Microablative fractional radiofrequency for sexual dysfunction and vaginal Trophism: A randomized clinical trial

Abstract Objectives: To evaluate Microablative Fractional Radiofrequency (MAFRF) as a possible option in treating vaginal atrophy. Methods: This was a randomized, controlled clinical trial with postmenopausal women diagnosed with vaginal atrophy. The treatment consisted of three sessions of MAFRF, compared to vaginal estrogen administration and an untreated control group. Assessments occurred at baseline and 90 days. The primary endpoints were sexual function, evaluated by the Female Sexual Function Index (FSFI), and vaginal health, assessed by the Vaginal Health Index (VHI). Secondary outcomes included vaginal microbiota composition (Nugent score) and epithelial cell maturation (Maturation Value ‒ MV). Results: One hundred and twenty women (40 in each group) were included. Concerning the FSFI, both groups, MAFRF (median 4.8 [3.6‒6.0]) and vaginal estrogen (mean 4.7 ± 1.1), experienced improved sexual desire when compared to the control group (median 3.6 [2.4‒4.8]). Regarding the total score of VHI, the authors observed an improvement in the mean of the MAFRF (23.7 ± 2.0) and vaginal estrogen groups (23.5 ± 1.9) when compared to the control (14.8 ± 2.9). The Nugent score was reduced in the MAFRF and estrogen groups (p < 0.01) compared to the control group. Lastly, the MV was modified after treatment with MAFRF (p < 0.01) and vaginal estrogen (p < 0.001). No differences existed between the MAFRF and vaginal estrogen groups in the studied variables. No adverse effects were reported following the MAFRF protocol. Conclusions: Radiofrequency was comparable in efficacy to estrogen administration for treating vulvovaginal atrophy. It deserves consideration as a viable option in managing this condition.

O ato de cuidar em saúde mental: aspectos alinhados à cultura de segurança do paciente / The act of caring in mental health: aspects aligned to patient safety culture / El acto de cuidar en salud mental: aspectos alineados la cultura de seguridad del paciente

OBJETIVO: analisar o conhecimento sobre o cuidado prestado à pessoa que possui transtorno mental na perspectiva da segurança do paciente. MÉTODO: revisão integrativa da literatura, considerando-se a seguinte questão norteadora: “Como a Política de Segurança do Paciente pode ser incorporada na produção do cuidado às pessoas ou sujeitos em sofrimento psíquico?”. RESULTADOS: foram selecionados 12 artigos em língua inglesa nas bases de dados Scopus e MEDLINE. Predominaram os tipos de estudo revisão da literatura (42%), estudo crítico-reflexivo (17%) e análise de conteúdo (17%). CONCLUSÃO: a segurança do paciente no contexto da saúde mental é mais complexa quando comparada a de outros pacientes. Observa-se maior probabilidade de eventos adversos, violências, barreiras de acesso aos serviços e tratamentos, além de uma assistência de baixa qualidade, tardia e não planejada, tendo, como principal justificativa, o processo estigmatizador. A educação permanente e o cuidado centrado na pessoa são as principais ferramentas de solução desses casos.

OBJECTIVE: to analyze the knowledge about the care given to the person who has mental disorder from the perspective of the patient's safety. METHOD: Integrative literature review, considering the following guiding question: “How can the Patient Safety Policy be incorporated into the production of care for people or subjects in psychic suffering?” RESULTS: 12 English language articles were selected from the Scopus and MEDLINE databases. The types of study were: literature review (42%), critical-reflective study (17%) and content analysis (17%). CONCLUSION: patient safety in the context of mental health is more complex when compared to other patients. There is a higher probability of adverse events, violence, barriers to access to services and treatments, as well as low quality, late and unplanned care, having as main justification the stigmatization process. Permanent education and person-centered care are the main tools for solving these cases.

OBJETIVO: analizar el conocimiento sobre el cuidado prestado à la persona que posee trastorno mental en la perspectiva de la seguridad del paciente. MÉTODO: revisión integral de la literatura, considerándose la siguiente cuestión norteadora: cómo se puede incorporar la Política de seguridad del paciente en la producción de atención para personas con problemas psicológicos? RESULTADOS: se seleccionaron 12 artículos en inglés, en las bases de datos SCOPUS y MEDLINE. Predominaron los tipos de estudio Revisión de la literatura (42%), Estudio crítico-reflexivo (17%) y Análisis de contenido (17%). CONCLUSIÓN: la seguridad del paciente en el contexto de la salud mental es más compleja en comparación con otros pacientes, se observa mayor probabilidad de eventos adversos, violencias, barreras de acceso a los servicios y tratamientos, además de una asistencia de baja calidad, tardía y no planificada, teniendo como principal justificación el proceso estigmatizador. La educación permanente y el cuidado centrado en la persona son las principales herramientas de solución de estos casos.

Difficulties in the Diagnosis of Gaucher Disease in a Low-Income Country: A Case Report from Mozambique

Abstract Introduction: Gaucher disease (GD) is one of the common lysosomal storage disorder (LSD) with an estimated frequency of one in 40,000 newborns globally. GD is an autosomal recessive condition, which results from mutations in the GBA1 gene, causing partial or complete deficiency of β-glucocerebrosidase enzyme activity, which leads to the widespread accumulation of the substrate glucosylceramide. Aims: This report presents different challenges of clinical management and communication between medical specialties to reach diagnose of any rare disease in Mozambique, a low-income country, which health system has limited infrastructure, trained personnel, and budget for diagnosis and to provide treatment for rare genetic disorders such as GD. Case Presentation: The patient was a 15-year old black female patient of Mozambican nationality born from non-consanguineous parents. Three of the four patient's siblings were healthy; one sister had died of a disease with a similar clinical features. Our patient presented with abdominal distention and hepatosplenomegaly. Blood tests revealed pancytopenia and a high level of ferritin. Liver biopsy and histologic examination revealed infiltration of the splenic parenchyma and portal area of the liver as well as enlarged histiocytic cells with granular cytoplasm. Magnetic resonance imaging showed liver enlargement, changes in the femoral heads without osteonecrosis, a pathological fracture of the third thoracic vertebrae (T3), with absence of brain and spinal cord neurological abnormalities. The biochemical investigation disclosed low levels of β-glucocerebrosidase (0.223 nmol/h/ml; normal: above 0.98) and increased levels of lyso-Gb1 (0.43 µg/ml; normal: up to 0.003). Genotyping of the GBA1 gene indicated the presence of the pathogenic variant p.Arg87Trp (R48W) in homozygosis. Discussion and Conclusion: To the best of our knowledge, this report describes the first case of GD type 1 confirmed via biochemical and molecular genetic testing in Mozambique. As awareness of the GD and rare genetic diseases among Mozambican health professionals is very limited, and resources for diagnosis are scarce in the national health system, it is possible that other cases remain undiagnosed in this low-income country.

Educação permanente no serviço de atendimento pré-hospitalar móvel de urgência: revisão integrativa / Permanent education in the emergency mobile pre-hospital care service: an integrative review / Educación permanente en el servicio de atención prehospitalaria móvil de urgencia: revisión integradora

OBJETIVO: identificar como a educação permanente em saúde vem sendo incorporada na prática de ensino em publicações acerca do serviço de atendimento móvel de urgência. MÉTODO: revisão integrativa em três bases de dados, com corte temporal de 2010 a 2020. RESULTADOS: três artigos selecionados, emergindo duas categorias: Necessidade da prática de educação para atender demandas no atendimento pré-hospitalar móvel; e Incorporação da educação permanente como estratégia para novas práticas no serviço de atendimento móvel de urgência. CONCLUSÃO: há grande demanda de atendimentos nas redes de urgência, sobretudo no componente pré-hospitalar. Porém, a incorporação da educação permanente como estratégia para novas práticas no serviço ainda não está bem clara, posto que apenas três artigos a referiram. Sugere-se novas pesquisas introduzindo a educação permanente na prática do serviço pré-hospitalar móvel de urgência, já que proporciona uma releitura crítica das práticas de trabalho e das necessidades advindas delas, para, assim, transformá-las.

AIM: identify how continuing health education has been incorporated into teaching practice in publications about the mobile emergency service. METHOD: integrative review in three databases, with a time cut from 2010 to 2020. RESULTS: three selected articles, emerging in two categories: Need for education practice to meet demands in mobile pre-hospital care; and Incorporation of continuing education as a strategy for new practices in mobile emergency care. CONCLUSION: there is a great demand for services in emergency networks, especially in the pre-hospital component. However, the incorporation of continuing education as a strategy for new practices in the service is still unclear, since only three articles have mentioned it. New research is suggested introducing permanent education into the practice of mobile pre-hospital emergency service, since it provides a critical re-reading of work practices and the needs arising from them, thus transforming them.

OBJETIVO: identificar en publicaciones sobre el servicio de atención móvil de urgencia, cómo la educación Permanente en salud está siendo incorporada a la práctica de enseñanza. MÉTODO: revisión integradora en tres bases de datos, con corte temporal de 2010 a 2020. RESULTADOS: tres artículos seleccionados, emergiendo dos categorías: Necesidad de la práctica de educación para atender demandas en la atención prehospitalaria móvil; e Incorporación de la educación Permanente como estrategia para nuevas prácticas en el servicio de atención móvil de urgencia. CONCLUSIÓN: Hay una demanda grande del número de atendimientos en las redes de urgencia, principalmente en el componente prehospitalario. Sin embargo, la incorporación de la educación Permanente como estrategia para nuevas prácticas en el servicio, todavía no está muy clara, ya que solo tres artículos la mencionaron. Se sugiere que se realicen nuevas investigaciones que introduzcan la educación Permanente en la práctica del servicio prehospitalario móvil de urgencia, lo que proporcionaría una relectura crítica de las prácticas de trabajo y de sus necesidades, para, así, poder transformarlas.

Gestational gigantomastia with fatal outcome

Gigantomastia is a rare disease defined by an extreme and rapid enlargement of the breast, generally bilateral. The majority of cases are reported in pregnant women. Ninety-eight cases of gestational gigantomastia have been identified in electronic databases, and those with fatal outcomes comprised only 2 cases (2%). Despite its benign nature, it can lead to severe complications and even death. Its etiology has not been fully elucidated, but it has been speculated that a hormonal component may play a role in the pathogenesis. Currently, treatment options are limited, and surgery is gaining importance, but it is often not feasible in low-resource settings. Herein, we describe a case of a 30-year-old HIV-positive female with no relevant past medical history, who died due to the complications of gestational gigantomastia at the Maputo Central Hospital, in Mozambique.

Impact of microablative fractional radiofrequency on the vaginal health, microbiota, and cellularity of postmenopausal women

OBJECTIVES: We aimed to evaluate the effectiveness of microablative fractional radiofrequency (MAFRF) in the non-hormonal treatment of genitourinary syndrome of menopause. METHODS: We examined the cases of 55 postmenopausal women before and after treatment with regard to their vaginal health index (VHI), vaginal microbiota, vaginal pH, and cell maturation. Three applications of MAFRF were performed in the vagina/vaginal introitus. During the treatment, six vaginal smears were obtained and stained with the Papanicolaou stain for determining the degree of cell maturation and with Gram stain for classification of vaginal flora, as per the criteria of Spiegel and Amsel. For vaginal pH determination, pH indicator strips were applied against the vaginal wall. Statistical analysis was performed using SPSS for Windows (version 17.0). Data were reported as mean±standard deviation. The differences were analyzed using the statistical method of generalized estimation equations with autoregressive correlation structure "1" and robust standard errors. RESULTS: The mean age was 59.8±4.2 years, and the mean time of menopause was 15.4±4.5 years. After treatment, there was an increase in the percentage of Lactobacillus spp. (p<0.001). Consequently, there was a progressive decrease in vaginal pH during the treatment (p<0.001). Regarding cell maturation, there was a decrease in the percentage of parabasal cells (p=0.001) and an increase in the rate of superficial cells (p<0.001). Additionally, there was an improvement in the VHI index. The mean VHI values before and after treatment were 13.2±5.6 and 22.5±3.7, respectively (p<0.001). CONCLUSION: MAFRF treatment is well tolerated and leads to improvement in the vaginal microenvironment.

Educação permanente na reorganização do processo de trabalho no serviço de emergência / Continuing education in the reorganization of the work process in the emergency

Essa pesquisa deu origem a dois produtos, Banner e Folder, cuja intenção foi divulgar o rol de procedimentos odontológicos eleitos como urgência /emergência a ser encaminhado a equipe de odontologia do PSC, e que foram construídos pelos participantes da pesquisa, baseado no rol de procedimentos da ANS

Continuing education in health from the perspective of Augustine of Hippo / Educación continua en salud según la perspectiva de Agostinho de Hipona / Educação permanente em saúde sob a perspectiva de Agostinho de Hipona

ABSTRACT Objective: To reflect about continuing education from the perspective of Augustine of Hippo and his theories based on the construction of knowledge and the learning process. Method: This is a theoretical reflection study whose aim is to propose dimensions of analysis, emphasizing the history and challenges of continuing education. Such dimensions analyze the production of knowledge in Augustinian pedagogy, its historical aspects and its close relationship with lifelong education in health professions. Results: The results show the difficulty of continuing education to reach adequate importance in health services, and that of academia in appropriating the thoughts of renowned philosophers such as Augustine. This is a result of ignorance about the convergence of these principles and their relevance. Final considerations: Continuing education and Augustinian pedagogy walk hand in hand in terms of care, meeting the needs that originate from practice and that are reflected in it, challenging isolated knowledge and putting different areas of knowledge to work together.

RESUMEN Objetivo Reflexionar sobre la educación permanente según la perspectiva de Agostinho de Hipona y sus teorías basadas en la construcción del conocimiento y el proceso de aprendizaje. Método: Reflexión teórica apuntando a proponer dimensionas de análisis, destacando la historia y los desafíos de la educación continua. Dichas dimensiones analizan la producción del conocimiento en la pedagogía agostiniana, sus aspectos históricos y su relación cercana a la educación continua en salud. Resultados: Revelan la dificultad de la educación continua para que su dimensión se alcance en el servicio de salud, y la de que los académicos se apropien del pensamiento de filósofos renombrados como Agostinho, merced al desconocimiento de la convergencia de tales presupuestos y su relevancia. Consideraciones finales: La educación continua y la pedagogía agostiniana caminan juntas en el cuidar, atendiendo las necesidades devenidas de la práctica reflejada en ella, confrontando los saberes aislados y operando conjuntamente con ellos.

RESUMO Objetivo: Refletir sobre a educação permanente na perspectiva de Agostinho de Hipona e suas teorias pautadas na construção do conhecimento e no processo de aprendizagem. Método: Trata-se de uma reflexão teórica cujo intuito é propor dimensões de análise, enfatizando a história e os desafios da educação permanente. Tais dimensões analisam a produção do conhecimento na pedagogia agostiniana, seus aspectos históricos e sua relação próxima com a educação permanente em saúde. Resultados: Revela a dificuldade da educação permanente em ter sua dimensão alcançada noserviço de saúde, tal qual a da academia de apropriar-se do pensamento de filósofos renomados como Agostinho, fruto do desconhecimento da convergência desses pressupostos e de sua relevância. Considerações Finais: Considera-se que a educação permanente e a pedagogia agostiniana caminham juntas no cuidar, atendendo às necessidades advindas da prática e nela refletida, confrontando os saberes isolados e com eles operando em conjunto.

Genética e meio ambiente: decorrências éticas e jurídicas da ecogenética / Genetics and environment: Legal and ethical derivations of ecogenetics

O presente trabalho tem por escopo analisar as decorrências éticas, sociais e jurídicas de um específico ramo da genética: a ecogenética. Para tanto, foi adotada pesquisa bibliográfica, com base em fontes doutrinárias interdisciplinares, para se revisar a literatura sobre o tema, que ainda é escassa. O objeto de estudo da ecogenética é a inter-relação entre o meio ambiente e as características genéticas individuais que alteram as condições gerais de saúde. O atual desenvolvimento da biociência provocou uma alteração no foco, do tratamento e cura para a prevenção das doenças, assim como despertou questionamentos éticos sobre a influência das características genéticas e da atuação do meio ambiente sobre elas. Desloca-se o agir humano para a perspectiva da responsabilidade conferida tanto ao indivíduo, isoladamente, quanto à coletividade, em relação às gerações presentes e futuras. A importância do estudo no campo da ecogenética espraia-se para além de interesses individuais e familiares e traduz-se também na importância da adoção de medidas governamentais de prevenção.(AU)

This paper analyzes the ethical, social and legal derivations of a specific branch of genetics ­ ecogenetics. For this, a bibliographic methodology was adopted, based on interdisciplinary doctrinal sources, to review the literature on the subject, which is still scarce. The study object of ecogenetics is the relationship between the environment and the individual genetic characteristics that alter the general health conditions. The current bioscience developments moved the focus from treatment and cure to disease prevention as well as raised ethical questions about the influence of knowledge of genetic traits and the environmental factors that act on them. Moves the human act to the perspective of responsibility, both for the individual, as the community in relation to present and future generations. The importance of the ecogenetics research spreads beyond the individual and family interests, converting into important preconditions for governmental adoption of preventive measures.(AU)

Educação permanente na reorganização do processo de trabalho no serviço de emergência / Continuing education in the reorganization of the work process at emergency department

O presente trabalho tem como objeto de estudo a educação permanente como estratégia de reorganização do processo de trabalho, no serviço de emergência de um pronto socorro. Seu objetivo geral foi utilizar a educação permanente como reorganizadora do processo de trabalho no serviço de emergência de um pronto socorro tendo como objetivos específicos: Identificar as dificuldades dos funcionários do pronto socorro no seu processo de trabalho quanto ao encaminhamento de usuários ao serviço de emergência odontológica; Descrever a compreensão dos funcionários acerca do papel do odontólogo no serviço de emergência; Analisar estratégias ou formas de colaboração para atingir a integralidade da assistência e; Elaborar produtos que colaborem na educação permanente dos funcionários envolvidos no atendimento ao paciente, de acordo com a legislação específica, em prol da integridade da assistência. A metodologia utilizada foi a pesquisa convergente assistencial, tipo de pesquisaação na qual o pesquisador está envolvido em ações de assistência enquanto pesquisa. O cenário da pesquisa foi o setor de emergência de um pronto socorro localizado em São Gonçalo, cidade do Estado do Rio de Janeiro. A pesquisa contou com três etapas e os instrumentos de coleta de dados utilizados foram: Na primeira etapa, observação participante, na segunda etapa, questionário semi-estruturado e na terceira etapa, grupos educativos; Na primeira etapa, foi construído um fluxo de encaminhamento ao setor de emergência odontológica. Na segunda etapa, construíram-se quatro categorias, após análise de conteúdo de Bardin. São elas: 1) O modelo biomédico ainda refletido no pensar e no agir, evidenciado, diante da análise das respostas, que parte dos funcionários não compreenderem trabalho em equipe multidisciplinar e ainda fazerem alusão ao modelo biomédico; 2) A odontologia do dente por dente: Código de Hamurabi e Tiradentes, revelando que a maioria dos trabalhadores atribui significado bucal ao atendimento odontológico; 3) O que estou fazendo aqui? Construindo a identidade do odontólogo. Demonstrou-se que muitos dos participantes não compreendem o papel do dentista no processo de trabalho em emergência, ao atribuírem significado fora do contexto odontológico a ele, ou mesmo não responderem admitindo não sabê-lo; 4) Construindo pontes para a integralidade, apontando que poucos participantes compreendem os conceitos da EP e sua capacidade de transformar as situações problemas no cotidiano de sua vida profissional. Na terceira etapa, os participantes foram convidados aos grupos educativos, local de diálogo, reflexão e elaboração de hipóteses de soluções, seguindo a proposta da metodologia da problematização. Nesses grupos, discutiu-se a legislação acerca do serviço de emergência, refletiu-se sobre as dificuldades em cumpri-la no serviço e construiu-se o rol de procedimentos eleitos como de urgência /emergência no pronto socorro. Concluiu-se que pouco conhecimento se tinha acerca da legislação vigente sobre o assunto e que o desconhecimento do sentido pleno de educação permanente limitava às tomadas de decisões. Porém, as soluções encontradas pelo grupo, mesmo que este não tenha se constituído uniformemente ao longo dos encontros, foram um somatório de experiências reunidas, o que proporcionou o que Agostinho chama de sabedoria à pesquisa convergente assistencial, de despertar do pensamento crítico e à política nacional de educação permanente em saúde de empoderamento

The object of study of this paper is the continuing education as a strategy to reorganize the work process in the emergency room at emergency department. The general aims of this study was to use the permanent education as a strategy to reorganize the work process in the emergency room at emergency department. The specifics aims were: to identify the difficulties faced by the staff workers of the emergency settings related to the process of guiding patients to the emergency dental service ; to describe the understanding of the staff workers about the dentist's role in na emergency service; to analyze strategies or manners of collaboration for achieving comprehensive care and; to develop products that can collaborate in continuing education of staff workers involved in patient care, according to the specific laws related to the intregrity of care. The methodology used was the the kind of research which the researcher get involved in the assistance activities while observe. The setting of the study was the emergency department of an emergency room located in Sao Goncalo, State of Rio de Janeiro city. It had three stages and the data collection instruments used were: the first stage was a participatory observation, the second stage was a semi-structured questionnaire and the third stage was na educational focal groups. In the first stage was built a forwarded flow to the dental emergency section. On the second stage, after analysis of contente according to Bardin, it was built four following classes: 1) The biomedical model still reflected on the thinking and action, evidenced on the analysis of the responses, which the employees do not understand working in a multidisciplinary team and also mentioned the biomedical model; 2) Tooth for a tooth: The Code of Hammurabi and Tiradentes, revealing that most workers assign meaning to oral dental care; 3) What am I doing here? Building the identity of the dentist. The study reveals that many of the participants do not understand the dentist's role in emergency work process and they do not respond admitting not knowing it when asked for assign a meaning outside the dental contexto.4) Building up bridges for completeness, noting that few participants understood the concepts of the continuing education and its ability to transform problems situations in their daily professional life. In the third stage, the participants were invited to educational groups, opened for dialogue, reflection and solutions, following the proposal of the problematization methodology. Theese groups discussed the legislations about emergency service, reflected on the difficulties of fulfilling the laws during work and, built up the list of procedures elected as urgent / emergency in the emergency room. In conclusion that little knowledge about the current legislation on the topic and the lack of the full understanding about continuing education can limit the process of decision making. However, the solutions found by the group were a combination and summation of gathered experiences which provided what Augustine calls wisdom of convergent care research awakening the critical thinking and politics national continuing education in health empowerment