Podcast “A Ideia Inspirada”: potencialidades de ferramenta digital de áudio como extensão universitária no contexto da Covid-19

No atual contexto de pandemia, atividades presenciais foram suspensas, com o intuito de mitigar a disseminação do vírus Sars-CoV-2. Para a extensão universitária ficar em consonância com as realidades globais, sobreveio a necessidade de inovar e criar atividades utilizando novas tecnologias. Em meio a esse novo desafio, a Liga do Pulmão e Medicina Intensiva da Faculdade de Medicina da Universidade Federal do Ceará (UFC) concebeu o podcast “A Ideia Inspirada” como ferramenta de comunicação, visando contribuir, mesmo que de forma remota, na disseminação de conhecimento médico de maneira compreensível e democrática para a população

The evolution of medical education and what scares us about it

In the early Middle Ages, future doctors were not students; they were apprentices. Teaching consisted of knowledge about herbs and surgical skills, “taught” by older, experienced peers. In monasteries, monks occupied themselves copying classic texts in the scriptorium. These sources, however, were not consulted by apprentices at the time. In convents and nurseries, manuals of medical botany, especially the ones about herbs of their local orchards, were preferable reading. The first record on medical training in literature is attributed to Charaka, a Hindu physician who in 500 BC referred to the distinctive idea of a “master” from whom one could learn the art and medical practice. In the tenth century, in a somewhat pre-academic teaching style developed in Salerno and later in the Alexandrian model, Mentors were respected celebrities, authorized and of great powers. Shortly afterwards, Constantin came to Monte Cassino to translate Arabic medical writings into Greek (internationalizing medicine) and the University of Bologna was founded on September 18, 1088, by and for students

Podcast “A Ideia Inspirada”: potencialidades de ferramenta digital de áudio como extensão universitária no contexto da Covid-19

No atual contexto de pandemia, atividades presenciais foram suspensas, com o intuito de mitigar a disseminação do vírus Sars-CoV-2. Para a extensão universitária ficar em consonância com as realidades globais, sobreveio a necessidade de inovar e criar atividades utilizando novas tecnologias. Em meio a esse novo desafio, a Liga do Pulmão e Medicina Intensiva da Faculdade de Medicina da Universidade Federal do Ceará (UFC) concebeu o podcast “A Ideia Inspirada” como ferramenta de comunicação, visando contribuir, mesmo que de forma remota, na disseminação de conhecimento médico de maneira compreensível e democrática para a população

Diagnóstico e tratamento da tuberculose latente em pacientes com doenças inflamatórias crônicas e uso de imunobiológicos inibidores do TNF-α Diagnosis and treatment of latent tuberculosis in patients with chronic inflammatory diseases: use of TNF-alpha-targeting biological products

OBJETIVO: Traçar o perfil clínico-epidemiológico de pacientes candidatos ao uso de fármacos anti-TNF-α diagnosticados como portadores de tuberculose latente (TBL) e avaliar os desfechos do tratamento profilático com isoniazida. MÉTODOS: Análise descritiva prospectiva seguida de um estudo analítico observacional transversal dos desfechos do tratamento profilático em um grupo de 45 candidatos ao uso de fármacos anti-TNF-α. A avaliação dos pacientes constou de anamnese, exame clínico, radiografia de tórax e teste tuberculínico (TT) por Mantoux. RESULTADOS: A idade média dos pacientes foi 45 anos, e 56,0% dos pacientes eram mulheres. Doenças reumatológicas crônicas, doenças dermatológicas crônicas e doença de Crohn estavam presentes em 46,7%, 40,0% e 13,3% dos pacientes, respectivamente. A média de enduração do TT foi 14,6 mm (variação: 5-30 mm). A maioria dos pacientes (n = 30; 66,7%) apresentou enduração > 10 mm. Dos 16 pacientes com cicatriz vacinal BCG, a média de enduração foi de 15,7 mm, sendo que 14 tiveram enduração > 10 mm. Os resultados de radiografia de tórax foram considerados normais e com alterações mínimas em 64,4% e em 35,6%, respectivamente. Apenas 1 paciente (2,2%) abandonou o tratamento com isoniazida, 41 (91,2%) completaram o tratamento, 2 (4,4%) tiveram de interromper o tratamento por hepatite medicamentosa, e 1 (2,2%) foi transferido para outro hospital. Dos que completaram o tratamento, 5 apresentaram efeitos colaterais leves. CONCLUSÕES: A determinação do perfil dos candidatos ao uso de inibidores do TNF-α é importante para o manejo do tratamento da TBL, bem como para estabelecer protocolos clínicos de uso e acompanhamento do uso desses fármacosOBJECTIVE: To determine the clinical and epidemiological profile of patients who are candidates for TNF-α inhibitor use and are classified as having latent tuberculosis (LTB), as well as to evaluate the outcomes of prophylactic treatment with isoniazid. METHODS: A prospective descriptive analysis followed by an analytical, observational, cross-sectional study of the outcomes of prophylactic treatment in a group of 45 candidates for TNF-α inhibitor use. We evaluated the patients through anamnesis, clinical examination, chest X-ray, and tuberculin skin test (TST) using the Mantoux method. RESULTS: The mean age was 45 years, and 56.0% of the patients were female. Chronic rheumatic diseases, chronic dermatological diseases, and Crohn's disease were present in 46.7%, 40.0%, and 13.3% of the patients, respectively. The mean TST induration was 14.6 mm (range: 5-30 mm). The majority (n = 30) of the 45 patients (66.7%) had an induration > 10 mm. In the 16 patients with BCG vaccination scars, the mean induration was 15.7 mm, and 14 of those patients had an induration > 10 mm. Chest X-ray results were considered normal, with minimal alterations, in 64.4% and 35.6% of the patients, respectively. The treatment with isoniazid was abandoned by 1 patient (2.2%) and completed by 41 (91.2%), whereas it was interrupted because of drug-induced hepatitis in 2 (4.4%), and 1 patient (2.2%) was transferred to another hospital. Of those who completed the treatment, 5 experienced mild side effects. CONCLUSIONS: Determining the profile of candidates for TNF-α inhibitor use is important for the management of LTB treatment and for the establishment of clinical protocols for the use and monitoring of the use of these medication

Gravidez em paciente com microlitíase alveolar pulmonar grave

A microlitíase alveolar pulmonar (MAP) é uma doença rara que atinge ambos os pulmões, caracterizada pela presença de pequenos cálculos (fosfato de cálcio) nos espaços alveolares. Relatamos o caso de uma paciente do sexo feminino, de 26 anos, cujo diagnóstico foi confirmado com base nos achados marcantes na radiografia de tórax e tomografia computadorizada de alta resolução. A paciente, gestante de 28 semanas, retornou ao hospital 10 meses após o diagnóstico apresentando insuficiência respiratória hipoxêmica e com distúrbio ventilatório restritivo grave à espirometria. Após completadas 32 semanas e 4 dias de gestação, foi submetida aparto cesariano, com sucesso para mãe e filha. A MAP tem evolução clínica variável. Tem provável caráter autossômico recessivo e associação com história familiar positiva. A etiologia é incerta, e muitos autores especulam que haja um defeito enzimático local responsável pelo acúmulo intra-alveolar de cálcio. Relatos de pacientes com MAP que engravidaram são excepcionais, sendo o presente caso o primeiro descrito no Brasil. O curso dessa doença costuma ser lentamente progressivo, e os pacientes geralmente falecem devido à insuficiência cardiorrespiratória. O presente caso ilustra a necessidade de se oferecer aconselhamento genético e orientações sobre o risco de gravidez às pacientes, especialmente em casos de doença avançada. Atualmente, a única terapia efetiva é o transplante pulmonar

Tuberculose em ambiente hospitalar: perfil clínico em hospital terciário do ceará e grau de conhecimento dos profissionais de saúde acerca das medidas de controle -doi:10.5020/18061230.2010.p260

(TB) and to assess the knowledge of health personnel on fundamental concepts about TB and control measures for pulmonary tuberculosis in a hospital environment. Methods: The study was conducted in a tertiary hospital in Fortaleza-CE and involved patients admitted with TB and health professionals responsible for assistance. A first phase was characterized by a retrospective study of medical records of patients admitted with suspected TB. In a second stage, a cross-sectional study with application of a structured questionnaire assessed the knowledge of health personnel on TB control measures in a hospital environment. Results: Sixty-seven patients admitted with suspected TB had their medical records assessed. Among the confirmed cases, the most frequent clinical form was pulmonary (81.3%). Out of 55 patients admitted with suspected pulmonary tuberculosis, only 29 (52.7%) were admitted in a respiratory isolation bed. Twenty-six patients with suspected pulmonary tuberculosis on admission stayed a total of 148 days out of a respiratory isolation bed (average 4.1 days / patient). The knowledge of 159 health professionals about TB was assessed. Regarding the transmission of TB, 107 (67.2%) were unaware of airborne transmission and 109 (68.5%) ignored the clinical forms that require respiratory isolation. Conclusions: Pulmonary tuberculosis is the most frequent clinical form among inpatients in a tertiary hospital in Fortaleza- CE. Considerable fraction of health personnel doesn’t know key concepts related to tuberculosis and essential for the proper and safe care.Objetivos: Descrever características epidemiológicas e clínicas de pacientes internados com tuberculose (TB), além de avaliar o grau de conhecimento de profissionais de saúde acerca de conceitos fundamentais sobre TB e medidas de controle parapacientes com tuberculose pulmonar em ambiente hospitalar. Métodos: Estudo realizado em hospital terciário de Fortaleza-CE envolvendo pacientes internados com TB e profissionais de saúde responsáveis pela assistência. Uma primeira fase caracterizou-se por estudo retrospectivo com revisão de prontuários de pacientes admitidos com suspeita de TB. Em uma segunda etapa, estudo transversal com aplicação de questionário estruturado avaliou conhecimentos dos profissionais de saúde sobre o controle da TB em ambiente hospitalar. Resultados: Sessenta e sete pacientes admitidos com suspeita de TB tiveram seus prontuários avaliados. Entre os casos confirmados, a forma clínica mais frequente foi a pulmonar (81,3%). Dos 55 pacientes internados com suspeita de tuberculose pulmonar, apenas 29 (52,7%) foram admitidos em leito de isolamento respiratório. Vinte e seis pacientes com suspeita de tuberculose pulmonar à admissão totalizaram 148 dias internados fora de isolamento respiratório (média de 4,1 dias/paciente). Avaliou-se o conhecimento de 159 profissionais de saúde acerca de TB. Em relação à transmissão da TB, 107 (67,2%) desconheciam a transmissão por aerossóis e 109 (68,5%) desconheciam as formas clínicas que requerem isolamento respiratório. Conclusões: Tuberculose pulmonar é a forma clínica mais frequente entre pacientes internados em hospital terciário de Fortaleza-CE. Parcela considerável de profissionais de saúde desconhece conceitos fundamentais relativos à tuberculose e essenciais para a assistência adequada e segura

Tuberculosis in hospital environment: clinical profile in a tertiary hospital from Ceará and level of knowledge of health personnel about control measures

Objectives: To describe clinical and epidemiological characteristics of inpatients with tuberculosis (TB) and to assess the knowledge of health personnel on fundamental concepts about TB and control measures for pulmonary tuberculosis in a hospital environment. Methods: The study was conducted in a tertiary hospital in Fortaleza-CE and involved patients admitted with TB and health professionals responsible for assistance. A first phase was characterized by a retrospective study of medical records of patients admitted with suspected TB. In a second stage, a cross-sectional study with application of a structured questionnaire assessed the knowledge of health personnel on TB control measures in a hospital environment. Results: Sixty-seven patients admitted with suspected TB had their medical records assessed. Among the confirmed cases, the most frequent clinical form was pulmonary (81.3%). Out of 55 patients admitted with suspected pulmonary tuberculosis, only 29 (52.7%) were admitted in a respiratory isolation bed. Twenty-six patients with suspected pulmonary tuberculosis on admission stayed a total of 148 days out of a respiratory isolation bed (average 4.1 days / patient). The knowledge of 159 health professionals about TB was assessed. Regarding the transmission of TB, 107 (67.2%) were unaware of airborne transmission and 109 (68.5%) ignored the clinical forms that require respiratory isolation. Conclusions: Pulmonary tuberculosis is the most frequent clinical form among inpatients in a tertiary hospital in Fortaleza-CE. Considerable fraction of health personnel doesn’t know key concepts related to tuberculosis and essential for the proper and safe care. Descriptors: Tuberculosis; Infectious Disease Transmission; Exposure to Biological Agents; Health personnel

Synthesis and evaluation of novel hybrids β-carboline-4-thiazolidinones as potential antitumor and antiviral agents

A series of novel hybrids β-carboline-4-thiazolidinones were synthesized and evaluated for their in vitro antitumor activity against human cancer cell lines and for antiviral activity towards Herpes simplex virus type-1 (HSV-1). From the N′-(2-ylidene-4-thiazolidinone)-β-carboline-3-carbohydrazide series (9–11), compounds 9c and 11d were the most active, showing growth inhibition 50% (GI50) values less than 5 μM for all cell lines tested. Compound 9c, bearing the 4-dimethylaminophenyl group at C-1 of β-carboline was selected for further investigation concerning cell death and cell cycle profile, focusing on the human renal adenocarcinoma cell line 786-0. Treatments with 25 μM of compound 9c induced cell death after 15 h of treatment, characterized by phosphatidylserine exposure and loss of membrane integrity. Moreover, treatment with 12.5 μM promoted a sub-G1 arrest, which indicates cell death. Derivatives of the N-(2-substituted-aryl-4-thiazolidinone)-β-carboline-3-carboxamide series (18–23) showed a potent activity and high selectivity for glioma (U251) and ovarian (OVCAR-3) cancer cell lines. Also, some β-carboline-4-thiazolidinone hybrids showed potent antiviral activity against Herpes simplex virus type-1. The N-(2-substituted-aryl-4-thiazolidinone)-carboxamide moiety in 18, 19 and 22 confer a potent anti-HSV-1 activity for these derivatives, which presented EC50values of 0.80, 2.15 and 2.02 μM, respectively. The assay results showed that the nature of 4-thiazolidinone moiety and of the substituent attached at the 3- and 1- position of β-carboline nucleus influenced the antitumor and antiviral activities. © 2016 Elsevier Masson SASA series of novel hybrids β-carboline-4-thiazolidinones were synthesized and evaluated for their in vitro antitumor activity against human cancer cell lines and for antiviral activity towards Herpes simplex virus type-1 (HSV-1). From the N′-(2-ylidene-4-t12410931104FUNDAÇÃO ARAUCÁRIA DE APOIO AO DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO DO PARANÁ - FAFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESPCOORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPES23.444-FA2015/08338-6sem informaçãoThis work was supported by Fundação Araucária (Brazil, PR, Process number 23.444-FA) and Fundação de Amparo a Pesquisa de São Paulo (FAPESP, Process number 2015/08338-6). We thank CAPES for fellowships (Barbosa VA, Baréa P