Interfacing the operational storm surge model to a new mesoscale atmospheric mode

Chagas disease (Cd) is the third most common parasitic disease that causes damage to human health. Even a century after its description by Carlos Chagas and advances in its control, it remains a neglected disease. To eradicate the parasite or reduce the parasitic load, specific treatment for Trypanosoma cruzi (T. cruzi) is advisable; benznidazole (BNZ) is the drug that is currently prescribed. The purpose of this study is to report the adverse events (AE) due to the use of BNZ as a specific treatment for Cd, with a particular focus on hepatic changes. This was an observational, cross-sectional cohort study that included patients who were treated with BNZ. The medical records of patients who joined the Grupo de Estudo em doença de Chagas [Chagas Disease Study Group]/UNICAMP/Brazil and were treated with BNZ were reviewed for epidemiological, clinical, laboratory and AE parameters for the drug. The 204 patients who were assessed had an average age of 40.6 years ± 13.5 years, and 104 of them were women (50.98%). Fourteen (6.86%) individuals were in the acute phase of Cd, and 190 (93.13%) were in its chronic phase. AEs occurred in 85 patients (41.66%), 35 (41.17%) of whom had AEs related to the liver, characterized by an elevation of AST liver enzymes, ALT, alkaline phosphatase and gamma-glutamyltransferase (γGT). Other AEs that were observed included the following: 48 cases of cutaneous changes (56.47%), 8 cases of epigastric pain (9.41%), 7 cases of blood alteration (8.23%), and 3 cases of peripheral neuropathy (3.52%). Treatment was interrupted in 32 patients (37.64%) due to AD. Adverse events related to the liver secondary to the use of BNZ for Cd-specific treatment were frequent in this study and were characterized by an elevation of liver enzymes. Therefore, it is suggested that these enzymes be monitored during treatment with benznidazole

Aspectos medico trabalhistas de pacientes chagasicos com vinculo empregaticio

Orientadores: Maria Elena Guariento, Eros Antonio de AlmeidaTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: Foram avaliados 250 indivíduos portadores da infecção pelo T. cruzi com pelo menos duas sorologias positivas, com vínculo empregatício regulamentado. Divididos em dois grupos após entrevista, exame clínico e complementares: grupo FI com 143 indivíduos (forma indeterminada) e FC com 99 indivíduos (com algum grau de cardiopatia), sendo retirados os casos com megavísceras isoladas. Avaliados quanto ao sexo, raça, grau de escolaridade, tipo de serviço, vínculo previdenciário, salários, exame médico admissional, recusa ao exame admissional. O estudo constatou a existência de inadequação quanto a capacidade de trabalho dos portadores de T cruzi e a função desempenhada. Alguns elementos sugestivos de discriminação com os trabalhadores soropositivos. Seria necessário adotar-se estratégias de esclarecimento aos profissionais da área da saúde quanto a capacidade de trabalho dos portadores de infecção pelo T cruzi, bem como os peritos da Previdência SocialAbstract: We studied two hundred fifty confinned Chagas' disease patients with regular jobs. They were distributed in two groups: FI - N= 143 patients in the undetennined fonn; FC - N= 99 patients with cardiopathy. We excluded Chagas' disease patients with megaesophagus and megacolon but no cardiopathy. Age, gender, race, educational leveI, kind of job, regular employment, wages, admittance physical condition and rejection in the admittance physical exam. In the present report we demonstrate that Chagas' disease patients jobs are frequently not adapted for the jobs they have. Our data suggest that these patients endure discrimination. We conclude that health workers need more infonnation on Chagas' disease working capabilityDoutoradoMedicina InternaDoutor em Ciências Médica

Simulated medical consultations with standardized patients: In-depth debriefing based on dealing with emotions

ABSTRACT In general, students have few opportunities to address their emotions under the guidance of an experienced physician, which can undermine their self-confidence to deal with real patients in stressful situations. Emotional detachment and cynicism are defense mechanisms, which can emerge as a consequence. The consolidation of a professional identity committed to patients’ interests can become a challenge when medical students are not comfortable in their role as caregivers. In general, we consider that the undergraduate medical curriculum has been insufficient in providing appropriate environments for students to reflect on professional identity formation and on the future challenges of their profession. Objective: To develop an in-depth debriefing to address students’ emotions and professional identity formation in the context of a simulation activity with simulated patients at a medical school in Brazil. Methods: The authors conducted a simulated medical consultation activity using standardized patients (SPs) with an in-depth debriefing based on the feelings of the patient and the student. During each encounter the formation and consolidation of professional identity was discussed. Fourth- and sixth-year medical students (n=551) participated and answered a questionnaire about the activity and the learning outcome. Results: The students felt comfortable during the activity, due to "openness to dialogue", "proximity with colleagues and teachers" and the "judgment-free environment". More than 90% reported that what they had learned would be useful in their professional and personal lives, providing a greater "understanding of emotions", "empathy", "ability to listen" and "ability to deal with conflicts". More than half of them were motivated to study, especially "doctor-patient relationship", "treatment", "common diseases" and "medicine in general". Students considered the activity important for retrieving the initial reasons that had led them to embarking on the medical profession in the first place. Conclusions: Reflecting on disease and its impact on patients’ daily life may motivate learning in medicine, allowing for the recovery of the personal and social meaning of its practice. In-depth debriefing was important to nurture professional identity committed to empathy and patients’ interests. Activities planned to discuss the influence and importance of emotions in medical practice can help students to reconcile personal and professional identities