21.6% P = 0.002) were higher in RTR than in patients with CKD. Neoplastic skin lesions were present in nine (4.4%) RTR and in only one (1.0%) patient with CKD. Among the RTR, the ratio of basal cell carcinoma to squamous cell carcinoma was 2:1. CONCLUSIONS: This study revealed that an increased frequency of infectious skin diseases may be expected in patients who have undergone kidney transplantation. Among skin cancers, BCC is more frequently observed in RTR, especially in those using azathioprine.

Different profiles of chemokines, cytokines and cell growth factors in plasma samples from patients with leprosy, leprosy reactions and households contacts.

BACKGROUND: Leprosy is a highly neglected disease that is considered a serious public health problem in many countries. This illness is characterised by a variety of clinical and histopathological manifestations that are related to the patient immune response. OBJECTIVES: This work aimed evaluate the profile of circulating immune mediators in the plasma from patients classified clinically as paucibacillary (PB), multibacillary (MB), households contacts (HHC), type1 leprosy reaction (T1R), type2 leprosy reaction (T2R) and control individuals without medical history of leprosy (CTL). METHODS: To assessment of the plasma immune mediators was used multiplex microbeads immunoassay "Luminex". FINDINGS: The results showed that patients (PB) had a regulatory-biased profile, while MB revealed a pro-inflammatory trend of highly expressed biomarkers. HHC display conspicuously increased levels in the plasma of the chemokines (CCL2, CCL3, CCL4, CCL5 and CXCL8), pro-inflammatory cytokines (IFN-γ,TNF and IL-1ß), modulating cytokines (IL-9 and IL-1Ra) and growth factors (PDGF, G-CSF and IL-2). Interestingly, HHC displayed superior production of IFN-γ as compared to other leprosy groups, indicating a putative protective role for this cytokine during chronic Mycobacterium leprae exposure. MAIN CONCLUSION: Further investigations are currently underway to elucidate the potential of these mediators as biomarkers applicable to the diagnosis/prognosis of leprosy and also T1R and T2R leprosy reactions.

Epidemiological and clinical study of cases of endemic pemphigus foliaceus and pemphigus vulgaris in a reference center in the state of Minas Gerais, Brazil

Abstract Background: Pemphigus constitutes a group of autoimmune bullous diseases. A reduction in the incidence of endemic pemphigus foliaceus and an increase in pemphigus vulgaris has been described, but there are no studies in Minas Gerais that address the subject. Objective: To describe the epidemiological and clinical profile of patients with pemphigus treated at the Dermatology Service of a public University Hospital in the state of Minas Gerais, Brazil. Methods: An observational, descriptive, and cross-sectional study was carried out of cases of endemic pemphigus foliaceus and pemphigus vulgaris, for a period of six months. A questionnaire was filled out with epidemiological and clinical data on the disease. Results: A total of 122 patients were included in the study, 64 with endemic pemphigus foliaceus and 58 with pemphigus vulgaris. When comparing patients with endemic pemphigus foliaceus and those with pemphigus vulgaris, a statistical difference was observed between the median age of initial disease manifestation (p = 0.001), patient occupation (p = 0.010), area of residence (p = 0.000), forests (p = 0.000) and rivers/streams close to the dwelling (p = 0.001) and the number of systemic medications required to control the disease (p = 0.002). When comparing patients with endemic pemphigus foliaceus to those evaluated in a study carried out at the same service in 2008, there was a statistical difference in the area of residence (p = 0.030). Study limitations: The assessed population comes from a tertiary care service that is not a reference for the entire state. Conclusions: Patients with endemic pemphigus foliaceus and pemphigus vulgaris maintain statistically significant differences regarding their main variables in the literature, such as age and area of residence. Historically, there has been a reduction in cases of endemic pemphigus foliaceus and an increase in cases of pemphigus vulgaris in this population.

Epidemiological and clinical study of cases of endemic pemphigus foliaceus and pemphigus vulgaris in a reference center in the state of Minas Gerais, Brazil.

BACKGROUND: Pemphigus constitutes a group of autoimmune bullous diseases. A reduction in the incidence of endemic pemphigus foliaceus and an increase in pemphigus vulgaris has been described, but there are no studies in Minas Gerais that address the subject. OBJECTIVE: To describe the epidemiological and clinical profile of patients with pemphigus treated at the Dermatology Service of a public University Hospital in the state of Minas Gerais, Brazil. METHODS: An observational, descriptive, and cross-sectional study was carried out of cases of endemic pemphigus foliaceus and pemphigus vulgaris, for a period of six months. A questionnaire was filled out with epidemiological and clinical data on the disease. RESULTS: A total of 122 patients were included in the study, 64 with endemic pemphigus foliaceus and 58 with pemphigus vulgaris. When comparing patients with endemic pemphigus foliaceus and those with pemphigus vulgaris, a statistical difference was observed between the median age of initial disease manifestation (p = 0.001), patient occupation (p = 0.010), area of residence (p = 0.000), forests (p = 0.000) and rivers/streams close to the dwelling (p = 0.001) and the number of systemic medications required to control the disease (p = 0.002). When comparing patients with endemic pemphigus foliaceus to those evaluated in a study carried out at the same service in 2008, there was a statistical difference in the area of residence (p = 0.030). STUDY LIMITATIONS: The assessed population comes from a tertiary care service that is not a reference for the entire state. CONCLUSIONS: Patients with endemic pemphigus foliaceus and pemphigus vulgaris maintain statistically significant differences regarding their main variables in the literature, such as age and area of residence. Historically, there has been a reduction in cases of endemic pemphigus foliaceus and an increase in cases of pemphigus vulgaris in this population.

Different profiles of chemokines, cytokines and cell growth factors in plasma samples from patients with leprosy, leprosy reactions and households contacts

BACKGROUND Leprosy is a highly neglected disease that is considered a serious public health problem in many countries. This illness is characterised by a variety of clinical and histopathological manifestations that are related to the patient immune response. OBJECTIVES This work aimed evaluate the profile of circulating immune mediators in the plasma from patients classified clinically as paucibacillary (PB), multibacillary (MB), households contacts (HHC), type1 leprosy reaction (T1R), type2 leprosy reaction (T2R) and control individuals without medical history of leprosy (CTL). METHODS To assessment of the plasma immune mediators was used multiplex microbeads immunoassay "Luminex". FINDINGS The results showed that patients (PB) had a regulatory-biased profile, while MB revealed a pro-inflammatory trend of highly expressed biomarkers. HHC display conspicuously increased levels in the plasma of the chemokines (CCL2, CCL3, CCL4, CCL5 and CXCL8), pro-inflammatory cytokines (IFN-γ,TNF and IL-1β), modulating cytokines (IL-9 and IL-1Ra) and growth factors (PDGF, G-CSF and IL-2). Interestingly, HHC displayed superior production of IFN-γ as compared to other leprosy groups, indicating a putative protective role for this cytokine during chronic Mycobacterium leprae exposure. MAIN CONCLUSION Further investigations are currently underway to elucidate the potential of these mediators as biomarkers applicable to the diagnosis/prognosis of leprosy and also T1R and T2R leprosy reactions.

Frequency of skin diseases in renal transplant recipients and patients with chronic kidney disease in a tertiary center: a cross-sectional study

ABSTRACT BACKGROUND: The prevalence of chronic kidney disease (CKD) has increased in the recent decades, along with the number of patients in the terminal stages of this disease, requiring transplantation. Some skin disorders are more frequent in patients with CKD and in renal transplant recipients (RTR). OBJECTIVES: To evaluate the frequency of skin diseases in RTR and patients with CKD receiving conservative treatment. DESIGN AND SETTING: This observational cross-sectional study recruited consecutive patients with CKD and RTR from a nephrology clinic at a teaching hospital in Brazil between 2015 and 2020. METHODS: Quantitative, descriptive, and analytical approaches were used. The sample was selected based on convenience sampling. Data were collected from dermatological visits and participants' medical records. RESULTS: Overall, 308 participants were included: 206 RTR (66.9%, median age: 48 years, interquartile range [IQR] 38.0-56.0, 63.6% men) and 102 patients with CKD (33.1%, median age: 61.0 years, IQR 50.0-71.2, 48% men). The frequency of infectious skin diseases (39.3% vs. 21.6% P = 0.002) were higher in RTR than in patients with CKD. Neoplastic skin lesions were present in nine (4.4%) RTR and in only one (1.0%) patient with CKD. Among the RTR, the ratio of basal cell carcinoma to squamous cell carcinoma was 2:1. CONCLUSIONS: This study revealed that an increased frequency of infectious skin diseases may be expected in patients who have undergone kidney transplantation. Among skin cancers, BCC is more frequently observed in RTR, especially in those using azathioprine.

From wet nurses to orphaned mothers: reflections on the right to maternity in Brazil. / Das amas de leite às mães órfãs: reflexões sobre o direito à maternidade no Brasil.

This article addresses the compulsory seizing of children from vulnerable women in Brazil. Its objectives were: to discuss the violation of the right to maternity; to present the imposed restrictions especially on poor, black and indigenous women; the strategic control over their lives and children, and the resistance movements that oppose segregation. The sources of the research were: narratives of women in vulnerable situations, family members and health workers; interviews with strategic actors; document analysis; field journal. It became evident that vulnerabilities -linked to the criminalization of poverty and racial prejudice- have justified these separations. The lack of responsibility that State and society practice towards the support network for women, the devaluation of non-hegemonic productions of maternity, and the reinforcement of a 'reason of the world', that produces violence as a tool for exclusion establishing practical limits on the right to maternity. Women and children are disregarded in their singularities. Resistance movements have shown that intersectoral dialogues are an alternative to overcome discrimination and vulnerabilities.

O artigo aborda a retirada compulsória de filhos de mulheres em situação de vulnerabilidade no Brasil. Objetivou-se refletir sobre a violação do direito à maternidade; apresentar os limites impostos, especialmente às mulheres pobres, negras e indígenas e as estratégias de controle sobre sua vida e de seus filhos; e os movimentos de resistência que se contrapõem às segregações. Foram fontes da pesquisa: narrativas de mulheres em situação de vulnerabilidade, de familiares e trabalhadores da saúde; entrevistas com atores estratégicos; análise documental; diários de campo. Evidenciou-se que vulnerabilidades atreladas à criminalização da pobreza e ao preconceito racial têm justificado as separações. A desresponsabilização do Estado e da sociedade quanto à formação de uma rede de apoio às mulheres, a desvalorização de produções não hegemônicas de maternidades e o reforço de uma razão de mundo que produz a violência como ferramenta para exclusão vão conformando limites práticos quanto ao direito à maternidade. Mulheres e seus filhos são desconsiderados em suas singularidades. Os movimentos de resistência mostraram que diálogos intersetoriais são uma alternativa para superar discriminações e vulnerabilidades.

Das amas de leite às mães órfãs: reflexões sobre o direito à maternidade no Brasil / From wet nurses to orphaned mothers: reflections on the right to maternity in Brazil

Resumo O artigo aborda a retirada compulsória de filhos de mulheres em situação de vulnerabilidade no Brasil. Objetivou-se refletir sobre a violação do direito à maternidade; apresentar os limites impostos, especialmente às mulheres pobres, negras e indígenas e as estratégias de controle sobre sua vida e de seus filhos; e os movimentos de resistência que se contrapõem às segregações. Foram fontes da pesquisa: narrativas de mulheres em situação de vulnerabilidade, de familiares e trabalhadores da saúde; entrevistas com atores estratégicos; análise documental; diários de campo. Evidenciou-se que vulnerabilidades atreladas à criminalização da pobreza e ao preconceito racial têm justificado as separações. A desresponsabilização do Estado e da sociedade quanto à formação de uma rede de apoio às mulheres, a desvalorização de produções não hegemônicas de maternidades e o reforço de uma razão de mundo que produz a violência como ferramenta para exclusão vão conformando limites práticos quanto ao direito à maternidade. Mulheres e seus filhos são desconsiderados em suas singularidades. Os movimentos de resistência mostraram que diálogos intersetoriais são uma alternativa para superar discriminações e vulnerabilidades.

Abstract This article addresses the compulsory seizing of children from vulnerable women in Brazil. Its objectives were: to discuss the violation of the right to maternity; to present the imposed restrictions especially on poor, black and indigenous women; the strategic control over their lives and children, and the resistance movements that oppose segregation. The sources of the research were: narratives of women in vulnerable situations, family members and health workers; interviews with strategic actors; document analysis; field journal. It became evident that vulnerabilities -linked to the criminalization of poverty and racial prejudice- have justified these separations. The lack of responsibility that State and society practice towards the support network for women, the devaluation of non-hegemonic productions of maternity, and the reinforcement of a 'reason of the world', that produces violence as a tool for exclusion establishing practical limits on the right to maternity. Women and children are disregarded in their singularities. Resistance movements have shown that intersectoral dialogues are an alternative to overcome discrimination and vulnerabilities.

Update on human papillomavirus - Part II: complementary diagnosis, treatment and prophylaxis.

In this nonsystematic review, the complementary diagnosis, treatment, prevention, and control of human papillomavirus are discussed. The histopathology is addressed regarding its indications, main findings and limitations, as a complementary diagnostic method largely used by dermatologists. Electron microscopy is briefly reviewed, along with its contribution to the accumulated knowledge on HPV, as well as the relevance of research in using this technology for future advances in diagnosis and treatment. Molecular information about the virus is continuously increasing, and the practical applications of HPV serology, molecular identification and genotyping are discussed. Vaccines are a valuable tool in primary HPV infection prevention and are now available in many countries; their composition, indications, and adverse effects are revisited. Local and systemic treatment options are reviewed and off-label prescriptions are discussed. Finally, health education focusing on HPV infection as a sexually transmitted infection of worldwide relevance and the many barriers to improve primary and secondary prevention are addressed.

Update on human papilloma virus - part I: epidemiology, pathogenesis, and clinical spectrum.

Infection with human papilloma virus (HPV) is related to a great number of cutaneous and mucosal manifestations. The spectrum of HPV ranges from inapparent infections, through various clinical benign presentations including cutaneous and mucosal disease, to malignant and premalignant conditions. New HPV types are currently described in the literature; many of them are characterized as high-risk types due to their oncogenic potential. Knowledge regarding their epidemiology and pathogenesis is important to understand not only infection and disease processes, but also to formulate the clinical and laboratory basis for diagnosis, therapeutics, and prophylactic measures. This non-systematic review aims to discuss and to update those aspects, with an emphasis on relevant topics for dermatologists. HPV infection and related diseases in the Brazilian scenario are highlighted, including common dermatologic conditions seen at clinics as well as the condition of a public health problem as a sexually transmitted infection. The oncogenicity of the virus and the variety of clinical outcomes - especially in the immunocompromised individuals - are addressed.

Phenotypic and functional features of innate and adaptive immunity as putative biomarkers for clinical status and leprosy reactions.

The aim of this study was to identify phenotypic and functional biomarkers associated with distinct clinical status of leprosy or leprosy reactions. The study included tuberculoid/borderline (BB/BT/T) and lepromatous (BL/L) leprosy poles as well as Type-1 and Type-2 leprosy reactions along with healthy controls (NI). A range of peripheral blood biomarkers of innate (neutrophils - NEU and monocytes - MON) and adaptive immunity (CD4+ and CD8+ T-cells) were evaluated ex vivo and upon in vitro stimuli with M. leprae antigen. Data analysis allowed the selection of NEUTLR4+ (ex vivo) and CD4+IL-10+ (in vitro) as universal biomarkers increased in all leprosy patients and those exhibiting leprosy reactions. A range of biomarkers were commonly found in both poles of leprosy patients, including decreased levels of MONTGF-ß+ (ex vivo) and increased levels of MONTNF-α+, CD4+TGF-ß+, CD8+TLR2+, CD8+TNF-α+, CD8+IL-4+ and CD8+TGF-ß+ (in vitro). Noteworthy was that MONHLA-DR+ (ex vivo) and CD8+IL-10+ (in vitro) were particularly found in BL/L patients. Leprosy patients with Type-1 reaction exhibited a larger list of altered biomarkers, mainly involving activation markers (TLR2, TLR4, HLA-DR and DAF-2T) in NEU and MON along with CD4+ and CD8+ cells. In summary, this study provided insights about immunological features of leprosy poles and leprosy reactional episodes with putative applicability, including novel biomarkers for complementary diagnosis and future therapeutic approaches in clinical studies.

Lobomycosis: a therapeutic challenge.

Lobomycosis or lacaziosis is a chronic granulomatous fungal infection caused by Lacazia loboi. Most cases are restricted to tropical regions. Transmission is believed to occur through traumatic inoculation in the skin, mainly in exposed areas. It is characterized by keloid-like nodules. There are only a few hundred cases reported. The differential diagnoses include many skin conditions, and treatment is difficult. The reported case, initially diagnosed as keloid, proved to be refractory to surgical treatment alone. It was subsequently approached with extensive surgery, cryotherapy every three months and a combination of itraconazole and clofazimine for two years. No signs of clinical and histopathological activity were detected during follow-up.

Lobomycosis: a therapeutic challenge

Abstract: Lobomycosis or lacaziosis is a chronic granulomatous fungal infection caused by Lacazia loboi. Most cases are restricted to tropical regions. Transmission is believed to occur through traumatic inoculation in the skin, mainly in exposed areas. It is characterized by keloid-like nodules. There are only a few hundred cases reported. The differential diagnoses include many skin conditions, and treatment is difficult. The reported case, initially diagnosed as keloid, proved to be refractory to surgical treatment alone. It was subsequently approached with extensive surgery, cryotherapy every three months and a combination of itraconazole and clofazimine for two years. No signs of clinical and histopathological activity were detected during follow-up.

[ARTIGO RETRATADO] Percepção dos Professores de Medicina de uma Escola Pública Brasileira em relação ao Sofrimento Psíquico de Seus Alunos / [RETRACTED ARTICLE] The Psychological Distress Suffered by Medical Students at a Brazilian Public university from the Viewpoint of their Teachers

RESUMO O sofrimento psíquico do estudante de Medicina é conhecido e já estudado. O papel do professor em detectar dificuldades geradoras de sofrimento psíquico em seus alunos e saber como lidar com elas é fundamental para a prevenção desse sofrimento. Entretanto, nem sempre os professores estão preparados para esses desafios. Objetivo: Estudar a percepção dos docentes do curso de Medicina da Universidade Federal de Minas Gerais (UFMG) em relação ao sofrimento psíquico de seus alunos. Método: Estudo transversal quantitativo realizado com os docentes do ciclo profissional do curso de Medicina da UFMG. A amostra de 102 docentes foi obtida por sorteio aleatório e dividida em quatro estratos: masculino até dez anos de docência, masculino com mais de dez anos, feminino com até dez anos de docência e feminino com mais de dez anos. Foi elaborado um questionário autoaplicativo de 28 itens com cinco opções da escala de Likert. Para análise dos dados foram construídos quatro indicadores: indicador de percepção de sofrimento psíquico (IPSP), indicador de compromisso do professor com as dificuldades emocionais do estudante (ICDE), indicador de atuação frente ao sofrimento psíquico (IAPS) e indicador geral (IG). Realizou-se análise dos quartis e calculou-se a diferença entre os grupos utilizando testes não paramétricos. Cinco questões não incluídas nos indicadores foram analisadas separadamente. Resultados: Dos 102 sorteados, 79 docentes responderam e sete se negaram a participar da pesquisa. Foi constatada preocupação com o sofrimento psíquico dos estudantes, variável entre os estratos. Para o IG, as professoras com mais tempo de docência obtiveram a mediana mais elevada em relação aos homens com menos tempo (p < 0,05). Para os demais indicadores, apesar da diferença entre os quartis, a comparação das medianas não mostrou diferenças estatisticamente significativas. Para as perguntas não incluídas nos indicadores, do total de professores, 85% já tiveram alunos com dificuldades emocionais. Os homens, com maior frequência, afirmaram desconhecer a existência de problemas emocionais entre os estudantes. Houve desconhecimento das instâncias de acolhimento psicólogico aos estudantes por 16,5% dos professores. A ocorrência de bullying na FMUFMG não foi percebida por mais de 50% dos professores. Apenas 28% admitiram que seus atos ou atitudes teriam desencadeado sofrimento psíquico no estudante. Ao se perguntar sobre apoio ao professor, 75,9%desejavam uma instância de apoio emocional ao professor. Conclusão: Este estudo, apesar das limitações, é inédito ao avaliar a percepção do docente do curso de Medicina em relação ao sofrimento psíquico dos estudantes. Tempo de docência e sexo feminino parecem exercer um papel importante na percepção do docente sobre o sofrimento psíquico do estudante. Parcela significativa de professores desconhece a existência das instâncias de apoio psicológico aos estudantes. Situações de assédio e bullying na escola médica permanecem negadas por muitos docentes.

ABSTRACT The psychological distress suffered by medical students is well-known. The role of the teaching staff in detecting difficulties causing students psychological distress and their knowledge of how to handle them is fundamental for preventing such problems. However, medical teachers are not always prepared to deal with these challenges. Objective: To study the perception of the teaching staff of the medical school at the Universidade Federal de Minas Gerais (FMUFMG) concerning the psychological distress of the students. Method: A cross-sectional quantitative study carried out with the faculty of the UFMG medical school. The sample of 102 teachers was obtained by random draw and divided into four groups: males with up to ten (10) years of teaching, males with more than ten (10) years, females with up to ten (10) years of teaching, and females with more than ten (10)years. A self-applied 28-item questionnaire with a 5-point Likert scale from strongly agree to strongly disagree was prepared. For the data analysis four indicators were elaborated: psychological distress perception indicator (IPSP), commitment of the teacher to the student emotional difficulties indicator (ICDE), performance in the face of psychological distress indicator (IAPS) and a general indicator (IG). Quartile analysis was carried out and the difference among the groups was calculated using nonparametric tests. Five questions that were not included in the indicators were independently analyzed. Results: Seven teachers refused to participate and 79 answers were collected.The results showed varying degrees of concern among the groups in relation to the psychological distress of students. For the IG, the female teachers with longer teaching experience obtained a higher median in relation to the men with less teaching experience (p<0.05). For the other indicators, despite the difference between the quartiles, the comparison of the medians showed no statistically significant differences. For questions not included in the indicators, it was shown that 85% of the sample had perceived psychological distress among their students. Male teachers more frequently deny psychological distress among students. 16.5% of the teachers did not know of any instances of institutional psychological care. The occurrence of bullying failed to be noted by more than 50% of the teachers. Only 28% of the teachers admitted that their actions or attitudes could precipitate a student's psychological distress. When questioned about emotional support for teachers, 75.9% would appreciate some institutional support. Conclusion: The present study, despite its limitations, is unique in assessing the perception of the medical teaching staff in relation to the psychological distress of the students. Teaching experience and being female seem to play an important role in the teacher's perception of psychological distress among students. A significant portion of the teaching staff ignores the existence of psychological support programs for students.

Case for diagnosis. Infective dermatitis associated with HTLV-1: differential diagnosis of atopic dermatitis.

Infective dermatitis associated with HTLV-1 (IDH) is the main cutaneous marker of HTLV-1 infection. This disease occurs primarily in children and should be differentiated from other eczemas, especially from atopic dermatitis. The largest series of IDH are from Jamaica and Brazil. There are an estimated 15 to 20 million infected people in the world, and Brazil is one of the endemic regions. Studies suggest that IDH in children may be a marker for the development of T-cell leukemia/lymphoma (ATL) or myelopathy associated with HTLV-1/tropical spastic paraparesis (HAM / TSP) in adulthood.

Percepção dos Professores de Medicina de uma Escola Pública Brasileira em relação ao Sofrimento Psíquico de Seus Alunos / The Psychological Distress Suffered by Medical Students at a Brazilian Public University from the Viewpoint of their Teachers

RESUMO O sofrimento psíquico do estudante de Medicina é conhecido e já estudado. O papel do professor em detectar dificuldades geradoras de sofrimento psíquico em seus alunos e saber como lidar com elas é fundamental para a prevenção desse sofrimento. Entretanto, nem sempre os professores estão preparados para esses desafios. Objetivo: Estudar a percepção dos docentes do curso de Medicina da Universidade Federal de Minas Gerais (UFMG) em relação ao sofrimento psíquico de seus alunos. Método: Estudo transversal quantitativo realizado com os docentes do ciclo profissional do curso de Medicina da UFMG. A amostra de 102 docentes foi obtida por sorteio aleatório e dividida em quatro estratos: masculino até dez anos de docência, masculino com mais de dez anos, feminino com até dez anos de docência e feminino com mais de dez anos. Foi elaborado um questionário autoaplicativo de 28 itens com cinco opções da escala de Likert. Para análise dos dados foram construídos quatro indicadores: indicador de percepção de sofrimento psíquico (IPSP), indicador de compromisso do professor com as dificuldades emocionais do estudante (ICDE), indicador de atuação frente ao sofrimento psíquico (IAPS) e indicador geral (IG). Realizou-se análise dos quartis e calculou-se a diferença entre os grupos utilizando testes não paramétricos. Cinco questões não incluídas nos indicadores foram analisadas separadamente. Resultados: Dos 102 sorteados, 79 docentes responderam e sete se negaram a participar da pesquisa. Foi constatada preocupação com o sofrimento psíquico dos estudantes, variável entre os estratos. Para o IG, as professoras com mais tempo de docência obtiveram a mediana mais elevada em relação aos homens com menos tempo (p<0,05). Para os demais indicadores, apesar da diferença entre os quartis, a comparação das medianas não mostrou diferenças estatisticamente significativas. Para as perguntas não incluídas nos indicadores, do total de professores, 85% já tiveram alunos com dificuldades emocionais. Os homens, com maior frequência, afirmaram desconhecer a existência de problemas emocionais entre os estudantes. Houve desconhecimento das instâncias de acolhimento psicólogico aos estudantes por 16,5% dos professores. A ocorrência de bullying na FMUFMG não foi percebida por mais de 50% dos professores. Apenas 28% admitiram que seus atos ou atitudes teriam desencadeado sofrimento psíquico no estudante. Ao se perguntar sobre apoio ao professor, 75,9% desejavam uma instância de apoio emocional ao professor. Conclusão: Este estudo, apesar das limitações, é inédito ao avaliar a percepção do docente do curso de Medicina em relação ao sofrimento psíquico dos estudantes. Tempo de docência e sexo feminino parecem exercer um papel importante na percepção do docente sobre o sofrimento psíquico do estudante. Parcela significativa de professores desconhece a existência das instâncias de apoio psicológico aos estudantes. Situações de assédio e bullying na escola médica permanecem negadas por muitos docentes.

ABSTRACT The psychological distress suffered by medical students is well-known. The role of the teaching staff in detecting difficulties causing students psychological distress and their knowledge of how to handle them is fundamental for preventing such problems. However, medical teachers are not always prepared to deal with these challenges. Objective: To study the perception of the teaching staff of the medical school at the Universidade Federal de Minas Gerais (FMUFMG) concerning the psychological distress of the students. Method: A cross-sectional quantitative study carried out with the faculty of the UFMG medical school. The sample of 102 teachers was obtained by random draw and divided into four groups: males with up to ten (10) years of teaching, males with more than ten (10) years, females with up to ten (10) years of teaching, and females with more than ten (10)years. A self-applied 28-item questionnaire with a 5-point Likert scale from strongly agree to strongly disagree was prepared. For the data analysis four indicators were elaborated: psychological distress perception indicator (IPSP), commitment of the teacher to the student emotional difficulties indicator (ICDE), performance in the face of psychological distress indicator (IAPS) and a general indicator (IG). Quartile analysis was carried out and the difference among the groups was calculated using nonparametric tests. Five questions that were not included in the indicators were independently analyzed. Results: Seven teachers refused to participate and 79 answers were collected. The results showed varying degrees of concern among the groups in relation to the psychological distress of students. For the IG, the female teachers with longer teaching experience obtained a higher median in relation to the men with less teaching experience (p<0.05). For the other indicators, despite the difference between the quartiles, the comparison of the medians showed no statistically significant differences. For questions not included in the indicators, it was shown that 85% of the sample had perceived psychological distress among their students. Male teachers more frequently deny psychological distress among students. 16.5% of the teachers did not know of any instances of institutional psychological care. The occurrence of bullying failed to be noted by more than 50% of the teachers. Only 28% of the teachers admitted that their actions or attitudes could precipitate a student's psychological distress. When questioned about emotional support for teachers, 75.9% would appreciate some institutional support. Conclusion: The present study, despite its limitations, is unique in assessing the perception of the medical teaching staff in relation to the psychological distress of the students. Teaching experience and being female seem to play an important role in the teacher's perception of psychological distress among students. A significant portion of the teaching staff ignores the existence of psychological support programs for students.

Case for diagnosis. Infective dermatitis associated with HTLV-1: differential diagnosis of atopic dermatitis

Abstract: Infective dermatitis associated with HTLV-1 (IDH) is the main cutaneous marker of HTLV-1 infection. This disease occurs primarily in children and should be differentiated from other eczemas, especially from atopic dermatitis. The largest series of IDH are from Jamaica and Brazil. There are an estimated 15 to 20 million infected people in the world, and Brazil is one of the endemic regions. Studies suggest that IDH in children may be a marker for the development of T-cell leukemia/lymphoma (ATL) or myelopathy associated with HTLV-1/tropical spastic paraparesis (HAM / TSP) in adulthood.

Uniform multidrug therapy for leprosy patients in Brazil (U-MDT/CT-BR): Results of an open label, randomized and controlled clinical trial, among multibacillary patients.

BACKGROUND: Leprosy control is based on early diagnosis and multidrug therapy. For treatment purposes, leprosy patients can be classified as paucibacillary (PB) or multibacillary (MB), according to the number of skin lesions. Studies regarding a uniform treatment regimen (U-MDT) for all leprosy patients have been encouraged by the WHO, rendering disease classification unnecessary. METHODOLOGY AND FINDINGS: An independent, randomized, controlled clinical trial conducted from 2007 to 2015 in Brazil, compared main outcomes (frequency of reactions, bacilloscopic index trend, disability progression and relapse rates) among MB patients treated with a uniform regimen/U-MDT (dapsone+rifampicin+clofazimine for six months) versus WHO regular-MDT/R-MDT (dapsone+rifampicin+clofazimine for 12 months). A total of 613 newly diagnosed, untreated MB patients with high bacterial load were included. There was no statistically significant difference in Kaplan-Meyer survival function regarding reaction or disability progression among patients in the U-MDT and R-MDT groups, with more than 25% disability progression in both groups. The full mixed effects model adjusted for the bacilloscopic index average trend in time showed no statistically significant difference for the regression coefficient in both groups and for interaction variables that included treatment group. During active follow up, four patients in U-MDT group relapsed representing a relapse rate of 2.6 per 1000 patients per year of active follow up (95% CI [0·81, 6·2] per 1000). During passive follow up three patients relapsed in U-MDT and one in R-MTD. As this period corresponds to passive follow up, sensitivity analysis estimated the relapse rate for the entire follow up period between 2·9- and 4·5 per 1000 people per year. CONCLUSION: Our results on the first randomized and controlled study on U-MDT together with the results from three previous studies performed in China, India and Bangladesh, support the hypothesis that UMDT is an acceptable option to be adopted in endemic countries to treat leprosy patients in the field worldwide. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00669643.

Uniform multidrug therapy for leprosy patients in Brazil (U-MDT/CT-BR): results of an open label, randomized and controlled clinical trial, among multibacillary patients

BACKGROUND: Leprosy control is based on early diagnosis and multidrug therapy. For treatment purposes, leprosy patients can be classified as paucibacillary (PB) or multibacillary (MB), according to the number of skin lesions. Studies regarding a uniform treatment regimen (U-MDT) for all leprosy patients have been encouraged by the WHO, rendering disease classification unnecessary. METHODOLOGY AND FINDINGS: An independent, randomized, controlled clinical trial conducted from 2007 to 2015 in Brazil, compared main outcomes (frequency of reactions, bacilloscopic index trend, disability progression and relapse rates) among MB patients treated with a uniform regimen/U-MDT (dapsone+rifampicin+clofazimine for six months) versus WHO regular-MDT/R-MDT (dapsone+rifampicin+clofazimine for 12 months). A total of 613 newly diagnosed, untreated MB patients with high bacterial load were included. There was no statistically significant difference in Kaplan-Meyer survival function regarding reaction or disability progression among patients in the U-MDT and R-MDT groups, with more than 25% disability progression in both groups. The full mixed effects model adjusted for the bacilloscopic index average trend in time showed no statistically significant difference for the regression coefficient in both groups and for interaction variables that included treatment group. During active follow up, four patients in U-MDT group relapsed representing a relapse rate of 2.6 per 1000 patients per year of active follow up (95% CI [0·81, 6·2] per 1000). During passive follow up three patients relapsed in U-MDT and one in R-MTD. As this period corresponds to passive follow up, sensitivity analysis estimated the relapse rate for the entire follow up period between 2·9- and 4·5 per 1000 people per year. CONCLUSION: Our results on the first randomized and controlled study on U-MDT together with the results from three previous studies performed in China, India and Bangladesh, support the hypothesis that UMDT is an acceptable option to be adopted in endemic countries to treat leprosy patients in the field worldwide.

Evaluation of Teaching on Leprosy by Students at a Brazilian Public Medical School / Avaliação do Ensino de Hansenologia pelos Estudantes de uma Escola Médica, Pública, Brasileira

ABSTRACT Objectives To evaluate teaching on leprosy at a public medical school located in a metropolis in southeastern Brazil with a low leprosy prevalence rate. Results An analysis performed by means of a comparative cross-sectional study on two parallel groups of students (freshmen and interns) demonstrated that most students began the medical course with some knowledge of the signs and symptoms of the disease. The interns were shown to have more theoretical knowledge and more favorable attitudes toward the disease compared to the freshmen. Most of the interns stated that the topic had been addressed during the course but that practical teaching was insufficient. Students who had had the opportunity for practical experience with patients were more confident in their ability to attend to similar cases. Conclusion Although from a statistical point of view the results may seem very favorable, the same cannot be said when assessing the situation from the perspective of education and public health, since a large number of final-year medical students have not been provided with basic information on the disease.

RESUMO Objetivo Avaliar o ensino sobre hanseníase numa escola médica localizada em metrópole do Sudeste brasileiro com baixo coeficiente de prevalência para hanseníase. Resultados Em análise realizada, utilizando um estudo comparativo entre dois grupos paralelos de estudantes do curso médico (ingressantes e internos), observou-se que a maioria dos estudantes ingressa no curso com conhecimentos sobre sinais e sintomas da doença. Os internos mostraram maior conhecimento teórico, assim como atitudes mais favoráveis em relação à doença, quando comparados aos ingressantes. A maioria dos internos afirmou que o tema foi abordado durante o curso médico, mas que o ensino prático foi insuficiente. Estudantes que tiveram experiência prática mostraram maior confiança em sua habilidade para atender casos semelhantes. Conclusão Embora do ponto de vista estatístico os resultados possam parecer favoráveis, não se pode afirmar o mesmo sob a perspectiva da educação e da saúde pública, uma vez que grande número de estudantes do último ano não possui informações básicas a respeito da doença.