QUALIDADE DE VIDA E SEXUALIDADE DE MULHERES HISTERECTOMIZADAS EM UMA MATERNIDADE PÚBLICA DA AMAZÔNIA BRASILEIRA

RESUMO Objetivo: descrever a qualidade de vida e sexualidade de mulheres histerectomizadas que se submeteram à cirurgia no Hospital da Mulher - HMML de Macapá-Amapá. Método: estudo do tipo descritivo exploratório, com delineamento transversal e abordagem quantitativa, realizado com mulheres de uma maternidade de Macapá, estado do Amapá, que se submeteram à histerectomia total nos anos de 2006 a 2016. Utilizaram-se como instrumentos para avaliar a qualidade de vida e a sexualidade de mulheres submetidas à histerectomia total a entrevista individual e os testes WHOQOL-bref e QS-F. Resultados: a amostra incluiu 41 mulheres histerectomizadas com idades entre 24 e 60 anos. A maioria delas considera que a sua QV é boa (53,7%). Quanto à satisfação com a saúde, pouco mais da metade referiu estar satisfeita (36,5%). No tocante à caracterização do desempenho sexual, 13 (31,7%) relataram desempenho sexual desfavorável a regular. Conclusão: a análise das médias dos escores de cada dimensão mostra melhor qualidade de vida no domínio psicológico. No entanto, as correlações do quociente sexual com os domínios da qualidade de vida são todas positivas e significativas

Aspectos clínicos inerentes à Síndrome de Burnout / Clinical aspects about Burnout Syndrome

A Síndrome de Burnout (SB) é caracterizada pela manifestação de três elementos: o estado de exaustão emocional, a despersonalização e a realização pessoal reduzida. O distúrbio está vinculado ao ambiente de trabalho que opera em ritmo acelerado devido às transformações globais impostas. No ano de 1978, a psicóloga social Christina Maslach, desenvolveu um método que permite avaliar o nível de Burnout em que o paciente se encontra, chamado de Maslach Burnout Inventory (MBI). Essa ferramenta utiliza três parâmetros para avaliação, demora cerca de 10 minutos para ser aplicada e, com os resultados em mãos, classifica-se o paciente em uma frequência de 7 níveis. A World Health Organization considera que o estresse seja o principal fator desencadeante da SB e, diante disso, foi proposta a divisão dos fatores de risco em três tópicos, sendo eles: I) aspectos individuais; II) aspectos específicos do trabalho e III) aspectos relacionados ao ambiente da organização. Entretanto, mais do que identificar o fator desencadeante ao qual o sujeito está exposto, também se faz necessário observar formas de mitigá-lo. Dessa maneira, a abordagem terapêutica do transtorno deve ser realizada com o acompanhamento psiquiátrico e psicológico, para estabelecer a melhor conduta de maneira individualizada. Por fim, a prevenção do estresse crônico eleva a performance e propicia o bem-estar ao trabalhador, reduzindo as taxas de absenteísmo social

VIVÊNCIAS NO ESTÁGIO SUPERVISIONADO EM SETOR CLÍNICO DE ENDOSCOPIA E COLONOSCOPIA – RELATO DE EXPERIÊNCIA.

Introduction: The study of upper digestive endoscopy (EDA) and colonoscopy are exams that have improved with advances in global technologies. They serve as a basis for diagnosing basic diseases of the digestive system, with high prevalence and mortality in the world. The non-mandatory internship chosen in this area of knowledge aims to learn and develop clinical skills with the aim of improving the medical academic curriculum and exposing the activity as an experience report to the scientific community. Method: descriptive, longitudinal study, carried out in the first half of 2023 in a private clinic in Belém do Pará, where the intern presents its advantages and difficulties when carrying out the procedure. Results: the confluence between the curriculum and practical internship activities proved to be productive, in accordance with the objectives of the study and a new clinical experience for the academic. Conclusion: the active methodology of the medical course was passed on to the scientific community, where placing students in direct contact with care in an uncontrolled environment is essential to their training.  Introdução: O estudo da endoscopia digestiva alta (EDA) e colonoscopia, são exames que se aprimoraram com os avanços das tecnologias mundiais. Servem de base ao diagnóstico de doenças bases do sistema digestório, de alta prevalência e mortalidade no mundo. O estágio não obrigatório escolhido nesta área do conhecimento visa aprender e desenvolver habilidades clínicas com o intuito melhor o currículo acadêmico médico e expor a atividade como relato de experiência a comunidade científica. Método: estudo descritivo, longitudinal, realizado no primeiro semestre de 2023 em uma clínica particular em Belém do Pará, onde o estagiário apresenta suas vantagens e dificuldades ao realiza-lo. Resultados: a confluência entre grade curricular e atividades prática em estágio mostraram-se produtiva, de acordo com os objetivos do estudo e uma nova experiência clínica ao acadêmico. Conclusão: repassado a comunidade científica a metodologia ativa do curso de medicina onde colocar os alunos em contato direto com o atendimento em um ambiente não controlado é essencial a sua formação.   &nbsp

Ceruloplasmin, transferrin and apolipoprotein A-II play important role in treatment's follow-up of paracoccidioidomycosis patients.

Paracoccidioidomycosis (PCM) is a systemic disease caused by thermodymorphic fungi of the Paracoccidioides brasiliensis complex, (Paracoccidioides spp.). Patients with PCM reveal specific cellular immune impairment. Despite the effective treatment, quiescent fungi can lead to relapse, usually late, the serological diagnosis of which has been deficient. The present study was carried out with the objective of investigating a biomarker for the identification of PCM relapse and another molecule behaving as an immunological recovery biomarker; therefore, it may be used as a cure criterion. In the evolutionary analysis of the proteins identified in PCM patients, comparing those that presented with those that did not reveal relapse, 29 proteins were identified. The interactions observed between the proteins, using transferrin and haptoglobin, as the main binding protein, were strong with all the others. Patient follow-up suggests that cerulosplamin may be a marker of relapse and that transferrin and apolipoprotein A-II may contribute to the evaluation of the treatment efficacy and avoiding a premature decision

Serological proteomic biomarkers to identify Paracoccidioides species and risk of relapse.

The sensitivity of the double agar gel immunodiffusion test is about 90% in patients with untreated paracoccidioidomycosis (PCM), but it is much lower in cases of relapse. In addition, serum from patients with PCM caused by Paracoccidioides lutzii, frequent in the Midwest region of Brazil, do not react with the classical antigen obtained from Pb B-339. These findings showed the need for alternative diagnostic methods, such as biological markers through proteomics. The aim of this study was to identify biomarkers for the safe identification of PCM relapse and specific proteins that could distinguish infections caused by Paracoccidioides brasiliensis from those produced by Paracoccidioides lutzii. Proteomic analysis was performed in serum from 9 patients with PCM caused by P. brasiliensis, with and without relapse, from 4 patients with PCM produced by P. lutzii, and from 3 healthy controls. The comparative evaluation of the 29 identified plasma proteins suggested that the presence of the immunoglobulin (Ig) alpha-2 chain C region and the absence of Ig heavy chain V-III TIL indicate infection by P. lutzii. In addition, the absence of complement factor B protein might be a predictor of relapse. The evaluation of these proteins in a higher number of patients should be carried out in order to validate these findings

An update on the occurrence of Paracoccidioides species in the Midwest region, Brazil: Molecular epidemiology, clinical aspects and serological profile of patients from Mato Grosso do Sul State.

BackgroundParacoccidioidomycosis (PCM) is a systemic and endemic fungal infection in Latin American, mainly in Brazil. The majority of PCM cases occur in large areas in Brazil, comprising the South, Southeast and Midwest regions, with the latter demonstrating a higher incidence of the species Paracoccidioides lutzii.Methodology and main findingsThis study presents clinical, molecular and serological data of thirteen new PCM cases during 2016 to 2019 from the state of Mato Grosso do Sul, located in the Midwest region, Brazil. From these thirteen cases, sixteen clinical isolates were obtained and their genomic DNAs were subjected to genotyping by tub1 -PCR-RFLP. Results showed Paracoccidioides brasiliensis sensu stricto (S1) (11/16; 68.8%), Paracoccidioides restrepiensis (PS3) (4/16; 25.0%) and P. lutzii (1/16; 6.2%) as Paracoccidiodes species. Therefore, in order to understand whether the type of phylogenetic species that are circulating in the state influence the reactivity profile of serological tests, we performed double agar gel immunodiffusion (DID), using exoantigens from genotyped strains found in this series of PCM cases. Overall, our DID tests have been false negative in about 30% of confirmed PCM cases. All patients were male, most with current or previous rural activity, with ages ranging from 17 to 59 years, with 11 patients (84.6%) over 40 years of age. No clinical or epidemiological differences were found between Paracoccidioides species. However, it is important to note that the only case of P. lutzii died as an outcome.ConclusionsThis study suggests P. brasiliensis sensu stricto (S1) as the predominant species, showing its wide geographic distribution in Brazil. Furthermore, our findings revealed, for the first time, the occurrence of P. restrepiensis (PS3) in the state of Mato Grosso do Sul, Brazil. Despite our setbacks, it would be interesting to provide the complete sequencing of these clinical isolates to complement the molecular information presented

Prevalence of Cryptococcal Antigenemia and Lateral Flow Assay Accuracy in Severely Immunosuppressed AIDS Patients

This study aimed to estimate the prevalence of cryptococcal antigenemia detected by lateral flow assay (LFA) in AIDS patients and its accuracy in the diagnosis of cryptococcosis. Conducted at a university hospital in Brazil from March 2015 to July 2017, it included AIDS patients over 18 years old with a CD4+ count ≤ 200 cells/mm3. Cryptococcal antigen (CrAg) detection using LFA and latex agglutination (LA), along with blood and urine cultures, were performed. The reference standard was the identification of Cryptococcus spp. in clinical specimens through microbiological or histopathological examination. Among 230 patients, the prevalence of CrAg detected by LFA (CrAg LFA) was 13.0%. Factors associated with cryptococcal antigenemia included fever, vomiting, seizures, and a lack of antiretroviral therapy. The sensitivity and specificity of CrAg LFA were 83.9% and 98.0%, respectively. The positive predictive value (PPV) was 86.7%, the negative predictive value (NPV) was 97.5%, and overall accuracy was 96.1%. Cross-reactions were observed in patients with histoplasmosis and paracoccidioidmycosis, but not with aspergillosis or positive rheumatoid factor. The study concludes that the LFA is a useful tool for detecting cryptococcal antigenemia in severely immunocompromised AIDS patients due to its high NPV, specificity, and PPV

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