SUMMARY Hypercalcemia is a frequent condition in clinical practice and when the most frequent causes are excluded, etiological diagnosis can be challenging. A rare cause of PTH-independent hypercalcemia is described in the present case report. A male adult with a history of androgenic-anabolic steroids abuse, and injection of mineral oil and oily veterinary compound containing vitamins A, D and E into muscles for local hypertrophy presented with hypercalcemia, nephrocalcinosis, and end-stage renal disease. On physical examination, the presence of calcified subcutaneous nodules and calcification of musculature previously infused with oily substances drew attention. Laboratory tests confirmed hypercalcemia of 12.62 mg/L, low levels of PTH (10 pg/mL), hyperphosphatemia (6.0 mg/dL), 25(OH)D of 23.3 ng/mL, and elevated 1,25(OH)2D (138 pg/mL). Imaging exams showed diffuse calcification of muscle tissue, subcutaneous tissue, and organs such as the heart, lung, and kidneys. The patient was diagnosed with PTH-independent hypercalcemia secondary to foreign body reaction in areas of oil injection. The patient underwent treatment with hydrocortisone for 10 days, single dose zoledronic acid and hemodialysis. He evolved with serum calcium levels of 10.4 mg/dL and phosphorus of 7.1 mg/dL. In addition, sertraline and quetiapine were prescribed to control body dysmorphic disorder. The medical community should become aware of new causes of hypercalcemia as secondary to oil injection since this should become increasingly frequent due to the regularity with which such procedures have been performed.

Abstract Objective: This study assessed maternal mortality (MM) and related factors in a large-sized municipality in the Southeastern region of Brazil (Campinas, São Paulo) during the period 2000-2015. Methods: This study consisted of two phases: 1. An analytical nested case-control phase that assessed the impact of individual and contextual variables on MM; and 2. an ecological phase designed to contextualize maternal deaths by means of spatial analysis. The case group consisted of all maternal deaths (n = 87) and the control group consisted of 348 women who gave birth during the same period. Data analysis included descriptive statistics, association, and multiple logistic regression (MLR) tests at p < 0.05 as well as spatial analysis. Results: Maternal Mortality Ratio was 37 deaths per 100.000 live births. Deaths were dispersed throughout the urban territory and no formation of cluster was observed. MLR showed that pregnant women aged > 35 years old (OR = 2.63) or those with cesarean delivery (OR = 2.51) were more prone to maternal death. Conclusion: Maternal deaths were distributed dispersedly among the different socioeconomic levels and more prone to occur among older women or those undergoing cesarean deliveries.

Resumo Objetivo: Esse estudo avaliou a mortalidade materna (MM) e fatores relacionados em um município de grande porte da região sudeste do Brasil (Campinas, São Paulo) no período de 2000-2015. Métodos: Esse estudo consistiu de duas fases: 1. Uma fase analítica de caso-controle que avaliou o impacto de variáveis individuais e contextuais na MM; 2. Uma fase ecológica delineada para contextualizar as mortes maternas por meio de análise espacial. O grupo caso consistiu de 87 mortes maternas e o grupo controle de 348 mulheres que tiveram bebês durante o mesmo período. Os dados foram analisados por estatística descritiva, testes de associação e regressão logística múltipla (RLM) (p < 0,05) assim como análise espacial. Resultados: A taxa de mortalidade materna foi de 37 mortes para cada 100.000 nascidos vivos. As mortes foram dispersas por todo o território urbano e não se observou formação de clusters. Na RLM observou-se que mulheres grávidas com idade > 35 anos (OR = 2,63) ou aquelas que passaram por cesárea (OR = 2,51) foram mais propensas à morte materna. Conclusão: As mortes maternas foram distribuídas dispersamente entre os diferentes níveis socioeconômicos e mais propensas a ocorrer entre mulheres > 35 anos de idade ou que passaram por cesárea.

Resumo O artigo tem como objetivo apresentar resultados de uma pesquisa que cartografou tecnologias e arranjos comunicacionais produzidos por e direcionados à populações vulnerabilizadas no território do Distrito Federal-Brasil no contexto da pandemia de ccovid-19. A pesquisa integrou uma investigação multicêntrica, de natureza qualitativa, estruturada em cinco etapas: mapeamento virtual das experiências; aprofundamento do conhecimento sobre as iniciativas através de entrevistas com suas lideranças; análise por experiência e transversal do material empírico; validação coletiva dos resultados através de sessões virtuais e construção de um mapa temático das experiências. Foram mapeadas 14 iniciativas sobre covid-19 que tinham um componente comunicacional e eram direcionadas à população de territórios periféricos, sendo selecionadas dez para a análise em profundidade. As respectivas lideranças foram entrevistadas, compondo um panorama cartográfico e temático das tecnologias e arranjos comunicacionais: histórias de vida; “boca a boca”; articulações em rede; comunicação orgânica presencial; cards; advocacy; redes sociais; uso de equipamentos territoriais como instrumentos de comunicação; jornal comunitário independente digital; aplicativo; rede de solidariedade e TV comunitária. Ressalta-se o compromisso das estratégias e tecnologias comunicacionais com o respeito às realidades locais, respeitando as características das comunidades, apontando para uma diferença crucial em relação à comunicação predominante sobre a pandemia nas instituições públicas de saúde.

Abstract The article aims to present results of a research that mapped communication technologies and arrangements designed and directed toward vulnerable populations in the territory of the Federal District (DF), Brazil, in the context of the COVID-19 pandemic. The research, which integrated a multicentric investigation, has a qualitative approach and was structured in five stages: virtual mapping of experiences; interviews with their leaders; individual and cross-sectional analysis of empirical material; collective validation of the results by virtual sessions and construction of a thematic map of the experiences. Fourteen initiatives on COVID-19 were mapped in the DF that had a communicational component and were aimed at the population of peripheral territories, with ten being selected for in-depth analysis.The respective leaders were interviewed, composing a thematic cartographic panorama of technologies and communication arrangements: life stories; “word of mouth”; network joints; in-person and organic communication; cards; advocacy; digital social networks; use of territorial equipment as communication tools; independent digital community newspaper; apps; solidarity network and community TV. The commitment of communication strategies and technologies regarding local realities, respecting the characteristics of communities, is highlighted, pointing to a crucial difference in relation to the predominant communication about the pandemic in public health institutions.

ABSTRACT Objective: the aim of this study was to compare the results of open and videolaparoscopic transvesical prostatectomy techniques in the treatment of benign prostatic hyperplasia (BPH) in a tertiary hospital. Methods: we reviewed medical records of patients who underwent transvesical adenectomy due to BPH between March 2019 and March 2021 at the urology service of Hospital de Clínicas do Paraná (HCPR), 42 patients were included in the open transvesical prostatectomy group and 22 in the videolaparoscopic group. Then, a comparison was made between the techniques in terms of surgical time, bleeding, length of stay, need for intensive care, among others, in addition to postoperative outcome. Results: the mean surgical time was shorter in the open technique compared to the laparoscopic technique (141 min vs 274 min). The videolaparoscopic group had a shorter mean hospital stay (3.5 days vs 6.36 days). There was no statistical significance in the comparison regarding the need for an intensive care unit, as well as in the assessment of postoperative bleeding. Conclusion: comparatively, the techniques demonstrated a similar outcome, with a low rate of complications and satisfactory results for the treatment of BPH. The laparoscopic technique is a surgery with a shorter hospital stay, but at the expense of a longer surgical time.

RESUMO Objetivo: o objetivo deste estudo foi comparar o resultado das técnicas de prostatectomia transvesical aberta e videolaparoscópica no tratamento de hiperplasia prostática benigna (HPB) em um hospital terciário. Métodos: foram revisados prontuários de pacientes submetidos a adenectomia transvesical devido a HPB entre março de 2019 a março de 2021 no serviço de urologia do Hospital de Clínicas do Paraná (HCPR), sendo incluídos 42 pacientes no grupo prostatectomia transvesical aberta e 22 no grupo videolaparoscópico. Em seguida foi feita a comparação entre as técnicas nos quesitos tempo cirúrgico, sangramento, tempo de internamento, necessidade de terapia intensiva, entre outras, além de desfecho pós-operatório. Resultados: o tempo cirúrgico médio foi menor na técnica aberta em comparação com a técnica videolaparoscópica (141 min vs 274 min). O grupo videolaparoscópico apresentou um tempo médio de internamento menor (3,5 dias vs 6,36 dias). Não houve significância estatística na comparação quanto a necessidade de unidade de terapia intensiva, assim como na avaliação do sangramento pós-operatório. Conclusão: comparativamente, as técnicas demonstraram um desfecho semelhante, com baixa taxa de complicações e resultados satisfatórios para o tratamento da HPB. Sendo a técnica videolaparoscópica uma cirurgia com menor tempo de internamento, porém às custas de um maior tempo cirúrgico. .

Abstract Background Most of the evidence about the impact of the post-acute COVID-19 Syndrome (PACS) reports individual symptoms without correlations with related imaging. Objectives To evaluate cardiopulmonary symptoms, their predictors and related images in COVID-19 patients discharged from hospital. Methods Consecutive patients who survived COVID-19 were contacted 90 days after discharge. The Clinic Outcome Team structured a questionnaire evaluating symptoms and clinical status (blinded for hospitalization data). A multivariate analysis was performed to address the course of COVID-19, comorbidities, anxiety, depression, and post-traumatic stress during hospitalization, and cardiac rehabilitation after discharge. The significance level was set at 5%. Results A total of 480 discharged patients with COVID-19 (age: 59±14 years, 67.5% males) were included; 22.3% required mechanical ventilation. The prevalence of patients with PACS-related cardiopulmonary symptoms (dyspnea, tiredness/fatigue, cough, and chest discomfort) was 16.3%. Several parameters of chest computed tomography and echocardiogram were similar in patients with and without cardiopulmonary symptoms. The multivariate analysis showed that PACS-related cardiopulmonary-symptoms were independently related to female sex (OR 3.023; 95% CI 1.319-6.929), in-hospital deep venous thrombosis (OR 13.689; 95% CI 1.069-175.304), elevated troponin I (OR 1.355; 95% CI 1.048-1.751) and C-reactive protein during hospitalization (OR 1.060; 95% CI 1.023-1.097) and depression (OR 6.110; 95% CI 2.254-16.558). Conclusion PACS-related cardiopulmonary symptoms 90 days post-discharge are common and multifactorial. Beyond thrombotic and markers of inflammation/myocardial injury during hospitalization, female sex and depression were independently associated with cardiopulmonary-related PACS. These results highlighted the need for a multifaceted approach targeting susceptible patients.

Resumo Fundamento A maioria da evidência sobre o impacto da síndrome COVID pós-aguda (PACS, do inglês, post-acute COVID-19 syndrome) descreve sintomas individuais sem correlacioná-los com exames de imagens. Objetivos Avaliar sintomas cardiopulmonares, seus preditores e imagens relacionadas em pacientes com COVID-19 após alta hospitalar. Métodos Pacientes consecutivos, que sobreviveram à COVID-19, foram contatados 90 dias após a alta hospitalar. A equipe de desfechos clínicos (cega quanto aos dados durante a internação) elaborou um questionário estruturado avaliando sintomas e estado clínico. Uma análise multivariada foi realizada abordando a evolução da COVID-19, comorbidades, ansiedade, depressão, e estresse pós-traumático durante a internação, e reabilitação cardíaca após a alta. O nível de significância usado nas análises foi de 5%. Resultados Foram incluídos 480 pacientes (idade 59±14 anos, 67,5% do sexo masculino) que receberam alta hospitalar por COVID-19; 22,3% necessitaram de ventilação mecânica. A prevalência de pacientes com sintomas cardiopulmonares relacionados à PACS (dispneia, cansaço/fadiga, tosse e desconforto no peito) foi de 16,3%. Vários parâmetros de tomografia computadorizada do tórax e de ecocardiograma foram similares entre os pacientes com e sem sintomas cardiopulmonares. A análise multivariada mostrou que sintomas cardiopulmonares foram relacionados de maneira independente com sexo feminino (OR 3,023; IC95% 1,319-6,929), trombose venosa profunda durante a internação (OR 13,689; IC95% 1,069-175,304), nível elevado de troponina (OR 1,355; IC95% 1,048-1,751) e de proteína C reativa durante a internação (OR 1,060; IC95% 1,023-1,097) e depressão (OR 6,110; IC95% 2,254-16,558). Conclusão Os sintomas cardiopulmonares relacionados à PACS 90 dias após a alta hospitalar são comuns e multifatoriais. Além dos marcadores trombóticos, inflamatórios e de lesão miocárdica durante a internação, sexo feminino e depressão foram associados independentemente com sintomas cardiopulmonares relacionados à PACS. Esses resultados destacaram a necessidade de uma abordagem multifacetada direcionada a pacientes susceptíveis.

ABSTRACT This study aimed to compare genitourinary symptoms and quality of life in women with breast cancer before and after chemotherapy treatment. This is a prospective and analytical study carried out with 60 women treated at a hospital in the state of Paraná. Sociodemographic data, menopausal status, climacteric symptoms, quality of life, and pelvic floor strength and resistance were collected. Descriptive statistics, t-tests, Shapiro-Wilk, Cochran, Factorial Analysis of Variance for Repeated Measures and Fishers least significance difference were used for data analysis. Participants suffered genitourinary alterations, such as reduced strength and resistance of the pelvic floor muscles, urinary incontinence and vulvovaginal atrophy, regardless of the evaluated factors (type of chemotherapy, parity, and menopausal status). Therefore, greater attention and discussion by multidisciplinary health teams is necessary, as these symptoms can be reduced and managed if recognized early.

RESUMEN Este estudio tuvo como objetivo comparar los síntomas genitourinarios y la calidad de vida en mujeres con cáncer de mama antes y después del tratamiento con quimioterapia. Se trata de un estudio prospectivo y analítico realizado con 60 mujeres que recibieron atención en un hospital del estado de Paraná (Brasil). Se recogieron datos sociodemográficos, estado menopáusico, síntomas climatéricos, calidad de vida y fuerza y resistencia del suelo pélvico. Se utilizaron estadísticas descriptivas, pruebas t de Shapiro-Wilk y de Cochran, análisis factorial de varianza para medidas repetidas y LSD-Fisher para el análisis de datos. Las participantes sufrieron alteraciones genitourinarias, como disminución de la fuerza y resistencia de los músculos del suelo pélvico, incontinencia urinaria y atrofia vulvovaginal, independientemente de los factores evaluados (tipo de quimioterapia, paridad y estado menopáusico). Se concluye que es necesaria una mayor atención y discusión por parte de los equipos de salud multidisciplinarios, ya que estos síntomas pueden reducirse y manejarse si se reconocen a tiempo.

RESUMO Este estudo teve como objetivo comparar os sintomas geniturinários e a qualidade de vida de mulheres com câncer de mama antes e após o tratamento quimioterápico. Trata-se de um estudo prospectivo e analítico realizado com 60 mulheres atendidas em um hospital no estado do Paraná. Foram coletados dados sociodemográficos, status menopausal, sintomas do climatério, qualidade de vida e força e resistência do assoalho pélvico. Utilizou-se estatística descritiva, assim como os testes t, de Shapiro-Wilk, de Cochran, análise da variância fatorial para medidas repetidas e método LSD de Fisher para análise dos dados. As participantes sofreram alterações geniturinárias como redução de força e resistência dos músculos do assoalho pélvico, incontinência urinária e atrofia vulvovaginal independente dos fatores avaliados (tipo de quimioterapia, paridade e status menopausal). Entende-se que é necessário que haja maior atenção e discussão por parte das equipes multiprofissionais de saúde, pois esses sintomas, se reconhecidos precocemente, podem ser reduzidos e gerenciados.

Abstract The article aims to present results of a research that mapped communication technologies and arrangements designed and directed toward vulnerable populations in the territory of the Federal District (DF), Brazil, in the context of the COVID-19 pandemic. The research, which integrated a multicentric investigation, has a qualitative approach and was structured in five stages: virtual mapping of experiences; interviews with their leaders; individual and cross-sectional analysis of empirical material; collective validation of the results by virtual sessions and construction of a thematic map of the experiences. Fourteen initiatives on COVID-19 were mapped in the DF that had a communicational component and were aimed at the population of peripheral territories, with ten being selected for in-depth analysis.The respective leaders were interviewed, composing a thematic cartographic panorama of technologies and communication arrangements: life stories; “word of mouth”; network joints; in-person and organic communication; cards; advocacy; digital social networks; use of territorial equipment as communication tools; independent digital community newspaper; apps; solidarity network and community TV. The commitment of communication strategies and technologies regarding local realities, respecting the characteristics of communities, is highlighted, pointing to a crucial difference in relation to the predominant communication about the pandemic in public health institutions.

Resumo O artigo tem como objetivo apresentar resultados de uma pesquisa que cartografou tecnologias e arranjos comunicacionais produzidos por e direcionados à populações vulnerabilizadas no território do Distrito Federal-Brasil no contexto da pandemia de ccovid-19. A pesquisa integrou uma investigação multicêntrica, de natureza qualitativa, estruturada em cinco etapas: mapeamento virtual das experiências; aprofundamento do conhecimento sobre as iniciativas através de entrevistas com suas lideranças; análise por experiência e transversal do material empírico; validação coletiva dos resultados através de sessões virtuais e construção de um mapa temático das experiências. Foram mapeadas 14 iniciativas sobre covid-19 que tinham um componente comunicacional e eram direcionadas à população de territórios periféricos, sendo selecionadas dez para a análise em profundidade. As respectivas lideranças foram entrevistadas, compondo um panorama cartográfico e temático das tecnologias e arranjos comunicacionais: histórias de vida; “boca a boca”; articulações em rede; comunicação orgânica presencial; cards; advocacy; redes sociais; uso de equipamentos territoriais como instrumentos de comunicação; jornal comunitário independente digital; aplicativo; rede de solidariedade e TV comunitária. Ressalta-se o compromisso das estratégias e tecnologias comunicacionais com o respeito às realidades locais, respeitando as características das comunidades, apontando para uma diferença crucial em relação à comunicação predominante sobre a pandemia nas instituições públicas de saúde.

Objectives: To investigate the most common sources of stress faced by medical students and the degree to which different stressors impact their lives. As a secondary objective, a new instrument, Medical Student Stress Factor Scale (MSSF), was developed based on these stressors. Methods: The MSSF was applied to 431 medical students. The Depression, Anxiety and Stress Scale was administered to investigate the relationship between these stressors and the students’ mental health. Results: The five greatest stressors were the extensive content, lack of time to study, sleep deprivation, excessive self-pressure for good grades, and lack of leisure time. The MSSF showed good psychometric characteristics, resulting in a 28-item scale with five subscales. The Relationships and Health subscales were associated with depressive symptoms; Relationships, Health, and Learning Environment/Academic Performance were associated with anxiety symptoms, while Health, and Learning Environment/Academic Performance were associated with stress symptoms. Conclusions: Our study presents important data about the most important stressors that affect medical students’ lives and cause mental health issues. The factors are generally related to academic performance and the learning environment and should be targeted in future interventions.

RESUMO Objetivo: Embora a necropsia seja considerada o exame padrão-ouro de diagnóstico, observa-se declínio em sua realização, enquanto cresce o número de eventos adversos na saúde, dos quais 17% são erros diagnósticos. O estudo objetivou estimar a prevalência do erro de diagnóstico, com base no diagnóstico anatomopatológico, em uma Unidade de Terapia Intensiva Pediátrica (UTIP). Métodos: Estudo de corte transversal, retrospectivo, de 31pacientes que foram a óbito entre 2004 e 2014. Os diagnósticos foram comparados para verificar se houve concordância de diagnóstico principal (CDP) e diagnóstico da causa da morte (DCM), classificados de acordo com os critérios de Goldman. Resultados: De 3.117 pacientes, 263 foram a óbito. Em 38 casos foi realizada autopsia (14,4%) e 31 foram incluídos no estudo. Observou-se decréscimo de 67% no número de autopsias em dez anos. Concordância absoluta entre os diagnósticos (classe V) foi observada em 18 casos (58,0%) e discordância (classe I), em 11 (35,4%). Observou-se maior dificuldade no diagnóstico de doenças agudas e de evolução fatal rápida, como as miocardites. Sete pacientes foram admitidos em estado geral grave, indo a óbito nas primeiras 24 horas de internação. Conclusões: A necropsia não só permite a identificação de erros diagnósticos, como também a oportunidade de se aprender com o erro. Os resultados enfatizam a importância desse exame para a elucidação diagnóstica e a construção de uma base de informações sobre os principais diagnósticos envolvidos em pacientes que evoluem rapidamente para o óbito em UTIP, aumentando o grau de suspeição pela equipe da Unidade.

ABSTRACT Objective: Although autopsy is deemed the gold standard for diagnosis, its performance has been decreasing while adverse events have been increasing, of which 17% consist in diagnostic errors. The purpose of this study was to estimate the prevalence of diagnostic errors based on anatomopathological diagnosis in a Pediatric Intensive Care Unit (PICU). Methods: This is a cross-sectional, retrospective study on 31patients who died between 2004 and 2014. Diagnoses were compared in order to assess whether there was agreement between clinical major diagnosis (CMD) and the cause of death as described in the autopsy record (CDAR), which were classified according to the Goldman Criteria. Results: Of 3,117 patients, 263 died (8.4%). Autopsy was conducted in 38 cases (14.4%), and 31 were included in the study. Therewas a 67% decrease in the number of autopsies over the last 10years. Absolute agreement between the diagnoses (class V) was observed in 18 cases (58.0%), and disagreement (class I), in 11 (35.4%). Therewas greater difficulty in diagnosing acute diseases and diseases of rapid fatal evolution such as myocarditis. Sevenpatients were admitted in critical health conditions and died within the first 24 hours of hospitalization. Conclusions: Autopsy not only enables to identify diagnostic errors, but also provides the opportunity to learn from mistakes. The results emphasize the relevance of the autopsy examination for diagnostic elucidation and the creation of an information database concerning the main diagnoses of patients who rapidly progress to death in PICU, increasing the index of clinical suspicion of the team working at this unit.

RESUMO Objetivo Avaliar a qualidade de vida e seus fatores associados em pacientes com hanseníase. Métodos Estudo transversal com 63 indivíduos com diagnóstico de hanseníase acompanhados em um serviço de atendimento especializado da região sudeste de Mato Grosso. Para avaliação da qualidade de vida, aplicou-se o questionário World Health Organization Quality of Life Bref . Utilizou-se regressão linear simples e múltipla para avaliar a associação entre varáveis sociodemográficas e os domínios de qualidade de vida. Resultados A maior média de qualidade de vida foi observada no domínio psicológico (16,28±2,30) e a menor, no domínio ambiente (13,86±2,21). As mulheres, indivíduos sem companheiro e aqueles que possuíam casa própria apresentaram menores médias de qualidade de vida no domínio psicológico. Os indivíduos que não receberam visita de Agentes Comunitários de Saúde apresentaram menores médias de qualidade de vida no domínio ambiente. Após análise multivariada, verificou-se que melhor qualidade de vida esteve associada à autodeclaração de cor branca no domínio ambiente, e pior qualidade de vida foi associada à menor escolaridade no domínio físico. Conclusão Este estudo evidenciou a influência dos fatores socioedemográficos sobre a qualidade de vida de pacientes com hanseníase, indicando a necessidade de realização de uma assistência em saúde de maneira integral, compreendendo os determinantes sociais da saúde.

ABSTRACT Objective To evaluate quality of life and associated factors in patients with leprosy. Methods A cross-sectional study with 63 people diagnosed as leprosy, seen at a reference service for the disease in the southeastern region of Mato Grosso, Brazil. The questionnaire World Health Organization Quality of Life Bref was used to evaluate quality of life. Simple and multiple linear regressions evaluated the association between sociodemographic variables and quality of life domains. Results The highest mean of quality of life was observed in the psychological domain (16.28±2.30), and the lowest in the environmental domain (13.86±2.21). Females, individuals with no partners, and people who owned their own house had the lowest quality of life means within the psychological domain. People who did not receive visits by Community Health Workers had the lowest means in quality of life within the environmental domain. Multivariate analysis revealed that the best quality of life was associated to self-reported white skin color within the environmental domain, and the worst quality of life was associated to less schooling within the physical domain. Conclusion This study showed the influence of sociodemographic factors on the quality of life of patients with leprosy, and indicated the need for comprehensive health care, considering the social determinants of health.

ABSTRACT Introduction: Tissue expansion is an important reconstruction method to solve defects such as burns and giant nevi or breast reconstruction. This article aims to report the experience of the Plastic Surgery Service of the Hospital de Clínicas of the Federal University of Paraná (UFPR) with the use of expanders. Methods: This is a retrospective, descriptive, and analytical study of patients who underwent tissue expansion for reconstructive surgery at the Hospital de Clínicas da UFPR, from January 2010 to December 2016. Results: 61 patients and 80 surgeries were analyzed, including re-expansion procedures. Age ranged from 2 to 73 years (mean 31). The majority of patients were female (83.6%), aged over 40 years, undergoing breast reconstruction treatment after radical mastectomy (36%). The complications observed in these patients were: signs of infection (14.7%), suture dehiscence (3.2%), seroma (3.2%), defect in the expander (3.2%), exposure of the expander (3, 2%), necrosis (1.6%) and signs of hypoperfusion (1.6%). Patients undergoing breast reconstruction had the highest number of complications (40.1%). Reexpansion was necessary for 37.7% of patients. Conclusion: The skin expansion technique is indicated for several pathologies’ treatment. The tissue expansion procedure has high complication rates. Knowing the patient’s profile, the main types of complications, and the factors associated with these complications can help prevent them.

RESUMO Introdução: Expansão tecidual é um método de reconstrução importante para a cobertura de defeitos como queimaduras e nevos gigantes ou na reconstrução mamária. Esse artigo tem como objetivo relatar a experiência do Serviço de Cirurgia Plástica do Hospital de Clínicas da Universidade Federal do Paraná (UFPR) com o uso de expansores. Métodos: Esse é um estudo retrospectivo, descritivo e analítico dos pacientes que foram submetidos à expansão tecidual para cirurgia reconstrutora no Hospital de Clínicas da UFPR, entre o período de janeiro de 2010 a dezembro de 2016. Resultados: Foram analisados 61 pacientes e 80 cirurgias, incluindo os procedimentos de reexpansão. A idade variou entre 2 a 73 anos (média 31). A grande maioria dos pacientes pertenceu ao sexo feminino (83,6%), na faixa etária acima de 40 anos, sendo submetidos ao tratamento para reconstrução mamária após mastectomia radical (36%). As complicações observadas nesses pacientes foram: sinais de infecção (14,7%), deiscência da sutura (3,2%), seroma (3,2%), defeito no expansor (3,2%), exposição do expansor (3,2%), necrose (1,6%) e sinais de hipoperfusão (1,6%). Pacientes submetidos à reconstrução mamária tiveram o maior número de complicações (40,1%). A reexpansão foi necessária em 37,7% dos pacientes. Conclusão: A técnica de expansão de pele é indicada para o tratamento de diversas patologias. O procedimento de expansão tecidual apresenta taxas de complicações altas e o conhecimento do perfil do paciente, dos principais tipos de complicações e dos fatores associados a essas complicações podem auxiliar na sua prevenção.

ABSTRACT BACKGROUND: Different approaches to learning can exert considerable influence on the teaching-learning process in medical education. This study aimed to investigate the association of surface and deep learning with study patterns, preferred type of assessment, practices of cheating and quality of sleep among medical students. DESIGN AND SETTING: Cross-sectional study on medical students enrolled in all six years of a medical school in Juiz de Fora, Brazil. METHODS: Questionnaires were applied to evaluate learning approaches (R-SPQ-2F), study patterns, sources and choices, and quality of sleep. Students’ learning approaches (deep or surface) were assessed in relation to their study patterns, study resources, quality of sleep and whether they cheated in tests. RESULTS: Among the 710 students included, 43% frequently studied on the night before an exam, 65% had used psychostimulants to study and more than 46% had cheated in an exam. Regarding quality of sleep, most students (53.4%) reported that their quality of sleep was poor, such that 45.3% slept for fewer than five hours before an exam. Those who studied just prior to an exam, used class summaries, preferred multiple-choice questions and cheated during the test had a more surface-learning approach. On the other hand, those who read books, preferred practical exams and slept better had a deeper approach. CONCLUSION: The type of learning approach was associated with study patterns and choices among medical students. Educators need to be attentive to the type of learning their students use and think of measures that impact teaching and assessment methods.

Resumo: Este artigo tem como objetivo analisar a participação de mulheres no campo médico paulista entre os anos de 1898 e 1930. Para tanto, foram analisados os dois periódicos médicos de maior circulação nesse período: a Revista Médica de São Paulo e os Anais Paulistas de Medicina e Cirurgia. Partindo da análise das fontes, buscou-se refletir de que maneira foram estabelecidas relações entre os discursos sobre gênero, política e ciência na imprensa médica paulista. Nesse sentido, buscamos discutir a inserção profissional das médicas em áreas que, inicialmente, se mostrariam mais permeáveis à presença de mulheres, tais como a benemerência, além da ginecologia, obstetrícia e pediatria. Analisamos também o uso estratégico do recurso ao laboratório - e sua aparente neutralidade - no momento em que essas profissionais tentaram adentrar outras áreas e defrontar os tabus vinculados ao contanto com corpos masculinos.

Abstract: This article aims to analyze the participation of women in paulista’s medical field between 1898 and 1930. To achieve this purpose, we have analyzed two medical journals of large circulation in this period: the São Paulo’s Medical Journal and Paulista’s Annals of Medicine and Surgery. Starting from the documental analyze, we achieve to think the complexes relations established among gendered, political and scientific discourses in paulistas’s medical press. We also sought to discuss the professional insertion of women in some fields that initially would be more permeable to them, such as charity, gynecology, obstetrics and pediatrics. Besides that, we will discuss the strategical mobilization of seeming neutrality that rounds the laboratorial activities, as a resource that women physicians used to insert themselves in some fields, deceiving the taboo involving male bodies.

ABSTRACT The objective of this research was to characterize the nutritive value of corn silage made on intensive dairy farms and demonstrate the nutritional variations between silages located at the top and at the center of a bunker silo. Thirty-two dairy farms were visited in four Brazilian states. One corn bunker silo of each farm was chosen and samples were collected from the top and center parts. The nutritive value, fermentation end-products, and microbial counts were assessed. The predicted milk was determined by Milk2006 spreadsheet. The mean, standard deviation, maximum, minimum, and 95% confidence interval of all data were calculated. The ash, neutral detergent fiber (NDF), starch, in vitro NDF, and dry matter (DM) digestibility data were compared with reference value. Both statistical procedures were performed through the PROC MEANS of SAS. The mean values found at the center for NDF, starch, total digestible nutrients (TDN-1x), and estimated milk were 503 g kg−1 DM, 308 g kg−1 DM, 583 g kg−1, and 1,124 kg t−1, respectively. The top silages presented a mean TDN-1x and predicted milk of 559 g kg−1 and 1046 kg t−1, respectively. For NDF digestibility and starch concentration, 53.1% and 62.5% of the center samples presented a value equal to or above the reference value (500 g kg−1 and 300 g kg−1 DM for NDF digestibility and starch concentration, respectively). Overall, the corn silage produced on intensive dairy farms in Brazil has satisfactory nutritive value, especially in terms of starch concentration. Some parameters, such as the concentration of fiber and its digestibility, should be improved. This study also shows that a silo may contain two different types of silage: top and center. This alerts nutritionists and farmers when feeding and sampling corn silage from bunker silos.

Lithopedion (litho = stone, pedion = child) is the term used to describe an intra-abdominal calcified fetus. In the international literature, about 300 cases were described. In this case, an 84-year old woman was admitted with abdominal pain and the abdominal physical examination showed a mass with hard consistency with 23 cm height and 32 cm width. The abdominal x-ray examination showed the presence of bone density image suggesting an intra-abdominal calcified fetus. The computer tomography confirmed that it was a litoquelifopedion of 29-30 weeks of pregnancy and with about 44 years of evolution.

Lithopedion (litho = piedra, pedion = niño), es el término utilizado para describir un feto intrabdominal calcificado. Es un evento raro, con aproximadamente 300 casos descritos en la literatura internacional. Este artículo trata del caso de una mujer de 84 años con dolor abdominal, donde se evidenció en el examen físico, una masa abdominal de consistencia pétrea, con dimensiones de 23 cm de altura y 32 cm de longitud. El examen radiológico del abdomen reveló la presencia de imagen de densidad ósea, sugiriendo la existencia de un feto abdominal calcificado. La tomografía computarizada confirmó tratarse de un litoquelifopedion de 29-30 semanas, con aproximadamente 44 años de evolución.