Case control study for measuring influenza vaccine effectiveness in Portugal - Final report Season 2009-10

O Departamento de Epidemiologia em conjunto com o Departamento de Doenças Infecciosas do INSA realizaram um estudo, na época de 2009-2010, que teve por objectivo estimar a efectividade da vacina sazonal (em indivíduos com 65 e mais anos) e pandémica (todas as idades). O estudo contou com a participação de: Portugal, Espanha, Irlanda, França, Itália, Hungria e Roménia. Este estudo surge enquadrado no projecto europeu multicêntrico - I-MOVE- Monitoring influenza vaccine efectiveness during influenza seasons and pandemics in the European Union, coordenado pela EpiConcept SARL e financiado pelo ECDC, que pretende estimar a efectividade da vacina sazonal e pandémica durante e após a época de gripe

Avaliação das práticas de higienização das mãos em três unidades de terapia intensiva

Background and objectives: Hand Hygiene (HH) is a simple and effective measure in the fight against Healthcare-associated Infections (HAIs). Despite the effort made by professionals of the Infection Control Service, compliance with practices remains low, generally below 50%. For this reason, this study aimed to evaluate HH practices in three Intensive Care Units of a private hospital in Belo Horizonte, MG, Brazil. Methods: Cross-sectional, descriptive study performed in three ICUs of a private hospital in Belo Horizonte, MG, Brazil. From July 2016 to July 2017, all HH documents of the study hospital were evaluated, totaling 1,100 observations in loco performed by the nurses of the Infection Control Service. Data analysis was performed using descriptive statistics and linear regression using the Pearson correlation coefficient. Results: The rate of adhesion ranged from 27.3 to 88.2%, with an average of 47% (±16.8). Consumption of alcohol preparation and liquid soap obtained, respectively, an average of 32 and 47 ml/patient-day. Pearson's coefficient showed a positive correlation between alcohol consumption and adhesion rate (r=0.49, p=0.01). Conclusion: Healthcare workers still need to be aware of the importance of HH for reducing HAIs.Justificación y objetivos: La Higienización de las Manos (HM) es una medida simple y eficaz en el combate a las Infecciones Relacionadas a la Asistencia Sanitaria (IRAS). A pesar del esfuerzo realizado por los profesionales del Servicio de Control de Infección Hospitalaria, el cumplimiento de las prácticas sigue siendo bajo, generalmente inferior al 50%. Por este motivo, este estudio objetivó evaluar las prácticas de HM en tres Unidades de Terapia Intensiva de un hospital privado de Belo Horizonte, MG, Brasil. Método: Estudio transversal, descriptivo de naturaleza cuantitativa, realizado en tres UTIs de un hospital privado de Belo Horizonte, MG, Brasil. En el período de julio/2016 a julio/2017 se evaluaron todos los documentos de HM del hospital de estudio, totalizando 1.100 observaciones in loco realizadas por los enfermeros del Servicio de Control de Infección. Para el análisis de los datos se adoptó estadística descriptiva y regresión lineal utilizando el coeficiente de correlación de Pearson. Resultados: La tasa de adhesión las prácticas de HM varió entre el 27,3 y el 88,2%, con una media del 47% (±16,8). El consumo de preparación alcohólica y jabón líquido obtuvieron, respectivamente, una media de 32 y 47 ml / paciente-día. Se observó una correlación positiva entre el consumo de alcohol y la tasa de adhesión (r2=0,49, p=0,01). Conclusiones: Los profesionales de la salud todavía necesitan sensibilización acerca de la importancia de la HM para reducir las IRAS.Justificativa e objetivos: Higienização das Mãos (HM) é uma medida simples e eficaz no combate às Infecções Relacionadas à Assistência à Saúde (IRAS). Apesar do esforço feito pelos profissionais do Serviço de Controle de Infecção Hospitalar (SCIH), o cumprimento das práticas ainda permanece baixo, geralmente inferior a 50%. Por esse motivo, este estudo objetivou avaliar as práticas de HM em três Unidades de Terapia Intensiva de um hospital privado de Belo Horizonte, MG, Brasil. Método: Estudo transversal, descritivo de natureza quantitativa, realizado em três UTIs de um hospital privado de Belo Horizonte, MG, Brasil. No período de julho/2016 a julho/2017 foram avaliados todos os documentos de HM do hospital de estudo, totalizando 1.100 observações in loco realizadas pelos enfermeiros do SCIH. Para análise dos dados adotou-se estatística descritiva e regressão linear utilizando o coeficiente de correlação de Pearson. Resultados: A taxa de adesão à HM variou entre 27,3 e 88,2%, com média de 47% (±16,8). O consumo de preparação alcoólica e sabonete líquido obtiveram, respectivamente, uma média de 32 e 47 ml/paciente-dia. Houve correlação positiva entre o consumo de preparação alcoólica e a taxa de adesão (r2=0,49, p=0,01). Conclusão: Os profissionais de saúde ainda necessitam de sensibilização acerca da importância da higiene de mãos para redução das IRAS. Descritores: Higiene das Mãos. Infecção hospitalar. Cuidados Críticos

Histomorfometric Analysis of the Endochondral Ossification of the limbs of Rats submitted to Usnic Acid from Cladonia Substellata (AHTI) encapsulated in Plga-Microspheres / Análise Histomorfométrica da Ossificação Endocondral dos membros de Ratos submetidos ao Ácido Úsnico de Cladonia Substellata (AHTI) encapsulado em Microesferas de Plga

The aim of this study was to evaluate the histology and morphometry of endochondral ossification in limbs of rats submitted to usnic acid from Cladonia substellata (AHTI) encapsulated in PLGA-microspheres. It was used 12 pregnant Wistar rats that were randomly distributed in the control groups (n = 6), which received 1.0 mL of saline solution; and treated (n = 6), that received 25 mg/kg/day of encapsulated usnic acid in PLGA microspheres by oral administration. It was analyzed six fetuses from each rat under study. At the 20th day of gestation were euthanized the females and their fetuses removed for histomorphometric analysis of the anterior and posterior limbs. The results showed the epiphyseal discs of the animals with cell alterations, as in the morphology and numbers of chondrocytes. It also showed a decrease in the amount of collagen type I collagen in bone tissue. However, this study showed low toxicity of the encapsulated usnic acid on bone development, when compared to its conventional dosage form. In this way, the toxicity of usnic acid can be reduced by encapsulation in PLGA-microspheres

evidence- and practice-based guidance

The authors thank Luı́s Veloso, Daniela Carvalho, and Catarina Oliveira Silva (from CTI, Clinical Trial & Consulting Services) for their assistance with the project.Systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), and Sjögren's syndrome (SS) are heterogeneous autoimmune diseases. Severe manifestations and refractory/intolerance to conventional immunosuppressants demand other options, namely biological drugs, and small molecules. We aimed to define evidence and practice-based guidance for the off-label use of biologics in SLE, APS, and SS. Recommendations were made by an independent expert panel, following a comprehensive literature review and two consensus rounds. The panel included 17 internal medicine experts with recognized practice in autoimmune disease management. The literature review was systematic from 2014 until 2019 and later updated by cross-reference checking and experts' input until 2021. Preliminary recommendations were drafted by working groups for each disease. A revision meeting with all experts anticipated the consensus meeting held in June 2021. All experts voted (agree, disagree, neither agree nor disagree) during two rounds, and recommendations with at least 75% agreement were approved. A total of 32 final recommendations (20 for SLE treatment, 5 for APS, and 7 for SS) were approved by the experts. These recommendations consider organ involvement, manifestations, severity, and response to previous treatments. In these three autoimmune diseases, most recommendations refer to rituximab, which aligns with the higher number of studies and clinical experience with this biological agent. Belimumab sequential treatment after rituximab may also be used in severe cases of SLE and SS. Second-line therapy with baricitinib, bortezomib, eculizumab, secukinumab, or tocilizumab can be considered in SLE-specific manifestations. These evidence and practice-based recommendations may support treatment decision and, ultimately, improve the outcome of patients living with SLE, APS, or SS.publishersversionpublishe

O PROTAGONISMO ESTUDANTIL COMO BASE PARA UMA FORMAÇÃO MÉDICA DE QUALIDADE: UM RELATO DE EXPERIÊNCIA.

Introduction: Medical Education proposed by the traditional curriculum of universities is insufficient for quality professional training. Thus, it is clear that, despite the development of different spheres and skills in leadership by the individual being essential, the aforementioned grid still persists in medical schools. In order to promote a change in this reality, this paper reports the experience of students from the first period of medicine who managed to develop these skills through positions in different areas of activity. Experience report: On the subject of remote education, medicine freshmen decided to work in leadership and management of people in areas of action in a student organization. Areas such as Capacity Building, Administration, Marketing, Research and Activities in Medical Education and Human Rights and Peace were related to the performance of each of the freshmen through educational interventions and activities, in order to meet the demands of other students linked to this organization, supplementing the regular curriculum. Discussion: The exclusively hospital-centered and technical medical curriculum becomes insufficient for a quality Medical Education. Therefore the participation in extracurricular activities becomes essential as a complement to the professional's training. Thus, developing leadership skills and abilities and encouraging different activities can not only provide personal development, but also allow for an exchange of knowledge between students and the population involved in the activities, in addition to providing professional development from the beginning of graduation. Conclusion: Based on the experience of this report, students were able to develop leadership skills and acquire essential responsibilities to medical training since the first period of medical school. Therefore, the description of the experience of this work encourages the reproducibility of similar initiatives that can contribute to quality medical training for future health professionals.Introdução: A Educação Médica proposta pela matriz curricular tradicional da maioria das universidades no país é insuficiente para a formação profissional de qualidade, por pouco incentivar,  apesar de ser essencial, o desenvolvimento  de diferentes esferas e habilidades em liderança pelos discentes. A fim de fomentar a mudança dessa realidade, este trabalho relata a experiência de estudantes do primeiro período de medicina que conseguiram desenvolver essas habilidades por meio de cargos em diversos eixos de atuação. Relato da experiência: No contexto do ensino remoto, calouros de medicina decidiram atuar em cargos de liderança e de gestão de pessoas com eixos de atuação em uma organização estudantil. Eixos como Capacity Building, Administração, Marketing, Pesquisa e Atividades em Educação Médica e Direitos Humanos e Paz foram referentes à atuação de cada um dos calouros por meio de intervenções educativas e atividades, a fim de atender demandas de outros estudantes vinculados a essa organização, suplementando a matriz curricular regular. Discussão: O currículo médico exclusivamente hospitalocêntrico e técnico se torna insuficiente para uma Educação Médica de qualidade, logo a participação em atividades extracurriculares se torna essencial para uma complementação da formação do profissional. Dessa forma,  desenvolver competências e habilidades em liderança e incentivar diferentes atividades podem não só proporcionar um desenvolvimento pessoal, mas também permitir uma troca de conhecimento entre discentes e a população envolvida nas atividades, além de propiciar um desenvolvimento profissional desde o início da graduação. Conclusão: A partir da experiência deste relato, os estudantes conseguiram desenvolver habilidades de liderança e adquirir responsabilidades essenciais à formação médica desde o primeiro período do curso de medicina. Logo a descrição da experiência deste trabalho incentiva a reprodutibilidade de iniciativas semelhantes que possam contribuir para a formação médica de qualidade para futuros profissionais da saúde

Histomorfometria testicular do morcego Phyllostomus discolor (Chiroptera: Phyllostomidae) em áreas de Mata Atlântica de Pernambuco

This study analyzed the reproductive condition, by histomorphometry, of P. discolor collected in forest fragments of the South Coast of Pernambuco during the dry and rainy seasons. The animals are Collection and were classified according to the position testicular (descendants and not descendants). For histomorphometric analysis, 18 were randomly selected specimens during the rainy and dry seasons, being (n = 11) with descendant testicles and (n = 7) with testicles no descendant. The results showed that the highest area average occupancy of the seminiferous tubules were in the rainy season, regardless of the present specimens the testes descendant or not. This may be related to a greater investment in sperm production, since the rainy season, there is a greater availability of food due to rainfall. © 2014, Universidade de Sao Paulo. Faculdade de Medicina Veterinaria e Zootecnia, All rights reserved

Biological therapy in systemic lupus erythematosus, antiphospholipid syndrome, and Sjögren’s syndrome: evidence- and practice-based guidance

Systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), and Sjögren’s syndrome (SS) are heterogeneous autoimmune diseases. Severe manifestations and refractory/intolerance to conventional immunosuppressants demand other options, namely biological drugs, and small molecules. We aimed to define evidence and practice-based guidance for the off-label use of biologics in SLE, APS, and SS. Recommendations were made by an independent expert panel, following a comprehensive literature review and two consensus rounds. The panel included 17 internal medicine experts with recognized practice in autoimmune disease management. The literature review was systematic from 2014 until 2019 and later updated by cross-reference checking and experts’ input until 2021. Preliminary recommendations were drafted by working groups for each disease. A revision meeting with all experts anticipated the consensus meeting held in June 2021. All experts voted (agree, disagree, neither agree nor disagree) during two rounds, and recommendations with at least 75% agreement were approved. A total of 32 final recommendations (20 for SLE treatment, 5 for APS, and 7 for SS) were approved by the experts. These recommendations consider organ involvement, manifestations, severity, and response to previous treatments. In these three autoimmune diseases, most recommendations refer to rituximab, which aligns with the higher number of studies and clinical experience with this biological agent. Belimumab sequential treatment after rituximab may also be used in severe cases of SLE and SS. Second-line therapy with baricitinib, bortezomib, eculizumab, secukinumab, or tocilizumab can be considered in SLE-specific manifestations. These evidence and practice-based recommendations may support treatment decision and, ultimately, improve the outcome of patients living with SLE, APS, or SS

Histomorfometria testicular do morcego Phyllostomus discolor (Chiroptera: Phyllostomidae) em áreas de Mata Atlântica de Pernambuco

Esse estudo analisou a condição reprodutiva, por meio da histomorfometria, de P. discolor coletados em fragmentos de Mata Atlântica do litoral sul de Pernambuco, durante as estações seca e chuvosa. Os animais são de coleção e foram classificados de acordo com a posição testicular (descendentes e não descendentes). Para as análises histomorfométricas, foram selecionados aleatoriamente 18 espécimes durante as estações seca e chuvosa, dos quais (n = 11) com testículos descendentes e (n = 7) com testículos não descendentes. Os resultados demonstraram que as maiores médias da área de ocupação dos túbulos seminíferos foram na estação chuvosa, independente dos espécimes apresentarem os testículos descendentes ou não. Isso pode estar relacionado a um maior investimento em produção espermática, já que na estação chuvosa, existe uma maior disponibilidade de alimentos devido às precipitações pluviométricas.This study analyzed the reproductive condition, by histomorphometry, of P. discolor collected in forest fragments of the South Coast of Pernambuco during the dry and rainy seasons. The animals are Collection and were classified according to the position testicular (descendants and not descendants). For histomorphometric analysis, 18 were randomly selected specimens during the rainy and dry seasons, being (n = 11) with descendant testicles and (n = 7) with testicles no descendant. The results showed that the highest area average occupancy of the seminiferous tubules were in the rainy season, regardless of the present specimens the testes descendant or not. This may be related to a greater investment in sperm production, since the rainy season, there is a greater availability of food due to rainfall

A PRODUÇÃO DE UM JOGO RPG ELETRÔNICO COMO ABORDAGEM INTEGRADA DE SISTEMAS DO CORPO HUMANO: UM RELATO DE EXPERIÊNCIA

Introduction: The traditional education, based on expositive classes in which the teachers are the protagonists and the students are put as passive spectators, is still used by the majority of educational institutions. However, some methods can make students directly responsible for their knowledge and have shown to be effective in encouraging autonomy and reasoning. Furthermore, during the Covid-19 pandemic, there was a need to change the way of teaching, investing in active and attractive methodologies, such as electronic games, to ensure that learning is satisfying.Therefore, the objective of this report is to describe the experience of elaborating an educational game for and to medical students. Experience report: Based on the proposal of an academic work from the medical course, the game "Pâncrea Bit", a storyteller role playing game, was created and it integrated some subjects as diabetes 3C and chronic pancreatitis by a group with 13 participants which divided the functions. In addition, an educational material was produced with the topics covered in the game and complementary image animations. Discussion: Although there is no scientific proof of the efficiency of the educational method utilizing games in comparison to the traditional when analyzing the professionals quality, it is already known that this kind of teaching gives more satisfaction to the students.This was demonstrated by the massive participation of other students in conducting and solving the “Pâncrea Bit” quizzes. Conclusion: The gamification aroused interest, motivation and introduced the student as protagonist besides contributing to long-term memory, showing that is a valid  and applicable method to concretize knowledge in every learning stage.Introdução: A forma tradicional de educação, baseada em aulas expositivas, nas quais os professores são figuras protagonistas e o estudante é colocado na posição de espectador passivo, ainda é a mais utilizada pela maioria das instituições de ensino. Entretanto, alguns métodos podem transformar o estudante em ator diretamente responsável pela obtenção do seu conhecimento e demonstram ser eficazes ao incentivar autonomia e raciocínio. Ademais, durante a pandemia do Covid-19, houve a necessidade de modificação do método de ensino, sendo necessário o investimento em metodologias ativas e atrativas, como jogos eletrônicos, para garantir que a aprendizagem ocorra de forma satisfatória. Portanto, este relato objetiva descrever a experiência da elaboração de um jogo didático por estudantes de medicina para seus pares. Relato de experiência: A partir da proposta de um trabalho acadêmico do curso de medicina, houve a criação do jogo intitulado “Pâncrea Bit”, do tipo role playing game (RPG) storyteller, no qual houve a integração de conteúdos do curso médico (diabetes tipo 3C e pancreatite crônica) e a divisão de funções entre os 13 integrantes do grupo. Ademais, foi produzido um material didático com os assuntos abordados do jogo e animações em imagens complementares. Discussão: Apesar de não haver comprovação científica da eficácia do método ativo, através de jogos, em relação ao método tradicional, quando se trata de formar melhores profissionais, sabe-se que essa forma de ensino aumenta a satisfação do educando. Isso foi demonstrado com a participação maciça de outros estudantes na condução e resolução dos quizzes do “Pâncrea Bit”. Conclusão: A gamificação despertou interesse, motivação e introdução do aluno como protagonista, além de contribuir para a memória de longo prazo, mostrando-se um método válido e aplicável para a solidificação do conhecimento em diversos estágios de aprendizagem

Mucopolysaccharidosis I, II, and VI: Brief review and guidelines for treatment

Mucopolysaccharidoses (MPS) are rare genetic diseases caused by the deficiency of one of the lysosomal enzymes involved in the glycosaminoglycan (GAG) breakdown pathway. This metabolic block leads to the accumulation of GAG in various organs and tissues of the affected patients, resulting in a multisystemic clinical picture, sometimes including cognitive impairment. Until the beginning of the XXI century, treatment was mainly supportive. Bone marrow transplantation improved the natural course of the disease in some types of MPS, but the morbidity and mortality restricted its use to selected cases. The identification of the genes involved, the new molecular biology tools and the availability of animal models made it possible to develop specific enzyme replacement therapies (ERT) for these diseases. At present, a great number of Brazilian medical centers from all regions of the country have experience with ERT for MPS I, II, and VI, acquired not only through patient treatment but also in clinical trials. Taking the three types of MPS together, over 200 patients have been treated with ERT in our country. This document summarizes the experience of the professionals involved, along with the data available in the international literature, bringing together and harmonizing the information available on the management of these severe and progressive diseases, thus disclosing new prospects for Brazilian patients affected by these conditions