A dissecação enquanto estratégia de metodologia ativa nos cursos da saúde: Relato de experiências / Dissection as an active methodology strategy in health courses: Report of experiences

Este trabalho objetiva relatar a experiência de dissecação, como metodologia ativa para aprendizado de Anatomia, realizada por estudantes integrantes de um projeto de extensão da Universidade Federal da Paraíba (UFPB), descrevendo suas vantagens e importância na consolidação dos conhecimentos de discentes dos cursos da área de saúde. A técnica foi realizada nos laboratórios de Anatomia do Departamento de Morfologia da UFPB, sendo utilizados cadáveres humanos e instrumental de dissecação. Foram confeccionadas peças de tórax, dorso, abdome, membros superior e inferior. Os extensionistas conseguiram produzir material de qualidade e consolidaram a aprendizagem em Anatomia. Vale ressaltar a importância da dissecação como estratégia de ensino nas Ciências Morfológicas, e no desenvolvimento de habilidades e competências necessárias ao profissional de saúde; bem como as limitações para que este método seja aplicado de modo rotineiro aos cursos de graduação em saúde

Consequências clínicas e metabólicas da insegurança alimentar familiar em pessoas vivendo com HIV/AIDS: um estudo coorte

Food insecurity (FI) reaches 22.6% of the Brazilian population, but its prevalence and consequence in people living with HIV/Aids (PLWHA) are little known in Brazil. The consequences were studied in PLWHA, considering its effect on clinical morbidity associated with HIV/Aids, on the metabolic changes of HIV Lipodistrophic Syndrome, cardiovascular risk (CVR) and adherence to treatment. A cohort of 400 PLWHA accompanied on a reference service in the State of Paraíba, between March 2015 to May 2016, which were classified in two groups for exposure to FI, obtained by Brazilian Range of food insecurity and accompanied by a year to evaluate the outcomes. Described if the frequencies of socio-demographic variables, clinical, laboratory and the CVR; through its association with FI, using the Chi square and Mann-Whitney tests. Instrument devised to assess adherence to antiretroviral therapy (ART). Using Kaplan-Meier estimators and Nelson-Aalen to estimate survival. The Logrank test compared the curves for variable, and we used Cox regression model to estimate the risk associated with each outcome. Devised decision tree model to identify individuals with viral load (VL) detectable. The sample was characterized by most male (61.5%), race/color brown (54.8%), mean and median age of 44 years, 57.1% education; incomplete elementary school, 48.5% were retired, 32.8% with per capita incomes between 1/3 to 1/2 minimum wage in force. The average time to diagnosis was 7.8 years and use of HAART was 6.9 years. The prevalence of was 70.7% 399 of PLWHA, being higher in households with children under 18 years old, and FI afflicted 19.5 percent of these people. Moderate or severe FI (MFI/SFI) was associated with female sex, race/color; white, low education, low income per capita, being unemployed, not being adherent to HAART and have undetectable VL. There was no difference between the groups for levels of hemoglobin, hematocrit, serum proteins, glucose, lipid profile and body mass index. Individuals in MFI/SFI were more smokers, sedentary and with higher levels of ultra sensitive protein C. The CVR was classified as high 7.9, 40.7% of PLWHA and when used, respectively, the Framingham risk score and the Overall risk score, and not related to MFI/SFI. The Accession score 42 presented 63% of accuracy to detect the PLWHA with undetectable VL and 58.5 percent ranked as adherents. Poor adherence to HAART increased by 1.6 times the risk for care in the hospital, at 1.7 times the risk to introduce infectious diseases associated with HIV/Aids and immunodeficiencies in 1.9 times the risk to submit to undetectable VL after 12 months. The MFI/SFI was associated with worse survival to seek care at the hospital, introduce infectious diseases associated with HIV/Aids immunodeficiency and have CD4 count less than 350 cells/mm3, during the following 12 months. Individuals adhering to treatment in food safety or FI take had better survival for present undetectable VL. Being in MFI/SFI increased by 1.7 times the risk to seek care at the hospital, 1.9 times the risk for infectious disease associated with HIV/Aids immunodeficiency and 1.7 times the risk for HIV/Aids related diseases not associated with immunodeficiency, during the following 12 months. At the end of this period the VL was undetectable in 76.7 percent of 322 individuals, each with their own new tests. The evaluation of VL, CD4 cell count and treatment adherence was able to predict correctly 80.0% of PLWHA regarding detectable after 12 months VL from rules obtained by the decision tree model. The FI is a stressor that worsens the clinical evolution of PLWHA in the following 12 months, such as vulnerability to be better investigated and valued for the effective control of the Aids epidemic.A insegurança alimentar (IA) atinge 22,6% da população brasileira, porém sua prevalência e consequência em pessoas vivendo com HIV/Aids (PVHA) são pouco conhecidas no Brasil. Estudaram-se as consequências da IA em PVHA, considerando seu efeito sobre a morbidade clínica associada ao HIV/Aids, sobre alterações metabólicas da Síndrome Lipodistrófica do HIV, o risco cardiovascular (RCV) e a adesão ao tratamento. Realizou-se uma coorte de 400 PVHA acompanhadas em serviço de referência no Estado da Paraíba, entre março de 2015 a maio de 2016, que foram classificadas em dois grupos quanto à exposição à IA, obtida pela Escala Brasileira de Insegurança Alimentar e acompanhadas por um ano para avaliação dos desfechos. Descreveram-se as frequências das variáveis sociodemográficas, clínicas, laboratoriais e o RCV; com sua associação com IA, utilizando os testes quiquadrado e Mann-Whitney. Elaborou-se instrumento para avaliar a adesão à terapia antirretroviral (TARV). Utilizaram-se os estimadores de Kaplan-Meier e Nelson-Aalen para estimar a sobrevivência. O teste Logrank comparou as curvas por variável, e utilizou-se modelo de regressão de Cox para estimar o risco associado a cada desfecho. Elaborou-se modelo de árvore de decisão para identificar os indivíduos com carga viral (CV) detectável. A amostra caracterizou-se por maioria do sexo masculino (61,5%), raça/cor parda (54,8%), média e mediana da idade de 44 anos, 57,1% com escolaridade até ensino fundamental incompleto, 48,5% eram aposentados, 32,8% com renda per capita entre 1/3 a 1/2 salário mínimo vigente. O tempo médio de diagnóstico foi de 7,8 anos e de uso de TARV foi de 6,9 anos. A prevalência de IA foi de 70,7% em 399 PVHA, sendo maior nos domicílios com menores de 18 anos, e a IA grave acometeu 19,5% dessas pessoas. A IA moderada ou grave (IAMo/IAG) esteve associada ao sexo feminino, à raça/cor não branca, à baixa escolaridade, baixa renda per capita, estar desempregado, não ser aderente à TARV e ter CV detectável. Não houve diferença entre os grupos para níveis de hemoglobina, hematócrito, proteínas séricas, glicemia, perfil lipídico e índice de massa corporal. Indivíduos em IAMo/IAG eram mais tabagistas, sedentários e com maiores níveis de Proteína C ultrassensível. O RCV foi classificado como alto em 7,9 e 40,7% das PVHA quando se utilizaram, respectivamente, o Escore de Risco de Framingham e o Escore de Risco Global, e não se relacionou com IAMo/IAG. O Escore de Adesão 42 apresentou acurácia de 63% para detectar as PVHA com CV detectável e classificou 58,5% como aderentes. A má adesão à TARV aumentou em 1,6 vezes o risco para atendimento no hospital dia, em 1,7 vezes o risco para apresentar doença infecciosa associada à imunodeficiência do HIV/Aids e em 1,9 vezes o risco para apresentar CV detectável no seguimento de 12 meses. A IAMo/IAG esteve associada com pior sobrevida para procurar atendimento no hospital dia, apresentar doença infecciosa associada à imunodeficiência do HIV/Aids e ter contagem de CD4 menor que 350 células/mm3, durante o seguimento de 12 meses. Indivíduos aderentes ao tratamento em segurança alimentar ou IA leve tiveram melhor sobrevida para apresentar CV detectável. Estar em IAMo/IAG aumentou em 1,7 vezes o risco para procurar atendimento no hospital dia, em 1,9 vezes o risco para doença infecciosa associada à imunodeficiência do HIV/Aids e em 1,7 vezes o risco para doença relacionada ao HIV/Aids não associada à imunodeficiência, durante o seguimento de 12 meses. Ao final deste período a CV estava indetectável em 76,7% dos 322 indivíduos, que dispunham de novos exames. A avaliação da CV, contagem de células CD4 e adesão ao tratamento foi capaz de predizer corretamente 80,0% das PVHA quanto à CV detectável após 12 meses a partir de regras obtidas pelo modelo de árvore de decisão. A IA é um estressor que piora a evolução clínica de PVHA no seguimento de 12 meses, destacando-se como ponto de vulnerabilidade a ser melhor investigado e valorizado para o controle efetivo da epidemia de Aids

Aspergillus infection in the ascending aorta of a patient with aortic and mitral valve prostheses

We report the case of implantation of metallic mitral and aortic valve prostheses 6 months earlier, with subsequent multiple embolic episodes. The anatomicopathological examination of the thrombus of the third embolic episode was compatible with Aspergillus sp, which was treated with amphotericin B, followed by oral itraconazole. On the fourth embolism, vegetations were visualized in the ascending aorta on echocardiography and resonance imaging, and the patient underwent replacement of the aortic segment by a Haemashield tube and exploration of the aortic prosthesis, which was preserved, because no signs of endocarditis were found. Four months later, the patient died due to cardiogenic shock secondary to acute myocardial infarction caused by probable coronary embolism and partial dysfunction of the aortic prosthesis

Modelo de suporte à decisão aplicado à identificação de indivíduos não aderentes ao tratamento anti-hipertensivo

Objetivou-se desenvolver um modelo de apoio à tomada de decisão para identificar indivíduos não aderentes ao tratamento anti-hipertensivo. Propõe-se a utilização de árvore de decisão sobre um banco de dados de adesão ao tratamento envolvendo 118 usuários hipertensos de uma Unidade Básica. A variável de decisão foi a adesão ao tratamento. Incluíram-se 15 atributos preditores, selecionados entre variáveis relacionadas à adesão. Obteve-se como resultado uma árvore capaz de classificar corretamente 87,28% dos indivíduos. O modelo de árvore de decisão proposto auxilia na identificação de usuários não aderentes, de modo a contribuir com as equipes de saúde na abordagem a esses indivíduos

Nutritional risk, food insecurity and quality of life in people living with HIV/AIDS in Paraiba, Brazil

Nutritional risk and food insecurity are related to insufficient or inadequate access to food. These conditions can be worse for people living with HIV/AIDS. Loss of appetite is one characteristic of increased nutritional risk. It is not known if food security itself has an impact on nutritional risk beyond the lack of access to food. The objective of this study was to evaluate nutritional risk and its association with food insecurity and quality of life in people living with HIV/AIDS and undergoing antiretroviral therapy in Brazil. A cross-sectional study was carried out in 2015 with 479 people living with HIV/AIDS in Paraiba state. Questions involving nutritional risk, food insecurity, quality of life, nutritional status and socio demographics were asked. Nutritional risk was the dependent variable and the chi-square test was used to test its association with the other study variables. The associated variables were included in the Poisson multiple regression model with a robust variance. 75.6% of the study sample were considered to be at nutritional risk. The adjusted model showed food insecurity (assessed as severe, moderate or mild using the Brazilian Food Insecurity Scale) and quality of life to have independent effects. The prevalence ratio (PR) of nutritional risk was 1.13 and 1.09 for severe food insecurity and moderate food insecurity respectively and no effect was observed for mild food security. Nutritional risk was less frequent in individuals with a higher score for quality of life (PR = 0.92). We conclude that people living with HIV/AIDS in Paraiba Brazil have a high prevalence of nutritional risk, seriously affecting their biological vulnerability. The prevalence of nutritional risk was higher among people with moderate or severe food insecurity, independent of socio-economic or occupational status. Policies are needed to strengthen social support to reduce the lack of food access for this population group, as are programs to promote food security and well-being. These could reduce nutritional risk and contribute to reducing morbidity and mortality for those with HIV/AIDS

Self-reported and measured weight, height and body mass index for the diagnosis of the nutritional status in people living with HIV/AIDS

<div><p>ABSTRACT Objective To validate self-reported weight and height data for people living with HIV/AIDS. Methods This cross-sectional study involved 481 people living with HIV/AIDS seen at a reference unit in João Pessoa, state of Paraíba, Brazil, between September and December 2015, 99 (20.5%) of whom had their weight and height measured. The intraclass correlation coefficient was calculated to determine the relationship between the self-reported and measured weight, height and body mass index values, and linear regression analysis was used to generate equations to predict weight and height. It were significant p-value under 5% for statistic tests applied. Results In the sample with measured values, 57.6% of men, with a mean age of 44 years old and a mean income per capita equivalent to US$145.50, high correlations (r>0.90) between the self-reported and measured values for weight, height and body mass index were observed. The accuracy was 92.6%, and the Kappa coefficient was greater than 0.85. Women tended to underestimate weight and overestimate height. The men overestimated weight and underestimated height. The intraclass correlation coefficients were greater than 0.95. Conclusion The use of self-reported measures of weight, height and body mass index for nutritional assessment of people living with HIV/AIDS is valid and must be considered for similar populations when time and resources are limiting factors.</p></div