Metodologias ativas e o ensino tecnicista na saúde: a prática docente / Active methodologies and technicist teaching in health: the teaching practice

Objetivo: Caracterizar a percepção do docente sobre as metodologias ativas utilizadas na educação profissional da área da saúde, bem como, desenvolver um prospecto de aplicativo para dispositivos móveis com conteúdo voltado ao ensino ativo. Métodos: Trata-se de uma pesquisa de campo-ação, de natureza qualitativa em uma Instituição Escolar Vale do Paraíba, a coleta deu-se em Maio 2019 a amostra foi determinada por conveniência. Resultados: A estratégia que o professor utiliza para desenvolver um conteúdo é o instrumento mais importante para alcançar os objetivos a que se propõe. Entretanto, não existe um método pedagógico universal, e sim uma infinidade de recursos ou ferramentas que o mesmo lança mão para mediar o processo ensino. Conclusão: O papel do professor, enquanto facilitador no processo de ensino-aprendizagem é fundamental no sentido de abrir-se e adequar-se às novas demandas.(AU)

Objective: To characterize the perception of teachers about active methodologies used in professional education in the health area, as well as to develop an application prospectus for mobile devices with content aimed at active teaching. Methods: This is a field-action research, qualitative in nature in a School Institution Vale do Paraiba, the collection took place in May 2019 and the sample was determined by convenience. Results: The strategy that the teacher uses to develop content is the most important instrument to achieve the goals it proposes. However, there is no universal pedagogical method, but an infinity of resources or tools that it uses to mediate the teaching process. Conclusion: The teacher's role, as a facilitator in the teachinglearning process, is fundamental in the sense of opening up and adapting to new demands.(AU)

Objetivo: Caracterizar la percepción de los profesores sobre las metodologías activas y las prácticas pedagógicas utilizadas en la formación profesional en los cursos del área de la salud, así como desarrollar inicialmente un prospecto de una aplicación para dispositivos móviles con contenidos centrados en estrategias de enseñanza activa. Métodos: Se trata de una investigación de campo, de carácter cualitativo. Se elaboró un instrumento de recopilación de datos para las entrevistas con los docentes de una institución privada de enseñanza técnica, amostra determinada por conveniencia. Para elaborar el prospecto de aplicación se utilizó la metodología del Design Thinking. Resultados: La estrategia que el profesor utiliza para desarrollar un contenido es la herramienta más importante para lograr sus objetivos. Sin embargo, no existe un método pedagógico universal, sino una multitud de recursos o herramientas que el profesor utiliza para estimular el aprendizaje del alumno. Conclusión: El papel del profesor, como facilitador en el proceso de enseñanza-aprendizaje, es fundamental para adaptarse a las nuevas exigencias, para estar abierto a nuevas prácticas pedagógicas, para aceptar los retos que imprime la educación de hoy y del futuro, de enseñar a aprender y de aprender a enseñar.(AU)

CD3+CD4negCD8neg (double negative) T lymphocytes and NKT cells as the main cytotoxic-related-CD107a+ cells in lesions of cutaneous leishmaniasis caused by Leishmania (Viannia) braziliensis.

BACKGROUND: Cutaneous leishmaniasis (CL) is caused by Leishmania (Viannia) braziliensis, which infects dermal macrophages and dendritic cells, causing an intense immune-mediated-tissue inflammation and a skin ulcer with elevated borders that can heal spontaneously or after antimonial therapy. The resolution of lesions depends on an adaptive immune response, and cytotoxic cells seem to have a fundamental role in this process. The aim of this study is to better understand the role of cytotoxicity mediated mechanisms that occur during the immune response in the CL lesion milieu, considering distinct cytotoxic-related CD107a+ cells, such as CD8+, CD4+, CD4neg CD8neg (double-negative, DN) and CD4+CD8+ (double-positive, DP) T lymphocytes, as well as NK and NKT cells. METHODS: Lesion derived cells were assessed for T cell subpopulations and NK cells, as well as CD107a expression by flow cytometry. In addition, cytometric bead array (CBA) was used to quantify cytokines and granzyme B concentrations in supernatants from macerated lesions. RESULTS: Flow cytometry analyses revealed that NKT cells are the major CD107a-expressing cell population committed to cytotoxicity in CL lesion, although we also observed high frequencies of CD4+ and DN T cells expressing CD107a. Analysing the pool of CD107a+-cell populations, we found a higher distribution of DN T cells (44%), followed by approximately 25% of NKT cells. Interestingly, NK and CD8+ T cells represented only 3 and 4% of the total-CD107a+-cell pool, respectively. CONCLUSIONS: The cytotoxicity activity that occurs in the lesion milieu of CL patients seems to be dominated by DN T and NKT cells. These findings suggest the need for a reevaluation of the role of classical-cytotoxic NK and CD8+ T cells in the pathogenesis of CL, implicating an important role for other T cell subpopulations.

Vacinação contra pneumonia em pacientes idosos portadores de comorbidades. Análise do impacto do esquema de vacinação antipneumocócica nos pacientes com mais de 60 anos / Pneumonia immunization in older adults with comorbidities: an analysis of the impact of anti-pneumococcal vaccination schedule in patients over 60 years

OBJETIVO: Avaliar o impacto do esquema de vacinação antipneumocócica em pacientes com idade igual ou superior a 60 anos e analisar se ele é realizado conforme as diretrizes. MÉTODOS: Estudo prospectivo desenvolvido após busca ativa em prontuários e aplicação de questionário elaborado pelos autores a um grupo de 68 pacientes, em acompanhamento clínico ou hospitalizados. Foram incluídos pacientes de ambos os sexos e que necessitavam ser imunizados contra pneumonia adquirida na comunidade, por serem portadores de comorbidades. RESULTADOS: Apenas 25% foram vacinados; 75% dos indivíduos entrevistados não receberam orientação sobre a vacinação antipneumocócica, mas 41,2% tinham conhecimento sobre a vacina. CONCLUSÕES: São ainda deficitárias a chegada de informação ao indivíduo idoso e a recomendação da imunização e de qual esquema deve ser seguido no momento da vacinação.

OBJECTIVE: To evaluate the impact of anti- pneumococcal vaccination in patients aged 60 years and over, and to analyze if it is compliant with the guidelines. METHODS: A prospective study developed after active search in medical records and application of a questionnaire developed by the authors to a group of 68 patients being clinically monitored or hospitalized. Patients from both genders and who required immunization against community-acquired pneumonia were included because they had comorbidities. RESULTS: Only 25% were vaccined; 75% of all the subjects interviewed did not receive any information about the anti-pneumococcal vaccination, but 41,2% already knew about the vaccine. CONCLUSION: The availability of information to the elderly individual, as well as the immunization recommendation, and which regimen to follow at the time of vaccination are still deficient.

Incidência de trajeto intramiocárdico em grupo populacional / Incidence of intramyocardial bridge in a population sample

Fundamentos: A anomalia causada pelo trajeto intramiocárdico tem sido apontada como diagnóstico diferencialda doença arterial coronariana.Objetivo: Analisar a incidência de trajeto intramiocárdico (TIM) em amostra populacional.Métodos: Estudo observacional, retrospectivo, que analisou prontuários de 200 pacientes diagnosticados comtrajeto intramiocárdico (TIM) ou ponte miocárdica (PM) pela angiotomografia coronariana (angio-TC), no períodode setembro de 2010 a março de 2015, no Hospital Beneficência Portuguesa de São Paulo e MedImagem – serviçode Radiologia do Hospital. Foram analisadas as seguintes variáveis: sexo, idade, altura, peso, cor da pele, históriafamiliar de doença cardiovascular, tabagismo, presença ou não de stent, incidência de dislipidemia, sintomatologia,presença de hipertensão arterial sistêmica (HAS) e diabetes mellitus (DM), e artérias coronárias mais acometidas.Resultados: Dos 200 prontuários analisados, observou-se maior incidência de TIM nos pacientes do sexo masculino(63,7%, n=128); média de idade 57,78±15,0 anos; predomínio da cor branca (85,0%); média de peso 84,5 kg, commais da metade (n=125, 62,5%) dos pacientes abaixo do peso médio; 15 (7,5%) pacientes portavam stent; 81 (40,5%)apresentavam sintomas (dor torácica ou dispneia); 108 (54,0%) tinham história familiar de doença cardiovascular;73 (36,5%) apresentavam dislipidemia; 83 (41,5%) tinham HAS; 28 (14,0%) tinham DM; 98 (49,0%) pacientesapresentavam aterosclerose; e 56 (28,0%) pacientes eram tabagistas. A principal artéria acometida foi a descendenteanterior (n=193, 96,0%)Conclusões: Conclui-se, na população estudada que o TIM é predominante em pacientes masculinos, de corbranca, não obesos, mais idosos, com história familiar de doença cardiovascular. A principal artéria acometidafoi a descendente anterior.

Background: The anomaly caused by intramyocardial bridge has been identified as a differential diagnosis of coronary artery disease.Objective: To analyze the incidence of intramyocardial bridge (IMB) in a population sample.Methods: Retrospective observational study that analyzed medical records of 200 patients diagnosed with intramyocardial bridge (IMB)or myocardial bridge (MB) using coronary computed tomography angiography (CCTA) from September 2010 to March 2015 at HospitalBeneficência Portuguesa de São Paulo and MedImagem — the Radiology service of the Hospital. The following variables were analyzed:sex, age, height, weight, skin color, family history of cardiovascular disease, smoking, presence or absence of stent, incidence of dyslipidemia,symptoms, systemic arterial hypertension (SAH) and diabetes mellitus (DM), and the coronary arteries mostly affected.Results: Of the 200 patient records reviewed, there was a higher incidence of IMB in male patients (63.7%, n=128); mean age 57.78±15.0years; predominance of white color (85.0%); average weight 84.5 kg, with more than half (n=125, 62.5%) of patients below average weight;15 (7.5%) patients were stented; 81 (40.5%) had symptoms (chest pain or dyspnea); 108 (54.0%) had a family history of cardiovasculardisease; 73 (36.5%) presented dyslipidemia; 83 (41.5%) had SAH; 28 (14.0%) had MD; 98 (49.0%) patients had atherosclerosis; and56 (28.0%) patients were smokers. The main affected artery was the left anterior descending artery (n=193, 96.0%).Conclusions: The conclusion is that, in the study population, IMB is prevalent in male patients of white color, non-obese, older,with family history of cardiovascular disease. The main affected artery was the left anterior descending artery.

Associação entre valores de carga pressórica noturna na MAPA com o diagnóstico de apneia do sono / Association between sleep load pressure values with sleep apnea diagnosis

Fundamentos: A apneia do sono é fator de risco para várias condições cardiovasculares e, sendo assim, o seudiagnóstico é essencial.Objetivo: Verificar em pacientes portadores de hipertensão arterial sistêmica e apneia do sono, se há associaçãoentre esses diagnósticos.Métodos: Estudo retrospectivo, realizado com pacientes adultos, de ambos os sexos, provenientes do banco dedados da Clínica Paulista de Doenças Cardiovasculares, diagnosticados com hipertensão arterial sistêmica eapneia do sono, no período de janeiro de 2011 a janeiro de 2015. Utilizados dados da monitorização ambulatorialda pressão arterial (MAPA) e da polissonografia associados para verificar a presença de aumento da cargapressórica e ausência de descenso durante o sono e a presença de episódios obstrutivos que diagnosticaram apneiado sono. Os pacientes também foram avaliados em relação aos fatores de risco cardiovascular: sedentarismo,obesidade, tabagismo, nível glicêmico e perfil lipídico.Resultados: Foram avaliados 59 pacientes, sendo que 32 (54,2%) pacientes apresentaram na MAPA manutençãoou aumento da carga pressórica com ausência de descenso durante o sono, quando comparados à vigília. Dessespacientes, 31 (96,9%) apresentaram apneia do sono na polissonografia, mostrando uma associação de 97,0%.Conclusão: Neste estudo, observou-se forte associação entre hipertensão arterial sistêmica e apneia do sono.

Background: Sleep apnea is a risk factor for many cardiovascular conditions, therefore, its diagnosis is essential.Objective: To check in patients with systemic arterial hypertension and sleep apnea whether there is an association between thesediagnoses.Methods: Retrospective study with adult patients of both sexes from the database of Clínica Paulista de Doenças Cardiovascularesdiagnosed with systemic arterial hypertension and sleep apnea from January 2011 to January 2015. Data from ambulatory bloodpressure monitoring (ABPM) and polysomnography associated for the presence of increased pressure load and no pressure decreaseduring sleep and the presence of obstructive episodes that diagnosed sleep apnea. Patients were also evaluated for cardiovascularrisk factors: physical inactivity, obesity, smoking, glucose level and lipid profile.Results: Altogether, 59 patients have been evaluated, 32 of which (54.2%) presented, during ABPM, stable or increased pressureload with no decline during sleep compared to wakefulness. Of these patients, 31 (96.9%) had sleep apnea in polysomnography,showing an association of 97.0%.Conclusion: In this study, we observed a strong association between systemic arterial hypertension and sleep apnea.

T-cell receptor Vβ repertoire of CD8+ T-lymphocyte subpopulations in cutaneous leishmaniasis patients from the state of Rio de Janeiro, Brazil

In human cutaneous leishmaniasis (CL), the immune response is mainly mediated by T-cells. The role of CD8⁺ T-lymphocytes, which are related to healing or deleterious functions, in affecting clinical outcome is controversial. The aim of this study was to evaluate T-cell receptor diversity in late-differentiated effector (LDE) and memory CD8⁺ T-cell subsets in order to create a profile of specific clones engaged in deleterious or protective CL immune responses. Healthy subjects, patients with active disease (PAD) and clinically cured patients were enrolled in the study. Total CD8⁺ T-lymphocytes showed a disturbance in the expression of the Vβ2, Vβ9, Vβ13.2, Vβ18 and Vβ23 families. The analyses of CD8⁺T-lymphocyte subsets showed high frequencies of LDE CD8⁺T-lymphocytes expressing Vβ12 and Vβ22 in PAD, as well as effector-memory CD8⁺ T-cells expressing Vβ22. We also observed low frequencies of effector and central-memory CD8⁺ T-cells expressing Vβ2 in PAD, which correlated with a greater lesion size. Particular Vβ expansions point to CD8⁺ T-cell clones that are selected during CL immune responses, suggesting that CD8⁺ T-lymphocytes expressing Vβ12 or Vβ22 are involved in a LDE response and that Vβ2 contractions in memory CD8⁺T-cells are associated with larger lesions.

T-cell receptor Vß repertoire of CD8+ T-lymphocyte subpopulations in cutaneous leishmaniasis patients from the state of Rio de Janeiro, Brazil.

In human cutaneous leishmaniasis (CL), the immune response is mainly mediated by T-cells. The role of CD8+ T-lymphocytes, which are related to healing or deleterious functions, in affecting clinical outcome is controversial. The aim of this study was to evaluate T-cell receptor diversity in late-differentiated effector (LDE) and memory CD8+ T-cell subsets in order to create a profile of specific clones engaged in deleterious or protective CL immune responses. Healthy subjects, patients with active disease (PAD) and clinically cured patients were enrolled in the study. Total CD8+ T-lymphocytes showed a disturbance in the expression of the Vß2, Vß9, Vß13.2, Vß18 and Vß23 families. The analyses of CD8+T-lymphocyte subsets showed high frequencies of LDE CD8+T-lymphocytes expressing Vß12 and Vß22 in PAD, as well as effector-memory CD8+ T-cells expressing Vß22. We also observed low frequencies of effector and central-memory CD8+ T-cells expressing Vß2 in PAD, which correlated with a greater lesion size. Particular Vß expansions point to CD8+ T-cell clones that are selected during CL immune responses, suggesting that CD8+ T-lymphocytes expressing Vß12 or Vß22 are involved in a LDE response and that Vß2 contractions in memory CD8+T-cells are associated with larger lesions.

Apoptosis and frequency of total and effector CD8+ T lymphocytes from cutaneous leishmaniasis patients during antimonial therapy.

BACKGROUND: Leishmaniasis is an important parasitic disease affecting millions worldwide. Human cutaneous leishmaniasis (CL) is endemic in Rio de Janeiro, Brazil, where is caused by Leishmania braziliensis. The adaptive immune response is accountable for the healing of CL and despite of key role of CD8+ T cells in this immune response little is known about the CD8+ T lymphocytes frequencies, apoptosis and antigen-responsive CD8+ T lymphocytes of CL patients during antimonial therapy. METHODS: Using flow cytometry, we examined total and effector CD8+ T cells from CL patients before (PBT), during (PDT) and after (PAT) treatment for apoptosis and frequencies upon isolation and after in vitro L. braziliensis antigens (LbAg)-stimulation culture. Besides, a correlation study between immunological findings and lesion size was done. RESULTS: PDT showed lower frequencies of total CD8+ T lymphocytes and higher levels of apoptosis of these cells, which were also observed following LbAg-stimulation culture. Regarding effector CD8+ T cells, high frequencies were observed in PDT, while lower frequencies were observed in PAT. Interestingly, PDT showed higher frequencies of apoptotic-effector CD8+ T lymphocytes. Similar results were seen after in vitro antigenic-stimulation assays. Correlation analysis showed that the greater the size of lesion, the smaller the frequency of effector CD8+ T lymphocytes in PDT and PAT, as well as a positive correlation between apoptotic-effector CD8+ T cells frequency and lesion size of PDT. CONCLUSIONS: Changes in effector CD8+ T-lymphocyte frequencies, during and after treatment, seem to represent a critical stage to generate an efficient immune response and suggest that these cells would be evolved in the triggering or in the resolution of lesion, under the influence of therapy. This hypothesis opens new perspectives to clarify controversial statements about the protective or deleterious role of CD8+ T cells in the cure or aggravation of CL and the new approach of evaluating patients during treatment proved to be of utmost importance for understanding the immune response in the healing process of human CL.

Avaliação da variação de razão normalizada internacional em pacientes anticoagulados através de metodologia diferenciada / Assessment of INR variations in anticoagulated patients through a differentiated methodology

Fundamentos: A varfarina apresenta um intervalo terapêutico estreito e resposta variável. O risco decomplicações hemorrágicas ou a ocorrência de eventos tromboembólicos obriga o paciente a controle terapêutico rigoroso. Objetivo: Verificar a flutuação da Razão Normalizada Internacional (RNI) em pacientes com terapia de anticoagulação com varfarina através de controle diferenciado. Métodos: Estudo retrospectivo não controlado, com 50 pacientes com fibrilação atrial, eventos embólicos ou prótese valvar. Utilização de questionário para: caracterização demográfica; dados clínicos da doença; tratamento; anticoagulante em uso; conhecimento sobre a terapêutica; percepção acerca do uso de anticoagulante; adesão ao tratamento (Morisky). Foram coletados os últimos cinco registros da RNI do prontuário do paciente e verificação de ao menos trêsmedidas entre 2,0≤RNI≤3,0. Resultados: Aderência ao tratamento ocorreu em 64,0% dos relatos e 54,0% foi comprovado pelocontrole de RNI. A amostra foi composta predominantemente de indivíduos com formação universitária (50,0%) e com renda superior a cinco salários mínimos (56,0%). Apesar do controle diferenciado do RNI, 30,0% permaneceram fora da meta. O controle da RNI nesta população foi superior aos resultados obtidos com controle convencional. Nível socioeconômico esteve associado diretamenteao melhor resultado de controle. Conclusão: Apesar do controle diferenciado do RNI, parte dos pacientes permaneceu fora da meta. O nível de escolaridade foi o fator de obtenção do melhor controle. Questiona-se o fornecimento de anticoagulantes que não necessitem do controle do RNI para pacientes portadores da FA não valvar.

Background: Warfarin has a narrow therapeutic range and variable response. The risk of hemorrhagic complications or the occurrence of thromboembolic events impose strict therapeutic controls on patients.Objective: Verify fluctuations of the International Normalized Ratio (INR) in patients on anticoagulation therapy with warfarin through differentiated control. Methods: Uncontrolled retrospective study of fifty patients with atrial fibrillation, embolic events or prosthetic valves who completed a questionnaire on: demographic characteristics; clinical data on the disease; treatment; anticoagulants being taken;knowledge of treatment; perceptions of taking anticoagulants; adherence to treatment (Morisky). The last five INRs were collected from patient records and checked for at least three measurements between 2.0≤INR≤3.0. Results: Adherence to treatment occurred in 64,0% of the reports, with 54,0% confirmed by INR controls.The sample consisted predominantly (50,0%) of university graduates with incomes of more than five times the minimum wage (56%). Despite differentiated INR control, 30,0% remained off-target, although INR control in this population exceeded the results obtained through conventional control. Social and economic levels were directly associated with better control outcomes. Conclusion: Despite differentiated INR control, some patients remained off-target, with education levels being the factor for obtaining better control. The supply of anticoagulants is questioned, when no INR control is required for patients with non valvular AF.

Identificação de diabetes mellitus 2 em cardiopatas com provável resistênciainsulínica através da hemoglobina glicada / Identification of DM2 in cardiac patients with probable insulin resistance through glycated Hb

Fundamentos: A presença de diabetes mellitus (DM) acarreta abordagem terapêutica e seguimento diferenciados, especialmente em cardiopatas, sendo essencial a prevenção primária e secundária de eventos cardiovasculares nesses pacientes. Objetivos: Observar a presença de DM2 em pacientes cardiopatas portadores de hemoglobina glicada entre 5,7-6,4 %, através da solicitação precoce da curva glicêmica (teste oral de tolerância à glicose - TOTG). Métodos: Foram estudados, de forma retrospectiva, prontuários de 113 pacientes: 51 homens e 62 mulheres, portadores de doença arterial coronariana manifesta ou subclínica, selecionados após avaliação clínica elaboratorial. Foram analisados dosagem de glicemia em jejum, hemoglobina glicada, curva glicêmica, ureia, creatinina, perfil lipídico, idade, sexo, IMC, presença de hipertensão arterial sistêmica, aterosclerose, insuficiência cardíaca, doença arterial coronariana prévia e testes isquêmicos positivos sem necessidade de intervenção. Resultados: Foram diagnosticados como portadores de resistência insulínica através da curva glicêmica 37,2 % dos homens, sendo que 5,9 % apresentavam glicemia de jejum <99mg/dL e 15,7% apresentaram curva compatível do DM2. Quanto à glicemia de 2 horas entre as mulheres, observaram-se 38,8% casos de resistência insulínica, sendo que 19,6 % eram normoglicêmicas na glicemia de jejum e 8 % apresentaram valores >200mg/dL, sendo que 3,2%apresentaram glicemia de jejum <99mg/dL. Conclusão: Pacientes com hemoglobina glicada na faixa para portadores de resistência insulínica eram,na realidade, portadores de DM. Foram identificados pacientes com DM através do TOTG no grupo de portadores de resistência insulínica. A presença de IMC aumentado associou-se à presença de pacientes com DM nesta amostra.

Background: The presence of diabetes mellitus (DM)requires different therapeutic approaches and follow-ups, especially in cardiac patients, with primary and secondary prevention of cardiovascular events being essential for these patients. Objectives: To observe the presence of DM2 in cardiac patients with glycated hemoglobin levels between 5.7 and 6.4% by early requests for glycemic curves obtained through the Oral Glucose ToleranceTest (OGTT). Methods: A retrospective study analyzed the medical records of 113 patients (51 men and 62 women) with manifest or subclinical coronary artery disease, selected after clinical and laboratory evaluation, witht he following measurements: fasting glycemia, glycated hemoglobin, glycemic curve, urea, creatinine, lipids profile, age, gender and BMI, as well as the presence of hypertension, atherosclerosis, heart failure, previous coronary artery disease and positive ischemic tests with no need for intervention. Results: Insulin resistance was diagnosed through glycemic curves in 37.2% of the men, of whom 5.9% had fasting glucose below 99 mg/L and 15.7%presented curves compatible with DM2. Based on glycemia at 2 hours, there were 38.8% cases of insulin resistance among the women, while 19.6% were normoglycemic fasting glucose and 8% had values greater than 200 mg/dL, of which 3.2% had fast ingglucose below 99 mg/dL. Conclusion: Patients with glycated hemoglobin in the insulin resistance range actually had DM, identified through the OGTT in the group with insulin resistance .The presence of increased BMI was associated with the presence of diabetic patients in this sample.

Immunophenotyping in saliva as an alternative approach for evaluation of immunopathogenesis in chronic periodontitis.

BACKGROUND: To date, flow cytometric immunophenotyping has not been used to investigate immune patterns in saliva samples from individuals with inflammatory processes in the oral cavity, such as chronic periodontitis (CP). Saliva analysis could be a non-invasive method for evaluating oral health. The objective of this study is to determine the phenotype of leukocytes and total immunoglobulin A (IgA), IgG, and IgM titers in the saliva of individuals with CP. METHODS: Saliva samples were obtained from patients with CP (n = 12) and from a control group (n = 27) without oral diseases. Flow cytometry was performed to determine the frequency of T cells (CD4(+) and CD8(+)), B cells, and natural killer (NK) cells as well as the total leukocyte population. Immunoglobulin titers were determined by dot enzyme-linked immunosorbent assay. RESULTS: Cell immunophenotyping revealed that patients with CP had a higher frequency of total leukocytes (47.94% ± 5.1%; P < 0.001), B cells (43.93% ± 6.2%; P = 0.006), NK cells (0.16% ± 0.04%; P = 0.03), and CD4(+) T cells (38.99% ± 4.4%; P = 0.002) than individuals without oral pathologies (24.75% ± 2.2%, 20.60% ± 2.7%, 0.09% ± 0.03%, and 16.82% ± 3.5%, respectively). No significant differences in salivary total IgA, IgG, and IgM titers were found between the two cohorts studied. Nevertheless, higher total IgG levels were observed in patients with CP, which could indicate a possible correlation between clinical attachment level and salivary IgG (P = 0.07; r(2) = 0.08). CONCLUSION: These results show that cell phenotyping by flow cytometry could be an effective tool for determining leukocyte profiles in saliva samples from patients with CP and healthy individuals.

Determinação do risco cardiovascular em população de check-up espontâneo através do escore de Framingham / Determination of cardiovascular risk in spontaneous check-up population through the Framingham score

Fundamentos: As doenças cardiovasculares (DCV) estão entre as principais causas de morte em todo o mundo. Muitos dos pacientes que sofrem morte súbita são previamente assintomáticos, o que torna relevante a preocupação com a triagem da doença cardiovascular. A probabilidade de doença coronariana na população em geral pode ser calculada com base nos resultados do Framingham Heart Study. Objetivo: Determinar o risco cardiovascular em população assintomática de check-up espontâneo, utilizando o escore de Framingham. Métodos: Foram coletadas através de estudo de coorte retrospectivo, informações do prontuário de 83 indivíduos, 50 homens e 33 mulheres, com idade entre 30-79 anos, assintomáticos, que realizaram a primeira consulta nos últimos dois anos. Os dados de sedentarismo, tabagismo e presença de diabetes mellitus foram analisados de forma separada, utilizando-se o teste do qui-quadrado. As variáveis da escala de Framingham foram analisadas em escala numérica através do teste de Mann-Whitney. Resultados: Procuraram avaliação cardiológica 52,0 % dos homens quando estavam na faixa de risco moderado a alto e escore de Framingham médio de 9,8, com risco cardiovascular de 14,2 % para o desenvolvimento de doença cardiovascular em cinco anos; 72,7 % das mulheres procuraram avaliação cardiológica quando estavam na faixa de risco baixo, e escore de Framingham médio de 7,2 com risco cardiovascular de 8,3 % para o desenvolvimento de doença cardiovascular em cinco anos. Conclusão: Na população assintomática que fez check-up espontâneo, utilizando-se o escore de Framingham, os homens apresentaram risco moderado e alto de DCV, enquanto que esse risco foi muito reduzido entre as mulheres.

Background: Cardiovascular diseases (CVD) are among the leading causes of death all over the world. Many sudden deaths occur among formerly asymptomatic patients, underscoring the importance of concern over screening for cardiovascular disease. The probability of coronary disease among the general population may be calculated on the basis of the Framingham Heart Study findings. Objective: To determine the cardiovascular risk in an asymptomatic spontaneous check-up population, using the Framingham score.Methods: Information was collected from the medical records of 83 asymptomatic individuals (50 men and 33 women) between 30 and 79 years old having their first consultation in the past two years. Data on sedentary lifestyles, smoking and diabetes mellitus were analyzed separately though the chi-square test. The Framingham scale variables were analyzed on a numerical scale through the Mann-Whitney test. Results: Cardiological evaluations were sought by 52 % of men in the moderate to high risk range with an average Framingham score of 9.8 and cardiovascular risk of 14.2 % for developing cardiovascular disease within five years, with 72.7 % of the women seeking cardiological evaluations when in the low risk range and an average Framingham score of 7.2 with a cardiovascular risk of 8.3 % for developing cardiovascular disease within five years.Conclusion: In an asymptomatic spontaneous check-up population, using the Framingham score, the men presented moderate to high cardiovascular risks, with these risks being far lower among the women.

Pleurotomy with subxyphoid pleural drain affords similar effects to pleural integrity in pulmonary function after off-pump coronary artery bypass graft.

BACKGROUND: Exacerbation of pulmonary dysfunction has been reported in patients receiving a pleural drain inserted through the intercostal space in comparison to patients with an intact pleura undergoing coronary artery bypass grafting (CABG). Evidence suggests that shifting the site of pleural drain insertion to the subxyphoid position minimizes chest wall trauma and preserves respiratory function in the early postoperative period. The aim of this study was to compare the pulmonary function parameters, clinical outcomes, and pain score between patients undergoing pleurotomy with pleural drain placed in the subxyphoid position and patients with intact pleural cavity after off-pump CABG (OPCAB) using left internal thoracic artery (LITA). METHODS: Seventy-one patients were allocated into two groups: I (n = 38 open left pleural cavity and pleural drain inserted in the subxyphoid position); II (n = 33 intact pleural cavity). Pulmonary function tests and clinical parameters were recorded preoperatively and on postoperative days (POD) 1, 3 and 5. Arterial blood gas analysis and shunt fraction were evaluated preoperatively and in POD1. Pain score was assessed on POD1. To monitor pleural effusion and atelectasis chest radiography was performed routinely 1 day before operation and until POD5. RESULTS: In both groups a significant impairment was found in lung function parameters until on POD5. However, no significant difference in forced vital capacity and forced expiratory volume in 1 second were seen between groups. A significant decrease in partial pressure of arterial oxygen and an increase in shunt fraction values were observed on POD1 in both groups, but no statistical difference was found when the groups were compared. Pleural effusion and atelectasis until on POD5 were similar in both groups. There were no statistical differences in pain score, duration of mechanical ventilation and postoperative hospital stay between groups. CONCLUSION: Subxyphoid insertion of pleural drain provides similar effects to preserved pleural integrity in pulmonary function, clinical outcomes, and thoracic pain after OPCAB. Therefore, our results support the hypothesis that once pleural cavities are incidentally or purposely opened during LITA dissection, subxyphoid placement of the pleural drain is recommended.

O processo de alfabetização como facilitador na modificação da auto-estima de adultos / Literary process as an easer on the changes on adults' self-steem

A alfabetização é essencial para auxiliar a modificação da auto-estima de jovens e adultos. Este trabalho visou identificar se esta população apresenta modificação em sua auto-estima por iniciar um processo de alfabetização. Observou-se que, durante a fase de ingresso na alfabetização, os alunos possuíam uma visão idealizada do aprendizado, com expectativas acentuadas a respeito de seu futuro. Na fase posterior ao ingresso escolar, pode se notar que a diferença entre os desenhos foi bastante nítida, as produções gráficas se tornaram muito mais pobres em detalhes e em conteúdo. Esta diferenciação foi explicada devido ao fato de, a maioria dos alunos, já possuir um grau mais avançado no processo de alfabetização, fazendo com que a habilidade de expressão através de desenhos diminua, uma vez que estes já possuem outra forma, mais aprimorada, a escrita. Concluiu-se que indivíduos analfabetos possuem grande motivação para iniciar o processo de aprendizado, a busca por este trabalho promove melhorias em sua auto-estima, porém, a falta de programas que sejam adequados às demandas deste público faz com que diminua a mobilização(AU)