Resumo Objetivo: Avaliar os fatores relacionados à ansiedade e ao efeito do treinamento baseado em simulação (TBS) na ansiedade, autoconfiança e satisfação do estudante em relação ao aprendizado do exame pélvico e de mamas. Métodos: Estudo longitudinal com alunos do quarto ano de medicina da Universidade José do Rosário Vellano, utilizando questionário autorrespondido com 12 itens em escala tipo Likert sobre a ansiedade em relação ao exame ginecológico, pré e pós-TBS. Após o treinamento, avaliou-se também o grau de autoconfiança e satisfação com o processo de aprendizado. Resultados: Foram incluídos 80 alunos com média etária de 24,1 ± 4,2 anos, dos quais 62,5% eram mulheres. Na avaliação pré-treinamento, a ansiedade dos alunos em relação ao exame pélvico foi maior do que a ansiedade em relação ao exame das mamas (2,4 ± 1,0 versus 1,7 ± 0,8, respectivamente; p < 0,001). O principal motivo de ansiedade em relação tanto ao exame pélvico quanto ao de mamas foi o receio de machucar a paciente. O TBS reduziu significativamente a ansiedade dos alunos (2,0 ± 0,8 versus 1,5 ± 0,5, respectivamente; p < 0,001). A satisfação e autoconfiança dos estudantes foram elevadas (6,8 ± 0,3 e 6,0 ± 0,9, respectivamente), sem diferença entre gêneros. Conclusão: O uso de TBS no ensino de exame pélvico e mamário resultou em uma diminuição na ansiedade e elevada autoconfiança em um grupo de estudantes de medicina, de ambos os gêneros, e bons níveis de satisfação em relação ao treinamento.

Abstract Objective: To evaluate factors associated with anxiety and the effect of simulation-based training (SBT) on student anxiety, self-confidence and learning satisfaction in relation to pelvic and breast examination. Methods: A longitudinal study was conducted with 4th year medical students at the Universidade José do Rosário Vellano. A 12-item, self-report questionnaire on student anxiety at performing gynecological examinations was applied before and after SBT, with answers being given on a Likert-type scale. After training, the self-confidence levels and satisfaction of the students related to the learning process were also evaluated. Results: Eighty students with a mean age of 24.1 ± 4.2 years were included in the study. Of these, 62.5% were women. Pre-SBT evaluation showed that students were more anxious at performing a pelvic examination than a breast examination (2.4 ± 1.0 versus 1.7 ± 0.8, respectively; p < 0.001). The primary reason for anxiety regarding both pelvic and breast examination was fear of hurting the patient. SBT significantly reduced student anxiety (2.0 ± 0.8 versus 1.5 ± 0.5, respectively; p < 0.001). The satisfaction and self-confidence of the students were found to be high (6.8 ± 0.3 and 6.0 ± 0.9, respectively), with no difference between genders. Conclusion: The use of SBT in teaching students to perform pelvic and breast examinations resulted in reduced anxiety and increased self-confidence in a group of medical students of both genders, with high levels of satisfaction in relation to the training.

Resumo A pandemia da “novel coronavirus disease” 2019 (COVID-19), infecção causada pelo coronavírus 2 da síndrome respiratória aguda grave (SARS-CoV-2), tem descortinado uma realidade até então oculta: a vulnerabilidade da população residente em instituições de longa permanência para idosos (ILPI). Diversas publicações científicas têm revelado a concentração de até 60% dos óbitos atribuídos à COVID-19 em tais instituições. A maioria dos residentes em ILPI reúnem os principais fatores de risco para morbimortalidade pela COVID-19, o que torna imprescindível a definição de ações voltadas à prevenção da transmissibilidade do SARS-CoV-2 neste ambiente, além das medidas usuais de distanciamento social e isolamento dos portadores da doença. Propõem-se, no presente artigo, estratégias de rastreamento da infecção em residentes e trabalhadores de ILPI por meio de testes laboratoriais disponíveis no Brasil. A identificação precoce de indivíduos portadores do SARS-CoV-2 com possibilidades de transmissão ativa e continuada do vírus permite a adoção de medidas que interrompam o ciclo de transmissão local da infecção.

Abstract An infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the 2019 Novel Coronavirus Disease (COVID-19) pandemic has unveiled a hitherto hidden reality: the vulnerability of the population living in long-term care facilities for the elderly (LTCF). To date, several scientific publications have revealed a concentration of up to 60% of deaths attributed to COVID-19 in such institutions. Most LTFC residents share the primary risk factors currently associated with increased morbimortality due to the COVID-19 infection. It is crucial to define actions to prevent SARS-CoV-2 spread in this environment, besides the usual measures of social distancing and isolation of the carriers of this disease. This paper proposes strategies for the investigation of this infection in LTCF residents and workers using laboratory tests available in Brazil. The early identification of individuals with SARS-CoV-2, who may actively and continuously spread the virus, allows adopting measures aimed at interrupting the local transmission cycle of this infection.

Resumo A pandemia da “novel coronavirus disease” 2019 (COVID-19), infecção causada pelo coronavírus 2 da síndrome respiratória aguda grave (SARS-CoV-2), tem descortinado uma realidade até então oculta: a vulnerabilidade da população residente em instituições de longa permanência para idosos (ILPI). Diversas publicações científicas têm revelado a concentração de até 60% dos óbitos atribuídos à COVID-19 em tais instituições. A maioria dos residentes em ILPI reúnem os principais fatores de risco para morbimortalidade pela COVID-19, o que torna imprescindível a definição de ações voltadas à prevenção da transmissibilidade do SARS-CoV-2 neste ambiente, além das medidas usuais de distanciamento social e isolamento dos portadores da doença. Propõem-se, no presente artigo, estratégias de rastreamento da infecção em residentes e trabalhadores de ILPI por meio de testes laboratoriais disponíveis no Brasil. A identificação precoce de indivíduos portadores do SARS-CoV-2 com possibilidades de transmissão ativa e continuada do vírus permite a adoção de medidas que interrompam o ciclo de transmissão local da infecção.

Abstract An infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the 2019 Novel Coronavirus Disease (COVID-19) pandemic has unveiled a hitherto hidden reality: the vulnerability of the population living in long-term care facilities for the elderly (LTCF). To date, several scientific publications have revealed a concentration of up to 60% of deaths attributed to COVID-19 in such institutions. Most LTFC residents share the primary risk factors currently associated with increased morbimortality due to the COVID-19 infection. It is crucial to define actions to prevent SARS-CoV-2 spread in this environment, besides the usual measures of social distancing and isolation of the carriers of this disease. This paper proposes strategies for the investigation of this infection in LTCF residents and workers using laboratory tests available in Brazil. The early identification of individuals with SARS-CoV-2, who may actively and continuously spread the virus, allows adopting measures aimed at interrupting the local transmission cycle of this infection.

As alterações neurocognitivas associadas ao HIV (HAND) são relativamente frequentes entre pacientes infectados pelo HIV, porém são subdiagnosticadas. Avaliação de HAND na prática clínica diária é desafiador e diferentes ferramentas têm sido propostas. Objetivo : Avaliar fatores de risco e comparar diferentes ferramentas de rastreamento de alterações neurocognitivas em pacientes infectados pelo HIV. Métodos : Pacientes infectados pelo HIV foram avaliados usando a Escala Internacional de Demência pelo HIV (IHDS), Mini Exame do Estado Mental (MEEM) e um questionário de autopercepção neurocognitiva recomendado pela Sociedade Clínica Europeia de AIDS. Dados sociodemográficos, clínicos e laboratoriais foram obtidos por revisão de prontuário e entrevista com o paciente. Resultados : Entre os 63 pacientes incluídos no estudo, um baixo desempenho no IHDS foi observado em 54,0% e o escore no IHDS esteve inversamente associado à idade (OR 0,13; IC95% [0,02-0,67]). Em relação à autopercepção cognitiva, 63,5% dos pacientes não relataram nenhum prejuízo nos três domínios avaliados pelo instrumento. Nenhum paciente apresentou escore no MEEM abaixo do ponto de corte ajustado para escolaridade. Conclusão : Escores no IHDS sugestivos de HAND foram observados em mais da metade dos pacientes e valores mais baixos foram encontrados entre pacientes mais velhos. Houve pouca concordância entre os diferentes métodos de avaliação, sugerindo que o MEEM é inadequado para avaliação de HAND e o questionário de auto-avaliação tem uma baixa sensibilidade, não parecendo ser útil como ferramenta de triagem.

HIV-associated neurocognitive disorder (HAND) is relatively frequent among HIV-infected patients and is often underdiagnosed. Assessment of HAND in daily clinical practice is challenging and different tools have been proposed. Objective : To evaluate risk factors and compare different screening tools for neurocognitive impairment in HIV-infected patients. Methods : HIV-infected patients were evaluated using the International HIV-Dementia Scale (IHDS), Mini-Mental State Examination (MMSE) and a neurocognitive self-perception questionnaire recommended by the European AIDS Clinical Society. Sociodemographic, clinical and laboratory data were obtained through chart review and patient interview. Results : Among the 63 patients included, low performance on the IHDS was observed in 54.0% and IHDS score was inversely associated with age (OR 0.13; 95%CI [0.02-0.67]). Regarding cognitive self-perception, 63.5% of patients reported no impairment on the three domains covered by the questionnaire. Among those patients self-reporting no problems, 42.1% had low performance on the IHDS. None of the patients scored below the education-adjusted cut-off on the MMSE. Conclusion : IHDS scores suggestive of HAND were observed in more than half of the patients and lower scores were found among older patients. There was low agreement between the different tools, suggesting that the MMSE may be inadequate for assessing HAND. The self-assessment questionnaire had low sensitivity and might not be useful as a screening tool.

IntroductionThe prevalence of sexual dysfunction (SD) and dissatisfaction with sexual life (DSL) in patients with chronic hepatitis C virus infection (CHC) was jointly investigated via a thorough psychopathological analysis, which included dimensions such as fatigue, impulsiveness, psychiatric comorbidity, health-related quality of life (HRQL) and sociodemographic and clinical characteristics.MethodsMale and female CHC patients from an outpatient referral center were assessed using the Brief Fatigue Inventory, the Barrat Impulsiveness Scale, the Beck Depression Inventory (BDI), the Hospital Anxiety and Depression Scale, the Hamilton Anxiety Scale (HAM-A), and the World Health Organization Quality of Life Scale-Brief Version (WHOQOL-BREF). Structured psychiatric interviews were performed according to the Mini-International Neuropsychiatric Interview. SD was assessed based on specific items in the BDI (item 21) and the HAM-A (item 12). DSL was assessed based on a specific question in the WHOQOL-BREF (item 21). Multivariate analysis was performed according to an ordinal linear regression model in which SD and DSL were considered as outcome variables.ResultsSD was reported by 60 (57.1%) of the patients according to the results of the BDI and by 54 (51.4%) of the patients according to the results of the HAM-A. SD was associated with older age, female gender, viral genotype 2 or 3, interferon-α use, impulsiveness, depressive symptoms, antidepressant and benzodiazepine use, and lower HRQL. DSL was reported by 34 (32.4%) of the patients and was associated with depressive symptoms, anxiety symptoms, antidepressant use, and lower HRQL.ConclusionsThe prevalence of SD and DSL in CHC patients was high and was associated with factors, such as depressive symptoms and antidepressant use. Screening and managing these conditions represent significant steps toward improving medical assistance and the HRQL of CHC patients.

INTRODUCTION: Chronic hepatitis C virus infection patients have higher rates of psychiatric disorders than the general population. Chronic hepatitis C virus infection is known to be associated with impaired health related quality of life. To our knowledge, there is no previous research of health related quality of life in chronic hepatitis C patients that combined structured psychiatric interview and careful psychopathological evaluation, including depression, anxiety and fatigue instruments. The aim of this study was to evaluate health related quality of life of chronic hepatitis C patients and to investigate the association with sociodemographic, psychopathological and psychiatric factors. MATERIALS AND METHODS: Eighty-one individuals with chronic hepatitis C virus infection receiving care at a Brazilian public university-based outpatient service for infectious diseases were enrolled in the study. The World Health Organization Quality of Life Scale Brief Version was used to assess health related quality of life. Standard psychiatric interview (Mini International Neuropsychiatric Interview-Plus) was conducted to establish Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I psychiatric diagnosis. Further instruments completed psychopathological investigation: Beck Depression Inventory, Hospital Anxiety and Depression Scale, Brief Fatigue Inventory, Hamilton Depression Scale and Hamilton Anxiety Scale. Pearson Chi-Square and Kruskal-Wallis were performed for categorical and continuous univariate analysis, respectively. Correlation between psychopathological and health related quality of life scores was performed according to Spearman's correlation. Multivariate analysis was performed according to stepwise forward ordinal logistic regression. The significance threshold was fixed at α = 0.05. RESULTS: Depressive disorders were associated with worse scores in overall health related quality of life and in all domains. Fatigue was associated with lower scores in physical and psychological domains, and married status with higher scores in psychological health related quality of life. We found strong correlation among scores of depression, fatigue and health related quality of life. CONCLUSION: Depression and fatigue must be properly investigated and managed in HCV patients in order to improve HRQL. WHOQOL-BREF proved to be a useful instrument to assess HRQL in HCV patients.

Introduction Rapid diagnostic tests (RDTs) may improve the early detection of visceral leishmaniasis (VL), but their real-world performance requires additional study. Therefore, we evaluated the performance of an rK39-based RDT (Kalazar Detect™) for the detection of VL in an endemic, large urban area. Methods Data were collected from a registry of rK39 RDT performed at 11 emergency care units in Belo Horizonte, Brazil, and from a national database of reportable communicable diseases of the Sistema de Informação de Agravos de Notificação (SINAN). Results The rapid rK39 test was performed in 476 patients, with 114 (23.9%) positive results. The analysis of rK39 RDT performance was based on 381 (80%) cases reported to the SINAN database, of which 145 (38.1%) were confirmed cases. Estimates for sensitivity and specificity were 72.4% (95% CI: 64.6-79%) and 99.6% (95%CI: 97.6-99.9%), respectively. Positive and negative predictive values were estimated at 99.1% (95%CI: 94.9-99.8%) and 85.5% (95%CI: 80.8-89.1%), respectively. In addition, close agreement between the rK39 RDT and indirect immunofluorescence was observed. Conclusions In summary, the rK39 RDT showed a high specificity but only moderate sensitivity. In endemic areas for VL, treatment may be considered in cases with clinical manifestations and a positive rK39 RDT, but those with a negative test should be subjected to further investigation.

The host immune response plays an important role in viral clearance in patients who are chronically infected with hepatitis C virus (HCV) and are treated with interferon and ribavirin. Activation of the immune system involves the release of pro and anti-inflammatory molecules that can be measured in plasma samples. The present study aimed to evaluate the association between pretreatment plasma levels of chemokines and soluble tumor necrosis factor receptors (sTNF-R) and the virological response in treated patients with chronic hepatitis C infection. Forty-one chronically-infected HCV patients that were being treated with interferon-α (IFN-α) plus ribavirin were included in the study. Socio-demographic, clinical and laboratory data were collected and pretreatment plasma levels of chemokine CCL2, CCL3, CCL11, CCL24, chemokine CXCL9, CXCL10, sTNF-R1 and sTNF-R2 were measured. The virological response was assessed at treatment week 12, at the end of treatment and 24 weeks after treatment. Pretreatment CXCL10 levels were significantly higher in patients without an early virological response (EVR) or sustained virological response (SVR) compared to responders [512.9 pg/mL vs. 179.1 pg/mL (p = 0.011) and 289.9 pg/mL vs. 142.7 pg/mL (p = 0.045), respectively]. The accuracy of CXCL10 as a predictor of the absence of EVR and SVR was 0.79 [confidence interval (CI) 95%: 0.59-0.99] and 0.69 (CI 95%: 0.51-0.87), respectively. Pretreatment plasma levels of the other soluble inflammatory markers evaluated were not associated with a treatment response. Pretreatment CXCL10 levels were predictive of both EVR and SVR to IFN-α and ribavirin and may be useful in the evaluation of candidates for therapy.

Hepatitis C is an important burden worldwide being an important cause of cirrhosis and liver cancer in different parts of the world. Host immune response, especially T helper type 1 (Th1) cell-mediated, seems to play an important role in disease progression but is also crucial for viral elimination following specific therapy. Immune activation can be evaluated using peripheral levels of different cytokines, such as different chemokines (e.g. CCL5, CXCL10) and tumor necrosis factor alpha (TNF-α), and their soluble receptors (e.g. soluble TNF-α receptors 1 (sTNF-R1) and 2 (sTNF-R2). This review article focuses on the potential use of peripheral inflammatory markers as predictors of liver histological changes and therapeutic response among patients with chronic hepatitis C.

Pegylated interferon-alpha combined with ribavirin is the current gold standard treatment for chronic hepatitis C. Illicit drug dependence is not a rare co-morbidity among chronic hepatitis C population, what can make antiviral treatment an outmost challenge. Despite high sustained virological response rate following antiviral treatment, serious psychiatric adverse reactions may occur, like depression and suicide attempt. We report a patient with recurrent depressive disorder, previous history of suicide attempt and illicit drug dependence. We discuss the singularities and challenges of managing this patient in order to complete the antiviral treatment.

Foram revisados prontuários e radiografias de 38 pacientes infectados pelo HIV com culturas de escarro ou lavado broncoalveolar positivas para Mycobacterium tuberculosis no intuito de comparar características clínicas, radiológicas e baciloscópicas de pacientes HIV-positivos com tuberculose pulmonar de acordo com a contagem de linfócitos CD4. A idade média dos pacientes foi 32 anos e 76% eram homens. Mediana de CD4 foi 106 cells/mm³ e 71% tinham CD4 <200cel/mm³. Baciloscopia de escarro foi positiva em 45%. Pacientes com CD4 <200 cel/mm³ apresentaram significativamente menos padrão pós-primário (p=0,02) e relataram emagrecimento mais freqüentemente (p=0,04). Embora sem significância estatística, pacientes com contagem mais baixa de CD4 apresentaram menor positividade na baciloscopia de escarro (p=0,18). Pacientes HIV-positivos com tuberculose pulmonar confirmada por cultura apresentam alta proporção de padrão diferentes do pós-primário na radiografia torácica. Pacientes com CD4 abaixo de 200 cells/mm³ apresentaram menos freqüentemente padrão pós-primário e maior proporção relatou perda de peso.

Medical charts and radiographs from 38 HIV-infected patients with positive cultures for Mycobacterium tuberculosis from sputum or bronchoalveolar lavage were reviewed in order to compare the clinical, radiographic, and sputum bacilloscopy characteristics of HIV-infected patients with pulmonary tuberculosis according to CD4+ lymphocyte count (CD4). The mean age of the patients was 32 years and 76% were male. The median CD4 was 106 cells/mm³ and 71% had CD4 < 200 cells/mm³. Sputum bacilloscopy was positive in 45% of the patients. Patients with CD4 < 200 cells/mm³ showed significantly less post-primary pattern (7% vs. 63%; p = 0.02) and more frequently reported weight loss (p = 0.04). Although not statistically significant, patients with lower CD4 showed lower positivity of sputum bacilloscopy (37% vs. 64%; p = 0.18). HIV-infected patients with culture-confirmed pulmonary tuberculosis had a high proportion of non-post-primary pattern in thoracic radiographs. Patients with CD4 lower than 200 cells/mm³ showed post-primary patterns less frequently and reported weight loss more frequently.

A paralisia periódica é uma complicação rara do aldosteronismo primário na população não asiática. Nós relatamos o caso de uma mulher brasileira que se apresentou à unidade de emergência com tetraparesia proximal simétrica e recebeu posteriormente o diagnóstico de aldosteronismo primário. Este relato de caso mostra que o aldosteronismo primário deve ser incluído no diagnóstico diferencial da paralisia periódica, especialmente entre pacientes hipertensos.

Periodic paralysis is an uncommon complication of primary aldosteronism in the non-Asian population. We describe the case of a Brazilian woman who presented to the emergency room with proximal symmetric tetraparesis that was later diagnosed as primary aldosteronism. This case report shows that primary aldosteronism should be included in the differential diagnosis of periodic paralysis, especially among hypertensive patients.

Few patients with symptomatic neurosyphilis present with signs and symptoms of acute meningitis. Here we report two cases of syphilitic meningitis diagnosed in HIV patients with meningeal syndrome. The first case, a 30-year-old black bisexual male, had concurrent meningeal and ocular syphilis with persistent unusually low CSF glucose levels. He responded well to 21 days of intravenous penicillin therapy. The second case was a 55-year-old female with epilepsy, depression, behavioral disorder and confusion. The diagnosis of HIV infection was made after onset of the syphilitic meningitis. She was treated with 21 days i.v. penicillin with improvement in her clinical condition. The clinical aspects of combined neurosyphilis and HIV infection, plus special features of diagnosis and treatment are discussed.