Abstract Background The relationship between Multidrug Resistant-Gram Negative Bacteria (MDR-GNB) infection and colonization in critically ill COVID-19 patients has been observed, however, it is still poorly understood. This study evaluated the risk factors for acquiring MDR-GNB in patients with severe COVID-19 in Intensive Care Units (ICU). Methods This is a nested case-control study in a cohort of 400 adult patients (≥ 18 years old) with COVID-19, hospitalized in the ICU of 4 hospitals in the city of Curitiba, Brazil. Cases were critical COVID-19 patients with one or more MDR GNB from any surveillance and/or clinical cultures were taken during their ICU stay. Controls were patients from the same units with negative cultures for MDR-GNB. Bivariate and multivariate analyses were done. Results Sixty-seven cases and 143 controls were included. Independent risk factors for MDR bacteria were: male gender (OR = 2.6; 95% CI 1.28‒5.33; p = 0.008); the hospital of admission (OR = 3.24; 95% CI 1.39‒7.57; p = 0.006); mechanical ventilation (OR = 25.7; 95% CI 7.26‒91; p < 0.0001); and desaturation on admission (OR = 2.6; 95% CI 1.27‒5.74; p = 0.009). Conclusions Male gender, desaturation, mechanical ventilation, and the hospital of admission were the independent factors associated with MDR-GNB in patients in the ICU with COVID-19. The only modifiable factor was the hospital of admission, where a newly opened hospital posed a higher risk. Therefore, coordinated actions toward a better quality of care for critically ill COVID-19 patients are essential.

Abstract Aim: Baropodometry is used to map pressure areas and plantar pressure oscillation, however, children’s evaluation reliability is not established. To establish the intra-rater and inter-rater reliability of baropodometry for analysis of plantar support and postural control (stabilometry) of children. Materials and Methods: Reliability study. The sample consisted of 112 healthy children of both sexes; aged 4 to 12 years old. For the baropodometer analysis, children were positioned in orthostatic position, bipodal support, with parallel and bare feet during four rounds of 15-second evaluations, executed by two independent evaluators. In order to establish the reliability of the results at different age ranges, participants were divided into two groups: children ages 7 years and younger (n = 44) and children aged 8 to 12 years old (n = 68). The variables analyzed were pressure area and maximum plantar pressure, area, and amplitude of oscillation of the center of pressure. Results: Reliability was rated from good to excellent for the intra- and inter-evaluators (ICC 0.81-0.86 and ICC 0.87-0.95, respectively) on plantar pressure variables, and poor to moderate for the center of pressure oscillations (ICC 0.33-0.55; ICC 0.47-0.57, intra and inter-evaluators, respectively). Conclusion: Excellent baropodometry reliability was observed when analyzing children’s plantar pressure at different age groups, and a single evaluation established reliable results. However, the stabilometry analysis with a baropodometer has poor reliability, and therefore, it should not be used for children aged 4 to 12 for postural control.

Resumo O gene msp4 de A. marginale é unicodon, estável e pouco heterogêneo, sendo considerado como um marcador útil para caracterização filogeográfica desta bactéria. Este trabalho teve como objetivo analisar a filogeografia de A. marginale com base no gene msp4 em bovinos de corte do Pantanal Brasileiro, comparativamente a outra regiões do mundo. Alíquotas de sangue foram colhidas de 400 bovinos (200 vacas e 200 bezerros) em cinco propriedades de cria e recria extensiva. Como resultado, 56,75% (227/400) mostraram-se positivas para A. marginale pela qPCR para o gene msp1β e destas, 8,37% (19/227) amostras foram positivas na PCR convencional para o gene msp4. Na análise de distância Network, 14 sequências do Pantanal brasileiro foram agrupadas em um único grupo com as da Thailândia, Índia, Espanha, Colômbia, Paraná (Brasil), México, Portugal, Argentina, China, Venezuela, Austrália, Italia e Minas Gerais (Brasil). Dentre 68 sequências do Brasil e do mundo, constatou-se a presença de 15 genótipos, sendo o genótipo número um (#1) o mais distribuído. As sequências msp4 de A. marginale detectadas em bovinos de corte no Pantanal brasileiro apresentaram baixo polimorfismo com formação de dois genogrupos filogeneticamente relacionados àqueles encontrados em ruminantes de países das América do Sul e Central, Europa e Ásia.

Abstract The msp4 gene of A. marginale is unicodon, stable and mostly homogeneous, being considered as a useful marker for phylogeographic characterization of this bacterium. The objective of this work was to analyze the phylogeography of A. marginale based on the msp4 gene in beef cattle from the Brazilian Pantanal, compared to those found in other regions worldwide. The blood samples investigated were collected from 400 animals (200 cows and 200 calves) reared in five extensive breeding farms in this region. The results indicated that of the evaluated samples, 56.75% (227/400) were positive for A. marginale based on the msp1β gene by quantitatitve PCR (qPCR), while 8.37% (19/227) were positive for the msp4 gene in the conventional PCR. In the Network distance analysis, 14 sequences from the Brazilian Pantanal were grouped into a single group with those from Thailand, India, Spain, Colombia, Parana (Brazil), Mexico, Portugal, Argentina, China, Venezuela, Australia, Italy and Minas Gerais (Brazil). Among 68 sequences from Brazil and the world, 15 genotypes were present while genotype number one (#1) was the most distributed worldwide. Both Splitstree and network analyses showed that the A. marginale msp4 sequences detected in beef cattle from the Brazilian Pantanal showed low polymorphism, with the formation of one genogroup phylogenetically related to those found in ruminants from South and Central America, Europe, and Asia.

OBJECTIVE: To evaluate the effectiveness and safety of first-generation protease inhibitors for the treatment of genotype 1 hepatitis C virus-infected patients at Brazilian reference centers. METHODS: This multicenter cross-sectional study included hepatitis C virus genotype 1 monoinfected patients treated with Peg-interferon, ribavirin, and either boceprevir (n=158) or telaprevir (n=557) between July 2013 and April 2014 at 15 reference centers in Brazil. Demographic, clinical, virological, and adverse events data were collected during treatment and follow-up. RESULTS: Of the 715 patients, 59% had cirrhosis and 67.1% were treatment-experienced. Based on intention-to-treat analysis, the overall sustained viral response was 56.6%, with similar effectiveness in both groups (51.9% for boceprevir and 58% for telaprevir, p=0.190). Serious adverse events occurred in 44.2% of patients, and six deaths (0.8%) were recorded. Cirrhotic patients had lower sustained viral response rates than non-cirrhotic patients (46.9% vs. 70.6%, p<0.001) and a higher incidence of serious adverse events (50.7% vs. 34.8%, p<0.001). Multivariate analysis revealed that sustained viral response was associated with the absence of cirrhosis, viral recurrence after previous treatment, pretreatment platelet count greater than 100,000/mm3, and achievement of a rapid viral response. Female gender, age>65 years, diagnosis of cirrhosis, and abnormal hemoglobin levels/platelet counts prior to treatment were associated with serious adverse events. CONCLUSION: Although serious adverse events rates were higher in this infected population, sustained viral response rates were similar to those reported for other patient cohorts.

Resumo: Este estudo tem como objetivo compreender o significado de competência na percepção dos docentes dos módulos de Habilidades e Atitudes. Trata-se de uma pesquisa descritiva e exploratória. A escolha do referencial teórico e metodológico considerou a perspectiva hermenêutica. O estudo foi realizado em uma universidade pública com docentes do curso de Medicina, por meio de entrevista individual e não estruturada. Os dados foram submetidos à análise do discurso evidenciando as categorias empíricas: “Competência como eixo norteador e estruturante às necessidades educacionais”; “Docência na educação médica: a prática profissional possibilita habilidades” e “Estratégias para o desenvolvimento docente”. Considera-se que as mudanças requeridas no curso médico precisam encontrar apoio na gestão e na liderança dos professores, na implementação de um programa de desenvolvimento do corpo docente, que se tornará um valioso instrumento de reflexão para os educadores, a fim de melhorar o exercício da docência no curso médico.

Abstract: This study aims to understand the meaning of competence in the perception of the teachers in the modules of Skills and Attitudes. It's a descriptive and exploratory research. The choice of the theoretical and methodological framework considered the hermeneutic perspective. The study was conducted in a public university in the medical school, through individual and unstructured interview. The data were submitted to discourse analysis showing the empirical categories, "Competence as a guiding and structuring axis to educational needs"; "The teaching in medical education: professional practice and enabling skills" and "Strategies for teacher development". It is considered that the required changes in medical school need to find support in the management and leadership of teachers in the implementation of a faculty development program, which will become a valuable tool of reflection for educators in order to improve exercise of teaching in the medical school.

Trata-se de um estudo descritivo-exploratório, de abordagem qualitativa e com objetivo de identificar elementos que interferem no processo de enfrentamento da violência contra a mulher. Realizou-se entrevista com representantes de 15 serviços que integram a Rede de Atenção a Pessoas em Situação de Violência na cidade de Salvador, Bahia, Brasil. Os dados foram organizados com base na análise temática de Bardin. O estudo mostrou que a articulação intersetorial e a atenção disponibilizada pelos serviços são elementos que interferem no enfrentamento da violência contra a mulher. Ambos os elementos guardam relação com o fortalecimento da rede de atenção a mulheres vítimas de violência. O estudo sinaliza para a necessidade de se conhecer as atribuições de outras instituições e reafirma a importância da articulação entre elas. Oferece ainda elementos que orientam o desenvolvimento de políticas e ações articuladas no sentido de favorecer o processo de enfrentamento da violência contra as mulheres.

This is an exploratory descriptive study with qualitative approach in order to identify factors that interfere in the process of dealing with violence against women. We conducted interviews with representatives of 15 departments participating in the Network of Care for People Experiencing Violence in the city of Salvador, Bahia, Brazil. Data were organized on the basis of thematic analysis of Bardin. The study showed that intersectoral coordination and care services are provided by the factors that interfere in the fight against violence against women. Both elements are related to strengthening the network of care for women victims of violence. The study points out the need to know the powers of other institutions and reaffirms the importance of coordination between them. It also provides the elements that guide the development of coordinated policies and actions to facilitate the process of dealing with violence against women.

Trata-se de um estudo descritivo-exploratório, de abordagem qualitativa e com objetivo de identificar elementos que interferem no processo de enfrentamento da violência contra a mulher. Realizou-se entrevista com representantes de 15 serviços que integram a Rede de Atenção a Pessoas em Situação de Violência na cidade de Salvador, Bahia, Brasil. Os dados foram organizados com base na análise temática de Bardin. O estudo mostrou que a articulação intersetorial e a atenção disponibilizada pelos serviços são elementos que interferem no enfrentamento da violência contra a mulher. Ambos os elementos guardam relação com o fortalecimento da rede de atenção a mulheres vítimas de violência. O estudo sinaliza para a necessidade de se conhecer as atribuições de outras instituições e reafirma a importância da articulação entre elas. Oferece ainda elementos que orientam o desenvolvimento de políticas e ações articuladas no sentido de favorecer o processo de enfrentamento da violência contra as mulheres.

This is an exploratory descriptive study with qualitative approach in order to identify factors that interfere in the process of dealing with violence against women. We conducted interviews with representatives of 15 departments participating in the Network of Care for People Experiencing Violence in the city of Salvador, Bahia, Brazil. Data were organized on the basis of thematic analysis of Bardin. The study showed that intersectoral coordination and care services are provided by the factors that interfere in the fight against violence against women. Both elements are related to strengthening the network of care for women victims of violence. The study points out the need to know the powers of other institutions and reaffirms the importance of coordination between them. It also provides the elements that guide the development of coordinated policies and actions to facilitate the process of dealing with violence against women.

This paper describes the digestive system of Caiman crocodilus, Melanosuchus niger and Paleosuchus palpebrosus based on anatomical and topographical inferences. The study involves two digestive systems of C. crocodilus, one of M. niger and one of P. palpebrosus, already fixed in 10% formaldehyde, belonging to the collection of the Wild Animal Research Laboratory (LAPAS) of the Federal University of Uberlândia. The work begins with a description of the digestive system of the aforementioned crocodilians, followed by topographical associations, aided by photographs taken with a SONY® DSC-H20 camera, X-rays of the gastrointestinal tract and a photograph of the digestive system of C. crocodilus prior to formaldehyding, which also belong to the LAPAS collection. The results indicate that the digestive system of crocodilians consists of a wide mouth, short pharynx, long straight esophagus, dilated stomach in relation to the rest of the tract, pancreas lodged between the first two ventral duodenal loops, coiled small intestine, large intestine with diameter larger than the preceding segments, and cloaca as the terminal portion of the digestive, urinary and reproductive systems. The anatomical and topographical description of the digestive system of C. crocodilus (Linnaeus, 1758) (Crocodylia: Alligatoridae), M. niger (Spix, 1825) (Crocodylia: Alligatoridae) and P. palpebrosus (Cuvier, 1807) (Crocodylia: Alligatoridae) can be extended to the other crocodilians due to interspecies and intraspecific behavioral similarities.

Mediante comparaciones anatómicas y topográficas describimos el sistema digestivo de C. crocodillus, M. nigeri y P. palpebrosus. Se utilizaron dos sistemas digestivos de C. crocodillus, uno de M. nigeri y uno de P. palpebrosus, fijados en formalina al 10% y pertenecientes al laboratorio de enseñanza e investigación de fauna silvestre (LAPAS) de la Universidade Federal de Uberlândia. En primera instancia se realizó la descripción del sistema digestivo de las mencionadas especies, seguido de comparaciones topográficas. Luego, fueron tomados registros fotográficos con cámara DSC H20 SONY. Adicional a esto, nos apoyamos con radiografías del tracto gastrointestinal y fotografías del sistema digestivo de C. crocodillus antes de ser fijados en formalina. Los resultados demuestraron que el sistema digestivo de estas tres especies de caimanes está constituido por una boca grande, faringe corta, esófago alargado y rectilíneo, estómago dilatado con relación a las otras partes del tracto digestivo, páncreas alojado entre las dos primeras curvaturas duodenales ventrales, intestino delgado plegado, intestino grueso con un diámetro mayor en relación a los segmentos anteriores y una cloaca donde también terminan los sistemas urinarios y reproductor. La descripción anatómica y topográfica del sistema digestivo de C. crocodillus, M. niger y P. palpebrosus puede ser extrapolada para otros cocodrilos por la semejanza comportamental interespecies e intraespecíficas.

O Programa de Hepatopatias do Hospital da Fundação Santa Casa de Misericórdia do Pará surgiu pela necessidade de prestar assistência a hepatopatas na região amazônica priorizando assistência qualificada, identificação das etiologias, seguimento clínico, e tratamento direcionado. Este trabalho visa descrever dados relativos à epidemiologia clínica, fatores etiológicos e análise histopatológica. Dos 1469 pacientes avaliados, através de exames clínicos, laboratoriais, endoscópicos e de imagem e/ou histopatológico, foram considerados hepatopatas crônicos 935 (63,6%). Nesta casuística, a média de idade foi 50 anos, 666 (71,2%) do sexo masculino e maior procedência de Belém. Os agentes etiológicos mais prevalentes foram alcoolismo (53,7%) e hepatites virais (39,1%). Biópsia hepática realizada em 403/935 (43,1%), demonstrou hepatite crônica (34%) e cirrose (34%) na maioria das amostras. Conclui-se, portanto, que a doença hepática crônica na região é mais prevalente no sexo masculino, sendo o alcoolismo a principal etiologia e mais da metade dos casos se encontravam em fase avançada no momento do diagnóstico.

The Liver Diseases Program of the Hospital Santa Casa de Misericordia do Pará was create because of the need to attend patients with liver diseases of the Amazônia area, taking as priority to attend with quality, diagnosis of aetiologies, clinical following and specific treatment. This study aim to describe dates related to epidemiology, aetiologics agents and histopathologic analisys. One thousand sixthy nine patients were evaluated through medical, laboratory, endoscopic, ultrasound or computadorized tomography and histopathologic examination. Nine hundred thirty five (63,6%) patients within 1469 patients were diagnose as chronic liver disease. The average age was 50 year, 666 (71,2%) were male, and the most patients lived in Belem, state of Pará. The aetiologic agents most prevail were alcoholism (53,7%) and viral hepatitis (39,1%). Hepatic biopsy were done in 403 (43,1%) within the 935 patients and the results showed chronic hepatitis (34%) and chirrosis (34%). In sumary the chronic liver disease in the amazon region is more prevail in male than female, the alcoholism is the principal aetiologie, and the most of these cases were diagnose in the severe phase.