What determines mortality in malignant pheochromocytoma? : report of a case with eighteen-year survival and review of the literature

Pheochromocytoma (PCC) is a tumor derived from adrenomedullary chromaffin cells. Prognosis of malignant PCC is generally poor due to local recurrence or metastasis. We aim to report a case of malignant PCC with 18-year survival and discuss which factors may be related to mortality and long-term survival in malignant pheochromocytoma. The patient, a 45-year-old man, reported sustained arterial hypertension with paroxysmal episodes of tachycardia, associated with head and neck burning sensation, and hand and foot tremors. Diagnosis of PCC was established biochemically and a tumor with infiltration of renal parenchyma was resected. No genetic mutation or copy number variations were identified in SDHB, SDHD, SDHC, MAX and VHL. Over 18 years, tumor progression was managed with 131I-MIBG (iodine-metaiodobenzylguanidine) and 177Lutetium-octreotate therapy. Currently, the patient is asymptomatic and presents sustained stable disease, despite the presence of lung, para-aortic lymph nodes and femoral metastases. Adequate response to treatment with control of tumor progression, absence of significant cardiovascular events and other neoplasms, and lack of mutations in the main predisposing genes reported so far may be factors possibly associated with the prolonged survival in this case. Early diagnosis and life-long follow-up in patients with malignant pheochromocytoma are known to be crucial in improving survival

Educação permanente como ferramenta para alcançar indicadores do Previne Brasil em equipes de saúde da família no município mineiro de Barão de Cocais

Previne Brasil is a new funding model for Basic Primary Health Care. In a work meeting with a Family Health Team – ESF in Barão de Cocais, MG; carried out in October 2021, it was identified that the professionals had difficulties in using the e-SUS, which led to translated into unfavorable results in the evaluation of health indicators. So a Permanent Education Program was created to provide improvement on Previne Brasil indicators by training the professionals on using e-SUS tools. With the aim of training ESF professionals in the use of e-SUS tools to achieve the Previne Brasil indicators, a Permanent Education program was created. The permanent education activity was guided by the conceptions of active methodologies using problematization as an instrument. It took place Developed between October and December 2021, and the object of the action was health professionals from the Basic Health Care the ESF. After carrying out the activity and implementing the contents, it was identified that the goal was achieved reached in 57.14% of the evaluated indicators. The indicators those that were not reached in the first quarter four months of the year have shown an increase and a tendency to progress for the rest of the year, according to data contained in Table 1. The experience was passed on extended to other teams of the city, which provided better results. the rest of the professionals in the municipality, allowing better results to be achieved.O Previne Brasil se mostra como novo modelo de financiamento de custeio da Atenção Primária à Saúde. Em reunião com uma Equipe de Saúde da Família (ESF) em Barão de Cocais, MG; realizada em outubro de 2021, identificou-se que os profissionais tinham dificuldades no uso do e-SUS, o que se traduzia em resultados desfavoráveis na avaliação dos indicadores de saúde. Com o objetivo de capacitar os profissionais das ESF no uso das ferramentas do e-SUS para alcançar os indicadores de Previne Brasil, surgiu um programa de Educação Permanente. A atividade de educação permanente foi orientada pelas concepções de metodologias ativas, utilizando-se como instrumento a problematização. Desenvolvida entre outubro e dezembro de 2021 teve como objeto da ação os profissionais da saúde das ESF. Após a realização da atividade e implementação dos conteúdos foi identificado identificamos que a meta foi alcançada em 57,14% dos indicadores avaliados, os que ainda não foram alcançados no primeiro quadrimestre do ano mostraram aumento e tendência a progressão para o resto do ano, conforme dados contidos no quadro 1. A experiência foi ampliada para o resto dos profissionais do município permitindo alcançar melhores resultados

Glaucoma e envelhecimento: dificuldades terapêuticas vivenciadas por idosos

Introduction: Glaucoma is a public health problem among chronic-degenerative visual diseases due to its high incidence and for causing disability. Thus, the Glaucoma Patient Assistance Program was created to improve follow-up and avoid bleak prognoses. Objectives: to analyze the difficulties of the elderly in the use of eye drops for the treatment of glaucoma.Methods: an exploratory research was carried out where the population was composed of elderly patients with glaucoma treated at the Integrated Unit of Ipiranga linked to Basic Care in District III of João Pessoa-PB, a questionnaire was the instrument for data collection for the 61 participants. Results: it was found that 38 (62.3%) %) of the participants , 53 (87%) received 1-2 minimum wages, and 23 (37.7%) studied only until primary school. As for administration, 37 (60.7%) had no problems remembering if they had already used the eye drops, 39 (63.9%) had no difficulty using it, and 34 (55.7%) were unable to follow its use in the basic assistance. Conclusion: respondents have their obstacles to medication adherence regardless of the disease, the lack of follow-up in basic care only adds another one, so that’s why educating them would enable lower dropout rates and better prognoses.Introdução: dentre as doenças crônico-degenerativas visuais, o glaucoma constitui um problema de saúde pública por sua alta incidência e incapacidade. Assim, o Programa de Assistência ao Portador de Glaucoma foi criado para melhorar o acompanhamento e evitar prognósticos sombrios. Objetivos: objetivo é analisar as dificuldades dos idosos no uso do colírio para tratamento do glaucoma. Método: pesquisa exploratória em população composta por pacientes de terceira idade com glaucoma, atendidos na Unidade Integrada do Ipiranga vinculada à Atenção Primária do Distrito III (João Pessoa-PB). O tamanho da amostra foi de 61 participantes, um questionário foi o instrumento para a coleta de dados. Resultados: na caracterização da amostra 38 (62,3%) eram do sexo feminino, 53 (87%) recebem de 1 a 2 salários mínimos e 23 (37,7%) estudaram só até o primário. Quanto à administração, 37(60,7%) não têm problemas para lembrar se já usaram o colírio, 39 (63,9%) não sentem dificuldade ao usá-lo e 34 (55,7%) não conseguem acompanhar seu uso na assistência básica. Discussão: A maioria revelou-se feminina, de baixa renda e desacompanhada da assistência básica neste quesito. Uma parcela significativa também se mostrou de baixa escolaridade. Contudo, apesar das limitações, a predominância revelou cumprir a terapêutica. Conclusão: Após aplicação do questionário foram detectados empecilhos próprios à adesão medicamentosa nos idosos. A falta de acompanhamento na atenção básica só acrescenta mais um desafio, por isso a educação do público possibilitaria menores taxas de abandono e melhores prognósticos

What determines mortality in malignant pheochromocytoma? – Report of a case with eighteen-year survival and review of the literature

SUMMARY Pheochromocytoma (PCC) is a tumor derived from adrenomedullary chromaffin cells. Prognosis of malignant PCC is generally poor due to local recurrence or metastasis. We aim to report a case of malignant PCC with 18-year survival and discuss which factors may be related to mortality and long-term survival in malignant pheochromocytoma. The patient, a 45-year-old man, reported sustained arterial hypertension with paroxysmal episodes of tachycardia, associated with head and neck burning sensation, and hand and foot tremors. Diagnosis of PCC was established biochemically and a tumor with infiltration of renal parenchyma was resected. No genetic mutation or copy number variations were identified in SDHB, SDHD, SDHC, MAX and VHL. Over 18 years, tumor progression was managed with 131I-MIBG (iodine-metaiodobenzylguanidine) and 177Lutetium-octreotate therapy. Currently, the patient is asymptomatic and presents sustained stable disease, despite the presence of lung, para-aortic lymph nodes and femoral metastases. Adequate response to treatment with control of tumor progression, absence of significant cardiovascular events and other neoplasms, and lack of mutations in the main predisposing genes reported so far may be factors possibly associated with the prolonged survival in this case. Early diagnosis and life-long follow-up in patients with malignant pheochromocytoma are known to be crucial in improving survival

Professores e Alunos: o engendramento da violência da escola

The school violence engendering is partially analyzed, considering the violence production in the school environment. This is a bibliographic research with quantitative and qualitative approach. Sources: 77 theses and 15 dissertations carried out in Brazil (2007 to 2012). Data collection and organization: Content Analysis. Main reference: Bernard Charlot and Pierre Bourdieu. Results: the sources showed that Brazilian teachers participate effectively in the school violence engendering, contributing to violence production in the school environment. The students are the main victims. The teacher is less affected by physical and verbal violence. The symbolic power is the most perpetrated by the teacher against the student. The school also plays a major role in it.Analisa-se o engendramento de uma face da violência da escola, tendo em vista a produção da violência em espaço escolar. Pesquisa bibliográfica quanti-qualitativa. Fontes: 77 dissertações e 15 teses produzidas no Brasil (2007 a 2012). Coleta e organização dos dados: Análise de Conteúdo. Fundamentação base: Bernard Charlot e Pierre Bourdieu. Resultados: as fontes apontaram que professores brasileiros são protagonistas na constituição da violência da escola, contribuindo para a produção da violência em espaço escolar. Os alunos são as principais vítimas dessa violência. O professor sofre menos violência física e verbal do que o aluno. A violência simbólica é a mais usada pelo professor contra o aluno. A escola também usa desse expediente

A global metagenomic map of urban microbiomes and antimicrobial resistance

We present a global atlas of 4,728 metagenomic samples from mass-transit systems in 60 cities over 3 years, representing the first systematic, worldwide catalog of the urban microbial ecosystem. This atlas provides an annotated, geospatial profile of microbial strains, functional characteristics, antimicrobial resistance (AMR) markers, and genetic elements, including 10,928 viruses, 1,302 bacteria, 2 archaea, and 838,532 CRISPR arrays not found in reference databases. We identified 4,246 known species of urban microorganisms and a consistent set of 31 species found in 97% of samples that were distinct from human commensal organisms. Profiles of AMR genes varied widely in type and density across cities. Cities showed distinct microbial taxonomic signatures that were driven by climate and geographic differences. These results constitute a high-resolution global metagenomic atlas that enables discovery of organisms and genes, highlights potential public health and forensic applications, and provides a culture-independent view of AMR burden in cities.Funding: the Tri-I Program in Computational Biology and Medicine (CBM) funded by NIH grant 1T32GM083937; GitHub; Philip Blood and the Extreme Science and Engineering Discovery Environment (XSEDE), supported by NSF grant number ACI-1548562 and NSF award number ACI-1445606; NASA (NNX14AH50G, NNX17AB26G), the NIH (R01AI151059, R25EB020393, R21AI129851, R35GM138152, U01DA053941); STARR Foundation (I13- 0052); LLS (MCL7001-18, LLS 9238-16, LLS-MCL7001-18); the NSF (1840275); the Bill and Melinda Gates Foundation (OPP1151054); the Alfred P. Sloan Foundation (G-2015-13964); Swiss National Science Foundation grant number 407540_167331; NIH award number UL1TR000457; the US Department of Energy Joint Genome Institute under contract number DE-AC02-05CH11231; the National Energy Research Scientific Computing Center, supported by the Office of Science of the US Department of Energy; Stockholm Health Authority grant SLL 20160933; the Institut Pasteur Korea; an NRF Korea grant (NRF-2014K1A4A7A01074645, 2017M3A9G6068246); the CONICYT Fondecyt Iniciación grants 11140666 and 11160905; Keio University Funds for Individual Research; funds from the Yamagata prefectural government and the city of Tsuruoka; JSPS KAKENHI grant number 20K10436; the bilateral AT-UA collaboration fund (WTZ:UA 02/2019; Ministry of Education and Science of Ukraine, UA:M/84-2019, M/126-2020); Kyiv Academic Univeristy; Ministry of Education and Science of Ukraine project numbers 0118U100290 and 0120U101734; Centro de Excelencia Severo Ochoa 2013–2017; the CERCA Programme / Generalitat de Catalunya; the CRG-Novartis-Africa mobility program 2016; research funds from National Cheng Kung University and the Ministry of Science and Technology; Taiwan (MOST grant number 106-2321-B-006-016); we thank all the volunteers who made sampling NYC possible, Minciencias (project no. 639677758300), CNPq (EDN - 309973/2015-5), the Open Research Fund of Key Laboratory of Advanced Theory and Application in Statistics and Data Science – MOE, ECNU, the Research Grants Council of Hong Kong through project 11215017, National Key RD Project of China (2018YFE0201603), and Shanghai Municipal Science and Technology Major Project (2017SHZDZX01) (L.S.