Whey protein supplementation and its potentially adverse effects on health: a systematic review.

Whey protein comprises soluble whey proteins and its benefits are well described in the literature. However, there are not many studies investigating the potential adverse effect of a diet with indiscriminate use of this supplement. The aim of this study was to perform a systematic review of papers that addressed this theme. A search was conducted in Medline, LILACS, TOXNET, Web of science, and Scopus electronic databases. In the end, 11 documents comprised this review. The majority of the papers associated the damaging effect with the chronic and abusive use of whey protein, with the kidneys and liver being the main organs affected. The other studies related whey protein to aggravation of aggression, presence of acne, and modification of the microbiota. Therefore, excessive consumption over a long period of protein supplementation may have some adverse effects on the body, which is aggravated when associated with sedentary lifestyle. PROSPERO registration no.: CRD42020140466. Novelty: A systematic review of experimental and randomized studies about the use of whey proteins supplements and its impact on physical health. Analysis revealed that chronic and without professional guidance use of whey protein supplementation may cause some adverse effects specially on kidney and liver function. Presented data support a need for future studies co-relating the use of different types of whey protein with and without exercise to better see the impact on human physical health.

O ensino da prática médica no internato em tempo de pandemia: aprendizados e impactos emocionais / Teaching medical practice in clerkships during a pandemic: learning and emotional impacts

Resumo: Introdução: Diante da pandemia ocasionada pelo vírus Sars-CoV-2, diversos profissionais da saúde depararam-se com novos desafios. Estudantes internos de Medicina também se encontram imersos nesse cenário e foram afetados no desempenho de seus papéis. Consiste este trabalho na observação dos aspectos físicos e psíquicos dos estudantes de Medicina que estão no período do internato nessa conjuntura. Objetivo: Desse modo, objetivou-se identificar os aprendizados e os impactos emocionais que os internos estão vivenciando no início de suas inserções no Sistema Único de Saúde diante da pandemia. Método: Para tanto, realizou-se uma análise qualitativa das narrativas de 37 internos de Medicina da Universidade Estadual do Ceará (23 do sexo masculino e 14 do sexo feminino), com média de idade de 25,5 anos, que responderam a um questionário eletrônico que lhes fora enviado como estratégia para auxiliar a coordenação do curso a organizar o internato no contexto pandêmico. Resultado: A relação dos internos com preceptores de Medicina foi destacada como causadora de sofrimento psíquico e carente de aprendizado antes e durante a pandemia. Observou-se a presença constante de sentimentos ambivalentes. Muitos dos internos de Medicina desejavam ajudar reconhecendo a importância de sua contribuição neste momento complexo da saúde no país. Todavia, alguns se sentiam inseguros com a situação crítica decorrente da pandemia, com receios acerca da segurança pessoal e familiar dos internos. Uma das razões pontuada foi a escassez de equipamentos de proteção individual (EPI). Conclusão: Vários internos ressaltaram o interesse em continuar o internato, e, por isso, é fundamental que os EPI estejam disponíveis para uso dos alunos. Diante do contexto de pandemia ou não, é imprescindível que o relacionamento entre preceptores e internos seja mais pedagógico e proporcione aprendizado aos estudantes. A apresentação desta experiência pode servir como recurso para a compreensão de cenários semelhantes, auxiliando a iluminar as relações do internato de Medicina que precisam passar por melhorias contínuas, quer em tempos de pandemia ou não, para favorecer a busca contínua por uma formação acadêmica de qualidade.

Abstract: Introduction: The pandemic caused by the Sars-CoV-2 virus has generated new challenges for numerous health professionals. Clerkship students are also immersed in this scenario and have been affected in the performance of their duties. This work consists of observing the physical and psychological aspects of medical students currently in their clerkship. Objective: Thus, the objective was to identify the learning and emotional impacts that clerkship students are experiencing in their initial placements in the Unified Health System against the backdrop of the pandemic. Method: A qualitative analysis of the accounts given by 37 medical interns at the Universidade Estadual do Ceará (23 men and 14 women; mean age 25.5 years old) was conducted. They answered an electronic questionnaire applied by the course coordination as a strategy to assist in the organization of the clerkship program during the pandemic. Results: The relationship between the clerkship students and medical preceptors was highlighted as causing psychological distress and lack of learning before and during the pandemic. There was a constant presence of ambivalent feelings. Many clerkship students wanted to help, recognizing that they could make an important contribution during this health crisis in the country. However, some felt insecure about the critical situation resulting from the pandemic and feared for the safety of the clerkship students and their respective families. One of the cited reasons was the scarcity of personal protective equipment (PPE). Conclusions: Several clerkship students highlighted the interest in continuing the clerkship program and that is why it is essential that PPE is available for students to use. Whether in the grips of a pandemic or not, it is essential that the relationship between preceptors and clerkship students is more pedagogical and provides learning to students. The presentation of this experience can serve as a resource for the understanding of similar scenarios, helping to shed light on the medical intern's relationships that need to undergo continuous improvements, whether during a pandemic or not, to support the ongoing quest for an academic education of quality.

Factors behind burnout increase in medical students. Are the criteria so important? / Fatores por trás do burnout crescente em estudantes de medicina. Os critérios são tão importantes?

Abstract: Introduction: Medical students' mental health has been a concern to the scientific community, especially as a result of the epidemic of mental comorbidities that have become commonplace among the various social groups in modern society. Objectives: To evaluate the prevalence of Burnout among first- to fourth- year medical students and compare different criteria to define the syndrome. Methods: A total of 511 students from three universities in Brazil answered validated instruments to assess burnout (The Maslach Burnout Inventory) and quality of life (WHOQOL-BREF), and a questionnaire prepared by the authors to assess sociodemographic data Results: There was a prevalence of 31.1% of three-dimensional burnout, 37% of two-dimensional burnout and 44,8% of one-dimensional burnout. There were worse levels of emotional exhaustion among students with two-dimensional burnout, compared to those with only one-dimensional criterion, and worse levels of depersonalization among students with three-dimensional burnout, compared to those with two-dimensional criterion only. The same assessed variables showed correlation with all three criteria. Considering the four domains of quality of life - psychological, physical, environment and social relationships, the psychological and physical domains were the ones that correlated the most to all three aspects of the three-dimensional criteria. Emotional exhaustion was the dimension with the strongest association with three of the four quality of life domains. Conclusions: We question whether the three-dimensional criterion should really be the gold standard to define Burnout.

Resumo: Introdução: A saúde mental dos estudantes de medicina tem sido uma preocupação para a comunidade científica, especialmente como resultado da epidemia de comorbidades mentais que se tornaram comuns entre os vários grupos sociais da sociedade moderna. Objetivos: Este estudo teve como objetivos avaliar a prevalência de burnout em estudantes do primeiro ao quarto ano de um curso de Medicina e comparar as diferentes classificações de critério diagnóstico da síndrome. Métodos: Um total de 511 estudantes de três universidades brasileiras responderam a dois instrumentos validados para avaliar burnout e qualidade de vida, e a um questionário elaborado pelos autores para avaliar dados sociodemográficos e hábitos. Resultados: Houve prevalência de 31,1% de burnout tridimensional, 37% de burnout bidimensional e 44,8% de burnout unidimensional. Constatou-se um maior nível de exaustão no grupo com burnout bidimensional, em comparação ao grupo unidimensional, e verificou-se um maior nível de cinismo naqueles com burnout tridimensional, em comparação ao bidimensional. As variáveis que apresentaram correlação com a síndrome foram as mesmas nos três critérios analisados. Os domínios psicológico e físico foram os mais afetados na qualidade de vida dos escolares com burnout. A exaustão emocional foi a dimensão que apresentou correlações mais fortes com três dos quatro domínios analisados no instrumento WHOQOL-BREF. Conclusão: Observaram-se prejuízos nas diversas áreas relacionadas à qualidade de vida dos alunos. Questionamos se o uso do Maslach Burnout Inventory, por meio da abordagem tridimensional, realmente é o critério ideal a ser utilizado na triagem do burnout.

A via das quinureninas e suas implicações na esquizofrenia / Kynurenine pathway and its implications in schizophrenia

Introdução: a esquizofrenia é uma doença mental grave heterogênea, de extrema complexidade, manifestada por vários distúrbios de cognição, pensamento, memória, comportamento e afeto. Sua fisiopatologia, apesar dos avanços, continua de difícil compreensão. Objetivo: realizar uma revisão da literatura a respeito da relação entre a via das quinureninas e a fisiopatologia da esquizofrenia. Metodologia: foi conduzida a busca de artigos através das bases de dados Medline e Lilacs, utilizando os descritores schizophrenia/ esquizofrenia e as palavras-chave kynurenine pathways/via das quinureninas. Por meio desta busca, foram selecionados 38 artigos publicados entre os anos de 1990 e 2018. Resultados: estudos mais recentes vêm demonstrando que anormalidades no metabolismo do triptofano por meio da via das quinureninas poderiam estar relacionadas com os mecanismos neurofisiopatológicos da esquizofrenia. Os metabólitos gerados pela via das quinureninas possuem propriedades neuroativas. Dentre eles, destaca-se o ácido quinurênico, antagonista endógeno do receptor N-metil-D-aspartato. Seus níveis cerebrais estão aumentados em pacientes esquizofrênicos, provavelmente devido a uma condição pró-inflamatória, resultando dessa forma, em possíveis alterações neurológicas responsáveis pelo desenvolvimento da esquizofrenia. Conclusão: não somente uma melhor compreensão da fisiopatologia da esquizofrenia, como também o desenvolvimento de novos alvos terapêuticos, poderão ser obtidos a partir de um melhor entendimento da relação entre anormalidades na via das quinureninas e a gênese da esquizofrenia.

Introduction: Schizophrenia is a severe heterogeneous mental illness of extreme complexity, manifested by various disorders of cognition, thought, memory, behavior and affection. Its pathophysiology, despite advances, remains difficult to understand. Objective: to review the literature on the relationship between the kynurenine pathway and the pathophysiology of schizophrenia. Methodology: a literature review was carried out using the descriptors kynurenine pathways/via das quinureninas and the keywords kynurenine pathways/via das quinureninas using Medline and Lilacs databases. Through this search, were selected 38 articles published between the years of 1990 and 2018. Results: recent studies have shown that abnormalities in tryptophan metabolism through the kynurenine pathway may be related to the neuropathophysiological mechanisms of schizophrenia. The metabolites generated by the kynurenine pathway have neuroactive properties. Among them, kynurenic acid, an endogenous antagonist of the N-methyl-D-aspartate receptor, stands out. Their brain levels are increased in schizophrenic patients, probably due to a pro-inflammatory condition, resulting in possible neurological changes responsible for the development of schizophrenia. Conclusion: not only a better knowledge of pathophysiology, but also the development of new therapeutic targets will be obtained with a better understanding of the relationship between abnormalities in the kynurenine pathway and the genesis of schizophrenia.

Uso de fármacos anticorpos monoclonais, imunomoduladores e anti-inflamatórios no tratamento da infecção por COVID-19 / Use of monoclonal antibodies, immunomodulators, and anti-inflammatory drugs in the treatment of COVID-19

O objetivo deste estudo foi realizar o levantamento bibliográfico de artigos científicos e ensaios clínicos sobre a utilização de anticorpos monoclonais, imunomoduladores e anti-inflamatórios como possíveis alternativas terapêuticas para uso em pacientes com COVID-19, com ênfase nos mecanismos de ação e resultados de ensaios clínicos. Foram analisados artigos obtidos na base de dados MEDLINE® e ensaios clínicos disponíveis no site ClinicalTrials no período de 6 de abril a 6 de maio de 2020. Os ensaios realizados com os fármacos apresentados nesta revisão bibliográfica sugerem a viabilidade de uso de algumas dessas drogas como alternativas para tratamento da COVID-19. No entanto, observou-se que, em função do número reduzido de participantes dos estudos disponíveis, é indispensável a continuidade de pesquisas e dos ensaios clínicos com esses medicamentos, para estimar a eficácia dessas drogas no tratamento do SARS-CoV-2, contra o qual ainda não há terapia específica

The objective of this study was to carry out a bibliographic survey of scientific articles and current clinical trials on the use of monoclonal antibodies, immunomodulators, and anti-inflammatories as possible therapeutic alternatives for use in patients with COVID-19, highlighting their mechanisms of action and results of clinical trials. Articles from the MEDLINE® database and clinical trials available on the ClinicalTrials website were analyzedThe tests performed with the drugs presented in this bibliographic review suggest the feasibility of using some of these drugs as treatment alternatives for COVID-19. However, it was observed that the small samples evaluated in these tests make it imperative to proceed with research and clinical trials with these drugs to provide greater evidence of the effectiveness of these drugs in the treatment of the disease caused by SARS-CoV-2, for which there is no specific therapy so far.

Jogo de cartas como estratégia para o ensino de doenças autoimunes na graduação médica / Card game as strategy for the teaching of autoimmune diseases in medical graduation / Juego de cartas como estrategia para la enseñanza de enfermedades autoinmunes en la graduación médica

A experiência relatada neste artigo envolveu a elaboração e aplicação do ImunoDAI, um jogo de cartas desenvolvido por alunos e professores do curso de Medicina para abordar o conteúdo técnico de vinte Doenças Autoimunes (DAI). As DAI compreendem numerosas doenças com diferentes apresentações clínicas que compartilham uma etiologia complexa, porém comum, representada pela resposta imunológica contra autoantígenos. O ImunoDAI trata-se de um jogo produzido coletivamente que, enquanto recurso pedagógico, possibilitou o trabalho com as DAI por meio da elaboração de quatro cartas contendo informações sobre as principais causas da doença; imunopatogênese; sinais e sintomas; diagnóstico e tratamento. A utilização do jogo facilitou a fixação dos conteúdos e favoreceu o processo de ensino-aprendizagem ao permitir múltiplas interações, promover a aprendizagem dos conteúdos, desenvolver autonomia, criatividade, cooperação mútua, discussões e tomadas de decisões, habilidades indispensáveis aos futuros médicos.

The experience reported in this article involved the development and application of ImmunoDAI, a card game developed by students and professors of the medical course to address the technical content of twenty autoimmune diseases (DAI). The DAI comprise numerous diseases with different clinical presentations that share a complex but common etiology represented by the immune response against autoantigens. The ImunoDAI is a collectively produced game that, as a pedagogical resource, made possible the work with the DAI through the elaboration of four letters containing information about the main causes of the disease; immunopathogenesis; signals and symptoms; diagnosis and treatment. The use of the game facilitated the fixing of contents and favored the teaching-learning process by allowing multiple interactions, promoting content learning, developing autonomy, creativity, cooperation, discussions and decision making, skills that are indispensable for future doctors.

A experiencia relatada en este artículo involucró la elaboración y aplicación del ImunoDAI, un juego de cartas desarrollado por alumnos y profesores del curso de Medicina para abordar el contenido técnico de veinte Enfermedades autoinmunes (DAI). Las DAI comprenden numerosas enfermedades con diferentes presentaciones clínicas que comparten una etiología compleja, pero común, representada por la respuesta inmunológica contra autoantígenos. El ImunoDAI es un juego producido colectivamente que, en cuanto recurso pedagógico, posibilitó el trabajo con las DAI por medio de la elaboración de cuatro cartas conteniendo informaciones sobre las principales causas de la enfermedad; inmunopatogenia; signos y síntomas; diagnóstico y tratamiento. La utilización del juego facilitó la fijación de los contenidos y favoreció el proceso de enseñanza-aprendizaje al permitir múltiples interacciones, promover el aprendizaje de los contenidos, desarrollar autonomía, creatividad, cooperación, discusiones y tomas de decisiones, habilidades indispensables para los futuros médicos.

Paródias e contação de história: formas lúdicas de ensinar parasitologia no ensino superior / Parodies and storytelling: ludical forms of teaching parasitology in higher education

Introdução: embora a parasitologia seja de grande importância para o entendimento da relação dos seres humanos com o meio e com outros seres, a forma como esta disciplina é apresentada em cursos de graduação nem sempre a torna interessante aos alunos. Assim, a busca por práticas pedagógicas atrativas e lúdicas é necessária, favorecendo a aceitação e a compreensão das temáticas em parasitologia e contribuindo para a formação de profissionais melhor preparados para a vida profissional. Objetivo: o presente relato tem como objetivo narrar a experiência da utilização de ferramentas lúdicas como metodologias ativas no ensino de parasitologia no curso de Medicina da Universidade Estadual do Ceará e retratar a percepção dos alunos sobre o uso destas metodologias. Metodologia: trata-se de um relato de experiência, de abordagem descritiva, do processo de construção e aplicação de estratégias pedagógicas lúdicas, a saber: duas paródias e uma história, seguidas da aplicação de estudo dirigido. Ao final do semestre e aproximadamente um ano após a conclusão da disciplina, foram coletados depoimentos espontâneos dos alunos em cuja turma foram aplicadas as estratégias. Resultados: foram produzidas duas paródias sobre os temas filariose e esquistossomose, além de uma história sobre himenolepíase. As peças criadas versavam sobre vários aspectos dos parasitos e parasitoses em questão, tais como ciclos de vida, epidemiologia, manifestações clínicas, tratamentos e especificidades. Através de depoimentos espontâneos dos discentes, observou-se a aceitação positiva das estratégias, traduzida nos relatos, principalmente, como facilitadores no processo de assimilação dos conteúdos abordados. Conclusão: estratégias lúdicas como paródia e contação de história mostram-se como importantes instrumentos que auxiliam o aluno a assimilar conhecimentos básicos sobre parasitologia, através de um processo agradável e acessível, viabilizando a construção dos saberes.

Introduction: although parasitology is of great importance for the understanding of the relationship between human beings and the environment and with other beings, the way this discipline is presented in undergraduate courses does not always make students interested. Thus, the search for attractive and playful pedagogical practices is necessary, favoring the acceptance and understanding of the themes in parasitology and contributing to the formation of professionals better prepared for professional life. Objective: this report aims to describe the experience of using play tools as active methodologies in teaching parasitology in the medical course of the State University of Ceará and to portray students' perceptions about the use of these methodologies. Methodology: this is an experience report, of a descriptive approach, of the process of construction and application of playful pedagogical strategies, namely: two parodies and a history, followed by the application of exercises and resume about them. At the end of the semester and approximately one year after completion of the course, spontaneous testimonies were collected from the students in whose class the strategies were applied. Results: two parodies were produced on the topics filariasis and schistosomiasis, in addition to a story on hymenolepiasis. The pieces were based on several aspects of the parasites and parasitoses in question, such as life cycles, epidemiology, clinical manifestations, treatments and specificities. Through the spontaneous testimonies of the students, the positive acceptance of the strategies was observed, mainly translated as facilitators in the process of assimilation of the contents. Conclusion: playful strategies like parody and storytelling are important tools that help the student to assimilate basic knowledge about parasitology, through a pleasant and accessible process, making feasible the construction of knowledge

Guillain-Barre syndrome and its correlation with dengue, Zika and chikungunya viruses infection based on a literature review of reported cases in Brazil.

Guillain-Barre syndrome (GBS) is one of the main neurologic manifestations of arboviruses, especially Zika virus infection. As known, the prevalence of these diseases is high, so the risk of having an increase on GBS is relevant. The study purposes making a comparative survey between the involvement of dengue, Zika and chikungunya infections in the development of the GBS in Brazil, as well as search in literature resemblances and distinctions between beforehand reported cases. It was performed an electronic search in online databases, with articles published between the years of 2004-2018. A total of 729 articles about the proposed search were found, and 10 were selected according to inclusion and exclusion criteria. The medium age found in Brazilian studies was 429. The time lapse for the neurological symptoms manifest was 6,5-11 days. Facial palsy, paresthesia and member weakness were the main symptoms related. Pediatric cases are rare. There are many studies that implicated the association of GBS and arboviruses and point it to one of the main neurological manifestation of these infections. More research and consistent data are needed to clarify unanswered questions and guide public health measures.

Enteric parasitic infections in HIV/AIDS patients before and after the highly active antiretroviral therapy.

Enteroparasites are related to gastrointestinal alterations among patients with HIV/AIDS, some causing severe manifestations in the period before the institution of the highly active antiretroviral therapy (HAART). The prevalence of enteroparasitoses in patients with HIV/AIDS seen at two hospitals in Ceará , Brazil, was compared in the pre-HAART (Group 1; n = 482) and HAART (Group 2; n = 100) eras. Fecal parasitologic examinations (FPE) were performed using the direct, Lutz, Baermann-Moraes and modified Ziehl-Neelsen methods. The following parasites were detected in Groups 1 and 2, respectively: Strongyloides stercoralis--30.1% and 11% (p<0.0001), Ascaris lumbricoides--15.6% and 2% (p<0.0001), hookworms--3.7% and 2% (p<0.0001), Trichuris trichiura--13.1% and 1% (p<0.0001), Hymenolepis nana--0 and 1% (p = 0.1718), Giardia duodenalis--7.9% and 1% (p = 0.0076), Entamoeba histolytica/dispar--3.3% and 1% (p = 0.3301), Isospora belli--4.8% and 1% (p = 0.0993), Cryptosporidium sp.--8.1% and 0 (p = 0.0007), and non-pathogenic protozoans as well. There was a significant reduction in the prevalence of enteroparasites between the eras (63.9% to 24%; p<0.0001). In the HAART era, the following observations were made: greater frequency of enteroparasites in patients without antiretroviral therapy (p = 0.0575), as in those with AIDS (p = 0.08), and diarrhea (36% of the patients); lack of association with positive FPE (p = 0.626); and non-detection of Cryptosporidium sp. Strongyloides stercoralis showed an elevated prevalence in the two eras and was more frequent in men (32.41%) than women (19.04%) of Group 1 (p = 0.018), a finding suggesting the transmission of the helminth through sodomy. The advent of the HAART modified the profile of opportunistic infections, including parasites, probably due to the reconstitution of cellular immunity and the direct action of HAART on the parasites.

Enteric parasitic infections in HIV/AIDS patients before and after the highly active antiretroviral therapy

Enteroparasites are related to gastrointestinal alterations among patients with HIV/AIDS, some causing severe manifestations in the period before the institution of the highly active antiretroviral therapy (HAART). The prevalence of enteroparasitoses in patients with HIV/AIDS seen at two hospitals in Ceará , Brazil, was compared in the pre-HAART (Group 1; n = 482) and HAART (Group 2; n = 100) eras. Fecal parasitologic examinations (FPE) were performed using the direct, Lutz, Baermann-Moraes and modified Ziehl-Neelsen methods. The following parasites were detected in Groups 1 and 2, respectively: Strongyloides stercoralis - 30.1 percent and 11 percent (p<0.0001), Ascaris lumbricoides - 15.6 percent and 2 percent (p<0.0001), hookworms - 13.7 percent and 2 percent (p<0.0001), Trichuris trichiura - 13.1 percent and 1 percent (p<0.0001), Hymenolepis nana - 0 and 1 percent (p = 0.1718), Giardia duodenalis - 7.9 percent and 1 percent (p = 0.0076), Entamoeba histolytica/dispar - 3.3 percent and 1 percent (p = 0.3301), Isospora belli - 4.8 percent and 1 percent (p = 0.0993), Cryptosporidium sp. - 8.1 percent and 0 (p = 0.0007), and non-pathogenic protozoans as well. There was a significant reduction in the prevalence of enteroparasites between the eras (63.9 percent to 24 percent; p<0.0001). In the HAART era, the following observations were made: greater frequency of enteroparasites in patients without antiretroviral therapy (p = 0.0575), as in those with AIDS (p = 0.08), and diarrhea (36 percent of the patients); lack of association with positive FPE (p = 0.626); and non-detection of Cryptosporidium sp. Strongyloides stercoralis showed an elevated prevalence in the two eras and was more frequent in men (32.41 percent) than women (19.04 percent) of Group 1 (p = 0.018), a finding suggesting the transmission of the helminth through sodomy. The advent of the HAART modified the profile of opportunistic infections, including parasites, probably due...