Transformative education for medical postgraduates: centring planetary health

The purpose of this article is to report, reflect upon and learn from a postgraduate course in Planetary Health. The 195 hours postgraduate course occurred in 2022 and involved 44 students at the Department of Pathology at University of São Paulo in Brazil.  The course activities for students were carried out remotely and included self-reflexive, dialogical and creative learning methods. The evaluation was composed of four aspects: participation; poetic memory of encounters; 'plant' or planning a planetary health action; and 'penning'. This study used a qualitative method of thematic analysis to verify three main learning activities: poetic memories, "'Plant' a planetary health action" and 'Penning'. From the 44 students enrolled, 26 fulfilled the optional formulary given consent to participate in this study.  'Planting' a planetary action was organized in different levels: community, work and research, interpersonal, personal. In the 'penning' analysis, students repeatedly referred to art and future as core to learn about planetary health. This could be induced by the way that the course was structured, but rises to a point of the arts' potential to create awareness and a transformative topic for medical education touching other dimensions of learning like emotions and hope. 

Effectiveness of intracuff alkalinized lidocaine associated with intravenous dexamethasone in reducing laryngotracheal morbidity in children undergoing general anesthesia for tonsillectomy: a randomized controlled trial.

BACKGROUND: Postoperative sore throat is one of the main postoperative complaints in patients undergoing tonsillectomy. As the primary outcome, we aimed to determine whether endotracheal tube cuffs filled with alkalinized lidocaine are associated with a lower incidence of postoperative sore throat and anesthesia emergence phenomena in children undergoing tonsillectomy or adenotonsillectomy. We also assessed the potential additional benefits of IV dexamethasone in reducing postoperative laryngotracheal morbidity. METHODS: This is a clinical prospective, randomized, controlled trial. Patients were randomly allocated to one of four groups, as follows: air - endotracheal tube cuff filled with air; air/dex - endotracheal tube cuff filled with air and intravenous dexamethasone; lido - endotracheal tube cuff filled with alkalinized lidocaine; and lido/dex - endotracheal tube cuff filled with alkalinized lidocaine and intravenous dexamethasone. Perioperative hemodynamic parameters and the incidence of postoperative nausea and vomiting, coughing and hoarseness were recorded. Postoperative sore throat was assessed in the postanesthetic care unit and 24 hours post tracheal extubation. RESULTS: In total, 154 children aged 4-12 years, ASA physical status I or II, undergoing general anesthesia for elective tonsillectomy and adenotonsillectomy, were assessed for postoperative sore throat in this study. The incidence of postoperative sore throat 24 hours after tracheal extubation was significantly lower in the lido/dex group compared to groups air and air/dex (p = 0.01). However, no additional reduction in these symptoms was observed from the intravenous administration of dexamethasone when comparing the lido and lido/dex groups. Similarly, there were no differences among groups regarding perioperative hemodynamic variables or postoperative nausea and vomiting, coughing, and hoarseness during the study period. CONCLUSION: Intracuff alkalinized lidocaine, associated with intravenous dexamethasone, might be effective in reducing sore throat 24 hours post-tonsillectomy or adenotonsillectomy in children when compared to the use of air as the cuff insufflation media.

Promoting healthy eating without plastics: An ethical practice in primary care

Effective clinical interventions to engage in new habits remain a challenge despite intense research. One such strategy is to include the environmental issue of plastic packaging from ultra-processed food in nutrition recommendations. It expands the notion of health, contributing to engaging in healthy eating behaviors, in addition to being an ethical practice for health professionals. It brings co-benefits for both the environment and individual health through motivational incentives of less individual pollution, contributing to healthier food systems. Primary health professionals should be prepared to deal with risks of plastics and waste reduction strategies in their practice.

Challenges of animals shelters in caring for dogs infected with Leishmania and other pathogens.

The incidence of human Visceral Leishmaniasis (VL) has decreased in Brazil; however, the number of areas reporting human and canine cases has increased, with Leishmania infantum usually preceding human infection. This study aimed to analyze the profile of infectious diseases that are endemic for both human and canine VL, in dogs housed in a shelter located in the state of Rio Grande do Norte, Northeast Brazil. Data was obtained between November/2021 to April/2022. All dogs residing at the shelter (98 dogs) were examined and blood was collected for testing for L. infantum, Ehrlichia canis, and Babesia sp. Statistical analyses considered the clinical and laboratory findings. Of the 98 animals, approximately 43% were positive for L. infantum antibodies, 19% were positive for L. infantum kDNA, and 18% were L. infantum positive by culture. Greater levels of anti-leishmania antibodies were observed in dogs with symptoms suggestive of VL. The dogs tested positive for E. canis (19/98) and B. canis (18/98). Lutzomyia longipalpis was captured inside the shelter, representing 74.25% (n = 225) of whole sandflies in the dog shelter. Concomitant infection by L. infantum and E. canis increased the odds of death. Treatment of VL included the use of allopurinol (n = 48) and miltefosine (n = 8). Treated animals showed more signs of Leishmania infection. Tickborn parasites and Leishmania were prevalent in sheltered dogs in a VL-endemic area, which increases the odds of death and poses an additional challenge for caring for abandoned dogs and at the same time setting protocols to manage reservoirs of L. infantum.

Effect of a cajuína hydroelectrolytic drink on the physical performance and hydration status of recreational runners.

Cajuína is a processed drink derived from cashew and is widely consumed in the northeast region of Brazil. This study evaluated the effect of a cajuína-based hydroelectrolytic drink on the aerobic performance and hydration status of recreational runners. Seventeen males (31.9 ± 1.6 years, 51.0 ± 1.4 ml/kg/min) performed three time-to-exhaustion running sessions on a treadmill at 70% VO2max, ingesting cajuína hydroelectrolytic drink (CJ), high carbohydrate commercial hydroelectrolytic drink (CH) and mineral water (W) every 15 min during the running test. The participants ran 80.3 ± 8.4 min in CJ, 70.3 ± 6.8 min in CH and 71.8 ± 6.9 min in W, with no statistical difference between procedures. Nevertheless, an effect size of η2 = 0.10 (moderate) was observed. No statistical difference was observed in the concentrations of sodium, potassium, and osmolality in both serum and urine between the three conditions. However, the effect size was moderate (urine sodium) and high (serum sodium, potassium, and osmolality). Urine specific gravity, sweating rate and heart rate were not significantly different between drinks. The cajuína-based hydroelectrolytic drink promotes similar effects compared to commercial hydroelectrolytic drink and water, considering specific urine gravity, heart rate, sweating, and time to exhaustion in recreational runners.

Viver ou morrer?: a influência das emoções desencadeadas por palavras nos tempos de reação manual / Living or dying?: the influence of emotions triggered by words on manual reaction times / ¿Viviendo o muriendo?: la influencia de las emociones provocadas por las palabras en los tiempos de reacción manual

Estímulos afetivos influenciam o comportamento devido a facilitações/inibições que ocorrem no sistema sensóriomotor. Para estímulos positivos, respostas ipsilaterais tendem a ser facilitadas e as contralaterais inibidas. Para estímulos negativos, o padrão é invertido. Atualmente, 34 voluntários foram submetidos à Tarefa de Compatibilidade Espacial Afetiva, cujos estímulos de valência inata foram as palavras "viver" e "morrer". No mapeamento 1, executaram-se respostas ipsilaterais para a palavra "viver" e respostas contralaterais para a palavra "morrer". No mapeamento 2, ocorreu o inverso. Através da análise temporal, investigamos se e como palavras que desencadeiam emoções inatas modulam a resposta motora. No mapeamento 1, constatamos respostas ipsilaterais mais lentas à palavra "viver" do que contralaterais à palavra "morrer" (a partir do 3º quintil). Porém, no mapeamento 2, houve diferença apenas no 3º quintil. Os efeitos facilitadores da resposta contralateral ao estímulo negativo estão possivelmente associados a mecanismos automáticos de vigilância para detectar/evitar estímulos de ameaça

Affective stimuli influence behavior due to facilitations/inhibitions that occur in the sensory-motor system. For positive stimuli, ipsilateral responses tend to be facilitated and contralateral inhibited. For negative stimuli, the pattern is reversed. Currently, 34 volunteers were submitted to the Affective Spatial Compatibility Task, whose innate valence stimuli were the words "living" and "dying". In mapping 1, ipsilateral responses were executed for the word "living" and contralateral for the word "dying". In mapping 2, the reverse occurred. Using temporal analysis, we investigated whether and how words that trigger innate emotions modulate the motor response. In mapping 1, we found slower ipsilateral responses to the word "living" than contralateral responses to the word "dying" (from the 3rd quintile). However, mapping 2 revealed a difference only in the 3rd quintile. The facilitating effects of the contralateral response to the negative stimulus are possibly associated with automatic vigilance mechanisms to detect/avoid threatening stimuli

Los estímulos afectivos influyen en el comportamiento debido a las facilitaciones/inhibiciones que se producen en el sistema sensoriomotor. Para los estímulos positivos, las respuestas ipsilaterales tienden a ser facilitadas y las contralaterales inhibidas. Para los estímulos negativos, el patrón se invierte. Actualmente, 34 voluntarios fueron sometidos a la Tarea de Compatibilidad Espacial Afectiva, cuyos estímulos de valencia innata fueron las palabras "vivir" y "morir". En el mapeo 1, se ejecutaron respuestas ipsilaterales para la palabra "vivir" y contralaterales para la palabra "morir". En el mapeo 2, ocurrió lo contrario. Mediante un análisis temporal, investigamos si las palabras que desencadenan emociones innatas modulan la respuesta motora y cómo lo hacen. En el mapeo 1, encontramos respuestas ipsilaterales más lentas a la palabra "vivir" que respuestas contralaterales a la palabra "morir" (del tercer quintil). Sin embargo, el mapeo 2 reveló una diferencia sólo en el 3er quintil. Los efectos facilitadores de la respuesta contralateral al estímulo negativo están posiblemente asociados a mecanismos automáticos de vigilancia para detectar/evitar estímulos amenazantes

Interference of Parenteral Nutrition Components in Silicon-Mediated Protection Against Aluminum Bioaccumulation.

Aluminum and silicon are contaminants found in formulations used to prepare parenteral nutrition. Both elements are leached from glass containers, mainly during the heating cycle for sterilization. Insoluble and biologically inactive species of hydroxyaluminosilicates have been shown to form in solutions containing Al and Si. Therefore, this interaction may play an important role in protecting the body against Al toxicity. In this study, the bioavailability of Al in the presence of Si, calcium gluconate (Gluc.), and potassium phosphate (Phosf.) was investigated in rats. The rats were divided into 10 groups of 5 animals each: control, Al, Si, Al + Si, Gluc, Gluc + Al, Gluc + Al + Si, Phosf, Phosf + Al, and Phosf + Al + Si. The doses, consisting of 0.5 mg/kg/day Al and 2 mg/kg/day Si in the presence or absence of Gluc. or Phosf., were intraperitoneally administered for 3 months. Tissues were analyzed for Al and Si content. Al accumulated in the liver, kidneys, and bones, and the simultaneous administration of Si decreased Al accumulation in these tissues. The presence of Si reduced the amount of Al present by 72% in the liver, by 45% in the kidneys, and by 16% in bone. This effect was lees pronounced in the presence of parenteral nutrition compounds though. Si tissue accumulation was also observed, mainly when administered together with phosphate. These results suggest that Si may act as a protector against Al toxicity, by either reducing Al absorption or increasing its excretion, probably through hydroxyaluminosilicates formation. The presence of calcium gluconate and potassium phosphate decreases or inhibits this effect.

Sérgio Ferreira beyond Pharmacology: His Role as a Science Communicator.

Historically, toxins from animal venoms have contributed significantly to the discovery of new drugs, as illustrated by captopril, the first drug developed from an animal toxin approved for human use [...].

Desafios da implementação da rede cegonha: reflexões sobre planejamento e avaliação dos serviços de acolhimento com classificação de risco obstétrico / Challenges of the implementation of the Stork Network: reflections on planning and evaluation of reception services with obstetric risk classification / Desafíos de la implementación de la Red Cigüeña: reflexiones sobre la planificación y evaluación de servicios de acogida con clasificación de riesgo obstétrico

Considerando o ciclo das Políticas públicas, o planejamento e a avaliação são elementos cruciais, favorecendo organização e julgamento de valor a respeito de uma intervenção ou sobre qualquer um dos seus componentes, envolvendo tanto quem faz uso dos serviços como quem produz os mesmos. Na perspectiva da melhoria da assistência prestada à mulher e ao recém-nascido na porta de entrada dos serviços de atenção materno-infantis, é realizado o Acolhimento com Classificação de Risco Obstétrico que cursa como uma ferramenta de apoio à tomada de decisão clínica que tem como intuito a identificação da paciente crítica ou mais grave, permitindo um atendimento de maneira rápida e segura de acordo com o potencial de risco, com base nas evidências científicas existentes. Objetivo: Realizar uma reflexão teórica acerca dos avanços e limitações relacionados aoplanejamento e avaliação dos serviços deAcolhimento com Classificação de RiscoObstétrico.Metodologia:Trata-se de um estudo de caráter descritivo, em formato de artigo de reflexão, em que foram definidas duas dimensões categóricas que retratam o contexto do planejamento e avaliação dos serviços de Acolhimento com Classificação de RiscoObstétrico.Resultados:Percebemos que ainda é possível identificar muitas arestas no planejamento e na qualidade da prestação deste tipo de serviço, principalmente no que diz respeito à garantia da integralidade e do cuidado de acordo com as necessidades da mulher.Conclusões:Para que uma articulação entre os diferentes atores seja alcançada são necessárias estratégias de planejamento que tornem viável buscar a qualidade assistencial e que deem condições de avaliar essa assistência prestada (AU).

Considering the cycle of Public Policies, planning and evaluation are crucial elements, favoring organization and judgment of valuesregarding an intervention or any of its components, involving both those who use the services and those who produce them. With a view toimproving the care provided to women and newborns at the entranceto maternal and child care services, the Reception with Obstetric Risk Classification iscarried out as a tool to support clinical decision-making which aims to identify critical or more severe patients, allowing a quick and safe care according to the risk potential, based on existing scientific evidence.Objective:To carry out a theoretical reflection on the advances and limitations related to the planning and evaluation of Reception serviceswith Obstetric Risk Classification.Methodology:This is a descriptive study, in the form of a reflection article, in which two categorical dimensions were defined and that portray the context of planning and evaluation of Reception serviceswith Obstetric Risk Classification.Results:We realized that it is still possible to identify many edges in the planning and quality of the provision of this type of service, especially with regard to ensuring comprehensiveness and care according to the needs of women.Conclusions:In order to achieved thearticulation between the different actors, it is necessary to plan strategies that make it feasible to seek care quality and that provide conditions for evaluating this assistance provided (AU).

Considerando el ciclo de las Políticas Públicas, la planificación y la evaluación son elementos cruciales, favoreciendo la organización y el juicio de valor sobre una intervención o cualquiera de sus componentes, involucrando tanto a quienes utilizan los servicios como a quienes los producen. Con el objetivode mejorar la asistenciabrindadaa lasmujeresy recién nacidosen elingresoa los servicios de atención materno-infantil, se realiza laAcogidacon Clasificación de Riesgo Obstétrico como una herramienta de apoyo a la toma de decisiones clínicas que tiene como objetivo identificar las pacientes más graves, permitiendo una atención rápida y segura de acuerdo al potencial de riesgo, segúnla evidencia científica existente.Objetivo: Realizar una reflexión teórica sobre los avances y limitaciones relacionados con la planificación y evaluación de los servicios de Acogida con Clasificación de Riesgo Obstétrico.Metodología:Se trata de un estudio descriptivo, en forma de artículo de reflexión, en el que se definieron dos dimensiones categóricas que retratan el contexto de planificación y evaluación de los servicios de Acogida con Clasificación de Riesgo Obstétrico. Resultados: Percibimos que aún es posible identificar muchas asperezasen la planificación y calidad de la prestación de este tipo de servicio, especialmente en lo que se respectaa garantizar la integralidad y la atención acorde a las necesidades de las mujeres. Conclusiones: Para que se logre una articulación entre los diferentes actores, son necesarias estrategias de planificación que viabilicen la búsqueda de la calidad de la atención y que proporcionen condiciones para evaluar esta asistencia brindada (AU).

Experiences and perceptions of adults pre- and/or post-lumbar spine surgery: a meta-ethnography.

STUDY DESIGN: Qualitative meta-ethnography. Pre-registered with OSF:10.17605/OSF.IO/UTZE6. PURPOSE: To understand the patient experience pre- and/or post-lumbar spine surgery. METHODS: Literature search: A literature search was conducted in MEDLINE, EMBASE, EmCare and CINAHL from inception to October 17, 2022. Study selection criteria: Peer-reviewed qualitative or mixed-method studies of English text investigating the beliefs, perceptions, or experiences of adults (≥18 years old) pre- and/or post-lumbar spine surgery for degenerative, non-traumatic or non-infectious concerns. Data synthesis: The eMERGE meta-ethnography reporting guidelines were followed to create themes and subthemes from the original themes of the included studies. A quality appraisal was performed using the McMaster Quality Appraisal tool. RESULTS: We included 18 studies and identified five themes that were separated into pre- and post-operative categories. The two pre-operative themes included [1]: the influence of physiotherapy interventions on patients' experiences, and [2] the importance of education/the power of communication, and the three post-operative themes included [1]: psychosocial coping [2], redefining oneself post-operatively, and [3] experience with the healthcare system. CONCLUSIONS: These findings emphasize the complexity of the peri-operative experience for individuals undergoing lumbar spine surgery. Future research should focus on addressing psychosocial factors that may optimize patient experiences and recovery following LSS.

The results of this study identified potential pre-operative and post-operative factors that may influence whether patients' have positive or negative perioperative experiences with lumbar spine surgery.Health care providers should be encouraged to focus on psychosocial factors that can be implemented in the health care system to improve the perioperative experience of patients undergoing lumbar spine surgery.