Sofrimento psíquico no contexto da pandemia por COVID-19: impressões durante a Residência de Medicina de Família e Comunidade

Objetivo: Apresentar impressões acerca do sofrimento psíquico no contexto da pandemia por COVID-19, durante a Residência de Medicina de Família e Comunidade. Experiência: Na Atenção Primária à Saúde, são ouvidas e auxiliadas pessoas com seus diversos problemas de saúde, dentre eles os de saúde mental. Assim, durante a Residência de Medicina de Família e Comunidade, em uma Unidade de Saúde da Família de João Pessoa-PB, foram observadas demandas relacionadas ao sofrimento psíquico, decorrente da pandemia por COVID-19. Devido à alta infectividade e morbimortalidade do COVID-19, houve mudanças no processo de trabalho da unidade e na rotina dos atendimentos. Foi também observada a ocorrência do agravamento do estado de saúde mental dos pacientes e profissionais da unidade. Conclusão: A pandemia por COVID-19 revolveu o mundo e seu modo de viver. Não seria diferente com a Residência de Medicina de Família e Comunidade e a Atenção Primária à Saúde, que sentiu mudanças também no campo da saúde mental, na qual foi gerado ou agravado o sofrimento psíquico nos usuários e profissionais da saúde.

Antiviral regimen complexity index as an independent predictor of sustained virologic response in patients with chronic hepatitis C.

BACKGROUND: Hepatitis C virus (HCV) infection affects more than 170 million people worldwide, and one-third of them have human immunodeficiency virus (HIV) coinfection. Multiple studies have been conducted in order to identify the factors that may explain different responses to treatment among patients. However, the reasons why HIV-HCV coinfected patients have lower responses to treatment are not clear. In addition, no studies have evaluated the influence of the complexity of the therapeutic regimen for hepatitis C infection on clinical outcomes.  OBJECTIVES: To (a) investigate the influence of the antiviral regimen complexity in the sustained viral response (SVR) in patients with chronic hepatitis and (b) adapt a method of quantifying complexity of an antiretroviral regimen for patients infected with HCV.  METHODS: A single center, retrospective study was conducted in HCV and HIV-HCV coinfected patients. We selected patients treated with interferon alfa-2a plus ribavirin between January 2005 and December 2010. Patients with severe psychiatric disorders, those included in a clinical trial, and those known to be nonadherent to treatment were excluded. The dependent variable was the sustained virologic response and the independent variables were sex, age, race, stage fibrosis (F) ≥2, presence or absence of cirrhosis, low hepatitis C baseline viral load (defined as ≤800,000 IU), viral genotype, rapid virological response (RVR), serum gamma-glutamyltransferase (GGT) levels, ratio of alanine aminotransferase to aspartate aminotransferase (ALT/AST), serum cholesterol level, presence or absence of diabetes mellitus, and antiviral regimen complexity index. The latter variable included drugs for HCV and HIV infection, but no medication for other comorbidities. To evaluate the complexity of antiviral treatment we performed an adaptation of the system developed by Martin et al. (2007) in HIV patients. The factors determining the complexity of treatment were the number of medications, dosing schedules, administration methods, special instructions, and required preparations associated with antiviral regimens.  Sample size was estimated by the Freeman equation. To determine the independent variables associated with SVR, we performed an univariate logistic regression and subsequently a multivariate analysis with those variables that demonstrated a statistically significant difference in the univariate analysis.  RESULTS: A total of 156 patients was included (76% men, mean age 44 years) of whom 45% were HIV-HCV coinfected. 75% were genotypes 1 or 4. The univariate analysis variables-genotypes 2 and 3 (OR=3.10; CI [1.38-6.95]; P=0.006); HIV-HCV coinfection (OR=0.36; CI [0.19-0.69]); presence of cirrhosis (OR=0.27; CI [0.10-0.73]; P=0,01); F≥2 (OR=0.44; CI [0.23-0.84]; P=0.01); low baseline viral load (OR= 2.05; CI [1.01-4.17]; P=0.048); RVR (OR=17,60; CI [6.84-45.30]; P less than 0.001); complexity index (OR=0.71; CI [0.58-0.87]; P=0.001), showed statistically significant relationships with SVR. Complexity index (OR=0.67; CI [0.52-0.87]; P=0.002) and RVR (OR=20.04; CI [7.33-54.85]; P less than 0.001) were independent predictors of SVR in multivariate analysis. The reliability of the multivariate analysis was checked with the Hosmer and Lemeshow test (P=0.079).  CONCLUSIONS: The medication regimen complexity may be a crucial factor to achieve therapeutic success when treating patients for hepatitis C. The adaptation of this index in patients with HCV provides an objective value of the antiviral regimen complexity and could help us to identify patients in clinical practice who require multidisciplinary attention. Simplification of the antiretroviral regimen might result in a greater response to treatment for hepatitis C. 

Interobserver concordance in controlled attenuation parameter measurement, a novel tool for the assessment of hepatic steatosis on the basis of transient elastography.

BACKGROUND: The combination of transient elastometry with a controlled attenuation parameter (CAP) is available to evaluate hepatic steatosis (HS) along with liver stiffness. AIMS: To assess the concordance of CAP measurements between two independent observers in patients infected by HIV and/or hepatitis virus, as well as to determine the concordance of classification of the grade of HS using two cut-off values. MATERIALS AND METHODS: In a cross-sectional prospective study, CAP-enabled transient elastometry acquisitions were performed by two independent observers in patients with HIV or hepatitis virus infection. The interobserver concordance between the CAP examinations was assessed using the intraclass correlation coefficient and the concordance in the classification of patients in the grades of HS was characterized using the κ index. RESULTS: A total of 118 patients were included. Twenty (17%) patients were HIV monoinfected, 44 (37.3%) were hepatitis C virus monoinfected, and 52 (44%) had HIV/hepatitis C virus coinfection. The median (Q1-Q3) of the absolute difference of CAP values between the two observers was 20 (10-41) dB/m. The overall intraclass correlation coefficient was 0.84 (95% confidence interval: 0.77-0.88). The corresponding figures for liver stiffness measurements were 0.9 (0.4-2.6) kPa and 0.96 (95% confidence interval: 0.94-0.97). The κ indexes for the concordance of classification for the presence of HS, cut-off of 215 dB/m, and significant HS, cut-off of 252 dB/m, were 0.53 and 0.62, respectively. CONCLUSION: The determination of HS by means of CAP in HIV and/or hepatitis virus infection represents an observer-independent and easily performable method. However, the use of cut-off values for the classification of patients is suboptimal.

A model to predict the response to therapy against hepatitis C virus (HCV) including low-density lipoprotein receptor genotype in HIV/HCV-coinfected patients.

OBJECTIVES: Accurate prediction of sustained virological response (SVR) to pegylated interferon-α (Peg-IFN) plus ribavirin in HIV/hepatitis C virus (HCV)-coinfected patients could improve the management of these patients. We aimed to develop a model to predict SVR to Peg-IFN/ribavirin in HIV/HCV-coinfected individuals combining HCV genotype and baseline HCV RNA load with interleukin 28B and low-density lipoprotein receptor genetic variations. METHODS: Three hundred and twelve treatment-naive HIV/HCV-coinfected patients receiving Peg-IFN/ribavirin were analysed in an on-treatment approach. One hundred and eighty-one of them were included in the development group and 131 in the validation population. The predictive model was obtained from a logistic regression equation including the above-mentioned variables. The areas under the receiver operating characteristic (AUROC) curves (95% CI), sensitivity and specificity, as well as negative and positive predictive values, were calculated. RESULTS: SVR was achieved by 88 (48.6%) patients from the development group and 68 (51.9%) individuals from the validation group. The AUROC curve values (95% asymptotic CI) were 0.83 (0.77-0.89) for the development group and 0.84 (0.77-0.91) for the validation group. Using two cut-off values, maximum specificity and sensitivity were 89.7% and 96.6%, respectively, with a negative predictive value for SVR of 88.9% and a positive predictive value of 83.6%. Thirteen (7.2%) individuals were misclassified using these cut-off values. CONCLUSIONS: This model represents a reliable and easily applicable tool to individually evaluate the probability of achieving an SVR to Peg-IFN/ribavirin among HIV/HCV-coinfected patients.

Stepwise sequential screening for Down's syndrome (combined test associated with modified genetic sonography) in pregnant women with low risk for chromosomal disorders.

OBJECTIVE: To assess the sensitivity (Sen) and false positive ratio (FPR) of stepwise sequential screening [1st step: combined test (CT), 2nd step: modified genetic sonography (major malformation and nuchal fold, MGS)] as a screening method for Down's syndrome (DS) in the general population of pregnant women. METHODS: Prospective study. During a 5-year study period (July 2005 to June 2010), 17,911 pregnant women were screened for DS using a stepwise sequential screening method (CT+MGS). We evaluated the Sen and FPR (95% CI) of the two chromosomal disorder screening methods for DS: CT and CT+MGS. RESULTS: Seventeen thousand nine hundred and eleven cases were analysed, including 67 with chromosome abnormalities and 45 with DS. The Sen of CT for DS was 80% (95% CI; 68.3-91.7) (36/45) with a FPR of 4.2% (95% CI; 3.9-4.5) (752/17, 866). The Sen of CT+MSG for DS was 93.3 (95% CI; 85.9-99) (42/45) with a FPR of 4.8% (95% CI; 4.5-5.1) (860/17, 866). CONCLUSIONS: MGS coupled with CT increases the Sen of DS diagnosis by 13.3% (95% CI; 2.7-25.9), with an increase in FPR of 0.6% (95% CI; 0.5-0.7).

Evaluation of disk diffusion method compared to broth microdilution for antifungal susceptibility testing of 3 echinocandins against Aspergillus spp.

We tested the susceptibility of caspofungin, micafungin, and anidulafungin against Aspergillus spp. isolates by the new Clinical and Laboratory Standards Institute M51-A disk diffusion (DD) and the broth microdilution methods. A total of 65 clinical isolates of Aspergillus spp. were evaluated. The DD assay was performed on nonsupplemented Müeller-Hinton agar using caspofungin 2-µg, micafungin 1-µg, and anidulafungin 2-µg disks. Echinocandin minimal effective concentrations (MECs) and inhibition zones (IZs) were read after 24 to 48 (A. terreus) h at 35 °C. Caspofungin MECs for all Aspergillus spp. strains tested were ≤ 0.25 µg/mL; IZs were ≥ 15 mm for most species except for A. terreus (11-22 mm). Both micafungin and anidulafungin MECs were ≤ 0.015 µg/mL, but micafungin IZs were ≥ 14 mm while anidulafungin IZs were ≥ 22 mm. As for caspofungin, the DD method could be a useful method for susceptibility testing of micafungin and anidulafungin against Aspergillus spp.

Role of fetal echocardiography in stepwise sequential screening for chromosomal disorders (combined test associated with modified genetic sonography).

OBJECTIVES: To evaluate the contribution made by fetal echocardiography in identifying Down's syndrome (DS) and other chromosomal disorders in a stepwise sequential screening method (first step: combined test (CT), second step: modified genetic sonography (MGS) (major malformation and nuchal fold)), for DS in the general population of pregnant women. METHODS: Prospective study. During a 5-year study period (July 2005-June 2010) 17,911 pregnant women underwent CTs with MGS (with fetal cardiac morphological evaluation performed by obstetricians in a tertiary hospital) as a screening method for DS. We evaluated the sensitivity and false positive rate (FPR) (95% confidence interval (CI)) of three screening methods for DS and all chromosomal disorders: CT, CT + MGS, and CT + fetal echocardiography. RESULTS: A total of 17,911 cases were analyzed with 67 chromosome disorders and 45 DS cases being found. For DS, the CT sensitivity was 80% (95% CI; 68.3-91.7) (36/45) and 79.1% (95% CI; 69.4-88.8) (53/67) for all chromosome disorders, with a FPR of 4.2% (95% CI; 3.9-4.5) (752/17,866) and 4.1% (95% CI; 3.8-4.4) (735/17,844), respectively. For CT + MSG and CT + fetal echocardiography, the sensitivity for DS was 93.3% (95% CI; 85.9-0.99) (42/45) and 95.5% (95% CI; 90.5-0.99) (64/67) for all chromosome disorders. The FPR for CT + MSG was 4.8% (95% CI; 4.5-5.1) (860/17,866) and 4.6% (95% CI; 4.3-4.9) (836/17,844), respectively. The FPR of CT + fetal echocardiography was 4.4% (95% CI; 4.1-4.7) (792/17,866) for DS screening and 4.3% (95% CI; 4-4.6) (770/17,844) for chromosome abnormality screening. CONCLUSIONS: Fetal echocardiography is highly capable of identifying DS and other chromosomal disorders as a part of genetic sonography in stepwise sequential screening.

Contribution of "modified genetic sonography" to the combined test as a screening method for chromosomal abnormalities.

OBJECTIVES: We propose to assess the contribution of "modified genetic sonography" (MGS) to the combined test (CT) as a method of stepwise sequential screening (1st step: CT, 2nd step: MGS) for chromosome abnormalities in the general population of pregnant women. METHODS: Prospective study. During a 4 year study period (July 2005-June 2009) 16,548 pregnancies underwent a CT combined with MGS (major malformation and nuchal fold) as a screening method for chromosome abnormalities. We assessed sensitivity and false positive rate (FPR) (95% CI). RESULTS: We offered a chromosome abnormalities screening test to 96.6% of pregnancies (15,995 cases). 14,160 cases are analyzed (1st step: CT, 2nd step: MGS) including 49 chromosome abnormalities and 35 Down's syndrome (DS). The sensitivity of CT for DS was 77.1% [95% CI, 63.2-91] (27/35) and 77.5% for all chromosome abnormalities [95% CI, 65.8-89.2] (38/49) with a FPR of 4.4% [95% CI, 4.1-4.7]. If MGS was combined with CT, the sensitivity for DS was 91.4% [95% CI, 82.1-99] (32/35) and 93.8% for all chromosome abnormalities [95% CI, 87-99] (46/49) for a FPR of 5.1% [95% CI, 4.7-5.5]. CONCLUSIONS: The addition of an MGS to combined first-trimester screening test for aneuploidy improved sensitivity by 14.3% while only increasing the FPR by 0.7%.

Evaluación del cobas 4800 CT/NG test para la detección de Chlamydia trachomatis / Evaluation of the cobas 4800 CT/NG test for detecting Chlamydia trachomatis

Introducción: Se ha evaluado el nuevo sistema automatizado cobas 4800 CT/NG test para la detección de Chlamydia trachomatis (C. trachomatis) en muestras urogenitales. Material y métodos: Se analizaron 696 muestras (488 exudados uretrales y cervicales y 208 orinas) para la detección de ADN de C. trachomatis. Los resultados del cobas 4800 CT/NG test (c4800) se compararon con los obtenidos por el Cobas AMPLICOR CT/NG test (CAM). Las discordancias se analizaron mediante PCR convencional y electroforesis en gel de agarosa en microchips, MultiNA. Resultados: Se realizaron dos análisis simultáneos, el primero de ellos fue comparar los resultados obtenidos con los exudados en el c4800 y en CAM. En este caso, la sensibilidad, la especificidad y los valores predictivos positivo (VPP) y negativo (VPN) fueron del 77,9, el 100, el 100 y 96%, respectivamente. El segundo análisis fue comparar los resultados obtenidos para las muestras de orina con los obtenidos con sus correspondientes exudados en el c4800. Los valores obtenidos para sensibilidad, especificidad, VPP yVPN fueron: 100, 98,9, 92,9 y 100%, respectivamente. Los valores kappa de estas comparaciones fueron:0,857 exudados en c4800 y CAM y 0,957 para orina frente a exudados en c4800. Conclusiones: Los resultados obtenidos con c4800 demuestran que son equiparables con los obtenidos con CAM. Asimismo, observamos una correlación excelente al comparar las muestras de exudados con su correspondiente muestra de orina en c4800, por lo que se puede emplear dicha muestra de forma sistemática en el diagnóstico de estas infecciones tanto en varón como en mujeres (AU)

Introduction: To evaluate the new automated system cobas 4800 CT/NG test for detection of Chlamydiatrachomatis in urogenital specimens. Material and methods: We analyzed 696 specimens (488 swabs from urethral or cervical specimens, and208 urines) to detect C. trachomatis. The results of the cobas 4800 CT/NG test (c4800) were compared to those obtained with Cobas AMPLICOR CT/NG test (CAM). Discordant results were analyzed with a conventional PCR assay and microchip electrophoresis system in agarose gel, MultiNA. Results: We made two simultaneous analyses. In the first one, we compared the results obtained withs wab specimens using the c4800 system and CAM. In this case, the sensitivity, the specifity, the positive and negative predictive values (PPV and NPV) were: 77.9%, 100%, 100% and 96% respectively. In the second one, we compared the results obtained for urine and its corresponding swab specimens on the c4800. The values obtained were: 100%, 98.9%, 92.9% and 100% respectively. The kappa values of these comparisons were: 0.857 for swab specimens on the c4800 and CAM, and 0.957 for urine versus swab specimens on the c4800. Conclusions: The results obtained with c4800 system were completely comparable with those obtained with CAM .We also noted an excellent correlation with these results when we compared swab specimens with their urine samples in the c4800 system. Therefore this sample type could be used routinely to diagnose infections in men and women (AU)

[Evaluation of the cobas 4800 CT/NG test for detecting Chlamydia trachomatis]. / Evaluación del cobas 4800 CT/NG test para la detección de Chlamydia trachomatis.

INTRODUCTION: To evaluate the new automated system cobas 4800 CT/NG test for detection of Chlamydia trachomatis in urogenital specimens. MATERIAL AND METHODS: We analyzed 696 specimens (488 swabs from urethral or cervical specimens, and 208 urines) to detect C. trachomatis. The results of the cobas 4800 CT/NG test (c4800) were compared to those obtained with Cobas AMPLICOR CT/NG test (CAM). Discordant results were analyzed with a conventional PCR assay and microchip electrophoresis system in agarose gel, MultiNA. RESULTS: We made two simultaneous analyses. In the first one, we compared the results obtained with swab specimens using the c4800 system and CAM. In this case, the sensitivity, the specificity, the positive and negative predictive values (PPV and NPV) were: 77.9%, 100%, 100% and 96% respectively. In the second one, we compared the results obtained for urine and its corresponding swab specimens on the c4800. The values obtained were: 100%, 98.9%, 92.9% and 100% respectively. The kappa values of these comparisons were: 0.857 for swab specimens on the c4800 and CAM, and 0.957 for urine versus swab specimens on the c4800. CONCLUSIONS: The results obtained with c4800 system were completely comparable with those obtained with CAM. We also noted an excellent correlation with these results when we compared swab specimens with their urine samples in the c4800 system. Therefore this sample type could be used routinely to diagnose infections in men and women.

Vigilância em saúde do trabalhador: passos para uma pedagogia / Surveillance in occupational health: steps toward a pedagogy

A Vigilância em Saúde do Trabalhador (Visat) compõe um conjunto de práticas legalmente inscritas no Sistema Único de Saúde (SUS) e recomendadas pelas diretrizes políticas que tratam das relações saúde-trabalho no Brasil. Entretanto, a Visat ainda é inusual e, quando existe, depende de atitudes voluntaristas de alguns profissionais no nível dos serviços. Afora a omissão gerencial do sistema de saúde para a sua implementação, uma das razões para que isso ocorra é a falta de capacitação técnica de agentes públicos para efetuá-la. O artigotrata de uma proposta metodológica para a capacitação em Vigilância em Saúde do Trabalhador, a partir de experiências desenvolvidas há algunsanos, no campo de ensino em serviço. Para isso, são discutidas as bases teórico-conceituais que norteiam a construção do campo da saúde do trabalhador e a pedagogia problematizadora utilizada no processo de educação permanente do SUS.

Surveillance in Occupational Health (Visat) comprises a set of practices legally entered in the National Health System (SUS) and recommended bythe policy guidelines that address the health-work relations in Brazil. However, the Visat is still uncommon and, when available, depends on proactive attitudes of some professionals at the service level. Asidefrom the failure of the management of the health system to implement Visat, another reason it is not implemented is the lack of technical capacity of public officials. The article presents a methodological proposalfor the training of Surveillance in Occupational Health using experiences developed some years ago in the of education in services.We discuss the theoretical and conceptual foundations that guidethe development of the of occupational health and the problem-based pedagogy used in the process of continuous education of the SUS.

Interobserver concordance in the assessment of liver fibrosis in HIV/HCV-coinfected patients using transient elastometry.

OBJECTIVES: Although the reproducibility of transient elastometry (TE) in hepatitis C virus (HCV)-monoinfected patients seems to be high, this may not be the case in HIV/HCV-coinfected patients because of different degrees of steatosis and/or inflammation. This study was aimed to determine the interobserver concordance of TE measurements in HIV/HCV-coinfected patients. METHODS: A total of 188 patients were evaluated in a cross-sectional, prospective study in two hospitals. The interobserver variability of TE results and the rate of unequal classification of significant fibrosis (cutoff value = 7.2 kPa) and cirrhosis (cutoff value = 14.6 kPa) for two observers were evaluated. RESULTS: The values of liver stiffness (LS) for two observers highly correlated [intraclass correlation index = 0.976; 95% confidence interval (CI): 0.968-0.982]. The kappa indexes for the concordance of patient classification were 0.60 for significant fibrosis and 0.89 for cirrhosis. Using two cutoff points to diagnose or rule out significant fibrosis (LS >or=9 kPa or <6 kPa) yielded a kappa index of 0.96, but 46% of patients were not classified. Covariables that influenced the interobserver agreement were a high interquartile range in the determination (adjusted odd ratio: 0.189; 95% CI: 0.087-0.411; P = 0.001) and elevated levels of triglycerides (adjusted odd ratio: 1.004; 95% CI: 1.000-1.008; P = 0.031). CONCLUSION: TE measurement is an observer-independent method to evaluate LS in HIV/HCV coinfected patients. The concordance of the classification of mild-to-severe fibrosis is good and for the diagnosis of cirrhosis is excellent. Lower interquartile ranges and triglyceride levels lead to a higher interobserver agreement.

Comparison of E-Test, disk diffusion and a modified CLSI broth microdilution (M 38-A) method for in vitro testing of itraconazole, fluconazole and voriconazole against dermatophytes.

We compared two agar-based methods, the E-test and the disk diffusion method with the Clinical Laboratory Standards Institute (CLSI) reference broth microdilution method (CLSI M38-A; MD). Forty six dermatophytes strains including 30 Trichophyton mentagrophytes, 8 T. rubrum and 8 M. gypseum were tested against three antifungal agents, i.e., fluconazole (FLC), itraconazole (ITC) and voriconazole (VRC). The level of agreement between the E-test and MD (+/-2 dilutions) was 45.6% for fluconazole, 19.5% for itraconazole and 52.1% for voriconazole. The results obtained with disk diffusion had low correlation with the results obtained by the CLSI broth microdilution reference method with azoles.

Comportamiento ee las hipoacusias de conducción / Conduction hypoacusis behavior

Los trastornos auditivos acarrean en el hombre cierta incomunicación con el medio, lo que conlleva a molestias y cierto retraimiento en las conductas interpersonales. Se realizó un estudio observacional y descriptivo en pacientes con trastornos en la audición, que acudieron a la Consulta de Audiología del Hospital Provincial Clínico Quirúrgico Docente “Manuel Ascunce Domenech” durante el año 2005. Se tuvo en cuenta el sexo, la edad, causas más frecuentes, promedio de pérdida auditiva y los resultados hallados en el estudio impedanciométrico. La obstrucción tubaria fue la enfermedad más frecuente, seguida de la otitis media crónica y la otoesclerosis, los primeros se observaron con más frecuencia en menores de 35 años y la otoesclerosis se manifestó por encima de esta edad. En estas enfermedades tuvo una frecuencia mayor el sexo masculino, no así en la otoesclerosis donde predominó el sexo femenino. Las enfermedades del oído medio fueron las causas mas frecuentes de hipoacusia de conducción, las pérdidas auditivas más severas estuvieron presentes en la otoesclerosis y la otitis media crónica. En la otoesclerosis predominó el timpanograma As y en las demás entidades los timpanogramas B y C.

Auditory disorders cause in man certain isolation with the enviroment, what involves inconvenience and certain reserve in the interpersonal behaviors. An observacional and descriptive study in patients with hearing disorders was performed, that came to the Audiology Consultation at "Manuel Ascunce Domenech" Educational Surgical Clinical Provincial Hospital during 2005 year. Sex, age, the most frequent causes, auditory loss average and the results found in the impedanciometric study were taking into consideration. Tubal obstruction was the most frequent disease, followed by the chronic otitis media and the otosclerosis, the first ones were observed with more frequency in younger than 35 years and otosclerosis was declared above this age. In these diseases had a greater frequency male sex, not like this in the otoesclerosis which female sex dominated. Middle ear diseses were the most frequent causes of conduction hypoacusis, the most severe auditory losses were present in otosclerosis and in chronic otitis media. In otoesclerosis the as tympanogram dominated and in the other entities B and C tympanograms.

Comportamiento de las hipoacusias de conducción / Conduction hypoacusis behavior

Los trastornos auditivos acarrean en el hombre cierta incomunicación con el medio, lo que conlleva a molestias y cierto retraimiento en las conductas interpersonales. Se realizó un estudio observacional y descriptivo en pacientes con trastornos en la audición, que acudieron a la Consulta de Audiología del Hospital Provincial Clínico Quirúrgico Docente Manuel Ascunce Domenech durante el año 2005. Se tuvo en cuenta el sexo, la edad, causas más frecuentes, promedio de pérdida auditiva y los resultados hallados en el estudio impedanciométrico. La obstrucción tubaria fue la enfermedad más frecuente, seguida de la otitis media crónica y la otoesclerosis, los primeros se observaron con más frecuencia en menores de 35 años y la otoesclerosis se manifestó por encima de esta edad. En estas enfermedades tuvo una frecuencia mayor el sexo masculino, no así en la otoesclerosis donde predominó el sexo femenino. Las enfermedades del oído medio fueron las causas mas frecuentes de hipoacusia de conducción, las pérdidas auditivas más severas estuvieron presentes en la otoesclerosis y la otitis media crónica. En la otoesclerosis predominó el timpanograma As y en las demás entidades los timpanogramas B y C(AU)

Auditory disorders cause in man certain isolation with the enviroment, what involves inconvenience and certain reserve in the interpersonal behaviors. An observacional and descriptive study in patients with hearing disorders was performed, that came to the Audiology Consultation at Manuel Ascunce Domenech Educational Surgical Clinical Provincial Hospital during 2005 year. Sex, age, the most frequent causes, auditory loss average and the results found in the impedanciometric study were taking into consideration. Tubal obstruction was the most frequent disease, followed by the chronic otitis media and the otosclerosis, the first ones were observed with more frequency in younger than 35 years and otosclerosis was declared above this age. In these diseases had a greater frequency male sex, not like this in the otoesclerosis which female sex dominated. Middle ear diseses were the most frequent causes of conduction hypoacusis, the most severe auditory losses were present in otosclerosis and in chronic otitis media. In otoesclerosis the as tympanogram dominated and in the other entities B and C tympanograms(AU)

[Study of resistance using the TRUGENE HIV-1 genotyping system and analysis of agreement between rule-based algorithms and virtual phenotyping]. / Estudio de resistencia mediante el sistema de genotipificación TRUGENE HIV-1 y análisis de concordancia entre algoritmos basados en reglas y el fenotipo virtual.

INTRODUCTION: This study attempts to describe the results obtained in the HIV resistance study performed with clinical samples obtained from patients receiving "HAART" therapy and to compare the results using different interpretation algorithms. METHODS: 397 samples have been analysed (TRUGENE HIV-1 GENOTYPING kit). The results were interpreted with the algorithms Visible Genetics and Retrogram. The concordance interalgorithm was done for 105 of these samples, including the virtual phenotype interpretation. RESULTS: The samples corresponded to multi regimen failure (39%), first and second failure (30.7% and 27.1% respectively). A 27.6% of the samples were wild type. The more frequent mutations to the ITIAN were T215Y/F (37.2%) and M184V (32.9%) following by other NAMS. The 69 insertion and Q151M complex had low representativity. For the ITINN K103N (25.8%), Y181C (11.2%) and G190A (10.9%). For the IP: key mutations L90M (26.1%), M46I (18.1%) and V82AFTS (12.9%); and accessory mutations L63P (50.5%), A71V (27.2%), L10I (25.2%) and M36I (19.2%). Low correlation was observed between interpretation systems, mainly for ITIAN and IP, being the virtual phenotype more flexible in the assignation of resistance. CONCLUSIONS: The requests for HIV resistance testing were similar for the three groups of patients. Many of the failures were the consequence of a poor adherence to the therapy. The mutation pattern found corresponded with the "TARGA" therapy. The low correlation found between interpretation systems, makes necessary the elaboration of a consensus algorithm.

Estudio de resistencia mediante el sistema de genotipificación TRUGENE HIV-1 y análisis de concordancia entre algoritmos basados en reglas y el fenotipo virtual / Study of resistance using the TRUGENE HIV-1 genotyping system and analysis of agreement between rule-based algorithms and virtual phenotyping

INTRODUCCIÓN. Describir los resultados obtenidos en el estudio de resistencia en enfermos con virus de la inmunodeficiencia humana (VIH) en tratamiento antirretroviral de gran actividad (TARGA) y comparar los resultados obtenidos empleando dos algoritmos de interpretación genotípica y el fenotipo virtual. MÉTODOS. Se han estudiado 397 muestras (TRUGENE HIV-1GENOTYPING kit), interpretando los resultados con los algoritmos Visible Genetics y Retrogram®. Se realizó el estudio de concordancia entre algoritmos de 105 de estas muestras incluyendo también la interpretación por el fenotipo virtual. RESULTADOS. Pacientes en multifracaso (39%), primer fracaso(30,7%) y segundo fracaso (27,1%). El 27,6% de las muestras fueron cepas salvajes. Las mutaciones a los inhibidores dela transcriptasa inversa análogos de nucleósidos (ITIAN)más frecuentes fueron T215Y/F (37,2%) y M184V (32,9%)seguida por otras mutaciones asociadas a los análogos de nucleósidos (NAMS). La inserción 69 y el complejo Q151M(1,5%) tuvieron poca representación. Para los inhibidores de la transcriptasa inversa no nucleósidos (ITINN) K103N(25,8%), Y181C (11,2%) y G190A (10,9%). Para los inhibidores de la proteasa (IP): mutaciones primarias L90M(26,1%), M46I (18,1%) y V82AFTS (12,9%); y mutaciones secundarias L63P (50,5%), A71V (27,2%), L10I (25,2%) yM36I (19,2%). Detectamos baja correlación entre sistemas de interpretación para ITIAN e IP, mostrándose el fenotipo virtual más flexible en la asignación de resistencia. CONCLUSIONES. Las peticiones de estudios de resistencia fueron similares para los tres grupos de pacientes. Muchos fracasos son el resultado de falta de adherencia al tratamiento. El patrón de mutaciones halladas se corresponde con los tratamientos TARGA. La baja correlación entre los sistemas de interpretación hace necesaria la elaboración de un algoritmo consensuado en función de la eficacia clínica (AU)

INTRODUCTION. This study attempts to describe the results obtained in the VIH resistance study performed with clinical samples obtained from patients receiving “HAART” therapy and to compare the results using different interpretation algorithms. METHODS. 397 samples have been analysed (TRUGENEHIV-1 GENOTYPING kit). The results were interpreted with the algorithms Visible Genetics and Retrogram TM. The concordance inter-algorithm was done for 105 of these samples, including the virtual phenotype interpretation. RESULTS. The samples corresponded to multi regimen failure (39%), first and second failure (30.7% and 27.1%respectively). A 27.6% of the samples were wild type. The more frequent mutations to the ITIAN were T215Y/F(37.2%) and M184V (32.9%) following by other NAMS. The69 insertion and Q151M complex had low representatively. For the ITINN K103N (25.8%), Y181C (11.2%) and G190A(10.9%). For the IP: key mutations L90M (26.1%), M46I(18.1%) and V82AFTS (12.9%); and accessory mutations L63P (50.5%), A71V (27.2%), L10I (25.2%) and M36I (19.2%).Low correlation was observed between interpretation systems, mainly for ITIAN and IP, being the virtual phenotype more flexible in the assignation of resistance. CONCLUSIONS. The petitions of VIH resistance testing were similar for the three groups of patients. Many of the failures were the consequence of a poor adherence to the therapy. The mutation pattern found corresponded with the “TARGA” therapy. The low correlation found between interpretation systems, makes necessary the elaboration of a consensus algorithm (AU)

Analisando uma equipe de trabalho em saúde, numa perspectiva interdisciplinar / Analyzing a work team in health, in an interdisciplinary perspective

O grupo, após várias discussões, escolheu o tema interdisciplinaridade por entender que uma equipe de profissionais de saúde pressupõe a integração dos mesmos e a interação das diferentes áreas de conhecimento, onde as ações técnicas são influenciadas e direcionadas por trocas subjetivas e comunicação não dependendo só do conhecimento e saberes específicos mas de momentos de interação entre profissionais na aplicação de disciplinas específicas...

Pais separados e filhos: análise funcional das dificuldades de relacionamento / Separated parents and children: functional Analysis of behavior difficulties

Estudos realizados revelam que a separaçäo conjugal pode exercer efeitos negativos sobre o relacionamento entre pais e filhos. A forma como os pais se realacionam com os filhos e entre si interfere na maneira positiva ou negativa de o filho enfrentar a separaçäo. Este trabalho teve como objetivos identificar dificuldades de relacionamento vivenciadas por pais e filhos e analisar as variáveis das quais estas dificuldades eram funçäo, além de promover a interaçäo entre eles. Os participantes foram 3 pais e 3 crianças, com idades entre 29 a 41 anos e 8 a 12 anos, respectivamente. O trabalho realizado na Clínica Psicológica da UEL consistiu de 36 encontros, sendo 11 com os pais, 11 com os filhos e 14 conjuntos. As intervenções consistiram de: desenhos, pinturas, orientações sobre disciplina, treino em expressividade emocional, dentre outras. A avaliaçäo inicial das dificuldades revelou a existência de comportamentos agressivos e inassertivos dos pais, sendo que os filhos também apresentaram dificuldades semelhantes. OS resultados da intervençäo apontaram melhoras nos comportamentos de imaturidade e isolamento dos filhos e na expressäo de sentimentos de pais e filhos. Embora tenham ocorrido mudanças comportamentais, sugerem-se intervenções futuras envolvendo pais que näo estäo com a guarda dos filhos, os quais contribuem para as dificudades de relacionamentopor eles apresentadas. (au)