Is there an overestimation of dengue compared with that of other acute febrile syndromes in childhood?

A group of children with clinical suspicion of dengue were assessed to determine if there was an overestimation of dengue compared with that of leptospirosis and leishmaniasis. This descriptive and analytical cross-sectional study, based on the active search of participants with acute febrile illness, was conducted at two pediatric hospitals. The collection of clinical and epidemiological data was performed using questionnaires, and laboratory tests specific for dengue were performed using immunochromatographic, serological, and molecular methods. Dengue-negative samples were assessed for Leptospira and Leishmania spp. using molecular tests. Data were assessed using analysis of variance (ANOVA), the chi-square test, and Fisher's exact test. In total, 86 participants were evaluated, of whom 39 (45%) were positive for dengue fever, 4 (5%) for leptospirosis, and 1 (1%) for leishmaniasis. Forty-two participants (49%) presented dengue-like symptoms. The predominant age range for the virus was 3-10 years. Most clinical manifestations were nonspecific, with frequent concomitant gastrointestinal and respiratory symptoms. Furthermore, we found that the acute febrile syndrome in childhood persists as a challenge for health professionals, especially in the early days of the disease, due to a plurality of diagnostic hypotheses, associated with the difficulty of establishing well-defined symptoms in children, especially in infants. Dengue fever continues to be a frequent pathology with acute febrile infections in childhood; however, there is an overestimation of the disease, especially in endemic regions, when one considers only the clinical epidemiological diagnosis.

Medical shift work: a narrative review.

Shift and night work combine training and practice in medical education, assuming an essential character in some medical specialties. Nevertheless, it is recognized that this work schedule affects biological functions, cognitive performance, and the safety of both patients and workers. The aim of this narrative literature review was to describe current knowledge about the impact of shift and night work in medical professionals. The LILACS, MEDLINE, and SciELO databases were searched for publications between 2010 and 2020 using the terms: "shift work schedule" and "physicians". A total of 12 publications reported outcomes on sleep quality, family relationships, burnout syndrome, and cardiovascular health. Despite these outcomes, the studies highlighted the importance of shift and night work in medical training, reflecting a loss of learning opportunities when limitations are placed on work hours. The studies suggested initiatives to mitigate the effects of shift work, including increased awareness by managers, a culture of respect for resting periods, the encouragement of family support networks, and the availability of natural light in the workplace.

O trabalho em turnos e noturno compõe a formação e a prática da educação médica, assumindo caráter essencial em algumas especialidades. Contudo, esse regime de trabalho é reconhecido por gerar efeitos em funções biológicas, na performance cognitiva e na segurança do paciente e do profissional. O objetivo deste trabalho, caracterizado como revisão narrativa de literatura, foi verificar o conhecimento atual sobre o impacto da jornada de trabalho em turnos e noturno na saúde de profissionais médicos. Foram utilizadas as bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde, Medical Literature Analysis and Retrieval System Online e Scientific Electronic Library Online, no período compreendido de 2010 a 2020, com os Descritores em Ciências da Saúde: "jornada de trabalho em turnos" e "médicos". Foram encontrados 82 artigos e, após aplicação dos critérios de inclusão, foram selecionados 12 artigos para análise. Os estudos demonstraram desfechos na qualidade do sono, nas relações familiares, na possibilidade de síndrome de burnout e na saúde cardiovascular dos profissionais. Sugerem-se iniciativas para amenizar os efeitos do trabalho em turnos, que incluam a sensibilização de gestores, a cultura de respeito pelo período de repouso, o estímulo à rede de apoio familiar e a oferta de estruturas ambientais de trabalho que permitam acesso à luminosidade natural.

Limitação terapêutica para crianças: revisão sistemática sobre final de vida / Therapeutic limitation for children: a systematic review on end-of-life / Limitación terapéutica para niños: una revisión sistemática sobre el final de la vida

Resumo Esta revisão sistemática visa identificar dificuldades enfrentadas por profissionais no manejo clínico de crianças em final de vida. Para tanto, realizou-se busca de artigos científicos nas bases de dados SciELO e LILACS por meio dos descritores "limitação de suporte terapêutico", "terminalidade" e "medidas de conforto", combinados com o descritor "crianças". Do total de 102 trabalhos completos encontrados, nove contemplaram os critérios de inclusão para a amostra do estudo. Os resultados apontam dificuldades em relação à tomada de decisões e à limitação terapêutica de pacientes infantis. Conclui-se que, quando se sentem melhor preparados para trabalhar com questões referentes ao processo de morte e morrer, os profissionais podem prestar um cuidado mais humanizado a pacientes e familiares.

Abstract This systematic review sought to identify difficulties faced by professionals in the clinical management of end-of-life child patients. Bibliographic search was conducted on the SciELO and LILACS databases using the descriptors "therapeutic limitation," "hospice care" and "comfort measures," combined with the descriptor "child." Of the 102 complete studies identified, nine met the established inclusion criteria. The results point to difficulties regarding decision making and therapeutic limitation for infant patients. In conclusion, when professionals feel better prepared to address issues related to the process of death and dying, they can provide more humanized care to patients and families.

Resumen Esta revisión sistemática tiene por objetivo identificar las dificultades que enfrentan los profesionales en el manejo clínico de los niños al final de la vida. Para ello, se realizó una búsqueda de artículos científicos en las bases de datos SciELO y LILACS utilizando las palabras clave "limitación del apoyo terapéutico", "final de la vida" y "medidas de confort", combinadas con "niños". Del total de 102 artículos completos encontrados, nueve cumplieron con los criterios de inclusión para la muestra del estudio. Los resultados apuntan a dificultades con relación a la toma de decisiones y a limitaciones terapéuticas de los pacientes pediátricos. Se concluye que los profesionales cuando se sienten más preparados para lidiar con cuestiones relacionadas con el proceso de muerte y morir pueden brindar una asistencia más humanizada a los pacientes y familias.

Association of Swede Score and 2011 IFCPC Nomenclature in Women with Abnormal Cytology.

OBJECTIVE: To assess the association between two colposcopic indices, the Swede score and the 2011 International Federation of Cervical Pathology and Colposcopy (IFCPC) Nomenclature as well as to determine the efficacy of the Swede score with cutoffs of 7 and 8. METHODS: In the present cross-sectional pilot study, 34 women who had at least 1 colposcopy-directed biopsy due to abnormal cytology were enrolled. The colposcopic findings were scored by both the Swede score and the 2011 IFCPC Nomenclature and were compared with each other. The Kappa coefficient and the McNemar test were used. Accuracy, sensitivity, specificity, and positive and negative predictive values (NPV and PPV, respectively) were calculated, as well as the effectiveness with cutoffs of 7 and 8 in identifying cervical intraepithelial neoplasm (CIN) 2+ when using the Swede score. RESULTS: The correlation between the 2 colposcopic indices was 79.41%. The Kappa coefficient and the McNemar p-value were 0.55 and 0.37, respectively. The IFCPC Nomenclature had sensitivity, specificity, accuracy, PPV, and NPV of 85.71, 55.00, 67.64, 57.14, and 84.61%, respectively. The Swede score had sensitivity, specificity, accuracy, PPV, and NPV of 100, 63.15, 79.41, 68.18, and 100%, respectively. A Swede score cutoff of 7 for CIN 2+ detection had a specificity of 94.73%, while with a cutoff of 8 it increased to 100%. The sensitivity for both values was 60%. The PPV and NPV for cutoffs of 7 and 8 were 90 and 75 and 100 and 76%, respectively. CONCLUSION: Although both colposcopic indices have good reproducibility, the Swede score showed greater accuracy, sensitivity, and specificity in identifying CIN 2 + , especially when using a cutoff of 8.

OBJETIVO: Avaliar a associação entre dois índices colposcópicos, o escore Swede e a Nomenclatura International Federation of Cervical Pathology and Colposcopy (IFCPC, na sigla em inglês) 2011, assim como determinar a eficácia do escore Swede com os pontos de corte 7 e 8. MéTODOS: Trata-se de um estudo transversal, com 34 mulheres incluídas, que realizaram colposcopia com biópsia dirigida devido a uma citologia anormal. Os achados colposcópicos foram categorizados pelo escore Swede e pela Nomenclatura IFCPC 2011 e comparados um com o outro. Foram avaliados o coeficiente Kappa e o teste de McNemar e foram calculados a acurácia, a sensibilidade, a especificidade e valores preditivos negativos e positivos (VPN e VPP, respectivamente) de cada índice, assim como a eficácia com os pontos de corte 7 e 8 do escore Swede para determinar as lesões de neoplasia intraepitelial cervical (NIC) 2 + . RESULTADOS: A concordância entre os 2 índices foi de 79,41% e o coeficiente Kappa e o valor-p do teste de McNemar foram 0.55 e 0.37, respectivamente. Pela Nomenclatura IFCPC 2011, obtivemos como sensibilidade, especificidade, acurácia, VPP e VPN, respectivamente: 85,71, 55,00, 67,64, 57,14 e 84,61%. Pelo escore Swede obtivemos como sensibilidade, especificidade, acurácia, VPP e VPN, respectivamente: 100, 63,15, 79,41, 68,18 e 100%. O uso do escore Swede para detecção das lesões NIC 2+ obteve como especificidade 94,73% com o valor de corte de 7, enquanto o valor de corte 8 obteve 100%. A sensibilidade para ambos os cortes foi de 60%. O VPP e o VPN com os cortes 7 e 8 foram, respectivamente: 90,00 e 75,00 e 100,00 e 76,00%. CONCLUSãO: Ambos os índices colposcópicos tiveram boa reprodutibilidade; no entanto, o escore Swede mostrou melhor acurácia, sensibilidade e especificidade em identificar as lesões NIC 2+ e o melhor ponto de corte para identificar as lesões NIC2+ foi com o valor 8.

Engineering Peptide Inhibitors of the HFE-Transferrin Receptor 1 Complex.

The protein HFE (homeostatic iron regulator) is a key regulator of iron metabolism, and mutations in HFE underlie the most frequent form of hereditary haemochromatosis (HH-type I). Studies have shown that HFE interacts with transferrin receptor 1 (TFR1), a homodimeric type II transmembrane glycoprotein that is responsible for the cellular uptake of iron via iron-loaded transferrin (holo-transferrin) binding. It has been hypothesised that the HFE/TFR1 interaction serves as a sensor to the level of iron-loaded transferrin in circulation by means of a competition mechanism between HFE and iron-loaded transferrin association with TFR1. To investigate this, a series of peptides based on the helical binding interface between HFE and TFR1 were generated and shown to significantly interfere with the HFE/TFR1 interaction in an in vitro proximity ligation assay. The helical conformation of one of these peptides, corresponding to the α1 and α2 helices of HFE, was stabilised by the introduction of sidechain lactam "staples", but this did not result in an increase in the ability of the peptide to disrupt the HFE/TFR1 interaction. These peptides inhibitors of the protein-protein interaction between HFE and TFR1 are potentially useful tools for the analysis of the functional role of HFE in the regulation of hepcidin expression.

Association of Swede Score and 2011 IFCPC Nomenclature in Women with Abnormal Cytology / A Associação entre o escore Swede e a nomenclatura IFCPC 2011 em mulheres com citologia anormal

Abstract Objective To assess the association between two colposcopic indices, the Swede score and the 2011 International Federation of Cervical Pathology and Colposcopy (IFCPC) Nomenclature as well as to determine the efficacy of the Swede score with cutoffs of 7 and 8. Methods In the present cross-sectional pilot study, 34 women who had at least 1 colposcopy-directed biopsy due to abnormal cytology were enrolled. The colposcopic findings were scored by both the Swede score and the 2011 IFCPC Nomenclature and were compared with each other. The Kappa coefficient and the McNemar test were used. Accuracy, sensitivity, specificity, and positive and negative predictive values (NPV and PPV, respectively) were calculated, as well as the effectiveness with cutoffs of 7 and 8 in identifying cervical intraepithelial neoplasm (CIN) 2+ when using the Swede score. Results The correlation between the 2 colposcopic indices was 79.41%. The Kappa coefficient and the McNemar p-value were 0.55 and 0.37, respectively. The IFCPC Nomenclature had sensitivity, specificity, accuracy, PPV, and NPV of 85.71, 55.00, 67.64, 57.14, and 84.61%, respectively. The Swede score had sensitivity, specificity, accuracy, PPV, and NPV of 100, 63.15, 79.41, 68.18, and 100%, respectively. A Swede score cutoff of 7 for CIN 2+ detection had a specificity of 94.73%, while with a cutoff of 8 it increased to 100%. The sensitivity for both values was 60%. The PPV and NPV for cutoffs of 7 and 8 were 90 and 75 and 100 and 76%, respectively. Conclusion Although both colposcopic indices have good reproducibility, the Swede score showed greater accuracy, sensitivity, and specificity in identifying CIN 2 + , especially when using a cutoff of 8.

Resumo Objetivo Avaliar a associação entre dois índices colposcópicos, o escore Swede e a Nomenclatura International Federation of Cervical Pathology and Colposcopy (IFCPC, na sigla em inglês) 2011, assim como determinar a eficácia do escore Swede com os pontos de corte 7 e 8. Métodos Trata-se de um estudo transversal, com 34 mulheres incluídas, que realizaram colposcopia com biópsia dirigida devido a uma citologia anormal. Os achados colposcópicos foram categorizados pelo escore Swede e pela Nomenclatura IFCPC 2011 e comparados um com o outro. Foram avaliados o coeficiente Kappa e o teste de McNemar e foram calculados a acurácia, a sensibilidade, a especificidade e valores preditivos negativos e positivos (VPN e VPP, respectivamente) de cada índice, assim como a eficácia com os pontos de corte 7 e 8 do escore Swede para determinar as lesões de neoplasia intraepitelial cervical (NIC) 2 + . Resultados A concordância entre os 2 índices foi de 79,41% e o coeficiente Kappa e o valor-p do teste de McNemar foram 0.55 e 0.37, respectivamente. Pela Nomenclatura IFCPC 2011, obtivemos como sensibilidade, especificidade, acurácia, VPP e VPN, respectivamente: 85,71, 55,00, 67,64, 57,14 e 84,61%. Pelo escore Swede obtivemos como sensibilidade, especificidade, acurácia, VPP e VPN, respectivamente: 100, 63,15, 79,41, 68,18 e 100%. O uso do escore Swede para detecção das lesões NIC 2+ obteve como especificidade 94,73% com o valor de corte de 7, enquanto o valor de corte 8 obteve 100%. A sensibilidade para ambos os cortes foi de 60%. O VPP e o VPN com os cortes 7 e 8 foram, respectivamente: 90,00 e 75,00 e 100,00 e 76,00%. Conclusão Ambos os índices colposcópicos tiveram boa reprodutibilidade; no entanto, o escore Swede mostrou melhor acurácia, sensibilidade e especificidade em identificar as lesões NIC 2+ e o melhor ponto de corte para identificar as lesões NIC2+ foi com o valor 8.

Urinary Angiotensinogen-Melatonin Ratio in Gestational Diabetes and Preeclampsia.

Background: A large research portfolio indicates that an activated renal renin-angiotensin system or a deficit on melatonin is associated with several cardiovascular pathologies. In this observational clinical study, we hypothesized that alterations in urinary melatonin or angiotensinogen levels may be altered in two common conditions, preeclampsia and gestational diabetes. Our study's primary objective was to assess melatonin and angiotensinogen as novel disease biomarkers detectable and quantifiable in the urine of pregnant women with or without pregnancy complications. Methods: This was a concurrent cohort study of pregnant women with selected obstetric pathologies (gestational diabetes, preeclampsia, hypertension and obesity with hypertension). A group of healthy controls was also included. Urinary 6-sulfatoxymelatonin and angiotensinogen were measured by sensitive and specific ELISAs in first morning void urine samples. The patients were included in the cohort consecutively, and the diagnosis was blinded at the level of urine collection. Urinary 6-sulfatoxymelatonin and angiotensinogen levels were investigated in the patients included in the cohort. Results: Urinary levels of angiotensinogen were significantly higher in the gestational diabetes [angiotensinogen/creatinine ratio median (25th, 75th): 0.11 (0.07, 0.18)] and preeclampsia [0.08 (0.06, 0.18)] groups than in those with healthy pregnancy [0.05(0.04, 0.06]; 6-sulfatoxymelatonin levels were significantly lower in the gestational diabetes [ug/h: median (25th, 75th): 0.12(0.08, 0.17)] and preeclampsia [0.12 (0.09, 0.15)] groups than in those with healthy pregnancy [0.20 (0.15, 0.27]. Neither morning void protein/creatinine ratio nor 24-h urine protein estimate were significantly different between the study groups. Conclusion: These results suggest that urinary angiotensinogen levels may indicate an intrarenal RAS activation while melatonin production appears to be defective in gestational diabetes or hypertension. An angiotensinogen/melatonin ratio is suggested as an early biomarker for identification of gestational diabetes or hypertension. This report provides a basis for the potential use of melatonin for the treatment of preeclampsia. A prospective study in a larger number of patients to determine the operative characteristics of these markers as potential diagnostic tests is justified.

Limitation of cytology and the impact on reduction of cervical cancer / Limitação da citologia e o impacto na redução do câncer de colo uterino

Introduction: Cervical cancer is the third most common malignant tumor in the female population and the fourth cause of death from cancer in women in Brazil. The squamocolumnar junction and the transformation zone concentrate 90% of pre-invasive and invasive cervical lesions. Objective: To evaluate the prevalence of cytology without cells of the squamocolumnar junction and feasibility of active search. Methods: Cross-sectional study at a university hospital between 2017 and 2018. The prevalence of cytology without squamocolumnar junction cells was calculated. A convenience sample was obtained and mean age and relationship with presence of transformation zone cells were calculated. An active search was performed and cytology collected, with estrogen preparation if indicated. Medical records of the other women were analyzed. Results: Squamocolumnar junction cells were not found in 28.84% of samples. Mean age was 53 years, without association with presence of squamocolumnar junction cells (p=0.409). Seventy-six women returned, 36 of which (47.37%) used estrogen. Level 2 or 3 cervical intraepithelial neoplasia, microinvasive carcinoma or cancer was not identified. A total of 134 medical records were analyzed; only 36 women (26.87%) completed screening. Conclusions: The presence of squamocolumnar junction cells indicates quality of cytology; the use of estrogen in postmenopausal women favors its collection. There were difficulties in active search. An immediate repetition of cytology should be considered.

Introdução: O câncer de colo uterino é o terceiro tumor maligno mais frequente na população feminina e a quarta causa de morte de mulheres por câncer no Brasil. A junção escamo-colunar e a zona de transformação concentram 90% das lesões pré-invasoras e invasoras cervicais. Objetivo: Avaliar prevalência de colpocitologias sem células da junção escamo-colunar e a viabilidade de busca ativa. Métodos: Estudo transversal em hospital universitário entre 2017 e 2018. Calculada prevalência de citologias sem células da junção escamo-colunar. Obtida amostra por conveniência, calculada média de idade e relação com a presença da junção escamo-colunar. Realizada busca ativa e colhidas citologias com preparo estrogênico, se indicado. Analisados os prontuários das demais mulheres. Resultados: A prevalência de ausência de células da junção escamo-colunar foi de 28,84%. A média de idade foi 53 anos, sem associação com presença da junção escamo-colunar (p=0,409). Retornaram 76 mulheres e 36 (47,37%) usaram estrogênio. Não identificamos neoplasia intraepitelial cervical graus 2 ou 3, carcinoma microinvasor e câncer. Analisados 134 prontuários, dos quais apenas 36 mulheres (26,87%) concluíram o rastreio. Conclusões: A presença de células da junção escamo-colunar indica qualidade da coleta, e o uso de estrogênio na pós-menopausa favorece sua obtenção. Houve dificuldade de busca ativa. A repetição imediata da citologia deve ser considerada.

A Rare Case of Lesion in the Vulva: Pigmented Apocrine Hamartoma.

ABSTRACT: Apocrine hamartoma is a rare benign neoplasm. The histology is characterized by an excess of apocrine glands located predominantly in the reticular dermis. Pigmented apocrine hamartoma represents a histopathological variation of apocrine hamartoma containing tubules and linear cysts covered by apocrine cells on the inside with melanin and on the outside with myoepithelial cells. At this time, 4 cases of this pathology have been described. This case report aims to present a case of pigmented apocrine hamartoma of the vulva in a young patient, emphasizing that while occurrence is rare, it must be considered when diagnosing a pigmented lesion of the vulva in young patients.

Limitação terapêutica em oncologia pediátrica / Limitation of therapeutic in pediatric oncology

Este estudo possui como objetivo compreender a perspectiva de profissionais da saúde, de uma unidade de oncologia pediátrica, sobre limitação terapêutica no tratamento de pacientes pediátricos em processo de morte. Trata-se de uma pesquisa de cunho qualitativo, realizada em hospital de ensino. Foram entrevistados ao todo 16 profissionais da saúde que atuam em unidade de oncologia pediátrica. Foi utilizada a análise de conteúdo para a interpretação dos dados. Os resultados apontaram que o conhecimento sobre limitação terapêutica apresentado pelos profissionais versa a partir da experiência de cada um. Foram apresentadas dificuldades de comunicação à família, falta de consenso sobre as decisões entre os médicos e não participação de outros profissionais da equipe em qualquer etapa do processo decisório. A distanásia com criança ainda acontece, mas é evitada por gerar sofrimento. Ao prestar assistência ao paciente pediátrico oncológico, a equipe deve atuar como uma unidade de cuidado. Aponta-se a importância do trabalho multiprofissional como meio de facilitar as decisões que devem ser tomadas.(AU)

This study aims to understand the perspective of health professionals, who work in a pediatric oncology unit, on limitation of therapeutic effort in the treatment of pediatric patients in the process of death. This qualitative research was carried out in a teaching hospital. A total of 16 health professionals who work in a pediatric oncology unit were interviewed. Content analysis was used to analyze data. The results showed that the professionals’ knowledge about limitation of therapeutic effort is based on their own experience. Difficulties in communication to families, lack of consensus on decisions among doctors and lack of participation of the other team professionals in any stages of the decision-making process were addressed. Dysthanasia is still a reality for children, but it is avoided because of the suffering it causes. When providing assistance to pediatric patients with cancer, the team must act as a care unit. The importance of multiprofessional work is pointed out as way to make easier taking decisions that must be made.(AU)

Pursuing Orally Bioavailable Hepcidin Analogues via Cyclic N-Methylated Mini-Hepcidins.

The peptide hormone hepcidin is one of the key regulators of iron absorption, plasma iron levels, and tissue iron distribution. Hepcidin functions by binding to and inducing the internalisation and subsequent lysosomal degradation of ferroportin, which reduces both iron absorption in the gut and export of iron from storage to ultimately decrease systemic iron levels. The key interaction motif in hepcidin has been localised to the highly conserved N-terminal region, comprising the first nine amino acid residues, and has led to the development of mini-hepcidin analogs that induce ferroportin internalisation and have improved drug-like properties. In this work, we have investigated the use of head-to-tail cyclisation and N-methylation of mini-hepcidin as a strategy to increase oral bioavailability by reducing proteolytic degradation and enhancing membrane permeability. We found that backbone cyclisation and N-methylation was well-tolerated in the mini-hepcidin analogues, with the macrocylic analogues often surpassing their linear counterparts in potency. Both macrocyclisation and backbone N-methylation were found to improve the stability of the mini-hepcidins, however, there was no effect on membrane-permeabilizing activity.

Perspectivas dos profissionais da saúde sobre o cuidado a pacientes em processo de finitude / Perspectives of health professionals about patients in process of finitude / Perspectivas de los profesionales de la salud sobre el cuidado a pacientes en proceso de finitud

Este estudo consiste em compreender quais são as percepções, os sentimentos e as dificuldades atribuídos pelos profissionais da saúde ao cuidado no processo de morte de pacientes. Para tanto, realizou-se um estudo descritivo e exploratório, de cunho qualitativo. A pesquisa foi aprovada pelo Comitê de Ética, sob o número 1.463.168, e foram seguidas as diretrizes da Resolução 510/2016. A coleta de dados foi realizada por meio de entrevistas e observações. Foram entrevistados médicos e enfermeiros que atuam na unidade de clínica médica em um hospital de ensino do Rio Grande do Sul, sendo realizadas dezessete entrevistas, correspondendo à totalidade destes profissionais na unidade. Os dados obtidos foram submetidos à triangulação, a partir da análise de conteúdo. Os resultados mostraram que o cuidado no processo de morte de pacientes gera sentimentos como frustração, impotência, tristeza e compaixão. É comum, nesse sentido, a utilização de estratégias defensivas - como racionalização e distanciamento - por parte dos médicos responsáveis. Além disso, percebeu-se que o tempo de tratamento permite cuidados diferenciados e maior humanização no processo. Concluiu-se ser necessário levar em consideração as dificuldades individuais e coletivas, os sentimentos, as situações pessoais e interpessoais, bem como a satisfação/insatisfação dos profissionais...(AU)

This study analyzes the perceptions, feelings and difficulties attributed by health professionals about care in the death process of patients. A descriptive and exploratory study of qualitative nature was performed. The research was approved by the Ethics Committee, under number 1,463,168, and the guidelines of Resolution 510/2016. Seventeen medical professionals and nurses working in the medical clinic unit at a teaching hospital in Rio Grande do Sul were interviewed. The obtained data were subjected to triangulation via content analysis. The results showed that care in the death process of patients generates feelings like frustration, impotence, sadness and compassion. Defensive strategies such as rationalization and distancing were common. Treatment time allowed for differentiated care and greater humanization in the process. Taking into account individual and collective difficulties, feelings, personal and interpersonal situations, satisfaction/dissatisfaction of professionals was shown to be needed...(AU)

Este estudio busca comprender cuáles son las percepciones, los sentimientos y las dificultades atribuidas por los profesionales de la salud sobre el cuidado en el proceso de muerte de pacientes. Por ello, se realizó un estudio descriptivo y exploratorio, con enfoque cualitativo. La investigación fue aprobada por el Comité de Ética, bajo el número 1.463.168, y se cumplieron las directrices de la Resolución 510/2016. Para la recolección de datos, se aplicó entrevistas y observaciones. Se entrevistaron a profesionales médicos y a enfermeros que actúan en la unidad de clínica médica en un hospital escuela de Rio Grande do Sul (Brasil). Se realizaron diecisiete entrevistas, resultado de la totalidad de esos profesionales en la unidad. Los datos obtenidos se sometieron a la triangulación a partir del análisis de contenido. Los resultados demostraron que el cuidado en el proceso de muerte de pacientes genera sentimientos como frustración, impotencia, tristeza y compasión. Es común el uso de estrategias defensivas, como racionalización y alejamiento, por parte de los médicos tratantes. El tiempo de tratamiento permite cuidados diferenciados y mayor humanización en el proceso. Se concluyó que es necesario tener en cuenta en esta situación las dificultades individuales y colectivas, los sentimientos, las situaciones personales e interpersonales, así como la satisfacción/insatisfacción de los profesionales...(AU)

Health Professionals' Mental Health: A Look at their Suffering / A Saúde Mental dos Profissionais da Saúde: Um Olhar ao Sofrimento de quem Cuida / La Salud Mental de los Profesionales de la Salud: Una Mirada al sufrimiento de quien Cuida

Abstract This study aimed to recognize the characteristics of work within the hospital context and their potential effects on mental health of professionals who provide health care for end-of-life patients. The descriptive and qualitative study relied on interviews and observations. Thirty-four physicians and nurses who work in clinical medicine or emergency medical services in a teaching hospital in Rio Grande do Sul were interviewed. The results, obtained through content analysis, showed that in clinical medicine health professionals suffer more when patients die or their condition gets worse, such suffering being a threat to mental health. In emergency medical services, death causes suffering only when it is traumatic. Intercurrences which are characteristic of emergency medical services and work organization are the major source of stress for such professionals, thus affecting their mental health. Therefore, the mental health of these professionals is weakened due to the demands in health care work. It is thus necessary to rethink the institution's organization, redefine attitudes and implement procedures that are coherent with the professionals' needs, in search of better working conditions and improved mental health.

Resumo Este estudo teve como objetivo conhecer as características do trabalho no contexto hospitalar e os possíveis efeitos na saúde mental dos profissionais que realizam o cuidado de pacientes no fim de vida. Realizou-se um estudo descritivo e qualitativo com base em entrevistas e observações. Foram entrevistados 34 médicos e enfermeiros que atuam nas unidades de clínica médica e pronto-socorro em um hospital de ensino do Rio Grande do Sul. Os resultados, obtidos a partir da análise de conteúdo, mostraram que na clínica médica há maior sofrimento quando acontece a morte ou a piora do paciente, fontes de prejuízo à saúde mental. No pronto-socorro, a morte gera sofrimento apenas quando traumática. As intercorrências próprias da emergência e da organização do trabalho são as maiores fontes de estresse para os profissionais, afetando sua saúde mental. Logo, a saúde mental dos profissionais encontra-se fragilizada frente às exigências do trabalho em saúde. É necessário repensar a organização institucional, redefinir ações e agir coerentemente com as necessidades dos profissionais, buscando melhorias no trabalho e na saúde mental.

Resumen El objetivo de este estudio fue conocer las características del trabajo en el contexto hospitalario y los posibles efectos en la salud mental de los profesionales que realizan el cuidado de pacientes al final de la vida. Se realizó un estudio descriptivo y cualitativo basado en entrevistas y observaciones. Se entrevistó a 34 médicos y enfermeros que actúan en las unidades de clínica médica y de servicios médicos de urgencia en un hospital de enseñanza de Rio Grande do Sul. Los resultados, obtenidos a partir del análisis de contenido, mostraron que en la medicina clínica hay mayor sufrimiento cuando ocurre la muerte o el empeoramiento del paciente, factores de daño a la salud mental. En los servicios médicos de urgencia, la muerte genera sufrimiento solamente cuando es traumática. Las intercurrencias propias de la emergencia y de la organización del trabajo son las mayores fuentes de estrés para los profesionales, afectando su salud mental. Por lo tanto, la salud mental de los profesionales se encuentra debilitada ante las exigencias del trabajo en salud. Es necesario repensar la organización institucional, redefinir acciones y actuar coherentemente con las necesidades de los profesionales, buscando mejoras en el trabajo y en la salud mental.

Dengue: 30 years of cases in an endemic area.

The present study aimed to review literature on studies of dengue cases conducted over 30 years in the state of Ceará.Between November 2015 and January 2016, articles published in Portuguese and English in 7 databases were searched using keywords and a Boolean operator. A total of 191 articles were identified in the databases; 133 were excluded according to the exclusion criteria, and 58 were included in the study.Of the 58 articles analyzed, 6 reported data from Brazil; including the Northeast region and the state of Ceará; 41 reported data for only the city of Fortaleza; 7 reported data for the state of Ceará; 4 reported data for cities in the interior of the state; and 3 included only children. The studies adopted different approaches and focused on different aspects of the disease. Study outcomes included the identification of serological, epidemiological, clinical, and laboratory characteristics; potential larvicides and biological predators of mosquitoes; potential antiviral agents; vector density characteristics; and educational dengue prevention and control strategies. Additionally, one vaccine trial was included.Although studies on dengue in the state of Ceará are scarce, they are encompassing, including several lines of research, and the number of studies and reports on dengue in the state of Ceará continues to increase.

Dengue: 30 years of cases in an endemic area

The present study aimed to review literature on studies of dengue cases conducted over 30 years in the state of Ceará. Between November 2015 and January 2016, articles published in Portuguese and English in 7 databases were searched using keywords and a Boolean operator. A total of 191 articles were identified in the databases; 133 were excluded according to the exclusion criteria, and 58 were included in the study. Of the 58 articles analyzed, 6 reported data from Brazil; including the Northeast region and the state of Ceará; 41 reported data for only the city of Fortaleza; 7 reported data for the state of Ceará; 4 reported data for cities in the interior of the state; and 3 included only children. The studies adopted different approaches and focused on different aspects of the disease. Study outcomes included the identification of serological, epidemiological, clinical, and laboratory characteristics; potential larvicides and biological predators of mosquitoes; potential antiviral agents; vector density characteristics; and educational dengue prevention and control strategies. Additionally, one vaccine trial was included. Although studies on dengue in the state of Ceará are scarce, they are encompassing, including several lines of research, and the number of studies and reports on dengue in the state of Ceará continues to increase.

Structural parameters, molecular properties, and biological evaluation of some terpenes targeting Schistosoma mansoni parasite.

The use of natural products has a long tradition in medicine, and they have proven to be an important source of lead compounds in the development of new drugs. Among the natural compounds, terpenoids present broad-spectrum activity against infective agents such as viruses, bacteria, fungi, protozoan and helminth parasites. In this study, we report a biological screening of 38 chemically characterized terpenes from different classes, which have a hydroxyl group connected by hydrophobic chain or an acceptor site, against the blood fluke Schistosoma mansoni, the parasite responsible for schistosomiasis mansoni. In vitro bioassays revealed that 3,7-dimethyl-1-octanol (dihydrocitronellol) (10) was the most active terpene (IC50 values of 13-52 µM) and, thus, we investigated its antischistosomal activity in greater detail. Confocal laser scanning microscopy revealed that compound 10 induced severe tegumental damage in adult schistosomes and a correlation between viability and tegumental changes was observed. Furthermore, we compared all the inactive compounds with dihydrocitronellol structurally by using shape and charge modeling. Lipophilicity (miLogP) and other molecular properties (e.g. molecular polar surface area, molecular electrostatic potential) were also calculated. From the 38 terpenes studied, compound 10 is the one with the greatest flexibility, with a sufficient apolar region by which it may interact in a hydrophobic active site. In conclusion, the integration of biological and chemical analysis indicates the potential of the terpene dihydrocitronellol as an antiparasitic agent.

A comunicação de Más Notícias na UTI: Perspectiva dos Médicos / The Communication of Bad News in ICU: Perspective of Doctors

RESUMO Este estudo objetivou compreender o processo de comunicação de más notícias no contexto da uma Unidade de Tratamento Intensivo para adultos, na perspectiva dos médicos. Configurou-se como uma pesquisa qualitativa, de caráter exploratório e descritivo. Os dados foram coletados a partir de entrevistas semiestruturadas e observação registrada em diário de campo. Participaram 12 médicos de um hospital-escola do interior do Rio Grande do Sul. A análise foi realizada por meio da análise de conteúdo. Destacam-se dificuldades dos médicos em comunicar más notícias, bem como o uso de mecanismos de defesa para realizar essa tarefa. Considera-se necessário resgatar a importância da reflexão sobre a relação médico-familiar como prática diária tão importante para a medicina.

ABSTRACT This study aimed to understand the process of the bad news communication in the context of the Intensive Care Unit for adults, from the perspective of the doctors. It was configured as a qualitative, exploratory and descriptive research. Data were collected through semi-structured interviews and observation recorded in daily field. Participated 12 doctors in a teaching hospital of Rio Grande do Sul. The analysis was performed through the content analysis. The results highlight the difficulties of the doctors to communicate bad news, as well as the use of defense mechanisms to accomplish this task. It is necessary to recover the importance of reflection on the doctor-family relationship as daily practice as important to the medicine.

Experiência Pedagógica em Patologia na Faculdade de Medicina da UFC / Educational Experience in Pathology at the UFC Medical School

RESUMO Objetivo Relatar a experiência da aplicação de material didático composto por catálogo com imagens macroscópicas e microscópicas, disponível em meio impresso e digital, acompanhado de coleções de lâminas, instrumento criado por alunos do mestrado e iniciação científica, focando a autonomia do aprendizado em Patologia Humana para os alunos da graduação. Métodos Foi elaborado um questionário para ser aplicado aos alunos, para avaliação de resultados alcançados pelo modelo criado, que será oferecido aos estudantes de diversos cursos que possuem a disciplina de Patologia Humana, oferecida na Faculdade de Medicina da Universidade Federal do Ceará (UFC). O catálogo relata a história e evolução da doença de uma paciente com tuberculose sistêmica, suas manifestações clínicas, exames físicos e laboratoriais, além de achados de necropsia, com diferentes aspectos da resposta inflamatória. Resultados Os alunos que viveram esta experiência se manifestaram a favor da implantação da nova ferramenta como material didático da disciplina e sua manutenção nos laboratórios. Conclusão A inovação nas aulas é necessária, e este modelo surge como um material complementar para a melhoria e motivação das aulas práticas no tema proposto.

ABSTRACT Objective To reporting on the application of new teaching material composed of a catalog with macroscopic and microscopic images, available in print and digital media, accompanied by slides of collections. This instrument was created by Master’s and Scientific Initiation students, focusing on the undergraduate students’ autonomy in learning Human Pathology. Methods A questionnaire was developed to be administered to students to assess the results achieved by the new model, which will be available to students whose courses require attending Human Pathology classes at the Federal University of Ceará (UFC) Medical School. The catalog describes the history and evolution of the disease in a patient with systemic tuberculosis, its clinical manifestations, physical and laboratorial tests and autopsy findings, with different aspects of the inflammatory response. Results The students who assessed this model were in favor of its implementation as teaching material for Human Pathology classes and its maintenance in laboratories. Conclusion Innovation in classes is necessary and this model emerges as supplementary material for the improvement and motivation of practical classes on the proposed theme.