The aftermath of hip fragility fractures - are we missing out on osteoporosis treatment?"

INTRODUCTION: Fragility fractures cause significant mortality and morbidity. Even though there are multiple guidelines for the management of fragility fractures, european countries still report treatment rates of less than 30%. Implementation of fracture liaison services can increase this percentage by 21%. Our goal is to describe the management of osteoporosis, in patients with hip fragility fracture treated in a portuguese hospital with no internal protocols in place. METHODS: A retrospective study was conducted. Patients treated surgically for hip fragility fracture in our hospital, during 2017, were included. Data until May 2020 was collected on osteoporosis recognition and pharmacological treatment prescription. RESULTS: A total of 102 patients were included, 87% female, with a mean age of 79.9±9.9 years at the time of the fracture. Pharmacological anti-osteoporotic treatment after the hip fragility fracture was prescribed in 35%. From those, 53% did not include bisphosphonates. General practice doctors were responsible for 44% of anti-osteoporotic prescriptions and "Osteoporosis" ICD10 codification in primary care was present in 10.7%. DISCUSSION/CONCLUSION: We found a gap in osteoporosis treatment after a hip fragility fracture, similar to literature reports when no fracture liaison service is in place. We believe that the lack of such protocols, the low rate of "osteoporosis" or "fragility fracture" mentioning at hospital discharge, together with the under recognition at primary care level, contribute to this reality. The implementation of new measures is crucial to improve prevention and management of fragility fractures.

Hearing Sensitivity of Primates: Recurrent and Episodic Positive Selection in Hair Cells and Stereocilia Protein-Coding Genes.

The large spectrum of hearing sensitivity observed in primates results from the impact of environmental and behavioral pressures to optimize sound perception and localization. Although evidence of positive selection in auditory genes has been detected in mammals including in Hominoids, selection has never been investigated in other primates. We analyzed 123 genes highly expressed in the inner ear of 27 primate species and tested to what extent positive selection may have shaped these genes in the order Primates tree. We combined both site and branch-site tests to obtain a comprehensive picture of the positively selected genes (PSGs) involved in hearing sensitivity, and drew a detailed description of the most affected branches in the tree. We chose a conservative approach, and thus focused on confounding factors potentially affecting PSG signals (alignment, GC-biased gene conversion, duplications, heterogeneous sequencing qualities). Using site tests, we showed that around 12% of these genes are PSGs, an α selection value consistent with average human genome estimates (10-15%). Using branch-site tests, we showed that the primate tree is heterogeneously affected by positive selection, with the black snub-nosed monkey, the bushbaby, and the orangutan, being the most impacted branches. A large proportion of these genes is inclined to shape hair cells and stereocilia, which are involved in the mechanotransduction process, known to influence frequency perception. Adaptive selection, and more specifically recurrent adaptive evolution, could have acted in parallel on a set of genes (ADGRV1, USH2A, PCDH15, PTPRQ, and ATP8A2) involved in stereocilia growth and the whole complex of bundle links connecting them, in species across different habitats, including high altitude and nocturnal environments.

Protein sequence comparison of human and non-human primate tooth proteomes.

In the context of human evolution, the study of proteins may overcome the limitation of the high degradation of ancient DNA over time to provide biomolecular information useful for the phylogenetic reconstruction of hominid taxa. In this study, we used a shotgun proteomics approach to compare the tooth proteomes of extant human and non-human primates (gorilla, chimpanzee, orangutan and baboon) in order to search for a panel of peptides able to discriminate between taxa and further help reconstructing the evolutionary relationships of fossil primates. Among the 25 proteins shared by the five genera datasets, we found a combination of peptides with sequence variations allowing to differentiate the hominid taxa in the proteins AHSG, AMBN, APOA1, BGN, C9, COL11A2, COL22A1, COL3A1, DSPP, F2, LUM, OMD, PCOLCE and SERPINA1. The phylogenetic tree confirms the placement of the samples in the appropriate genus branches. Altogether, the results provide experimental evidence that a shotgun proteomics approach on dental tissue has the potential to detect taxonomic variation, which is promising for future investigations of uncharacterized and/or fossil hominid/hominin specimens. SIGNIFICANCE: A shotgun proteomics approach on human and non-human primate teeth allowed to identify peptides with taxonomic interest, highlighting the potential for future studies on hominid fossils.

Effects of endogenous H2S production inhibition on the homeostatic responses induced by acute high-salt diet consumption.

The gaseous modulator hydrogen sulfide (H2S) is synthesized, among other routes, by the action of cystathionine-γ-lyase (CSE) and importantly participates in body fluid homeostasis. Therefore, the present study aimed to evaluate the participation of H2S in behavioral, renal and neuroendocrine homeostatic responses triggered by the acute consumption of a high Na+ diet. After habituation, adult male Wistar rats were randomly distributed and maintained for seven days on a control [CD (0.27% of Na+)] or hypersodic diet [HD (0.81% of Na+)]. CD and HD-fed animals were treated with DL-Propargylglycine (PAG, 25 mg/kg/day, ip) or vehicle (0.9% NaCl in equivalent volume) for the same period. At the end of the experiment, animals were euthanized for blood and tissue collection. We demonstrated that a short-term increase in dietary Na+ intake, in values that mimic the variations in human consumption (two times the recommended) significantly modified hydroelectrolytic homeostasis, with repercussions in the hypothalamic-neurohypophysial system and hypothalamic-pituitary-adrenal axis function. These findings were accompanied by the development of a clear inflammatory response in renal tubular cells and microvascular components. On the other hand, the inhibition of the endogenous production of H2S by CSE provided by PAG treatment prevented the inflammation induced by HD. In the kidney, PAG treatment induced the overexpression of inducible nitric oxide synthase in animals fed with HD. Taken together, these data suggest, therefore, that HD-induced H2S production plays an important proinflammatory role in the kidney, apparently counter regulating nitric oxide actions in renal tissue.

Predicting haplogroups using a versatile machine learning program (PredYMaLe) on a new mutationally balanced 32 Y-STR multiplex (CombYplex): Unlocking the full potential of the human STR mutation rate spectrum to estimate forensic parameters.

We developed a new mutationally well-balanced 32 Y-STR multiplex (CombYplex) together with a machine learning (ML) program PredYMaLe to assess the impact of STR mutability on haplogourp prediction, while respecting forensic community criteria (high DC/HD). We designed CombYplex around two sub-panels M1 and M2 characterized by average and high-mutation STR panels. Using these two sub-panels, we tested how our program PredYmale reacts to mutability when considering basal branches and, moving down, terminal branches. We tested first the discrimination capacity of CombYplex on 996 human samples using various forensic and statistical parameters and showed that its resolution is sufficient to separate haplogroup classes. In parallel, PredYMaLe was designed and used to test whether a ML approach can predict haplogroup classes from Y-STR profiles. Applied to our kit, SVM and Random Forest classifiers perform very well (average 97 %), better than Neural Network (average 91 %) and Bayesian methods (< 90 %). We observe heterogeneity in haplogroup assignation accuracy among classes, with most haplogroups having high prediction scores (99-100 %) and two (E1b1b and G) having lower scores (67 %). The small sample sizes of these classes explain the high tendency to misclassify the Y-profiles of these haplogroups; results were measurably improved as soon as more training data were added. We provide evidence that our ML approach is a robust method to accurately predict haplogroups when it is combined with a sufficient number of markers, well-balanced mutation rate Y-STR panels, and large ML training sets. Further research on confounding factors (such as CNV-STR or gene conversion) and ideal STR panels in regard to the branches analysed can be developed to help classifiers further optimize prediction scores.

Cherry stem infusions: antioxidant potential and phenolic profile by UHPLC-ESI-QTOF-MS.

The antioxidant potential and phenolic profile of infusions prepared with cherry stems from different commercial brands were studied. The phenolic profile of each infusion was characterized by UHPLC-ESI-QTOF-MS and 44 phenolic compounds belonging to eight distinct classes (hydroxybenzoic acids, hydroxycinnamic acids, phenylpropanoic acids, flavan-3-ols, flavonols, flavanones, flavones and isoflavones) were tentatively identified. For the first time, salicylic acid was identified in cherry stem infusions. In cell-based assays, all the infusions tended to inhibit lipid peroxidation and presented no cytotoxicity. Significant differences (p < 0.05) were found between a sample sold in bulk (lower antioxidant activity by DPPH˙ inhibition, ferric reducing antioxidant power, and oxygen radical absorbance capacity assays; lower amounts of total phenolics and flavonoids and a different quantitative phenolic profile) and samples sold in packages. These, in turn, were very similar to each other and revealed a high antioxidant potential and a very rich phenolic profile. These results reflect not only the antioxidant potential of cherry stem infusions but also the need to globally harmonize the control and regulation of herbal products in order to ensure in the market products with high quality, safety and efficacy.

Desmistificando a mordida cruzada posterior / Demystifying posterior crossbite

Resumo A mordida cruzada posterior é definida como uma relação anormal transversal interarcos, cuja dimensão vestibulolingual inferior mostra-se maior que a dimensão superior. Não possui autorresolução e, por isso se perpetua, quando não tratada. Essa má oclusão se desenvolve entre os 19 meses e os cinco anos de idade. Este trabalho propõe revisar relevantes informações a respeito do quadro de mordida cruzada posterior, além de demonstrar, através de um caso clínico, a efetividade do protocolo de expansão rápida da maxila em idade prepuberal, provendo ao leitor uma maior segurança na escolha do tratamento. O presente caso clínico foi realizado com um paciente do sexo masculino, 07 anos de idade, diagnosticado com atresia maxilar e mordida cruzada unilateral direita. O tratamento foi realizado imediatamente, sob forma de expansão rápida da maxila, com o uso do aparelho de HAAS modificado, ancorado em segundos molares decíduos. Como resultado se obteve uma expansão intermolar de aproximadamente 6,5mm, demonstrando sucesso no tratamento com o descruzamento das arcadas, além de estabilidade local notada após um ano removido o aparelho, sem o uso de contenções pós-disjunção. Concluiu-se que ao ser diagnosticada, a mordida cruzada posterior deve ser tratada de forma interceptativa, idealmente durante o primeiro período transitório do indivíduo, priorizando o protocolo de expansão rápida da maxila com um disjuntor modificado, ancorado em segundos molares decíduos, evitando uma série de efeitos colaterais nos dentes permanentes adjacentes, além de garantir, assim, maior estabilidade futura oclusal. (AU)

Abstract The posterior crossbite is defined as an abnormally transverse relationship, whose inferior buccolingual dimension is larger than the superior dimension. It has no self-solution and therefore perpetuates itself when left untreated. This malocclusion develops between 19 months and 5 years old. This work proposes to review relevant information regarding the posterior crossbite picture and to demonstrate through a clinical case the effectiveness of the rapid palatal expansion protocol in prepubertal age, providing the reader with a greater safety in the choice of treatment. The present clinical case was performed with a male patient, 7 years old, diagnosed with maxillary atresia, and right unilateral crossbite. The treatment was performed immediately, in the form of rapid maxillary expansion, with the use of modified HAAS device anchored in deciduous second molars. As a result, an intermolar expansion of approximately 6.5mm was obtained, demonstrating success in the treatment with uncrossing of the arches, besides local stability noticed after one year of device removal, without the use of post-disjunction restraints. It was concluded that, when diagnosed, posterior crossbite should be treated interceptably, preferably during the first transient period of the individual, prioritizing rapid maxilla expansion protocol with a modified expander, anchored in primary second molars, avoiding a series of side effects on adjacent permanent teeth, in addition to ensuring greater future occlusal stability.(AU)

Multiple myeloma in elderly patients-a Portuguese multicentric real-life study.

Patients older than 75 years old with multiple myeloma (MM) have shorter survival and are usually treated differently from what features in clinical trials. In this study, the authors characterized the Portuguese population of MM patients above 75 years old, treated between 2009 and 2016. We compared the outcomes obtained with bortezomib-based protocols (BBP), thalidomide-based protocols (TBP), and chemotherapy (CT) using univariate and multivariate controlling for age, performance status, International Staging System score, renal impairment, and number of comorbidities. We retrieved data from 386 patients, treated in 12 hospitals. Three hundred thirty-one cases were analyzed: 119 patients treated with BBP, 65 with TBP, 147 with CT. Median age was 79 years; CT-treated patients were older, had a worse performance status, and have more comorbidities. The median follow-up was 25 months. The 2-year OS was 58% and the median OS was 29.5 months. Patients treated with BBP had more frequently very good partial response (VGPR) or better response, and the subgroup of more fit patients had a significantly longer progression-free survival (PFS) and OS. The most frequently grade 3-4 toxicities were hematologic, infectious, and neurologic and were significantly lower in TBP and CT groups vs BBP. The most common second line was CT, followed by lenalidomide. Patients treated with lenalidomide had a higher probability of VGPR or better and a superior 1-year PFS. Despite the limitations of a retrospective study, our cohort represents the reality of older patients with MM in a western country. The hazard of death or progression was higher for old, fit patients treated, in first line, with CT and with TBP compared with that of BBP.

Doença de Parkinson: efeito da terapia vibratória no recrutamento da musculatura postural / Parkinson disease: effects of vibrating therapy in recruitment of postural muscle

A Doença de Parkinson (DP) é uma doença degenerativa e progressiva do sistema nervoso central, caracterizada por sintomas motores, alterações musculoesqueléticas e posturais que podem ser influenciadas por um processo de organização sensorial anormal. A eletromiografia (EMG) é uma ferramenta de avaliação não invasiva importante para análise do recrutamento da musculatura postural. A terapia vibratória surge como uma opção promissora na estimulação somatossensorial desta população. Objetivo: Avaliar os efeitos da terapia vibratória no recrutamento da musculatura postural em pacientes com DP. Métodos: Foram analisados os músculos longuíssimo lombar (LL) e trapézio ascendente (TA) por EMG. Foi realizada a aplicação de um protocolo de 8 semanas (24 atendimentos) de terapia vibratória em 10 indivíduos com DP, com avaliação e reavaliação por análise eletromiográfica da contração isométrica voluntária (CIV). Resultados: A terapia vibratória não mostrou resultados significativos na ativação da musculatura postural na DP, pela avaliação por EMG, sendo na comparação pré e pós-tratamento TAD (p = 0,655), TAE (p = 0,655), LLD (p = 0,848) e LLE (p = 0,565). Conclusão: Não houve resultados significativos na EMG após intervenção com terapia vibratória em indivíduos com DP, o que pode ser devido principalmente ao tamanho amostral. Sugere-se a realização de novos estudos com maior tamanho amostral para comprovar a eficiência da terapia vibratória nesta população.

Parkinson Disease (PD) is a degenerative and progressive disease of the central nervous system, characterized by motor symptoms, musculoskeletal and postural disturbance, which may be influenced by an abnormal sensory organization process. Electromyography (EMG) is an important non-invasive assessment tool for postural muscle recruitment analysis. Vibratory therapy appears as promising option to somatosensory stimulation in this population. Objective: To evaluate the effects of vibratory therapy on the recruitment of postural muscles in patients with PD. Methods: Longissimus lumborum (LL) and the upper trapezius (UT) muscles were analyzed by EMG. A protocol of 8 weeks (24 attendances) of vibratory therapy was applied in 10 individuals with PD, with evaluation and revaluation performed by EMG analysis of voluntary isometric contraction (VIC). Results: Vibratory therapy did not show significant results in the activation of the postural muscles in the PD, by the EMG evaluation, being the TAD (p = 0.655), APR (p = 0.655), LLD (p = 0.848) and LLE (p = 0.565). Conclusion: We did not observe significant results in the EMG after intervention with vibratory therapy in individuals with PD, which may be mainly due to the sample size. It is suggested to carry out new studies with a larger sample size to prove the efficiency of the vibratory therapy in this population.

Low birth weight and its associated factors.

OBJECTIVE: To calculate the frequency and evaluate the factors associated with low birth weight. METHODS: A retrospective study, with data from pregnant women who participated in the Programa de Atenção às Gestantes do Programa Einstein na Comunidade de Paraisópolis, between 2011 and 2014, and who returned for the postpartum evaluation of their newborns. Variables related to the pregnant woman, pregnancy, and newborn were evaluated. The outcome variable was low birth weight, defined as <2.5kg. The associations between the independent variables and low birth weight were assessed by χ2 and Mann-Whitney tests. Logistic regression models analyzed the combined effects of the independent variables on low birth weight. RESULTS: Data of 794 pregnant women and their newborns (52.1% males) were analyzed. The age of pregnant women varied from 13 to 44 years (median of 24 years), and the majority reported being married or living in cohabitation (74.7%), and having between 9 to 11 years of schooling (53.4%). The proportion of low birth weight was 7.6% (newborn mean weight of 3.2kg) and, in multivariate analysis, presence of twinning, age group of the pregnant women (showing protection for low birth weight between ages ≥18 years and <35 years), and cesarean section were associated with low birth weight. CONCLUSION: The proportion of low birth weight was 7.6% and twining, age of the pregnant woman, and cesarean delivery were associated with the occurrence of low birth weight.

Low birth weight and its associated factors / Baixo peso ao nascer e seus fatores associados

ABSTRACT Objective To calculate the frequency and evaluate the factors associated with low birth weight. Methods A retrospective study, with data from pregnant women who participated in the Programa de Atenção às Gestantes do Programa Einstein na Comunidade de Paraisópolis, between 2011 and 2014, and who returned for the postpartum evaluation of their newborns. Variables related to the pregnant woman, pregnancy, and newborn were evaluated. The outcome variable was low birth weight, defined as <2.5kg. The associations between the independent variables and low birth weight were assessed by χ2 and Mann-Whitney tests. Logistic regression models analyzed the combined effects of the independent variables on low birth weight. Results Data of 794 pregnant women and their newborns (52.1% males) were analyzed. The age of pregnant women varied from 13 to 44 years (median of 24 years), and the majority reported being married or living in cohabitation (74.7%), and having between 9 to 11 years of schooling (53.4%). The proportion of low birth weight was 7.6% (newborn mean weight of 3.2kg) and, in multivariate analysis, presence of twinning, age group of the pregnant women (showing protection for low birth weight between ages ≥18 years and <35 years), and cesarean section were associated with low birth weight. Conclusion The proportion of low birth weight was 7.6% and twining, age of the pregnant woman, and cesarean delivery were associated with the occurrence of low birth weight.

RESUMO Objetivo Calcular a frequência e avaliar os fatores associados ao baixo peso ao nascer. Métodos Estudo retrospectivo, com os dados das gestantes que participaram do Programa de Atenção às Gestantes do Programa Einstein na Comunidade de Paraisópolis, entre 2011 e 2014, e que retornaram para realizar a avaliação de seus recém-nascidos após o parto. Foram avaliadas as variáveis relacionadas à gestante, à gestação e ao recém-nascido. A variável desfecho foi o baixo peso ao nascer, definido como <2,5kg. As associações entre as variáveis independentes e o baixo peso ao nascer foram avaliadas por meio dos testes χ2e de Mann-Whitney. Modelos de regressão logística analisaram os efeitos combinados das variáveis independentes no baixo peso ao nascer. Resultados Foram analisados os dados de 794 gestantes e de seus recém-nascidos (52,1% do sexo masculino). A idade das gestantes variou de 13 a 44 anos (mediana de 24 anos) e a maioria referia ser casada ou estar em união estável (74,7%) e possuir entre 9 a 11 anos de estudo (53,4%). A proporção de baixo peso ao nascer foi de 7,6% (peso médio do recém-nascido de 3,2kg) e, na análise múltipla, a presença de gemelaridade, a faixa etária das gestantes (mostrando proteção para o baixo peso ao nascer nas idades ≥18 anos e <35 anos), e o parto cesárea se associaram com o baixo peso ao nascer. Conclusão A proporção de baixo peso ao nascer foi de 7,6% e gemelaridade, idade da gestante e parto cesárea se associaram com a ocorrência de baixo peso ao nascer.

Tratamento da atresia dos maxilares e mordida aberta anterior por hábito de sucção atípica ­ relato de caso / Treatment of maxillary atresia and anterior open bite by atypical suction habit ­ case report

A mordida aberta anterior é caracterizada como uma alteração da relação vertical entre o maxilar e o arco mandibular, apresentando um grande comprometimento estético-funcional. Muitas vezes, o hábito de sucção digital é o fator etiológico da mordida aberta anterior. Esse hábito deletério também pode provocar mordida cruzada posterior, estreitamento do arco maxilar, alterações na inclinação dos dentes anteriores e deformações na face. O objetivo deste trabalho é relatar um caso clínico de um paciente jovem com atresia dos maxilares e mordida aberta anterior associada ao hábito de sucção digital atípica. O paciente realizava a sucção simultânea dos dedos indicador e médio. O caso foi tratado com expansão da maxila, grade palatina fixa e aparelho ortodôntico autoligado, repercutindo positivamente no aspecto facial e na oclusão do paciente. (AU)

The anterior open bite is characterized as an alteration in the vertical relationship betweenmaxillar and mandibular arches, presenting a great aesthetic-functional impairment. Many times, digital sucking habit is the etiologic factor of the anterior open bite. This deleterious habit may also cause posterior crossbite, maxillary arch narrowing, changes in anterior tooth inclination and face deformities. The objective of this study is to report a clinical case of a young patient with jaws' atresia and anterior open bite associated to the habit of atypical digital suction. The patient performed simultaneous suction of the index and middle fingers. The case was treated with maxillary expansion, fixed palatine grille and self-ligating orthodontic appliance, affecting positively the patient`s facial appearance. and the occlusion. (AU)

Early bony changes associated with bisphosphonate-related osteonecrosis of the jaws in rats: A longitudinal in vivo study.

OBJECTIVE: To evaluate early bony changes in an animal model of Medication-Related Osteonecrosis of the Jaw (MRONJ) at the side of the local trauma and at the contralateral side, comparing with a control group. Bony changes were evaluated by Microcomputed Tomography (MicroCT) at three times points: at baseline (T0), after drug administration (T1) and after dental extraction (T2). DESIGN: Two groups were compared: the experimental group in which zoledronic acid (ZA) was administered (17 rats) and the control group (13 rats). Dental extractions of the lower left first molars were performed in all animals. The left side was considered as the supposed affected area in the ZA group, and the right side was considered as the unaffected area. In these areas, the following structural microtomographic bone parameters were calculated: Bone Mineral Density (BMD), Trabecular Thickness (Tb.Th), and Bone Volume Proportion (BV/TV). The comparison of quantitative bone parameters among the different sides and experimental phases of both studied groups were performed by ANOVA-factorial. RESULTS: None of the animals of the control group developed MRONJ. In the ZA group, 76% presented bone exposure. From T0 to T1, Tb.Th and BV/TV increased, and in T2, the mean values were higher in ZA group than in the control group. BMD increased throughout the different phases of both groups. CONCLUSIONS: Structural bony changes occurred in the ZA group at both mandibular sides before the dental extraction (T1). Tb.Th and BV/TV should be further investigated as potential early bone markers of MRONJ.

Applicability of plant-based products in the treatment of Trypanosoma cruzi and Trypanosoma brucei infections: a systematic review of preclinical in vivo evidence.

Chagas disease and sleeping sickness are neglected tropical diseases closely related to poverty, for which the development of plant-derived treatments has not been a promising prospect. Thus, we systematicaly review the preclinical in vivo evidence on the applicability of plant-based products in the treatment of Trypanosoma cruzi and Trypanosoma brucei infections. Characteristics such as disease models, treatments, toxicological safety and methodological bias were analysed. We recovered 66 full text articles from 16 countries investigating 91 plant species. The disease models and treatments were highly variable. Most studies used native (n = 36, 54·54%) or exotic (n = 30, 45·46%) plants with ethnodirected indication (n = 45, 68·18%) for trypanosomiasis treatment. Complete phytochemical screening and toxicity assays were reported in only 15 (22·73%) and 32 (48·49%) studies, respectively. The currently available preclinical evidence is at high risk of bias. The absence of or incomplete characterization of animal models, treatment protocols, and phytochemical/toxicity analyses impaired the internal validity of the individual studies. Contradictory results of a same plant species compromise the external validity of the evidence, making it difficult determine the effectiveness, safety and biotechnological potential of plant-derived products in the development of new anti-infective agents to treat T. cruzi and T. brucei infections.

Reflexões acerca do Ensino de Pediatria no Século XXI: o Cenário Brasileiro / Reflections on Teaching Pediatrics in 21st Century Brazil

RESUMO Introdução O Relatório Flexner é considerado o ponto de partida para a discussão do ensino da medicina no século XX. Após amplas discussões, em 2001, o Ministério da Educação homologa as Diretrizes Curriculares Nacionais do Curso de Graduação em Medicina (DCN). Tais diretrizes objetivam a formação de um médico generalista, humanista, reflexivo, crítico, que atue como promotor da saúde integral do ser humano. A Pediatria é a área da medicina onde a promoção da saúde integral é de extrema importância, pois a criança é o adulto do futuro. Objetivo Discutir as questões: O que se espera do médico geral, em relação à Pediatria, no século XXI? E a questão dela derivada: Mudanças nas diretrizes para o ensino de Pediatria são necessárias a partir das DCN? Métodos Ensaio reflexivo com base em dois documentos: Diretrizes Curriculares Nacionais do Curso de Graduação em Medicina (DCN) e Diretrizes para o Ensino de Pediatria (DEP) propostas por Eduardo Marcondes. Discussão Este artigo discorre a respeito das percepções de Marcondes acerca do ensino de Pediatria, correlacionando-as com as DCN e discutindo aspectos importantes na formação do médico, tais como: promoção, prevenção, proteção e reabilitação em saúde e educação médica em Pediatria. Considerações finais As Diretrizes para o Ensino de Pediatria propostas por Marcondes em 1993 parecem se manter extremamente atuais no contexto brasileiro do século XXI, ressalvando-se apenas diferenças de mortalidade e morbidade infantil.

ABSTRACT Introduction The Flexner report is considered the starting point for the discussion on the teaching of medicine in the 20th century. Following broad debate in 2001, the Ministry of Education approved the National Curricular Guidelines (DCNs) for the Undergraduate Course in Medicine. These guidelines are aimed at forming general, humanistic, reflective and critical physicians, to act as promoters of comprehensive human health. Pediatrics is a medical area where the promotion of comprehensive health is extremely important, since a child is a future adult. Objective Discuss issues like ‘What is expected from a pediatric general practitioner, in the 21st century?’ And the follow-on question: ‘Is it necessary to make changes in pediatric training through the National Curricular Guidelines?’ Methods Reflexive study based on two documents: the National Curricular Guidelines for the Undergraduate Course in Medicine and the Guidelines for Teaching Pediatrics proposed by Eduardo Marcondes. Discussion This article presents Marcondes’ views on the teaching of pediatrics in relation to the DCNs. It also discusses important aspects of the doctor´s training, such as health promotion, prevention, protection and rehabilitation and pediatric medical training. Final considerations The Guidelines for Teaching Pediatrics suggested by Marcondes in 1993 remain highly relevant to 21st century Brazil, with exception only to differences in infant mortality and morbidity rates.

Dor ­ 5º sinal vital: conhecimento de enfermeiros / Pain ­ 5 th vital sign: nurses' knowledge / El dolor ­ el 5to signo vital: el conocimiento de las enfermeras

Objetivo: compreender como os enfermeiros identificam a dor dos pacientes. Método: estudo de abordagem qualitativa desenvolvido na Clínica Médica de um hospital público do município de Campina Grande/PB. Os sujeitos compreenderam 11 enfermeiros com os quais foi utilizado um formulário estruturado para a produção dos dados e os depoimentos processados pela Técnica de Análise de conteúdo na modalidade Análise temática. O projeto de pesquisa foi aprovado pelo Comitê de Ética em Pesquisa, Parecer nº 0208.0-133.000- 12. Resultados: a dor para o enfermeiro é tratada apenas como um sintoma, sendo negligenciada a classificação desta como o quinto sinal vital. Os resultados indicam que os profissionais saem despreparados da graduação para avaliar a subjetividade da dor. Conclusão: os enfermeiros não sabem que a dor é considerada como o quinto sinal vital, por conseguinte a sua avaliação é ineficiente e os cuidados também o são.(AU)

Objective: understanding how nurses identify patients' pain. Method: a qualitative approach study developed at the Medical Clinic of a public hospital in the city of Campina Grande/PB. The sample consisted of 11 nurses with whom we used a structured form for data production and the depositions processed by content analysis technique in thematic analysis. The research project was approved by the Research Ethics Committee, Opinion nº 0208.0-133.000-12. Results: pain for nurses is treated only as a symptom, being neglected the classification of this as the fifth vital sign. The results indicate that the professionals leave unprepared from graduate to assessing the subjectivity of pain. Conclusion: the nurses did not know that pain is considered as the fifth vital sign; therefore, its evaluation and also care are inefficient.(AU)

Objetivo: comprender cómo las enfermeras identifican el dolor en los pacientes. Método: un estudio de enfoque cualitativo desarrollado en la Clínica Médica de un hospital público en la ciudad de Campina Grande/PB. La muestra estuvo conformada por 11 enfermeras con las que hemos utilizado un formulario estructurado para la producción de datos y las declaraciones procesadas mediante la técnica de análisis de contenido en el modo de análisis temático. El proyecto de investigación fue aprobado por el Comité de Ética en la Investigación, Opinión nº 0208.0-133.000-12. Resultados: el dolor a la enfermera se trata sólo como un síntoma, siendo descuidada la clasificación de este como el quinto signo vital. Los resultados indican que los profesionales salen descalificados de la graduación para evaluar la subjetividad del dolor. Conclusión: las enfermeras no sabían que el dolor es considerado como el quinto signo vital, por lo tanto, su evaluación es ineficiente y el cuidado también.(AU)

Escalda-pés: cuidando da enfermagem no Centro de Material e Esterilização / Escaldado de pies: cuidando de enfermería en el Centro de Material y Esterilización / Hot footbath therapy: taking care of the nursing at the Centre for Material and Sterilization

Objetivo: Relatar e analisar a utilização do escalda-pés como estratégia de promoção de qualidade de vida no trabalho (QVT) para a equipe de enfermagem do Centro de Material e Esterilização (CME) de um hospital universitário. Método: Trata-se de um relato de experiência com abordagem qualitativa da aplicação da técnica do escalda-pés em 18 trabalhadores de enfermagem do CME, no período de agosto a dezembro de 2010, uma vez por semana, totalizando 11 encontros. A técnica de verificação das respostas obtidas foi a análise de conteúdo. Resultados: Identificaram-se duas categorias temáticas. Os discursos evidenciaram que a adoção dessa estratégia proporcionou a sensação de bem-estar ao trabalhador e o fez refletir sobre o conceito de ambiência, suas condições de trabalho e a importância de se autocuidar. Conclusão: Espera-se que a QVT se torne uma política institucional no hospital em questão e em outros, pois a valorização e o cuidado com o trabalhador refletirão significativamente na diminuição das taxas de absenteísmo e na melhoria da qualidade do serviço prestado.

Objetivo: Relatar y analizar la utilización de la escalda de pies como estrategia de promoción de calidad de vida en el trabajo (QVT) para enfermería del Centro de Material y esterilización del Hospital Universitario. Método: Relato de experiencia con un enfoque cualitativo. Realizó el escalda de pies y dos reuniones de evaluación del proyecto. El análisis de las respuestas fue el análisis del contexto. Resultados: Se identificó dos categorías temáticas. Los discursos evidenciaron que la estrategia proporciono la sensación de bienestar del trabajador y hicieron reflexionar sobre el concepto de ambientar sus condiciones de trabajo y la importancia de auto cuidado. Conclusión: Espera que la QTV se transforme una política institucional en el HC-UFMG, pues la valorización y el cuidado con el trabajador hará reflexionar significantemente la disminución de las tasas de ausentismo y la mejoría de la calidad del servicio prestado.

Objective: To report and analyze the use of hot footbath therapy as strategy for promotion of quality of life at work (QLW) for the nursing staff of the Center for Supply and Sterilization (CME) of a University Hospital. Method: Experience report with a qualitative study of the use of hot footbath therapy technique in 18 nursing professionals at CME, from August to December 2010, once a week, totaling 11 meetings. The technique of response analysis was content analysis. Results: Two thematic categories were identified. The reports showed that this strategy provided well-being at work and led the professionals to reflect on the concept of ambience, their working conditions, and the importance of self-care. Conclusion: It is hoped that QLW becomes an institutional policy at hospitals, for the appreciation and care of employee reflecting in lower rates of absenteeism and improved service quality.