Definitive Treatment Of Primary Spontaneous Pneumothorax A 10 Year Experience.

OBJECTIVES: Primary spontaneous pneumothorax (PSP) is defined as a pneumothorax without obvious underlying lung disease. Definitive treatment should be offered to patients with recurrent or persistent PSP. The aim of this study was to compare the effectiveness of medical pleurodesis (MP) with video assisted thoracic surgery (VATS) on definitive treatment of PSP. METHODS: 10 years' retrospective study of PSP patients that underwent VATS or MP. Baseline characteristics, perioperative and follow-up data were compared. RESULTS: A total of 133 patients were included (MP=54; VATS=79). Baseline characteristics were similar between groups, with a male predominance (MP 83.6 vs VATS 85.5%) with a mean age of 24.78 and 25.81 years old, respectively. Post interventional length of hospital stay was similar (MP 4.94 vs VATS 4.47 days, p=0.20), but chest tube duration was longer in the VATS group (MP 2.94 vs VATS 3.56 days, p=0.03). The overall complications rate was low with no statistically significant difference between groups (MP 5/54 vs VATS 7/79, p=1.00). Regarding the follow-up, MP had a significant higher PSP recurrence rate (MP 11.1% vs VATS 1.3%, p=0.042), most occurring over the first two years. CONCLUSION: Despite both MP and VATS are safe methods with short hospital stay and few complications associated, the results of this study show that VATS had a significantly lower rate of recurrences. Overall, VATS should be offered as the first line treatment to patients with PSP.

Validation and application of a QuEChERS based method for estimation of half-life of imidazolinone herbicides in soils by LC-ESI-MS/MS.

A modified QuEChERS (quick, easy, cheap, effective, rugged and safe) method was validated and applied for the estimation of half-lives of two imidazolinone group herbicides, imazethapyr and imazapic, in the Dystric Plinthosol (FX) and Ferralsol (LVA) agricultural soils using liquid chromatography tandem mass spectrometry. The solutions were prepared in a matrix extract to avoid matrix effects. The analytical method showed satisfactory specificity, selectivity, linearity (R2 > 0.99), recoveries (range 85.0-117.0%), with RSD between 6.7% and 16.6%, and precision (range 94.7-108.5%), with RSD between 6.0% and 11.9%. The limit of detections for imazethapyr and imazapic in the soils were 2.2 µg kg-1 and 2.0 µg kg-1, and the limit of quantifications were 6.6 µg kg-1 and 6.1 µg kg-1. The half-lives of imazethapyr (35.7 and 97.9 days) and imazapic (40.4 and 64.4 days), in the FX and LVA soils, respectively, indicate that they are medium-persistence herbicides with possibility of leaching into groundwater. In addition, high concentrations of imazethapyr and imazapic were found in the soil samples after the time of application, meaning that there is a potential for prolonged soil residual activity due to carryover.

Chemical identification and evaluation of the antimicrobial activity of fixed oil extracted from Rhinella jimi.

CONTEXT: The toad Rhinella jimi (Stevaux, 2002) (Bufonidae) is used in traditional medicine to treat a number of illnesses (inflammation, infections, and wounds) in humans as well as animals. OBJECTIVES: The present work examined the antimicrobial actions of the extracted oils from the body fat of R. jimi (ORJ) against fungi and standard and multi-resistant lines of bacteria, as well as their effects when combined with aminoglycosides. MATERIALS AND METHODS: The toads were collected in the municipality of Exu in Pernambuco State, Brazil, and their body fat oils extracted in a Soxhlet apparatus using hexane. A gas chromatograph coupled to a mass spectrometer was used to identify the fatty acids, based on their methyl esters. The antimicrobial activities of the oil were analyzed against standard and multi-resistant lines of Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa, as well as against fungal lines of Candida albicans and Candida krusei using the broth micro-dilution method. RESULTS: The minimum inhibitory concentrations (MIC) of ORJ were 512 µg/mL for Candida krusei and ≥1024 µg/mL for the other microorganisms. When associated with amikacin, ORJ demonstrated an increase in its ability to inhibit E. coli growth (from 156.25 to 39.06 µg/mL), indicating synergistic interaction. In the same way, when allied with amikacin, gentamicin, and neomycin, the ORJ reduced the MICs meaningly, against P. aeruginosa. CONCLUSIONS: These data will enable searches to be made to obtain new products in combination with antibiotics, enhancing the efficacy of these drugs against drug-resistant microorganisms.

Mortality in a swiftly repurposed hospital in northeast Brazil during the first and second COVID-19 waves: A retrospective cohort study.

Background: The first months of the coronavirus disease 2019 (COVID-19) pandemic demanded rapid re-organization of available local resources. This study evaluated the performance of a private hospital in the Brazilian state of Ceará that was swiftly repurposed into a public tertiary COVID-19 centre during the first wave of the COVID-19 pandemic, and how it improved in the second wave. Methods: This retrospective cohort study included 2492 patients with COVID-19 at Hospital Estadual Leonardo da Vinci (HELV) during the first and second waves. Demographic, clinical and laboratory data were collected using a dedicated web platform (ResCOVID). A Poisson regression model was used to estimate factors associated with in-hospital mortality. Results: Differences in demographics and clinical features were found between the two waves. There was reduced in-hospital mortality during the second wave (36.2%) in comparison with the first wave (48.8%). Invasive mechanical ventilation showed the strongest association with increased risk of death in both waves {first wave: relative risk (RR) 4.28 [95% confidence interval (CI) 2.86-6.41], P<0.001; second wave: RR 12.94 (95% CI 3.4-49.12), P<0.001}. Conclusions: HELV was a pillar in the strategic public health plan to respond to COVID-19 in Ceará, helping to assist a group of moderate-to-severe cases and reduce the pressure on emergency and primary care facilities. Although mortality in intubated individuals remained high, there was an overall decrease in the in-hospital mortality rate in the second wave.

Improving the Quality of Venous Blood Sampling Procedure (Phlebotomy): Avoiding Tourniquet Use.

Background Phlebotomy guidelines discourage tourniquet use whenever possible. We assessed phlebotomists' capability of not using the tourniquet in venous blood sampling, hypothesizing it to be equal to 50% of the patients attended, and identifying the most frequent venipuncture site. Materials and Methods We assigned two phlebotomists of the same age (41 years) and experience (20 years) to record 10 phlebotomy days, the first with prioritized and the latter with nonprioritized patients. Each acquired daily data for the number of attended patients, age, gender, frequency of nontourniquet usage, and punctured vein. To test our work hypothesis we used the two-tailed single sample t -test. Differences between age-group means and nontourniquet use means by each phlebotomist were tested by two-tailed t -test for independent means. Results In 10 phlebotomy days, 683 patients were attended (males 43.2%). We found no statistically significant difference between age-group means. The combined capability of nontourniquet use was 50.5%, which did not differ from our null hypothesis, but the difference in individual group means was statistically significant, the means being 33% and 66.9% (prioritized vs. nonprioritized). The medial cubital vein was the most prone to be punctured (77.7%). Conclusion Performing phlebotomies without tourniquet was possible in at least half of the attended patients, though it was more limited in specific group populations.

New paradigm of human papillomavirus infection.

Laryngotracheobronchial papillomatosis is a rare dis- ease, with few reported cases. Histologically has been report- ed has a benign proliferation of the epithelium, limited to the larynx but it may occasionally become aggressive and result in persistent and recurrent involvement of the tracheobronchial tree, extending in more severe cases to the lungs.

ENDOBRONCHIAL TUBERCULOSIS.

Videobronchofibroscopy of a Chinese 74-year-old woman showing abundant whitish plaques in the vocal cords with antraconic lesions extending throughout the tracheal pathway and bronchial trees, predominantly in the upper left lobe, compatible with Endobronchial My- cobacterium tuberculosis. The evolution and prognosis varies, from complete resolution to severe endobronchial stenosis.

LINEAR ENDOSONOGRAPHY IN LUNG CANCER: A COMPREHENSIVE REVIEW.

The role of endobronchial ultrasound (EBUS) and trans-esophageal endobronchial ultrasound (EUS-B) in lung cancer is well established and scientifically validated. There is increasing data that endosonography is a crucial tool for the diagnosis of central lung lesions, and mediastinal staging and restaging of non-small cell lung cancer patients. The present article reviews the technical aspects of EBUS and EUS-B and focus on the last published research regarding its value in lung cancer.

FT-NIR and linear discriminant analysis to classify chickpea seeds produced with harvest aid chemicals.

Spectroscopy and machine learning (ML) algorithms have provided significant advances to the modern food industry. Instruments focusing on near-infrared spectroscopy allow obtaining information about seed and grain chemical composition, which can be related to changes caused by field pesticides. We investigated the potential of FT-NIR spectroscopy combined with Linear Discriminant Analysis (LDA) to discriminate chickpea seeds produced using different desiccant herbicides at harvest anticipation. Five herbicides applied at three moments of the plant reproductive stage were utilized. The NIR spectra obtained from individual seeds were used to build ML models based on LDA algorithm. The models developed to identify the herbicide and the plant phenological stage at which it was applied reached 94% in the independent validation set. Thus, the LDA models developed using near-infrared spectral data provided to be efficient, quick, non-destructive, and accurate to identify differences between seeds due to pre-harvest herbicides application.

Troxerutin Prevents 5-Fluorouracil Induced Morphological Changes in the Intestinal Mucosa: Role of Cyclooxygenase-2 Pathway.

Intestinal mucositis is a common complication associated with 5-fluorouracil (5-FU), a chemotherapeutic agent used for cancer treatment. Troxerutin (TRX), a semi-synthetic flavonoid extracted from Dimorphandra gardneriana, has been reported as a potent antioxidant and anti-inflammatory agent. In the present study, we aimed to evaluate the effect of TRX on 5-FU-induced intestinal mucositis. Swiss mice were randomly divided into seven groups: Saline, 5-FU, TRX-50, TRX-100, TRX-150, Celecoxib (CLX), and CLX + TRX-100. The weight of mice was measured daily. After treatment, the animals were euthanized and segments of the small intestine were collected to evaluate histopathological alterations (morphometric analysis), levels of malondialdehyde (MDA), myeloperoxidase (MPO), glutathione (GSH), mast and goblet cell counts, immunohistochemical analysis, and cyclooxygenase-2 (COX-2) activity. Compared to the saline treatment, the 5-FU treatment induced intense weight loss and reduction in villus height. TRX treatment (100 mg/kg) prevented the 5-FU-induced histopathological changes and decreased oxidative stress by decreasing the MDA levels and increasing GSH concentration. TRX attenuated inflammatory process by decreasing MPO activity, intestinal mastocytosis, and COX-2 expression. TRX also reversed the depletion of goblet cells. Our findings suggest that TRX at a concentration of 100 mg/kg had chemopreventive effects on 5-FU-induced intestinal mucositis via COX-2 pathway.

Narratividade na promoção da saúde: limites e possibilidades da racionalidade médica homeopática no cuidado centrado no sujeito / Narrativity in promoting health: limits and possibilities of homeopathic medical rationality in subject-centered care

Este artigo tem como objeto o papel da narração das histórias de vida dos pacientes durante a consulta homeopática na promoção da saúde e produção de autonomia dos sujeitos. Objetivos e Metodologia: A partir da abordagem sócio-histórica, foi realizada revisão de literatura narrativa, a fim de identificar os limites e as possibilidades do ato de narrar na racionalidade médica homeopática para a produção de subjetividades e autonomia na trajetória singular de cada indivíduo levar sua vida. Considerações Finais: Há atualidade e consonância de conceitos da racionalidade médica homeopática com o paradigma contemporâneo da promoção da saúde; as narrativas produzidas no ato da anamnese homeopática têm a potencialidade de ampliar a compreensão médica e do indivíduo para além da doença, analisando o fenômeno existencial do adoecimento. A anamnese homeopática, ao valorizar as experiências existenciais relatadas no âmbito de uma consulta, concorre para uma valorização dos sujeitos, o que contribuiria para a construção de sua subjetividade, autonomia e emponderamento.

This article focuses on the role of narrating patients' life stories during homeopathic consultations in promoting health and producing autonomy for subjects. Objectives and Methodology: Using a socio-historical approach, a narrative literature review was carried out in order to identify the limits and possibilities of the act of narrating in homeopathic medical rationality for the production of subjectivities and autonomy in the unique trajectory of each individual. your life. Final Considerations: The concepts of homeopathic medical rationality are current and consistent with the contemporary paradigm of health promotion; The narratives produced in the act of homeopathic anamnesis have the potential to expand medical and individual understanding beyond the disease, analyzing the existential phenomenon of illness. Homeopathic anamnesis, by valuing the existential experiences reported in the context of a consultation, contributes to an appreciation of the subjects, which would contribute to the construction of their subjectivity, autonomy and empowerment.

Headache as the most prevalent post-vaccination adverse event after Covid-19 vaccination / Dor de cabeça como evento adverso pós-vacinação mais prevalente após a vacinação contra Covid-19

BACKGROUND: In 2020, the first vaccines were approved, according to the WHO. However, speculations arose regarding their efficacy and post-vaccination adverse events (AEFV). OBJECTIVE: To evaluate the prevalence of headache as AEFI from the SARSCoV-2 vaccine in Piauí, Brazil. METHODS: This is a quantitative, observational, cross-sectional, and prevalence study. Data were provided by the Post-Vaccination Adverse Event Information System (SI-AEFV), from reported cases from January to September 2021. Data were analyzed, and the research was approved by the UFPI Research Ethics Committee. RESULTS: A total of 2,008 cases were analyzed. Headache was reported in 752 cases (27.99%) as an AEFV after vaccination against SARS-CoV-2. In most cases, patients were from Teresina (67.62%), of brown race/ethnicity (52.67%), female (79.00%), and the majority were not healthcare professionals (54.27%). The most common age of patients, with the original data, was 33 years. After data correction, the most common age was 28 years. The majority of these cases were not severe (96.44%), and the majority of cases were associated with the first dose of the Covid-19-Covishield-Oxford/AstraZeneca vaccine (43.18%).CONCLUSION: Thus, it is concluded from the partial analysis of the results that headache is the most common adverse event after vaccination against SARS-CoV-2. The profile of patients with the most notifications was brown women aged 30 to 40 years who received the first dose of the Covid-19-Covishield-Oxford/AstraZeneca vaccine. Regarding the severity of events, the vast majority were considered non-severe, and no deaths were mentioned, demonstrating the safety of immunobiologicals.

FUNDAMENTO: Em 2020, foram aprovadas as primeiras vacinas, segundo a OMS. No entanto, surgiram especulações quanto à sua eficácia e eventos adversos pós-vacinais (EAPV). OBJETIVO: Avaliar a prevalência de cefaleia como EAPV da vacina SARSCoV-2 no Piauí, Brasil. MÉTODOS: Trata-se de um estudo quantitativo, observacional, transversal e de prevalência. Os dados foram fornecidos pelo Sistema de Informação de Eventos Adversos Pós-Vacinação (SI-AEFV), dos casos notificados no período de janeiro a setembro de 2021. Os dados foram analisados ​​e a pesquisa foi aprovada pelo Comitê de Ética em Pesquisa da UFPI. RESULTADOS: Foram analisados ​​2.008 casos. Cefaleia foi relatada em 752 casos (27,99%) como EAPV após vacinação contra SARS-CoV-2. Na maioria dos casos, os pacientes eram procedentes de Teresina (67,62%), de raça/etnia parda (52,67%), do sexo feminino (79,00%) e a maioria não era profissional de saúde (54,27%). A idade mais comum dos pacientes, com os dados originais, era de 33 anos. Após correção dos dados, a idade mais comum foi 28 anos. A maioria desses casos não foi grave (96,44%), e a maioria dos casos esteve associada à primeira dose da vacina Covid-19-Covishield-Oxford/AstraZeneca (43,18%).CONCLUSÃO: Assim, conclui-se a partir da análise parcial dos resultados de que cefaleia é o evento adverso mais comum após vacinação contra SARS-CoV-2. O perfil dos pacientes com mais notificações foi de mulheres pardas com idade entre 30 e 40 anos que receberam a primeira dose da vacina Covid-19-Covishield-Oxford/AstraZeneca. Quanto à gravidade dos eventos, a grande maioria foi considerada não grave e não foram mencionados óbitos, demonstrando a segurança dos imunobiológicos.

Concerns of patients with systemic lupus erythematosus and adherence to therapy - a qualitative study.

PURPOSE: The objectives of this study were 1) to identify the impact of systemic lupus erythematosus (SLE) on patients' lives and their reactions to this, as well as their main concerns and expectations regarding their disease and treatments; and 2) to assess the relationship between these concerns and the adherence to treatments, medical visits, and diagnostic tests. PATIENTS AND METHODS: Qualitative study, using a convenient sample of SLE patients attending an outpatient rheumatology clinic. Semistructured interviews were conducted and audiotaped. The full transcripts were analyzed by two different coders using content analysis methodology. RESULTS: Fifteen participants were included. SLE had a major impact on these patients' lives. Their main concerns were fear of disease worsening and becoming dependent on other people, fear of not being able to take care of their children or provide for the family, and the possibility of transmitting SLE to their offspring. The main reasons for adherence to therapy were the wish to avoid manifestations of SLE and trust in the rheumatologist and routine. Nonadherence was more common in the beginning of the treatment because of the difficulty in accepting a chronic disease that requires lifelong therapy. CONCLUSION: Our data underlined the important interplay between adherence to medication and the possibility to gather accurate information and proper support during the treatment process. Good communication and efficient patient education strategies, focused on improving their knowledge about the disease and its treatments, may be important to improve adherence to therapy in SLE.

Equine infectious anemia prevalence in feral donkeys from Northeast Brazil.

Equine infectious anemia virus (EIAV) is an important cause of morbidity and mortality throughout the world. Although the virus infects all members of the Equidae the vast majority of studies have been conducted in horses (Equus caballus) with comparatively little information available for other equid species. Brazil has one of the most abundant donkey (E. asinus) populations of any nation although the economic importance of these animals is declining as transportation becomes increasingly mechanized. As a result, considerable numbers of donkeys especially in the Northeast of the country have been released and allowed pursue an almost feral existence. Consequently, this large and growing population constitutes a significant risk as a reservoir for the maintenance and transmission of important equine infectious diseases such as glanders and equine arteritis virus in addition to EIAV. This study examines the prevalence of EIA in a semi-wild donkey population from Mossoró city, in Northeast Brazil, using AGID followed by cELISA, rgp90 ELISA and immunoblot (IB). Serum samples were collected from 367 donkeys without obvious EIA clinical signs. Subsequent testing revealed seropositive rates of 1.6% (6/367) in officially approved AGID tests, 3.3% (12/367) in cELISA and 14.4% (53/367) in the rgp90 ELISA. However, 88.7% (47/53) of the rgp90 ELISA positive samples were almost certainly false reactions because they failed to react with two or more antigens in IB. Consequently, the rpg90 ELISA has a similar sensitivity to AGID with donkey serum samples. Such high false positive rates have not been observed previously with serum samples from horses. Another highly significant finding is that 56.9% (33/58) of the donkey serum samples tested in IB had reactivity to EIAV p26 only. Although this could result from recent infection with the virus, it has been found that in some equids p26 only reactivity persists for extensive periods of time suggesting exposure to antigens possessing cross-reactive determinants or EIAV strains with envelope glycoproteins that are different from any that have been previously characterized and so undetectable by current IB techniques.

Prevalência de sífilis e fatores de risco associados em internos do sistema prisional do Piauí / Prevalence of syphilis and associated risk factors in prisoners in the Piauí prison system / Prevalencia de sífilis y factores de riesgo asociados en internos del sistema penitenciario de Piauí

Objetivo: Objetivou-se analisar a prevalência de sífilis e fatores de risco em internos nos presídios do Estado do Piauí, Brasil. Métodos: Estudo epidemiológico, transversal, realizado com 2.131 presidiários. Na estatística inferencial foram aplicados testes de hipóteses, com a utilização de regressão logística. O nível de significância utilizado foi de 5%. Resultados: A prevalência de positividade para sífilis foi de 8,4% (IC95% = 7,3-9,6), sendo 19,5% no sexo feminino e 80,5% no sexo masculino. Na análise bivariada observou-se associação entre a sífilis e as variáveis: sexo, uso de drogas ilícitas, uso de piercings, prática sexual com parceiros do mesmo sexo, uso de drogas antes das relações sexuais e conhecimento sobre a forma de transmissão. No modelo multivariado permaneceu associada apenas o uso de drogas antes das relações sexuais. Conclusão: Faz-se necessário promover articulação entre esferas governamentais e entre gestão da saúde e da justiça, para elaborar estratégias de modo a contemplar a demanda de saúde dos internos do sistema prisional do Estado. (AU)

Objective: The objective was to analyze the prevalence of syphilis and risk factors in inmates in prisons in the State of Piauí, Brazil. Methods: Epidemiological, cross-sectional study carried out with 2,131 inmates. In inferential statistics, hypothesis tests were applied, using logistic regression. The level of significance used was 5%. Results: The prevalence of positivity for syphilis was 8.4% (95% CI = 7.3-9.6), 19.5% in females and 80.5% in males. In the bivariate analysis, an association was observed between syphilis and the variables: sex, use of illicit drugs, use of piercings, sexual practice with partners of the same sex, use of drugs before sexual intercourse and knowledge about the form of transmission. In the multivariate model, only drug use remained associated before sexual intercourse. Conclusion: It is necessary to promote articulation between governmental spheres and between health and justice management, in order to develop strategies in order to contemplate the health demand of inmates in the state prison system. (AU)

Objetivo: Este estudio tuvo como objetivo analizar la prevalencia de sífilis y factores de riesgo en reclusos en cárceles del estado de Piauí, Brasil. Métodos: Estudio epidemiológico transversal realizado con 2.131 internos. En estadística inferencial se aplicaron pruebas de hipótesis mediante regresión logística. El nivel de significancia utilizado fue del 5%. Resultados: La prevalencia de positividad para sífilis fue del 8,4% (IC 95% = 7,3-9,6), siendo 19,5% en mujeres y 80,5% en hombres. En el análisis bivariado se observó asociación entre sífilis y las variables: género, uso de drogas ilícitas, uso de piercings, práctica sexual con parejas del mismo sexo, uso de drogas antes de la relación sexual y conocimiento sobre la forma de transmisión. En el modelo multivariado, solo el consumo de drogas antes de las relaciones sexuales permaneció asociado. Conclusion: Es necesario promover la articulación entre los ámbitos gubernamentales y entre la gestión de la salud y la justicia, a fin de desarrollar estrategias para atender la demanda de salud de los internos del sistema penitenciario estatal. (AU)

Matriz de competências para o ensino da homeopatia na graduação médica / Competency matrix for undergraduate medical education in homeopathy

Resumo: Introdução: Currículos médicos de graduação são extremamente carregados em seu conteúdo, tornando-se primordial a necessidade de otimizar competências essenciais. As Diretrizes Curriculares Nacionais (DCN) do Curso de Graduação em Medicina preconizam uma valorização do tratamento do doente que possui muitas interfaces com a homeopatia. Apesar de ser uma especialidade médica no Brasil reconhecida desde 1980, a homeopatia ainda é pouco presente na graduação médica. Objetivo: Este estudo teve como objetivo desenvolver uma matriz de competências essenciais composta de conhecimentos e habilidades desejáveis para o ensino da homeopatia na graduação médica. Métodos: Trata-se de um estudo quanti-qualitativo realizado por meio da técnica Delphi normativa, em duas rodadas, com os docentes especialistas em homeopatia do país. Na primeira rodada, aplicou-se um questionário anônimo on-line para identificar as competências (conhecimentos e habilidades) necessárias em homeopatia para os discentes de graduação em Medicina. Após a análise de conteúdo, os temas foram agrupados nessas duas categorias que retornaram para apuração na segunda rodada, em que os especialistas assinalaram o grau de concordância (escala de Likert de quatro pontos: de não relevante a muito relevante). Para a definição de consenso, adotaram-se dois critérios: índice de De Loe e uma nota de relevância adotada pelos autores com vistas a discriminar mais os graus de consenso. Resultados: Dos 14 temas/subtemas relacionados como competências/conhecimentos, consideraram-se 11 como de alto consenso, dos quais cinco foram avaliados como primordiais, pois obtiveram nota de relevância acima de 9,0 (três relacionados ao grande tema clínica homeopática; um, à teoria e técnica homeopáticas; e outro, à pesquisa homeopática). Em relação às competências/habilidades, oito das 11 foram consideradas de alto consenso, e somente duas alcançaram nota acima de 9,0, ambas relacionadas à clínica homeopática. Conclusão: O ensino da homeopatia pode contribuir para a mudança paradigmática da medicina no sentido de valorizar o doente e promover a saúde, permitindo uma atuação médica mais humanizada e centrada no doente, o que justificaria a adoção de seu ensino, inclusive obrigatório, nas faculdades de Medicina. A elaboração de uma matriz de competências do que deve ser ensinado de homeopatia aos discentes da graduação médica vem ao encontro das DCN e instrumentaliza a reflexão na elaboração de uma futura ementa.

Abstract: Introduction: Undergraduate medical curricula are overloaded with content, making the need to optimize essential skills and knowledge paramount. The National Curricular Guidelines for the medical course (DCNs) put focus on patient treatment, which involves several interfaces with homeopathy. However, despite it being recognized as a medical specialty in Brazil since 1980, homeopathy is rarely present in undergraduate medical education. Objective: To develop a collection of essential skills and knowledge for teaching homeopathy as part of the undergraduate medical curriculum. Methods: Quanti-qualitative study performed using the standard Delphi technique in two rounds with specialized homeopathy teachers from Brazil. An anonymous online questionnaire was conducted to identify the learning competences needed in homeopathy for undergraduate medical students. Following content analysis, the themes and sub-themes were grouped into the two main categories of knowledge and skills, which were returned to the specialists who rated their importance for each item using the "Four-Point Likert Scale" from not at all important to very important. For the purpose of generating a general consensus, two criteria were adopted: the "De Loe index" and a importance score. Results: There was a high degree of consensus regarding eleven of the fourteen themes/sub-themes, five of which were considered essential, with an importance score above 9.0 (three related to the general theme, Homeopathic Clinic, one to Homeopathic Theory and Method and another to Homeopathic Research). There was also a high level of consensus regarding eight of the eleven skills, but only two gained a score of above 9.0, both related to Homeopathic Clinic. Conclusion: The teaching of Homeopathy can contribute to a paradigmatic change in medicine, particularly in the sense of prioritizing the patient and promoting health, as well as allowing for a more humanized and patient-centered medical engagement. These factors would justify the adoption of its teaching, so much so it could be made mandatory across all medical study. The establishment of a "competency matrix" for homeopathy study, which ought to be taught to students of the medical field, meets the DCNs and would be instrumental in future syllabuses.

Heart fossilization is possible and informs the evolution of cardiac outflow tract in vertebrates.

Elucidating cardiac evolution has been frustrated by lack of fossils. One celebrated enigma in cardiac evolution involves the transition from a cardiac outflow tract dominated by a multi-valved conus arteriosus in basal actinopterygians, to an outflow tract commanded by the non-valved, elastic, bulbus arteriosus in higher actinopterygians. We demonstrate that cardiac preservation is possible in the extinct fish Rhacolepis buccalis from the Brazilian Cretaceous. Using X-ray synchrotron microtomography, we show that Rhacolepis fossils display hearts with a conus arteriosus containing at least five valve rows. This represents a transitional morphology between the primitive, multivalvar, conal condition and the derived, monovalvar, bulbar state of the outflow tract in modern actinopterygians. Our data rescue a long-lost cardiac phenotype (119-113 Ma) and suggest that outflow tract simplification in actinopterygians is compatible with a gradual, rather than a drastic saltation event. Overall, our results demonstrate the feasibility of studying cardiac evolution in fossils.

A Mesozoic bird from Gondwana preserving feathers.

The fossil record of birds in the Mesozoic of Gondwana is mostly based on isolated and often poorly preserved specimens, none of which has preserved details on feather anatomy. We provide the description of a fossil bird represented by a skeleton with feathers from the Early Cretaceous of Gondwana (NE Brazil). The specimen sheds light on the homology and 3D structure of the rachis-dominated feathers, previously known from two-dimensional slabs. The rectrices exhibit a row of rounded spots, probably corresponding to some original colour pattern. The specimen supports the identification of the feather scapus as the rachis, which is notably robust and elliptical in cross-section. In spite of its juvenile nature, the tail plumage resembles the feathering of adult individuals of modern birds. Documentation of rachis-dominated tail in South American enantiornithines broadens the paleobiogeographic distribution of basal birds with this tail feather morphotype, up to now only reported from China.

Prática de saúde na atenção básica na perspectiva da política de humanização num município cearense / Practice in health and primary care from the perspective of humanization policy in the municipality of Ceará

O Sistema Único de Saúde após suas fases iniciais de garantia de acesso, de construção de infraestrutura, de definição de processos de financiamento, introduziu uma dimensão qualitativa que se traduziu pela Política Nacional de Humanização da Atenção e da Gestão em Saúde. A pesquisa objetivou compreender a humanização da saúde na atenção básica no Sistema Único de Saúde - Quixadá - Ceará, na perspectiva da política. Tratou-se de um estudo qualitativo, descritivo, desenvolvido nas Unidades básicas de saúde e contou com a participação de 3 gestores, 12 profissionais e 39 usuários, definidos por saturação teórica-empírica. A coleta de dados foi realizada mediante a entrevista semiestruturada no período de 07 de outubro à 28 de novembro de 2019 e analisados por Discurso do Sujeito Coletivo com base em Lefévre. Observou-se que ainda persiste um certo distanciamento das práticas humanizadas no contexto de saúde investigado com ênfase nas diretrizes estabelecidas pela Política de Humanização. (AU)

The Unified Health System, after its initial stages of guaranteeing access, building infrastructure, defining financing processes, introduced a qualitative dimension that was translated by the National Policy for the Humanization of Health Care and Management. The research aimed to understand the health humanization in primary care in the Unified Health System - Quixadá- Ceará, from the politics perspective. It was a qualitative, descriptive study, developed in the Basic Health Units and had the participation of 3 managers, 12 professionals and 39 users, defined by theoretical-empirical saturation. Data collection was carried out by means of a semi-structured interview from October 7 to November 28, 2019 and analyzed by Collective Subject Discourse based on Lefévre. It was observed that there is still a certain distance from humanized practices in the health context investigated with an emphasis on the guidelines established by the Humanization Policy. (AU)