A atenção à saúde do homem no Brasil permanece um desafio apesar da Política Nacional de Atenção Integral à Saúde do Homem (PNAISH). Este estudo discute as experiências do uso dos serviços pelos homens usuários e relações estabelecidas entre estes e os profissionais médico(a)s em serviços de saúde em Florianópolis, SC. Utilizando pesquisa qualitativa com triangulação de métodos (entrevistas semiestruturadas e grupos focais) em duas Unidades de Saúde da Família, revela-se que a atenção dividida dos médicos e a troca frequente de profissionais impactam negativamente na formação de vínculos. São reconhecidos os benefícios de uma abordagem que atua para além da precisão técnica e destaca-se a importância de estratégias como a manutenção de espaços de troca e escuta. O estudo contribui para a compreensão da implantação da PNAISH na Atenção Primária à Saúde e identifica desafios no cuidado à saúde dos homens.

La atención de la salud del hombre en Brasil continúa siendo un desafío, a pesar de la Política Nacional de Atención Integral a la Salud del Hombre (PNAISH). Este estudio discute las experiencias del uso de los servicios por parte de los hombres usuarios y las relaciones establecidas entre ellos y los profesionales médicos(as) en servicios de salud en Florianópolis (Estado de Santa Catarina). Utilizando la investigación cualitativa con triangulación de métodos (entrevistas semiestructuradas y grupo focales) en dos Unidades de Salud de la Familia, se revela que la atención dividida de los médicos y el cambio frecuente de profesionales causan un impacto negativo en la formación de vínculos. Reconoce los beneficios de un abordaje más allá de la precisión técnica y subraya la importancia de estrategias tales como mantenimiento de espacios de intercambio y escucha. El estudio contribuye para la comprensión de la implantación de la PNAISH en la Atención Primaria de la Salud e identifica desafíos en el cuidado de la salud de los hombres.

Despite the introduction of the National Policy for Comprehensive Men's Health Care (PNAISH, acronym in Portuguese), men’s health care remains a challenge in Brazil. This article discusses men's experiences of using health services in Florianópolis (SC) and doctor-male patient relationships. We conducted a qualitative study using methodological triangulation (semi-structured interviews and focus groups) in two family health centers. The findings reveal that divided doctor attention and high professional turnover have a negative impact on the formation of bonds. The results also highlight the benefits of approaches that extend beyond technical precision and the importance of strategies such as providing spaces for sharing experiences and listening. This study contributes to understanding the implementation of PNAISH in primary health care settings and underlines the challenges facing men's health care in Brazil.

RESUMO A resistência bacteriana a antibióticos (AMR-Bacteria) é um dos principais problemas de saúde global. Somente no ano de 2019, estimou-se que 1,27 milhão de pessoas morreu devido a complicações por doenças bacterianas resistentes. A abordagem One Health é a principal estratégia no enfrentamento da AMR-Bacteria. Assim, este ensaio objetiva refletir sobre a aplicação da abordagem Saúde Única no enfrentamento da AMR-Bacteria no âmbito da agropecuária. A AMR-Bacteria está parcialmente relacionada à produção intensiva de alimentos de origem animal. Um dos principais desafios para implantação da abordagem é a falta de comunicação entre atores. A solução para esse impasse perpassa o treinamento transdisciplinar para a formação de redes de pesquisa e desenvolvimento de ferramentas de vigilância. A Saúde Única pressupõe a negociação para construir políticas públicas sustentáveis. A busca por estratégias para o enfrentamento de AMR-Bacteria perpassa levar em consideração o equilíbrio entre a questão econômica da produção de alimentos, o bem-estar físico dos animais e os efeitos para o meio ambiente. Aqueles que desejam pôr em prática a abordagem devem formar equipes, combinar métodos e técnicas e envolver diferentes atores. A partir do olhar da Saúde Única pode-se conhecer melhor como ações humanas contribuem com a disseminação de AMR-Bacteria.

ABSTRACT The bacterial resistance to antibiotics (AMR-Bacteria) is one of the main global health problems. In 2019 alone, it was estimated that 1.27 million people died due to complications from resistant bacterial diseases. The One Health approach is the primary strategy in addressing AMR-Bacteria. Thus, this essay aimed to reflect on the application of the One Health approach in addressing AMR-Bacteria within the scope of agriculture. AMR-Bacteria is partially related to the intensive production of animal-origin foods. One of the main challenges for implementing the approach is the lack of communication among stakeholders. The solution to this impasse involves transdisciplinary training to form research networks and develop surveillance tools. One Health presupposes negotiation to build sustainable public policies. The search for strategies to address AMR-Bacteria involves considering the balance between the economic issue of food production, the physical well-being of animals, and the effects on the environment. Those wishing to implement the approach must form teams, combine methods and techniques, and involve different stakeholders. Through the lens of One Health, one can better understand how human actions contribute to the spread of AMR-Bacteria.

BACKGROUND. Tuberculosis (TB) is a major contributor to mortality among patients affected by HIV. TB diagnosis can be challenging, especially in those who are severely ill and unable to produce sputum. Urine lipoarabinomannan (LAM) is a rapid point-of-care diagnostic tool that is used on urine. The dilemma arises if a urine LAM test yields a negative result when the clinical presentation is strongly suggestive of TB. OBJECTIVE. To investigate how a urine LAM test result changes the physician's decision to start TB treatment in people living with HIV in Kalafong Provincial Tertiary Hospital (KPTH). METHOD. A cross-sectional study was done at KPTH in the internal medicine wards, family medicine and HIV outpatient departments. Patients who were HIV positive with a strong TB diagnosis suspicion, had a CD4 count <200 cells/mm³, were aged >13 years and had a urine LAM done to investigate TB were included. Outcomes investigated were: presenting symptoms, clinical signs, radiological and haematological investigations, including CD4 count and HIV viral load, urine LAM results and whether TB treatment was initiated or not. At KPTH, a register of all patients who have been given a urine LAM test is held at the TB notification centre, which was where the information regarding urine LAM results was retrieved from, as well as whether treatment was initiated or not. The patients' clinical hospital records and National Health Laboratory Service lab results were retrieved for necessary information. RESULTS. There were 430 patient records and urine LAM results retrieved: 307 (71.4%) had negative results and 123 (28.6%) had positive results. Of the 307 (71.4%) with a negative result, 120 (39.1%) were initiated on treatment, and only 3 of those who had positive results (1.6%) did not receive treatment. The urine LAM test results appeared to influence clinicians' decisions to treat when the result was positive. If the urine LAM was negative, clinicians still initiated treatment based on adequate clinical suspicion and other investigations. There was significant incongruency between patients with a negative urine LAM test who received TB treatment (p<0.001). CONCLUSION. The use of the urine LAM did not change the physician's decision to start TB treatment where the was a high suspicion of TB based on clinical presentation and other investigations. Physicians depended more on their clinical intuition where the urine LAM was negative.

BACKGROUND: In resource-limited emergency settings, blood testing is crucial for diagnostics but can lead to financial strain and diagnostic challenges if used indiscriminately. This quality improvement project (QIP) aimed to identify commonly requested blood tests in an emergency department (ED), assess their appropriateness, and establish evidence-based guidelines for judicious use. This project was conducted during the family medicine rotation of interns at a tertiary hospital in a semi-urban area. METHODS: The Plan-Do-Study-Act (PDSA) method was employed. Pre- and post-intervention data were collected. An educational intervention, featuring informative visual aids was implemented to help guide the medical practitioners in the unit on appropriate blood test ordering RESULTS: The intervention led to a significant 48.7% reduction in total daily blood tests ordered, with a notable decrease in full-panel requests and an increase in individual test ordering. CONCLUSION: Educational interventions, aimed at guiding blood test requests, can significantly reduce unnecessary testing. Long-term data collection is necessary to confirm sustained changes in practice. CONTRIBUTION: Our findings indicate that clear, evidence-based guidelines for the judicious use of blood tests can positively impact test ordering, particularly in resource-limited settings, and suggest opportunities for further long-term studies.

Achieving good health and well-being for all South Africans is a significant national issue. In the broader context, good health and well-being are also global issues, and as such, they are the primary focus of one of the United Nations' 17 Sustainable Development Goals (SDGs) - SDG 3. It represents a complex challenge that interfaces with the other 16 SDGs and cuts across all dimensions of sustainable development: politico-legal and governance, social, economic, and environmental. In responding to the complex challenge, certain paradigm shifts are needed, including moving from transactional to transformational approaches where all stakeholders are part of solutions for the collective good. This entails building trust across stakeholder groups for effective collaboration and generating and applying innovative and creative solutions. A preliminary pathway to impact is proposed to advance the conversation.

BACKGROUND: Mortality secondary to acute appendicitis (AA) is reported to be less than 6% but is higher in patients with a complicated presentation or those who have co-morbidities OBJECTIVE: To determine factors associated with mortality in patients presenting with acute appendicitis to a large tertiary hospital in Johannesburg, South Africa METHODS: Records of patients 18 years and older, admitted with AA over 5 years, were reviewed retrospectively. Data collected included demographic information, co-morbidities, clinical and laboratory findings, surgical treatment, and clinical outcomes RESULTS: Two hundred and thirty-one patients met the inclusion criteria. Of this cohort, 71% (164/231) were males. The mean age of the study group was 31 ± 12.2 years, and 69.3% were between 20 and 40 years old. Twenty-nine (12.6%) patients were HIV positive, the majority (82.8%) of whom were male. Fifty-eight (25.3%) had complicated AA. Eighteen (7.8%) patients died, of whom 83.3% (15/18) were male. Fifty percent (9/18) of the deaths occurred in the 40-60 age group (p=<0.001). Thirteen (72.2%) of those who died presented to the hospital more than 72 hours after the initial onset of symptoms. The median CRP of those who died (247.5 mg/L) was significantly higher compared to the survivors (99 mg/L) (p= 0.001 CONCLUSIONS: In this study, a quarter of the patients with AA presented with a complicated disease. Mortality secondary to AA was higher in individuals in the 21- 60-year age group and in patients who presented later than 72 hours following the onset of symptoms

Idiopathic non-cirrhotic portal hypertension is a rare diagnosis with an unknown aetiology. It is characterised by increased intrahepatic portal pressures in the absence of underlying liver disease. We present a unique case of a 32-year-old male patient who presented with a right hydrocele and an incidental finding of pancytopenia, massive splenomegaly, and features of portal hypertension. After known causes of portal hypertension were excluded, a liver biopsy was performed. Based on the liver biopsy findings, which demonstrated fibrotic portal tracts in the absence of cirrhosis and exclusion of other known causes of portal hypertension, our patient was diagnosed with idiopathic non-cirrhotic portal hypertension. Due to the persistent presence of hypersplenism and recurrent episodes of oesophageal variceal bleeding, our patient underwent a splenectomy, after which his features of portal hypertension resolved.

This article presents a rare case of a 26-year-old male admitted to the hospital following a mob assault and was initially diagnosed with an acute subdural hematoma. Following a sizable decompressive craniectomy, a subsequent complication of bi-frontal acute extradural hematoma was identified. We discuss this rare occurrence's pathophysiology, diagnosis, awareness, and management, shedding light on the challenges and considerations in such cases.

PURPOSE: Osteoporosis and fragility fractures are expected to rise in a rapidly aging South African population. However, currently, there are limited prevalence studies available for this population METHODS: We assessed the prevalence of osteoporosis from all Dual-energy X-ray absorptiometry (DEXA) scans on referral to a tertiary academic hospital in Johannesburg, South Africa. All DEXA scans were analyzed between January 01, 2006, and December 31, 2021. The World Health Organization (WHO) criteria were used to diagnose osteoporosis RESULTS: Of the 2264 DEXA scans analysed, 880 were osteoporotic (96.4% females, 3.6% males), with an overall osteoporosis prevalence of 38.8% (CI 38.6-40.8). The prevalence increased with age. Bone mineral density T-scores were lower in subjects with lower body mass index. The vertebral body with the highest prevalence of fractures was thoracic level T12. There were no significant differences when comparing T-scores by various bony regions between males and females above age 50 CONCLUSION: In those referred for DEXA scans, this study found a high prevalence of osteoporosis, especially in the older South African population, with notable levels in postmenopausal women. Being underweight was associated with increased severity. We also found a higher incidence of vertebral deformities with increasing age

BACKGROUND: Since COVID-19 became a global pandemic in 2020, Computed tomography (CT) chest and CT pulmonary angiography (CTPA) have been identified to be highly sensitive for identifying pulmonary features and complications OBJECTIVES: The study aimed to describe the typical imaging findings on CT chest imaging and the prevalence of pulmonary embolism in COVID-19 patients across three infection periods, each with a dominant virus strain, Beta, Delta, and Omicron variants METHODS: A retrospective review of CT chest and CTPA images for adult patients imaged from October 2020 to March 2022 at three university-affiliated hospitals in Johannesburg was undertaken RESULTS: A total of 307 chest CT scans were reviewed during the study period. The typical imaging findings were ground glass opacities (77%), patchy, peripheral distribution (59%), and septal thickening (59%). Consolidation, pleural effusion, and fibrosis were less frequently visualised. The overall prevalence of pulmonary embolism was 32%. There was no significant statistical difference in the observed imaging features during the three virus strain phases of the epidemic. Fewer imaging studies were done during the Omicron phase, which is attributable to the milder clinical profile of the variant CONCLUSION: The typical imaging pattern for patients with COVID-19 was peripheral, patchy ground glass opacities with interlobar septal thickening. Fibrotic banding and bronchiectasis were also frequently noted, especially when imaged late. Pulmonary embolism was found in almost a third of patients. No differences in imaging patterns were found during the various phases of the COVID-19 epidemic

Leukocytoclastic vasculitis is a hypersensitivity reaction involving immune complex deposition in dermal capillaries and venules. We report a case of a 34-year-old female patient with left-sided breast carcinoma who developed vasculitis following autologous left breast augmentation, confirmed histologically. Various aspects of the patient's treatment history may be implicated in the development of her leukocytoclastic vasculitis, including chemotherapy and radiation therapy, antibiotics, and the presence of breast carcinoma (leukocytoclastic vasculitis as a paraneoplastic syndrome). Based on the temporal relationship, histological findings, and the site of these pruritic lesions, we postulate that autologous breast augmentation is the most likely aetiology for the leukocytoclastic vasculitis in our patient, an association not previously reported.

BACKGROUND: Head and neck cancers are increasing in Africa, and head and neck defects commonly result from the excision of cancers. Although global studies have reported that the use of anterolateral thigh flaps (ALTF) can safely restore form and function, there are no reports from Africa regarding the efficacy of ALTF in managing these cancers. We report on the experience with the ALTF in the treatment of these cancers from a tertiary academic center in Johannesburg, South Africa METHODS: The study was a retrospective review of all patients admitted to our institution and who underwent ALTF over 5 years between January 2014 and December 2018. Inclusion criteria were head and neck patients who were 18 years or older, fit for a lengthy operation, and with stable medical conditions. Thirty-three patients met the criteria for the study RESULTS: Most patients (n=24) were male with squamous cell carcinoma (78.8%) of the oral cavity. Seven patients suffered complications either at the recipient or the donor site. At the donor site the complication was partial loss (12.1%) of the skin graft. At the recipient site complications were low and included vascular compromise (6%), dehiscence (3%), or complete flap loss (3%). However, there was a total flap survival in 97% of patients CONCLUSION: Reconstruction using the ALTF had a low complication rate and excellent flap survival. These results encourage frequent use of this method of reconstruction for head and neck defects

Abstract Nuclear Medicine plays an important role in the management of patients with chronic diseases, especially oncological and cardiovascular conditions. In this study, an analysis of the evolution of this field in Brazil was conducted within the framework of the Unified Health System. Retrospective analyses from 2015 to 2021 of public data were performed. Although Brazil has a considerable number of facilities, their geographical distribution is uneven. The same disparity is observed in relation to units that produce and distribute radiopharmaceuticals, limiting access for the Brazilian population, particularly to those with a half-life of less than two hours. There is a noticeable high technological dependence on foreign companies, with little or no domestic production, contributing to a deficit in the trade balance. Despite the increasing demands due to factors such as population aging and epidemiological changes, the area did not expand. It is crucial to implement social and economic policies to reduce vulnerabilities in the public healthcare system, ensure its sustainability, and promote equal and universal access to Nuclear Medicine.

Resumo A Medicina Nuclear desempenha um importante papel no manejo de pacientes com doenças crônicas, especialmente oncológicas e cardiovasculares. Neste estudo, foi realizada uma análise da evolução da área no Brasil, no âmbito do Sistema Único de Saúde. Para tanto, foram realizadas análises restrospectivas entre 2015 e 2021 de dados públicos. Embora o Brasil possua uma quantidade considerável de instalações, sua distribuição geográfica é desigual. A mesma disparidade é observada em relação às unidades produtoras e distribuidoras de radiofármacos, limitando o acesso da população brasileira, particularmente àqueles com meia-vida inferior a duas horas. Percebe-se a alta dependência tecnológica de empresas estrangeiras, com pouca ou nenhuma produção nacional, o que contribui para o déficit na balança comercial. Apesar das possíveis demandas crescentes sobre a área devido a fatores como o envelhecimento da população e mudanças epidemiológicas a área não se expandiu. É crucial implementar políticas sociais e econômicas voltadas à área para reduzir as vulnerabilidades do sistema de saúde, assegurar sua sustentabilidade e promover um acesso igualitário e universal aos serviços de Medicina Nuclear.

Resumen La Medicina Nuclear tiene un papel importante en el manejo de pacientes con enfermedades crónicas, especialmente oncológicas y cardiovasculares. Este estudio realizó un análisis de la evolución del área en Brasil, en el ámbito del Sistema Único de Salud brasileño. Para ello, se realizaron análisis retrospectivos entre 2015 y 2021 de datos públicos. Si bien Brasil tiene un número considerable de instalaciones, su distribución geográfica es desigual. Se observa la misma disparidad respecto a las unidades productoras y distribuidoras de radiofármacos, lo que limita el acceso de la población brasileña, particularmente aquellos con vida media inferior a dos horas. Existe una alta dependencia tecnológica de empresas extranjeras, con poca o nula producción nacional, lo que contribuye al déficit de la balanza comercial. A pesar de la posible demanda creciente en el área debido a factores como el envejecimiento de la población y los cambios epidemiológicos, este campo no se ha expandido. Es crucial implementar políticas sociales y económicas enfocadas en el área para reducir las vulnerabilidades del sistema de salud, asegurar su sostenibilidad y promover el acceso igualitario y universal a los servicios de Medicina Nuclear.

The Dipteryx genus, a member of the Fabaceae family with approximately 14 species, is found in Brazil’s Amazon Rainforest, Northeast and Central regions, and Central America. Plants of this genus are used in popular medicine and contain coumarins, flavonoids, terpenoids, and fatty acids. Dipteryx lacunifera Ducke, known as “garampara” or “fava de morcego”, occurs in Brazil’s central-north region and has economic and energy value, along with antioxidant properties. For this study, ethyl acetate and ethylic ether soluble fraction of ethanol extract were subjected to chromatographic analysis leading to the isolation of two flavonoids, vitexin (1) and isoquercetin (6). In addition, analysis by electrospray ionization-ion trap mass spectrometry (ESI(-)-ITMS) and ultra-performance liquid chromatography coupled with electrospray ionization quadrupole-time-of-flight mass spectrometry (UPLC-ESI-QTOF-MS/MS) annotated twenty-one compounds (1-21), with seventeen of these being reported for the first time in D. lacunifera. Molecular network (GNPS) analysis grouped compounds (7-21) into flavonoids-O-glucoside, flavononol-O-glucoside, flavone-C-glucoside, proanthocyanidin, flavonol, and flavonoid-O-methoxylated classes. The FEtOAc fraction demonstrated potential antioxidant activity (half maximal effective concentration (EC50) 39.50 ± 6.51 mg mL−1), suggesting it as a promising source of antioxidants. However, neither fraction exhibited inhibition of tumor cell lines tested. These findings enhance our understanding of the chemical and biological potential of the D. lacunifera species.