Abstract: Introduction: The Covid-19 pandemic has had a direct impact on medical student training, through the sudden change from face-to-face to remote learning and the stress and anxiety caused. Students need coping strategies for the sake of their mental health and to deal with situations of extreme anxiety. Experience Report: during the pandemic the ELAM (Study of Literature and Art in Medicine) group has sought to help students in lockdown deal with their mental struggles by promoting discussions on literature through texts it has produced, debates on social media and, primarily, through art activities such as watercolor painting and visual arts. Twenty-four watercolor paintings, videos, collages, chronicles and poems were produced. The main themes addressed were: love (N=2), ageing (N=2), sin and religion (N=4), life cycle (N=6), cancer, chaos, wisdom, mortality (N=3), time, looking and seeing (N=2) and regionalism (N=2). Discussion: Essential measures to tackle Covid-19 include social isolation, physical distancing and restrictions on people’s movements to prevent the rapid spread of the virus. When youngsters lack the mechanisms to cope with the resulting stressful situation, a series of mental disorders can be triggered, such as depression, anxiety and mood swings. Reflecting a broader trend in medical training, medical schools are increasingly investing in curricular content involving arts, and at this particular moment in time this represents an important coping strategy for students trying to deal with the pandemic. Conclusion: Getting through this difficult period of the Covid-19 pandemic has demanded a coping strategy to help students experience and vent their fears, where art has been the best form of expression, and the ELAM group has achieved such a strategy.

Resumo: Introdução: O momento da pandemia por Covid-19 tem um impacto direto na formação dos estudantes de Medicina, tanto pela modificação repentina na metodologia presencial para remota quanto pelo estresse e pela ansiedade gerados. A saúde mental dos estudantes necessita de estratégias de coping para que eles possam lidar com situações de extrema ansiedade. Relato de experiência: O grupo Estudo de Literatura e Arte na Medicina (Elam) criou, durante o período da pandemia, momentos de discussão de literatura por meio de produção textual e discussões em mídia social, e principalmente por meio de atividades artísticas com pintura em aquarela e artes plásticas, para lidar com os conflitos apresentados pelos alunos na quarentena. Foram 24 telas de aquarela, vídeos, telas de colagem em artes plásticas e textos de crônicas e poesias. Os temas abordados nos textos foram principalmente: amor (N = 2), envelhecer (N = 2), pecado e religiosidade (N = 4), ciclo da vida (N = 6), câncer, caos, sabedoria, mortalidade (N = 3), tempo, olhar e ver (N = 2) e regionalismo (N = 2). Discussão: O enfrentamento da Covid-19 impõe o isolamento social, o distanciamento físico e a restrição à mobilidade das pessoas como medidas fundamentais para evitar a rápida disseminação do vírus. Quando o jovem não dispõe de mecanismos para lidar com a situação estressante propiciada pela situação, pode haver o desencadeamento de uma série de psicopatologias, como depressão, ansiedade e distúrbios do humor. É uma tendência mais ampla na educação médica: cada vez mais, as escolas de Medicina estão investindo em currículo e programação em torno das artes, e, no momento atual, essa estratégia de coping se torna importante no enfrentamento da pandemia pelo estudante de Medicina. Conclusão: Atravessar esse momento de pandemia pela Covid-19 exigiu uma estratégia de coping para ajudar os alunos a vivenciar e extravasar seus medos, sendo a arte a melhor forma de expressão, o que foi atingido pelo grupo Elam.

RESUMO Introdução A interpretação do eletrocardiograma (ECG) é fundamental para a identificação de doenças cardiovasculares, que estão entre as principais causas de morte no mundo. A aquisição dessa competência é essencial na formação do médico generalista, e o uso de novas ferramentas de ensino, apoiadas na tecnologia, como o mobile learning, pode facilitar a aquisição desse conhecimento. Objetivos Este estudo teve por objetivo desenvolver e avaliar a usabilidade e a potencialidade para o uso em educação médica de um aplicativo móvel de ensino para interpretação do ECG. Métodos Com a participação de dois professores da área da saúde e um da computação, um analista de sistemas, um programador e um designer gráfico, foi desenvolvido um aplicativo móvel para ensino da interpretação do ECG, utilizando-se a linguagem Java. Para análise de validação foram empregados um questionário de avaliação da usabilidade baseado no System Usability Scale (SUS) e um questionário utilizado para avaliar a adequação de softwares para uso em educação médica, previamente traduzido para o português e aplicado no Brasil. Resultados Foi desenvolvido o aplicativo “ECG Fácil” para uso off-line e de acesso gratuito nas plataformas iOS e Android. Na fase de validação do aplicativo, 109 discentes tiveram acesso livre ao aplicativo móvel durante seis semanas e depois avaliaram a usabilidade por meio de questionário baseado no SUS. As respostas ao questionário mostraram boa confiabilidade, conforme a análise de validação pelo coeficiente alfa de Cronbach (valor: 0,74), e o aplicativo apresentou excelente aceitação, com escore médio de 85,3 na escala SUS. Enquanto isso, 15 docentes avaliaram o aplicativo por meio do questionário utilizado para avaliar a adequação de softwares para uso em educação médica, tendo a maioria concordado com os itens que indicam que ele é adequado ao uso em educação médica. Conclusão O aplicativo “ECG Fácil” foi considerado de boa usabilidade pelos alunos e adequado à finalidade educacional pelos professores. Estudos futuros com esse aplicativo serão necessários para avaliar a aquisição e a retenção de conhecimento sobre a interpretação do ECG pelos alunos.

ABSTRACT Introduction The interpretation of the electrocardiogram (ECG) is fundamental for the identification of cardiovascular diseases, which are among the main causes of death in the world. The acquisition of this competence is essential in the training of the general practitioner and the use of new teaching tools, based on technology such as the use of mobile learning, can facilitate the acquisition of this knowledge. Objectives The objective of this study was to develop and evaluate the usability and the potentiality for the use in medical education of a mobile teaching application for ECG interpretation. Methods With the participation of two health professors and a computer scientist, a systems analyst, a programmer and a graphic designer, a mobile application was developed to teach ECG interpretation using the Java language. For validation analysis, a usability evaluation questionnaire based on the System Usability Scale (SUS) and a questionnaire used to evaluate the suitability of software for use in medical education, previously translated into Portuguese and applied in Brazil, were used. Results The “ECG Fácil” application was developed for off-line use and free access on iOS and Android platforms. In the validation phase of the application, a total of 109 students had free access to the mobile application for 6 weeks and then evaluated usability through a SUS-based questionnaire. The answers to the questionnaire showed good reliability, according to the validation analysis by Cronbach’s alpha coefficient (value: 0.74), and the application presented an excellent acceptance with a mean score on the SUS scale of 85.3. Meanwhile, fifteen faculty members evaluated the application through the questionnaire used to assess the suitability of software for use in medical education, with most agreeing with items indicating that it is suitable for use in medical education. Conclusion The “ECG Fácil” application was considered to be of good usability by students and suitable for educational purpose by teachers. Future studies with this application will be needed to assess the acquisition and retention of knowledge about ECG interpretation by students.

Abstract Background Development of drug-resistance mutations is the main cause of failure in antiretroviral therapy. In Brazil, there is scarce information on resistance pattern for patients failing antiretroviral therapy. Objectives To define the HIV mutational profile associated with drug resistance in Brazilian patients from 5 large cities, after first, second or further failures to antiretroviral therapy. Methods We reviewed genotyping results of 1520 patients failing therapy in five Brazilian cities. Frequency of mutations, mean number of active drugs, viral susceptibility to each antiretrovirals drug, and regional differences were assessed. Results Mean time of antiretrovirals use was 22.7 ± 41.1 months. Mean pre-genotyping viral load was 4.2 ± 0.8 log (2.1 ± 2.0 after switching antiretrovirals). Mean number of remaining active drugs was 9.4, 9.0, and 7.9 after 1st, 2nd, and 3rd failure, respectively. We detected regional variations in drug susceptibility: while BA and RS showed the highest (∼40%) resistance level to ATV/r, FPV/r and LPV/r, in the remaining cities it was around half of this rate. We detected 90% efavirenz/nevirapine resistance in SP, only 45% in RS, and levels between 25% and 30% in the other cities. Regarding NRTI, we found a similar pattern, with RJ presenting the highest, and CE the lowest susceptibility rates for all NRTI. Zidovudine resistance was detected in only 3% of patients in RJ, against 45–65% in the other cities. RJ and RS showed 3% resistance to tenofovir, while in CE it reached 55%. DRV/r (89–97%) and etravirine (61–85%) were the most active drugs, but again, with a wide variation across cities. Conclusions The resistance mutational profile of Brazilian patients failing antiretroviral therapy is quite variable, depending on the city where patients were tested. This variation likely reflects distinctive choice of antiretrovirals drugs to initiate therapy, adherence to specific drugs, or circulating HIV-1 strains. Overall, etravirine and DRV/r remain as the most active drugs.

Highly-potent antiretroviral therapy is necessary to avoid viral replication in HIV patients; however, it can favor the appearance of resistance mutations. The mutations 41L, 67N, 70R, 210W, 215Y/F, 219E/Q, 44D and 118I are defined as nucleoside analogous mutations (NAMs), because they affect the efficacy of all nucleoside reverse transcriptase inhibitors (NRTI). The mutation most frequently associated with non-nucleoside reverse transcriptase inhibitors (NNRTIs) is 103N. 33W/F, 82A/F/L/T, 84V and 90M are called protease inhibitor resistance-associated mutations (PRAM), because they are associated with resistance to several protease inhibitors (PI). This study evaluated the development of resistance mutations and examine the susceptibility of HIV with these mutations to antiretrovirals in HIV-1 patients who have failed one or more therapy regimes. Analyses were made of 101 genotypic tests of patients with therapeutic failure to 2 or 3-drug regimens with NRTI, NNRTI or PI. We used the Stanford database to define the susceptibility profile of the viruses. The samples were divided into three treatment-failure groups: first (F), second (S) and multi-failure (MF) to antiretroviral regimens, and we correlated these groups with resistance profiles and principal mutations. There was a significant increase in resistance mutations V82A/F/L/T, I84V, L90M, M41L, K70R, L210W, T215Y/F and K219Q/E in MF. We also found significantly higher resistance to zidovudine, didanosine, stavudine and abacavir in MF. There was no increase in resistance to tenofovir (p=0.28) and lopinavir (p=0.079) in MF. A high degree of resistance to NNRTIs was observed in all groups. Increased resistance mutations will affect future therapeutic options for HIV patients in Brazil because it results in a significant increase in resistance to antiretroviral drugs.

Genotype testing for HIV-1 drug resistance is useful for selecting antiretroviral drug regimens for patients experiencing therapeutic failure, but the optimal means for interpreting the test results is unknown because many HIV-1 protease and reverse transcriptase (RT) mutations contribute to drug resistance. This study identified common combinations of resistance mutations related to antiretroviral resistance profiles. From April 2002 to March 2004, 101 protease and RT sequences were determined for HIV-1 isolates from patients who were failing antiretroviral therapy. The resistance profile was evaluated using the Stanford Database program. Male patients predominated (76.2%), the median age was 38 years, the average CD4 count was 279.21 cells/mm³ and the average viral load was 4.49 log. In relation to protease inhibitors (IP) 31 mutation patterns were detected, 49 mutation patterns were detected in Nucleoside RT Inhibitors (NRTI), and 17 patterns were found in the Non Nucleoside RT Inhibitors (NNRTI). K65R was detected in 5.9% of the isolates. The most frequent mutations were: L90M, M184V and K103N related to PI's, NRTI's and NNRTI's, respectively. The best antiretroviral susceptibility was found to be Lopinavir in the PI class and Tenofovir in the NRTI class. The top six mutation patterns accounted for 49% of the resistance to PI's, for 38.5% of NRTI resistance, and the top two mutation patterns accounted for 40.9% of resistance to NNRTI's.