Mapas conceituais no ensino médico – uma abordagem cardiovascular/ Concept maps in medical education - a cardiovascular approach

O presente resumo expandido apresenta o êxito da utilização de mapas conceituais como ferramenta aliada da Metodologia Ativa (MA), sobretudo no ensino de assuntos inerentes ao ciclo básico da Medicina. Diante disso, o projeto de extensão Conceitual Med, da Faculdade de Medicina de Itajubá, alcançou eficácia na aplicação desse mecanismo

Low intensity laser therapy effectiveness in controlling neuropathic pain in mice

La terapia láser de baja potencia (LLLT) ha sido ampliamente discutida en la literatura como forma alternativa de tratamiento para muchos tipos de dolor, especialmente para el neuropático. Esa terapia se destaca por el hecho de no ser invasiva, raramente causar efectos secundarios y ser de bajo costo. En cambio, para su eficacia, es necesario que se presenten los detalles de los parámetros, que todavía son muy discordantes en la literatura. Así, este trabajo tiene como objetivo investigar el efecto de la LLLT, en el rango del infrarrojo, con fluidez de 30 J/cm², en el control del dolor neuropático en modelos animales. Se utilizaron 24 ratones de la cepa suizo-albino, machos, con peso de 2530 gramos, divididos en tres grupos: Grupo Placebo (GP), Grupo Láser (GL30) y Grupo Sham (GS). Se llevó a cabo la inducción de la neuropatía por medio del modelo de constricción crónica del nervio isquiático y se realizó el tratamiento de la LLLT como sigue: GP con el láser con fluidez de 0 J/cm2, GL30 con fluidez de 30 J/cm2, y GS con simulación de cirugía sin intervención. Se realizaron las irradiaciones tres veces por semana, durante 90 días, en el punto de compresión del nervio, utilizándose la técnica de contacto. A efectos de evaluación, se utilizaron la prueba de placa caliente para hiperalgesia térmica y la prueba de Randall y Selitto para hiperalgesia mecánica. En los resultados del GP, observamos que no hubo mejora significativa en los días después de la cirugía en ninguna de las pruebas realizadas y, en el GP30, se verificó mejora significativa en ambas pruebas: desde el 30.º día de tratamiento para la prueba de placa caliente y desde el 45.º día para la prueba de Randall y Selitto, en que los ratones presentaron restauración total de la sensibilidad. Concluimos, por lo tanto, que el uso de la LLLT con fluidez de 30 J/cm2 en el tratamiento del dolor neuropático en modelos animales es efectivo.Low-level laser therapy (LLLT) has been widely discussed in the literature as an alternative form of treatment for several types of pain, especially neuropathic pain. This kind of therapy stands out for not being invasive, rarely causing side effects and being cost effective. However, for its effectiveness, it is necessary more detailed parameters, which are still very discrepant in the literature. Thus, this study aims to investigate the effect of LLLT, in the infrared range, with 30J/cm² fluency, on the control of neuropathic pain in animal models. A total of 24 male Swiss albino mice, weighing 25.30 grams, were divided into three groups: the Control Group (CG), the Laser Group (L30G) and the Sham Group (SG). The induction of neuropathy was held through the model of chronic constriction of the sciatic nerve (CCI), and the LLLT treatment was conducted as follows: The CG was treated with 0 J/cm2 fluency, whereas the L30G was treated with 30 J/cm2 fluency, and the SG with simulation of surgery without intervention. The irradiations were performed 3 times a week, for 90 days, at the nerve’s point of compression, using the contact technique. For the evaluation, the Hot Plate Test was used for thermal hyperalgesia, and the Randall-Selitto test was used for mechanical hyperalgesia. In the CG’s results, we observed no significant improvement in the days after surgery in any of the tests conducted, and, in the GL30, a significant improvement in both tests was observed: from the 30th day of treatment for the Hot Plate Test, and from the 45th for the Randall-Selitto Test, in which the mice showed total restoration of sensitivity. We thus conclude that the use of LLLT with 30 J/cm2 fluency in the treatment of neuropathic pain in animal models is effective.A terapia a laser de baixa intensidade (LLLT) vem sendo amplamente discutida na literatura como forma alternativa de tratamento para diversos tipos de dor, com destaque para a neuropática. Essa terapia sobressai pelo fato de não ser invasiva, raramente causar efeitos colaterais e ser de baixo custo. Em contrapartida, para sua eficácia, é necessário o detalhamento dos parâmetros, que ainda são muito discrepantes na literatura. Assim, este trabalho tem como objetivo investigar o efeito da LLLT, na faixa do infravermelho, com fluência de 30J/cm², no controle da dor neuropática em modelo animal. Foram utilizados 24 camundongos da cepa suíço albino, machos, pesando 25­30 gramas, divididos em três grupos: Grupo Placebo (GP), Grupo Laser (GL30) e Grupo Sham (GS). A indução da neuropatia foi feita através do modelo de constrição crônica do nervo isquiático (CCI), e o tratamento da LLLT realizou-se da seguinte maneira: GP com o laser com fluência de 0J/cm2, GL30 tratado com fluência de 30J/cm2, e GS com simulação de cirurgia sem intervenção. Executaram-se as irradiações 3 vezes por semana, durante 90 dias, no ponto de compressão do nervo, utilizando-se a técnica de contato. A fins de avaliação, foram utilizados o teste da placa quente, para hiperalgesia térmica, e o Teste de Randall-Selitto para hiperalgesia mecânica. Nos resultados do GP, observamos que não houve melhora significativa nos dias após a cirurgia em nenhum dos testes realizados e, no GL30, observou-se uma melhora expressiva em ambos os testes a partir do 30º dia de tratamento para o teste de Placa Quente e a partir do 45º para o Randall-Selitto, em que os camundongos apresentaram restauração total da sensibilidade. Concluímos, pois, que a utilização de LLLT com fluência de 30J/cm2 no tratamento da dor neuropática em modelo animal é eficaz

AVALIAÇÃO MICROBIOLÓGICA DE HORTALIÇAS E FRUTAS MINIMAMENTE PROCESSADAS COMERCIALIZADAS EM FORTALEZA (CE)

Avaliou-se a qualidade microbiológica de 15 amostras de hortaliças/tubérculos e de 15 amostras de frutas minimamente processadas, comercializadas em Fortaleza (CE). Foram realizadas análises de coliformes fecais e totais, pesquisa de Salmonella sp., contagem total de bolores e leveduras, contagem de Staphylococcus coagulase positiva e contagem total de psicrotróficos. Detectou-se a presença de Salmonella em 66,6% das amostras de hortaliças/tubérculos e em 26% das de frutas. Foi verificado que 13,3% das amostras de hortaliças/ tubérculos apresentaram contagem de coliformes fecais acima do limite estabelecido pela legislação brasileira. Contagens elevadas de coliformes totais, de bolores e leveduras e de psicrotróficos também foram encontradas em ambos os produtos, indicando condições inadequadas de higiene durante o processamento, comprometendo seu armazenamento e sua qualidade microbiológica. MICROBIOLOGICAL EVALUATION OF VEGETABLES AND FRUITS MINIMALLY PROCESSED MARKETED IN FORTALEZA (CE) Abstract The microbiological quality of 15 vegetables and 15 fruits minimally processed samples marketed in Fortaleza - CE (Brazil) was evaluated. The following analyses were carried out: total and fecal coliforms, Salmonella sp., total yeasts and moulds count, coagulase positive Staphylococcus count and total psychrotrophics count. Salmonella was detected in 66.6% of vegetable samples and 26% of fruit samples. Fecal coliforms count higher than legislation limit, it was verified in 13.3% of vegetable samples. High counts of total coliforms, yeasts and moulds and psychrotrophics were also found on both products, showing inadequate hygiene conditions during manufacturing, affecting storage and microbiological quality of minimally processed fruits and vegetables

Hepatites virais de potencial cronicidade

Hepatitis has great clinical relevance, causing impacts in liver functions. According to the World Health Organization, about 354 million people live with hepatitis B or C around the world without access to testing or treatment. In addition, the types B or C represent 80% of the deaths of all types of hepatitis. The objective of this article is to carry out a bibliography review about the hepatitis with chronic potential (B, C, and D), as well as its transmission forms, laboratory diagnosis, and treatments. This bibliographic review is based on articles published in the electronic databases Pubmed, Scielo, New England Journal of Medicine, Repositório Institucional UNESP, Google Scholar, Sage Journals and Brazilian Journal of Development. Only the articles published between 2008 and 2023 were considered. Original articles were selected as inclusion criteria in Portuguese, English, and Spanish. Furthermore, final paper articles and articles that preceded the stipulated time were excluded. 23 articles were included, which mainly discuss hepatitis, as well as forms of transmission, laboratory diagnosis, and treatments. In general, hepatitis is transmitted through infected blood and needles, vertical transmission and sexual contact with an infected partner, and to become infected with the hepatitis D virus, concomitant infection with the hepatitis B virus is necessary. For laboratory diagnosis, an integrated analysis of non-specific liver markers related to liver health, serological tests to identify specific antigens and antibodies, as well as molecular tests are considered. Treatment depends on the viral type, in addition to the stage of disease evolution. Essentially, medications are used to interfere with viral replication, seeking to prevent the development of serious forms of hepatitis. Accurate laboratory diagnosis is essential for early and effective treatment of the disease in order to prevent the development of its chronic form.As hepatites representam doenças de grande relevância clínica, causando comprometimento das funções hepáticas, além de acometer muitas populações ao redor de todo o globo. Segundo a Organização Mundial da Saúde, cerca de 354 milhões de pessoas ao redor do mundo vivem com hepatite B ou C, sem acesso a testes ou tratamento. Além disso, os subtipos B e C são responsáveis por 80% das mortes por hepatite. O objetivo do presente artigo foi realizar uma revisão bibliográfica a respeito das hepatites de potencial cronicidade (B, C e D), bem como suas formas de transmissão, diagnóstico laboratorial e tratamentos. Trata-se de uma revisão bibliográfica científica baseada em artigos publicados nas bases eletrônicas Pubmed, Scielo, New England Journal of Medicine, Repositório Institucional Unesp, Google acadêmico, Sage Journals e Brazilian Journal of Development. Foram considerados artigos publicados entre 2008 e 2023. Como critério de inclusão foram selecionados artigos originais, nos idiomas português, inglês e espanhol. Ademais, foram excluídos artigos de trabalho de conclusão de curso e que antecederam o tempo estipulado. Foram incluídos 23 artigos, os quais discute-se principalmente as hepatites, além formas de transmissão, diagnóstico laboratorial e tratamentos. De forma geral, as hepatites são transmitidas por meio de sangue e agulhas infectados, transmissão vertical e contato sexual com parceiro infectado, sendo que para infectar-se com o vírus da hepatite D é necessária infecção concomitante ao vírus da hepatite B. Dessa forma, para diagnóstico laboratorial considera-se uma análise integrada dos marcadores hepáticos inespecíficos, relacionados à saúde do fígado, os testes sorológicos para identificação de antígenos e anticorpos específicos, bem como testes moleculares. O tratamento depende do tipo viral, além do estágio de evolução da doença. De forma geral, são utilizados medicamentos para interferir na replicação viral, buscando evitar o desenvolvimento de formas graves da hepatite.  É essencial o diagnóstico laboratorial preciso para o tratamento precoce e eficaz da doença, com o intuito de prevenir o desenvolvimento de sua forma crônica

Previous BCG vaccination is associated with less severe clinical progression of COVID-19

Background: BCG vaccination, originally used to prevent tuberculosis, is known to “train” the immune system to improve defence against viral respiratory infections. We investigated whether a previous BCG vaccination is associated with less severe clinical progression of COVID-19./ Methods: A case-control study comparing the proportion with a BCG vaccine scar (indicating previous vaccination) in cases and controls presenting with COVID-19 to health units in Brazil. Cases were subjects with severe COVID-19 (O2 saturation < 90%, severe respiratory effort, severe pneumonia, severe acute respiratory syndrome, sepsis, and septic shock). Controls had COVID-19 not meeting the definition of “severe” above. Unconditional regression was used to estimate vaccine protection against clinical progression to severe disease, with strict control for age, comorbidity, sex, educational level, race/colour, and municipality. Internal matching and conditional regression were used for sensitivity analysis./ Results: BCG was associated with high protection against COVID-19 clinical progression, over 87% (95% CI 74–93%) in subjects aged 60 or less and 35% (95% CI − 44–71%) in older subjects./ Conclusions: This protection may be relevant for public health in settings where COVID-19 vaccine coverage is still low and may have implications for research to identify vaccine candidates for COVID-19 that are broadly protective against mortality from future variants. Further research into the immunomodulatory effects of BCG may inform COVID-19 therapeutic research.

THYROID CANCER: CLINICAL EVALUATION, ENDOCRINOLOGICAL MANIFESTATIONS AND SURGICAL MANAGEMENT

Thyroid cancer is more common in women and people over 40, but it can affect anyone. There are different types of thyroid cancer, the most common being differentiated carcinomas (papillary and follicular), which have a good prognosis and respond well to treatment. The clinical evaluation of thyroid cancer involves taking anamnesis, physical examination, measuring thyroid hormones and performing imaging tests and biopsy. The main symptom of thyroid cancer is the appearance of a nodule in the cervical region, which may be palpable or visible. The main surgical modalities are total thyroidectomy, which consists of complete removal of the thyroid gland; partial thyroidectomy or lobectomy, which consists of removing only part of the gland; and lymphadenectomy, which consists of removing lymph nodes affected by cancer. Objective: to synthesize the scientific evidence available on clinical assessment, endocrinological manifestations and surgical management in thyroid cancer. Methodology: based on the PRISMA checklist, the PubMed, Scielo and Web of Science databases were consulted to identify relevant studies published in the last 10 years. The descriptors used were: “thyroid cancer”, “thyroid neoplasm”, “clinical evaluation”, “surgical management” and “endocrinological manifestations”. Original studies in English or Portuguese that addressed the clinical, endocrinological or surgical aspects of thyroid cancer in humans were included. Studies that did not meet the inclusion criteria, were duplicates, had low methodological quality or did not have access to the full text were excluded. Results: 18 studies were selected, which revealed that thyroid cancer is a disease that presents different clinical, endocrinological and surgical aspects, depending on the type, stage and response to treatment. The studies analyzed provided evidence on diagnostic methods, indications and surgical techniques, the efficacy and safety of radioactive iodine therapy, and the role of suppressive hormone therapy in differentiated thyroid cancer. Conclusion: Thyroid cancer is a heterogeneous disease that requires a multidisciplinary approach for its diagnosis and treatment. The systematic review showed that there is consistent evidence on diagnostic methods, surgical modalities and radioactive iodine therapy in differentiated thyroid cancer. However, there are gaps in knowledge about the endocrinological manifestations of thyroid cancer and therapeutic alternatives for more complex or aggressive cases. Therefore, more studies are needed to clarify these aspects and improve the clinical management of patients with thyroid cancer.Thyroid cancer is more common in women and people over 40, but it can affect anyone. There are different types of thyroid cancer, the most common being differentiated carcinomas (papillary and follicular), which have a good prognosis and respond well to treatment. The clinical evaluation of thyroid cancer involves taking anamnesis, physical examination, measuring thyroid hormones and performing imaging tests and biopsy. The main symptom of thyroid cancer is the appearance of a nodule in the cervical region, which may be palpable or visible. The main surgical modalities are total thyroidectomy, which consists of complete removal of the thyroid gland; partial thyroidectomy or lobectomy, which consists of removing only part of the gland; and lymphadenectomy, which consists of removing lymph nodes affected by cancer. Objective: to synthesize the scientific evidence available on clinical assessment, endocrinological manifestations and surgical management in thyroid cancer. Methodology: based on the PRISMA checklist, the PubMed, Scielo and Web of Science databases were consulted to identify relevant studies published in the last 10 years. The descriptors used were: “thyroid cancer”, “thyroid neoplasm”, “clinical evaluation”, “surgical management” and “endocrinological manifestations”. Original studies in English or Portuguese that addressed the clinical, endocrinological or surgical aspects of thyroid cancer in humans were included. Studies that did not meet the inclusion criteria, were duplicates, had low methodological quality or did not have access to the full text were excluded. Results: 18 studies were selected, which revealed that thyroid cancer is a disease that presents different clinical, endocrinological and surgical aspects, depending on the type, stage and response to treatment. The studies analyzed provided evidence on diagnostic methods, indications and surgical techniques, the efficacy and safety of radioactive iodine therapy, and the role of suppressive hormone therapy in differentiated thyroid cancer. Conclusion: Thyroid cancer is a heterogeneous disease that requires a multidisciplinary approach for its diagnosis and treatment. The systematic review showed that there is consistent evidence on diagnostic methods, surgical modalities and radioactive iodine therapy in differentiated thyroid cancer. However, there are gaps in knowledge about the endocrinological manifestations of thyroid cancer and therapeutic alternatives for more complex or aggressive cases. Therefore, more studies are needed to clarify these aspects and improve the clinical management of patients with thyroid cancer

Erratum to: The study of cardiovascular risk in adolescents – ERICA: rationale, design and sample characteristics of a national survey examining cardiovascular risk factor profile in Brazilian adolescents

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Previous BCG vaccination is associated with less severe clinical progression of COVID-19

BACKGROUND: BCG vaccination, originally used to prevent tuberculosis, is known to "train" the immune system to improve defence against viral respiratory infections. We investigated whether a previous BCG vaccination is associated with less severe clinical progression of COVID-19 METHODS: A case-control study comparing the proportion with a BCG vaccine scar (indicating previous vaccination) in cases and controls presenting with COVID-19 to health units in Brazil. Cases were subjects with severe COVID-19 (O2 saturation < 90%, severe respiratory effort, severe pneumonia, severe acute respiratory syndrome, sepsis, and septic shock). Controls had COVID-19 not meeting the definition of "severe" above. Unconditional regression was used to estimate vaccine protection against clinical progression to severe disease, with strict control for age, comorbidity, sex, educational level, race/colour, and municipality. Internal matching and conditional regression were used for sensitivity analysis. RESULTS: BCG was associated with high protection against COVID-19 clinical progression, over 87% (95% CI 74-93%) in subjects aged 60 or less and 35% (95% CI - 44-71%) in older subjects. CONCLUSIONS: This protection may be relevant for public health in settings where COVID-19 vaccine coverage is still low and may have implications for research to identify vaccine candidates for COVID-19 that are broadly protective against mortality from future variants. Further research into the immunomodulatory effects of BCG may inform COVID-19 therapeutic research