Resumo: Introdução: Com o intuito de estimular o exercício do pensamento crítico e da criatividade e considerando a complexidade vinculada ao aprendizado de antibióticos, criou-se o Teste de Sensibilidade artística aos Antimicrobianos (TSaA). Trata-se de uma atividade inovadora no ensino de antimicrobianos que avalia conhecimento e raciocínio clínico por meio de apresentações envolvendo a arte. Desde o segundo semestre de 2014, o TSaA mostrou-se uma prática integrativa no ensino de antimicrobianos para estudantes de Medicina do quinto semestre da Universidade de Fortaleza (Unifor). O objetivo deste estudo foi analisar o TSaA como metodologia de ensino/aprendizagem sobre antimicrobianos e a satisfação dos alunos com essa atividade. M étodos: Os alunos do quinto semestre do curso de Medicina foram divididos em oito grupos de 12 alunos. Os alunos receberam o desafio de utilizar a arte como ferramenta de comunicação para mostrar os seus conhecimentos sobre antimicrobianos. Cada grupo ficou responsável por apresentar conteúdos relacionados a uma classe de antimicrobiano previamente sorteada. A apresentação da atividade foi avaliada por dois docentes simultaneamente que utilizaram um instrumento específico para esse fim. Ao término do TSaA, os alunos foram convidados a responder a um questionário que abordava questões sobre a sua percepção acerca da atividade, os benefícios no contexto da aprendizagem e as dificuldades identificadas. As perguntas eram tanto objetivas quanto abertas. Resultados: Participaram do estudo 92 estudantes. A metodologia adotada para a atividade foi considerada adequada para 82% dos participantes. As formas de apresentação mais utilizadas foram encenação e música. A maioria dos participantes percebeu o TSaA como uma estratégia valiosa de facilitação de aprendizagem sobre antimicrobianos. A associação do estudo do antibiótico com a arte foi considerada uma forma divertida de aprendizagem do tema, que os levou a trabalhar de forma integrada. Na opinião dos alunos, houve realmente uma maior fixação de conteúdo com essa atividade. Conclusão: O TSaA facilitou a aprendizagem sobre antimicrobianos e estimulou a criatividade e o raciocínio crítico/lógico nos estudantes de Medicina do quinto semestre.

Abstract: Introduction: To stimulate the practice of critical thinking and creativity and considering the complexity associated with antibiotic learning, the Antimicrobial Artistic Sensitivity Test (TSaA) was created, which is an innovative activity in antimicrobial teaching that evaluates knowledge and clinical reasoning through artistic presentations. Since the second semester of 2014 (2014.2), TSaA has proven to be an integrative practice in antimicrobial teaching for fifth-semester medical students of the University of Fortaleza/CE (UNIFOR). The objectives of this study were to analyze TSaA as a methodology of antimicrobial teaching / learning and students’ satisfaction with this practice. Methods: Fifth-semester medical students were divided into eight groups, each one with twelve participants. Students were challenged to show their knowledge of one class of antimicrobial drug using art as the communication tool. Each group was assigned to work with a specific class of antibiotic, which was previously randomly selected. Two teachers simultaneously evaluated the presentation, using a specific form to carry out this evaluation. In the end of the activity, students were invited to answer a questionnaire, with objective and subjective questions, addressing their perceptions of the activity, the benefits on antibiotic learning and identified difficulties. Results: A total of 92 students participated in the study. The methodology used to carry out the TSaA activity was considered adequate by 82% of the participants. Staging performance and music were the most frequently chosen forms of presentation. The majority of the participants indicated TSaA as a valuable strategy to facilitate antimicrobial learning. The association between antibiotic study and art was considered an amusing way of content learning. According to students’ perception, this practice also stimulated teamwork. In the students’ opinion, there was indeed a greater content learning with this activity. Conclusion: The Antimicrobial Artistic Sensitivity Test facilitated antimicrobial learning, stimulating the creativity and critical/logical thinking of fifth-semester medical students.

Resumo: Introdução: Na área médica, a forma de ensinar e aprender vem mudando com o tempo. Dessa forma, a investigação dos atributos que tornam um professor exemplar é importante para formular novas estratégias de ensino na educação médica. O presente estudo objetiva avaliar a percepção dos discentes e docentes do curso de Medicina sobre quais qualidades o docente deve ter para ser considerado um modelo. Método: Trata de um estudo quantitativo, transversal, com estudantes e professores do curso de Medicina da Universidade de Fortaleza (Unifor). Foi aplicado aos participantes um questionário elaborado pelos autores sobre os atributos mais importantes para ser considerado um bom professor. Cada atributo deveria receber peso de 1 a 5 caso o participante o julgasse menos ou mais importante. Resultados: Participaram do estudo 74 professores e 344 alunos. As maiores médias nos dois grupos foram para a “atitude no ambiente de ensino” e “interação com os alunos e colegas”, embora os professores tenham valorizado mais esses domínios (p = 0,03 e p = 0,006, respectivamente). O domínio “características pessoais” foi menos valorizado pelos alunos (p = 0,02). No domínio “atitude no ambiente de ensino”, facilitar a aprendizagem e ter uma atitude ética com o paciente foram as características mais valorizadas, embora os professores tenham valorizado ainda mais este último (p = 0,001). No domínio “interação com os alunos e colegas”, a capacidade de estimular a participação do aluno foi considerada menos importante pelos alunos (p = 0,001). No domínio “características pessoais”, ter entusiasmo pelo ensino foi bastante valorizado, entretanto os professores tenderam a dar um peso maior que os alunos (p = 0,001). A avaliação do domínio “desenvolvimento profissional” mostrou que o envolvimento com pesquisa foi o menos valorizado pelos participantes. Conclusões: Esses resultados sugerem que, para a identificação de um professor exemplar, os dois grupos valorizaram não apenas as atitudes relacionadas à docência, mas sobretudo as atitudes no ambiente de ensino e na interação com alunos e colegas. Sugerem ainda a necessidade de desenvolver estratégias de valorização da pesquisa científica, inclusive com incentivos para uma maior participação dos docentes e discentes, ressaltando a sua a importância na formação médica.

Abstract: Introduction: Learning and teaching methods have changed over time in medical education. Therefore, there is a strong case for investigating the attributes of a model professor in order to formulate new teaching strategies in medical education. This study aimed to ascertain which character traits are viewed in the eyes of medical students and teachers as essential to the profile of a model teacher. Methods: This is a quantitative, cross-sectional study conducted with medical students and teachers of the University of Fortaleza (UNIFOR) School of Medicine. Participants were invited to respond to a questionnaire, developed by the authors, addressing the most important characteristics of a model teacher. The respondents were asked to score each characteristic from 1 to 5 to reflect its respective importance. Results: A total of 418 people were surveyed, of whom 74 were teachers and 344 students. The highest scoring characteristics in both groups were “Attitude in the teaching environment” and “Interaction with students and colleagues”, although teachers placed more value on these attributes (p = 0.03 and p = 0.006 respectively). “Personality traits” was the least appreciated by the students (p = 0.02). In the “Attitude in the teaching environment” category, facilitating learning and maintaining an ethical attitude with the patient were the most valued characteristics in both groups, although the latter was more appreciated by the teachers (p = 0.001). In the “Interaction with students and colleagues” category, the ability to stimulate student participation was considered least important by the students (p = 0.001). Enthusiasm for teaching scored highly in both groups in the “Personality traits” category, though teachers tended to give rate it more highly than the students (p = 0.001). The analysis of the “Professional development” category showed that, for both groups, involvement in research was the least valued characteristic. Conclusions: These results suggest that not only attributes associated with teaching practice, but also teachers’ attitudes in the teaching environment and their interaction with students and colleagues were considered by both groups as important to their identification of a model teacher. They also suggest the necessity for developing strategies to value scientific research and stimulate greater participation of both students and teachers, underlining its importance in medical training.

Abstract INTRODUCTION: Coccidioidomycosis, a disease caused by Coccidioides immitis or Coccidioides posadasii, is endemic in arid climatic regions in Northeast Brazil. Its prevalence is higher among young adult males living in rural areas. Existing literature about this disease in Ceará, a Northeast Brazilian state, are scarce. Here, we aimed to outline the clinical and epidemiological profiles, radiological patterns, and therapeutic responses of patients with coccidioidomycosis in a reference center in Ceará, Brazil. METHODS This is a descriptive study with quantitative analysis. Patients who underwent medical follow-up in São José Hospital of Infectious Diseases and received confirmed mycological diagnosis of coccidioidomycosis between January, 2007 and December 2017 were included. Epidemiological, clinical, radiological, and therapeutic response data were collected from medical charts. RESULTS Thirty patients were included. The patients were males with median age of 30 years, and 73% were considered to have high-risk exposure to Coccidioides owing to professional activities. Cough (96.7%), dyspnea (63.3%), fever (86.7%), and pleuritic pain (60%) were the most prevalent clinical manifestations. Interstitial pattern (91.3%) was the most frequent pulmonary radiological finding. Fluconazole, amphotericin B, and itraconazole were administered for treatment (in 82.1%, 42.8%, and 21.4% of cases, respectively). A favorable outcome was observed in 83.8% of patients. CONCLUSIONS Coccidioidomycosis was more prevalent in the central and southern regions of the State of Ceará. Understanding the local epidemiology and clinical manifestations of the disease, in addition to the pulmonary radiologic findings, may aid the early detection of coccidioidomycosis and facilitate early diagnosis.

Abstract INTRODUCTION: Early diagnosis of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) can decrease transmission and significantly affect morbidity and mortality; however, Brazil still confronts the reality of late HIV diagnosis. METHODS: Medical records of 284 HIV-positive patients were reviewed in this cross-sectional study. RESULTS: Of all patients, 28% were diagnosed in the context of health assessments, whereas 27% were symptomatic at diagnosis. Early HIV infection (Group 1) was diagnosed in 60.2% of participants. They were younger than those with late diagnosis (Group 2) (p = 0.002). CONCLUSIONS: These findings highlight the need for strategies to increase HIV testing in asymptomatic individuals and older patients.

Resumo Introdução: O Protocolo Clínico e Diretrizes Terapêuticas para manejo da infecção pelo HIV em adultos (PCDT) de 2013 recomenda e normatiza início de terapia antirretroviral (TARV) em pacientes com qualquer contagem de LTCD4. O objetivo do estudo foi analisar o primeiro ano de TARV de pacientes em acompanhamento em um centro de referência em HIV/AIDS de Fortaleza, Ceará. Método: O estudo descritivo revisou formulários de solicitação de início e modificação de TARV em pacientes que iniciaram tratamento entre janeiro e julho de 2014. Foram avaliadas todas as mudanças que ocorreram durante o primeiro ano de terapia. Os dados foram analisados no programa Statistical Package for the Social Sciences (SPSS) versão 20. Foram calculados médias, desvios padrão, frequências, testes t Student e Mann-Whitney, com significância de p<0,05. Resultados: Dos 527 pacientes que iniciaram TARV, 16,5% (n=87) realizaram troca no primeiro ano. A maioria era do sexo masculino (59,8%; n=52), de 20 a 39 anos, com apenas uma mudança da TARV (72,4%; n=63). Efavirenz foi o fármaco mais substituído, seguido por tenofovir, zidovudina e lopinavir/ritonavir. O tempo médio de ocorrência das modificações da TARV foi de 120 dias, tendo reações adversas como causas principais. TARV foi efetiva na queda da carga viral desde o 2ºmês de tratamento (p=0,003) e na elevação de LTCD4 desde o 5º mês (p<0,001). Conclusão: Os principais fatores envolvidos em modificações de TARV inicial foram reações adversas, com apenas uma mudança de esquema na maioria dos pacientes. O manejo da TARV estava de acordo com o PCDT de 2013.

Summary Introduction: The Brazilian HIV/AIDS management and treatment guideline (PCDT), published in 2013, recommends and standardizes the use of highly active antiretroviral therapy (HAART) in all adult patients, in spite of LTCD4 count. This study aimed to analyze the first year of HAART use in patients from a reference center on HIV/AIDS management in Fortaleza, Ceará. Method: This descriptive study reviewed all prescription forms of antiretroviral regimens initiation and changes from January to July 2014. All antiretroviral regimen changes that occurred during the first year of therapy were evaluated. Data were analyzed with SPSS version 20. Mean, standard deviation and frequency, Student’s t and Mann-Whitney tests calculations were used, with significance at p<0.05. Results: From 527 patients initiating HAART, 16.5% (n=87) had a regimen change in the first year. These patients were mostly male (59.8%; n=52), aged 20 to 39 years, with only one HAART change (72.4%; n=63). Efavirenz was the most often changed drug, followed by tenofovir, zidovudine and lopinavir/ritonavir. Mean time of HAART changes was 120 days, with adverse reactions as the most prevalent cause. HAART was effective in decreasing viral load since second month of treatment (p=0.003) and increasing LTCD4 lymphocytes since fifth month (p<0.001). Conclusion: The main cause of initial HAART changes was adverse reaction and most patients had only one change in the HAART regimen. HAART prescription was in accordance to the PCDT from 2013.

ABSTRACT Since the beginning of the HIV burden, Visceral Leishmaniasis (VL)/HIV co-infection has been diagnosed not only in areas where VL is endemic (Latin America, India, Asia, Southern Europe), but also in North America, were it is considered an opportunistic disease. Clinical presentation, diagnostic tests sensitivity and treatment response in this population differs from VL alone. OBJECTIVES: To evaluate factors related to an unfavorable outcome in patients with VL/HIV diagnosis in a reference center in northeast Brazil. METHODS: Co-infected patients, diagnosed from 2010 to 2012, were included. Data from medical records were collected until one year after VL treatment completion. RESULTS: Forty-two HIV-infected patients were included in the study. Anemia, leukopenia, and thrombocytopenia were present in 95%, 70.7%, and 63.4%, respectively. Mean T CD4+ (LTCD4) lymphocyte count was 183 cells/dL. Highly active antiretroviral therapy (HAART) was being used by 54.7% of cases. A favorable outcome was seen in 71.4% of cases. Recurrence of VL occurred in nine patients and deaths were secondary to infectious complications (3/42 patients). Very low LTCD4 count (<100 cells/dL) was the only independent variable associated with an unfavorable outcome in multivariate analysis (p = 0.03). CONCLUSION: Low LTCD4 count at presentation was associated with unfavorable outcome in VL/HIV patients.

ContextoA ocorrência da associação de HIV com a hepatite por vírus B (HVB) e C (HVC) é preocupante visto que os pacientes coinfectados tendem a ter uma resposta pior à terapia antiviral e uma chance maior de progredirem para a cronificação da doença hepática e suas complicações. No Brasil, os estudos publicados sobre a prevalência dessas coinfecções ainda são escassos e, muitos deles, com resultados conflitantes entre si. Além disso, muitos pacientes coinfectados são portadores assintomáticos dos vírus das hepatites o que causa um atraso no seu diagnóstico, com consequente subnotificação de casos.ObjetivosEste estudo objetiva determinar a prevalência da infecção pelo HVB e HVC em pacientes recém-diagnosticados com HIV no Ceará/Brasil.MétodosCoorte retrospectivo com pacientes >18 anos, diagnosticados HIV+ de 2008-2010. Foram coletados dados referentes ao primeiro ano de acompanhamento desses pacientes através de revisão de prontuário: fatores de risco para HIV, HBV e HCV e resultados de provas sorológicas para esses vírus.ResultadosForam acompanhados 1291 pacientes HIV+. Testes sorológicos para HBV foram realizados em 52% dos casos: 23% apresentavam hepatite B prévia e 3,7% eram coinfectados. Apenas 25,4% tinham testes sorológicos para HCV: 1,5% tinham hepatite C prévia e 5,4% eram coinfectados. A maioria dos pacientes HBV/HIV referia ter múltiplos parceiros sexuais em um ano. Homossexualismo e bissexualismo estavam presentes em 28% e 20% respectivamente. No grupo HCV/HIV 38,8% referia múltiplos parceiros sexuais em um ano e o uso de drogas endovenosas ocorreu em 22,2% dos casos.ConclusãoO estudo reforça a necessidade de um treinamento dos profissionais de saúde e de facilitação do acesso do paciente ao suporte laboratorial para que seja possível o diagnóstico rápido e precoce das hepatites virais, o que levaria a um adequado manejo clínico desses pacientes e a uma redução da disseminação dessas doenças. O estudo sugere também a necessidade de realização de campanhas educacionais para a população, abordando os riscos de transmissão desses vírus e incentivando a vacinação para o HBV, com o intuito de diminuir a propagação dessas doenças.

ContextThe occurrence of HIV and hepatitis B (HBV) and C (HCV) virus associations is of great concern since co-infected patients respond poorly to antiviral treatment and usually progress to chronic and more complicated hepatic disease. In Brazil, these co-infections prevalence is not well known since published data are few and sometimes demonstrate conflicting results. Also, a significant number of co-infected individuals are HBV/HCV asymptomatic carriers, leading to under notification.ObjectivesThe present study aimed to determine the prevalence of the HBV and HCV infection in a recently diagnosed HIV population in the state of Ceará/Brazil.MethodsRetrospective cohort, with >18yo patients diagnosed HIV+ from 2008-2010. First year medical attention information was collected.ResultsA total of 1.291 HIV+ patients were included. HBV serologies were collected in 52% (23% had previous hepatitis B, 3.7% were co-infected) and HCV in 25.4% (1.5% had previous hepatitis C, 5.4% co-infection). The majority of HBV/HIV patients referred multiple sexual partners/year, 28% homosexualism and 20% bisexualism. In the HCV/HIV group 38.8% individuals had > one sexual partner/year and 22.2% used intravenous drugs.ConclusionThe study reinforce the need for better training healthcare workers and providing laboratory support for a prompt hepatitis diagnosis and adequate medical management to avoid complications and decrease viral spread.

This study was designed to describe the epidemiology and risk factors for nosocomial infection (NI) in a Brazilian neonatal intensive care unit (NICU). This study was a retrospective cohort from January to December, 2003. All neonates admitted to the NICU. Infection surveillance was conducted according to the NNIS, CDC. Chi-square test and logistic regression model were performed for statistical analyses. The study was conducted at a public, tertiary referral NICU of a teaching hospital in the Northeast of Brazil. A total of 948 medical records were reviewed. Overall NI incidence rate was 34%. The main neonatal NI was bloodstream infection (68.1%), with clinical sepsis accounting for 47.2%, and pneumonia was the second most common NI (8.6%). Multivariate analysis identified seven independent risk factors for NIs: birth weight, exposure to parenteral nutrition, percutaneous catheter, central venous catheter or mechanical ventilation, abruptio placentae and mother's sexually transmitted disease (STD). Neonates from mothers with STD or abruptio placentae, those weighing less than 1,500 g at birth or those who used invasive devices were at increased risk for acquiring NI.