Planejamento e programação local em saúde como metodologia de ensino-aprendizagem no curso de medicina

The study seeks to describe the experiences lived by students of the second period of medicine in the elaboration of a community-oriented PPLS assigned to a Family Health Unit (USF) It presented as a result the construction of the PPLS spreadsheets, with the listing and prioritization of problems, development of objectives, analysis of their viability, and operative programming, directed to guide the adolescents and adults of the FHU community assigned about the risks, consequences and protective measures of drug use and abuse. The elaboration of the PPLS allowed the student to get closer to the reality of the community, developing the planning of activities that will help the population to cope. Keywords: Health Policy, Planning and Management; Primary Care, Drugs.O estudo busca descrever as experiências vivenciadas pelos discentes do segundo período de medicina na elaboração de um PPLS voltado para comunidade adscrita uma Unidade de Saúde da Família (USF) Apresentou como resultado a construção das planilhas do PPLS, com a listagem e priorização dos problemas, desenvolvimento dos objetivos, análise da sua viabilidade, e programação operativa, direcionadas para orientar os adolescentes e adultos da comunidade adscrita da USF acerca dos riscos, consequências e medidas protetivas do uso e abuso de drogas. A elaboração do PPLS permitiu uma maior aproximação do estudante com a realidade da comunidade, desenvolvendo o planejamento de atividades que ajudarão a população no seu enfrentamento.

Transplante de microbiota fecal no tratamento da infecção por Clostridium difficile recorrente—uma revisão

Clostridium difficile infection (CDI) has become one of the major complications associated with the use of systemic antibiotics. Antimicrobials disrupt the balance of the colonic intestinal flora, predisposing the individual to infections by opportunistic strains, such as an CDI, that can characteristically cause a course of diarrhea and colitis. The standard treatment for these cases is the use of metronidazole or vancomycin for a period of 10 to 14 days. However, it is estimated that this therapy will fail in ∼ 5 to 35% of the patients, who will present a recurrence of CDI. The treatment options for recurrent CDI remain limited, but with promising therapies being constantly researched. The use of stools obtained from a donor to perform fecal microbiota transplantation (FMT) has been gaining space in several health centers, with reported success rates of 80 to 100%. However, there still is a limited experience in this subject, with the need for studies that allow the creation of a specific protocol for FMT

Relato de experiência sobre consulta de enfermagem realizada por acadêmicos como estratégia de promoção de saúde / Experience report on the nursing consultation performed by students as a health promotion strategy

Objetivo: Apresentar as experiências e as atividades vividas por acadêmicos de enfermagem sob supervisão de um professor, compartilhando aspectos teóricos e práticos do momento vivido pelos autores neste singular ambiente de assistência de enfermagem como forma de promoção em saúde para prevenção de diabetes mellitus e hipertensão arterial sistêmica. Métodos: Trata-se de um relato de experiência, com característica qualitativa a partir de métodos descritivos e observacionais. Foi realizada uma ação educativa pelos acadêmicos de enfermagem juntamente de um professor, com 93 participantes, em um Centro Universitário localizado na cidade de Niterói/RJ, em maio de 2022. Criou-se um instrumento para aplicação na consulta de enfermagem. Resultados e discussão: A realização das consultas de enfermagem oportunizou o amadurecimento profissional dos graduandos, visto que estes exerceram o raciocínio clínico ao pôr em prática seus conhecimentos teóricos e assistenciais previamente adquiridos no curso. Além disso, o público assistido ressaltou a importância do acolhimento recebido nas consultas, sendo um diferencial na prática do autocuidado. Conclusão: Os acadêmicos identificaram a potencialidade do enfermeiro diante do seu papel como educador em saúde. Diante disso, sugere-se construir consultórios de enfermagem nas universidades ao entender a sua importância na formação do profissional enfermeiro, oportunizando vivências práticas ricas em aprendizado ao reconhecer a realidade do aumento das doenças crônicas não transmissíveis no país

Assessment of calcinosis in Portuguese patients with systemic sclerosis: a multicenter study

© The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR) 2023Introduction/objectives: The study aims to define the clinical and subclinical calcinosis prevalence, the sensitivity of radiographed site and clinical method for its diagnosis, and the phenotype of Portuguese systemic sclerosis (SSc) patients with calcinosis. Method: A cross-sectional multicenter study was conducted with SSc patients fulfilling Leroy/Medsger 2001 or ACR/EULAR 2013 classification criteria, registered in the Reuma.pt. Calcinosis was assessed through clinical examination and radiographs of hands, elbows, knees, and feet. Independent parametric or non-parametric tests, multivariate logistic regression, and sensitivity calculation of radiographed site and clinical method for calcinosis detection were performed. Results: We included 226 patients. Clinical calcinosis was described in 63 (28.1%) and radiological calcinosis in 91 (40.3%) patients, of which 37 (40.7%) were subclinical. The most sensitive location to detect calcinosis was the hand (74.7%). Sensitivity of the clinical method was 58.2%. Calcinosis patients were more often female (p = 0.008) and older (p < 0.001) and had more frequently longer disease duration (p < 0.001), limited SSc (p = 0.017), telangiectasia (p = 0.039), digital ulcers (p = 0.001), esophageal (p < 0.001) and intestinal (p = 0.003) involvements, osteoporosis (p = 0.028), and late capillaroscopic pattern (p < 0.001). In multivariate analysis, digital ulcers (OR 2.63, 95% CI 1.02-6.78, p = 0.045) predicted overall calcinosis, esophageal involvement (OR 3.52, 95% CI 1.28-9.67, p = 0.015) and osteoporosis (OR 4.1, 95% CI 1.2-14.2, p = 0.027) predicted hand calcinosis, and late capillaroscopic pattern (OR 7.6, 95% CI 1.7-34.9, p = 0.009) predicted knee calcinosis. Anti-nuclear antibody positivity was associated with less knee calcinosis (OR 0.021, 95% CI 0.001-0477, p = 0.015). Conclusions: Subclinical calcinosis high prevalence suggests that calcinosis is underdiagnosed and radiographic screening might be relevant. Multifactorial pathogenesis may explain calcinosis predictors' variability. Key Points • Prevalence of subclinical calcinosis in SSc patients is substantial. • Hand radiographs are more sensitive to detect calcinosis than other locations or clinical method. • Digital ulcers were associated with overall calcinosis, esophageal involvement and osteoporosis were associated with hand calcinosis, and late sclerodermic pattern in nailfold capillaroscopy was associated with knee calcinosis. • Anti-nuclear antibody positivity may be a protective factor for knee calcinosis.info:eu-repo/semantics/publishedVersio

Direct antiviral therapy for treatment of hepatitis C: A real-world study from Brazil

Introduction and objectives: Direct antiviral agents (DAAs) including sofosbuvir (SOF), daclatasvir (DCV), simeprevir (SIM) and ombitasvir, paritaprevir and dasabuvir were introduced 2015 in Brazil for treatment of hepatitis C virus (HCV) infection. The aims of this study were to assess effectiveness and safety of HCV treatment with DAA in real-life world in a highly admixed population from Brazil. Materials and methods: All Brazilian reference centers for HCV treatment were invited to take part in a web-based registry, prospectively conducted by the Brazilian Society of Hepatology, to assess outcomes of HCV treatment in Brazil with DAAs. Data to be collected included demographics, disease severity and comorbidities, genotype (GT), viral load, DAA regimens, treatment side effects and sustained virological response (SVR). Results: 3939 patients (60% males, mean age 58 ± 10 years) throughout the country were evaluated. Most had advanced fibrosis or cirrhosis, GT1 and were treated with SOF/DCV or SOF/SIM. Overall SVR rates were higher than 95%. Subjects with decompensated cirrhosis, GT2 and GT3 have lower SVR rates of 85%, 90% and 91%, respectively. Cirrhosis and decompensated cirrhosis in GT1 and male sex and decompensated cirrhosis in GT3 were significantly associated with no SVR. Adverse events (AD) and serious AD occurred in 18% and 5% of those subjects, respectively, but less than 1% of patients required treatment discontinuation. Conclusion: SOF-based DAA regimens are effective and safe in the heterogeneous highly admixed Brazilian population and could remain an option for HCV treatment at least in low-income countries

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved