SUMMARY Primary hyperparathyroidism (PHPT) is an endocrine disorder characterized by hypercalcaemia and elevated or inappropriately normal concentrations of parathyroid hormone. Remission of PHPT caused by infarction or hemorrhage of a parathyroid adenoma rarely occurs, either spontaneously or induced, not always leading to a definitive cure. We report a case of 72-year-old women with primary hyperparathyroidism who underwent fine-needle aspiration cytology (FNAC) of a parathyroid adenoma mistaken for a thyroid nodule followed by normalization of parathyroid hormone (PTH) and serum calcium levels. Parathyroid origin was confirmed by immunohistochemistry. PTH levels began to rise at 4 months after FNAC demonstrating recurrence of the PHPT. This report shows that FNAC induced hemorrhage may cause remission of PHPT. Nevertheless, patient´s levels of PTH and serum calcium should be monitored, as remission may only be transitory. (PHPT occurs cure 72yearold yearold 72 year old fineneedle fine needle (FNAC (PTH immunohistochemistry Nevertheless patients patient s monitored transitory 7

Asbtract Introduction This study aimed to determine whether cytokine receptor-like factor 2 (CRLF2) antigen expression evaluated using multiparametric flow cytometry (MFC) could predict the genotype of CRLF2 and Janus kinase 2 (JAK2) status for application in the diagnosis of pediatric B-cell precursor acute lymphoblastic leukemia (BCP-ALL). Methods A total of 321 BCP-ALL bone marrow samples were collected, 291 at diagnosis and 13 at first relapse, while 17 samples were excluded due to low cellular viability. The CRLF2 antigen expression was evaluated using flow cytometry (percentage of positivity and median fluorescence intensity [MFI]). The CRLF2 transcript levels were assessed via quantitative reverse transcription polymerase chain reaction using SYBR Green. The CRLF2 rearrangements (CRLF2-r) were identified using the CRLF2 break-apart probe via fluorescence in situ hybridization. Sanger sequencing was performed to identify the JAK2 exon 16 mutations. Results We observed that 60 of the 291 cases (20.6%) presented CRLF2 antigen positivity, whereas the CRLF2 transcript overexpression was found in 19 of 113 cases (16.8%). The JAK2 mutation was found in four out of 116 cases (3.4%), all of which had CRLF2 ≥10% of positive cells and intermediate or high MFI (p < 0.0001). In addition, in the 13 cases with the CRLF2-r, a positive correlation was found with the CRLF2 antigen intermediate (61.5%) MFI (p= 0.017). Finally, the CRLF2-positive antigen was identified in the BCP-ALL subclones. Conclusion The identification of the CRLF2 antigen using the MFC, based on the percentage of positivity and MFI values, is a useful tool for predicting JAK2 mutations and CRLF2-r. receptorlike receptor like CRLF (CRLF2 MFC (MFC JAK (JAK2 Bcell B cell BCPALL. BCPALL BCP ALL . (BCP-ALL) 32 collected 29 1 relapse viability MFI. [MFI]) Green CRLF2r CRLFr r (CRLF2-r breakapart break apart hybridization 6 20.6% 206 20 (20.6% 11 16.8%. 168 16.8% 8 (16.8%) 3.4%, 34 3.4% , 3 4 (3.4%) 10 ≥10 p 0.0001. 00001 0.0001 0 0001 0.0001) addition CRLF2r, r, CRLF2-r 61.5% 615 61 5 (61.5% p= 0.017. 0017 0.017 017 0.017) Finally CRLF2positive CRLFpositive subclones values CRLF2r. r. (CRLF (JAK (BCP-ALL [MFI] 20.6 (20.6 16.8 (16.8% 3.4 (3.4% ≥1 0000 0.000 000 61.5 (61.5 001 0.01 01 [MFI 20. (20. 16. (16.8 3. (3.4 ≥ 0.00 00 61. (61. 0.0 (20 (16. (3. (61 0. (2 (16 (3 (6 ( (1

The aim of this study was evaluate the in vitro antifungal activity of crude extracts from Eugenia uniflora, Libidibia ferrea and Psidium guajava. The extracts were obtained by turbo-extraction using water (AQ) or acetone-water (AC-W) (7:3, v/v) as solvents and lyophilized to obtain the crude extracts (CE). The CE were characterized by UV-Vis, TLC and HPLC. The activity of CEs was investigated against clinical isolates of Candida spp. and the Minimum Inhibitory Concentration (MIC), MIC50 and MIC90 were determinated. The analysis by TLC showed that all CEs presented polyphenols (flavonoids and tannins). The CEs from E. uniflora showed higher amount of polyphenols (30.35 ± 2.15%, AC-W) and the HPLC analysis revealed the tannins in all extracts. The CEs of E. uniflora showed MIC range from 1.9 to 500.0 µg/mL, and lower values of MIC50 and MIC90 against non-albicans Candida isolates. Regarding L. ferrea and P. guajava, the results showing MIC from 3.9 to 1000.0 µg/mL (CE-AQ) against C. albicans. The results demonstrate antifungal performance from CE against various species of Candida spp., suggesting that the herbal species may be use as new potential antifungal agents. Additionally, the polyphenol content can play a pivotal role in the antifungal properties of CE.

Resumo Este estudo objetivou investigar saberes de alunos de medicina sobre espiritualidade e religiosidade no cuidado ao paciente. Trata-se de pesquisa exploratória, descritiva, quantitativa, pautada no Spirituality and Brazilian Medical Education, desenvolvida em duas escolas médicas do Ceará, Brasil. Os 437 participantes preencheram questionário posteriormente processado por análise descritiva. Os resultados apontaram que esses estudantes conhecem os significados e a relevância de espiritualidade e religiosidade na assistência ao paciente, mas ainda não se sentem preparados para a abordagem completa, em virtude das limitações de aprendizagem na formação acadêmica. Conclui-se que precisam aprender mais sobre a temática para efetiva abordagem do assunto com o paciente. Para tanto, é importante que as escolas médicas acrescentem o tema à matriz curricular.

Abstract The objective of this study was to investigate the knowledge of medical students about spirituality and religiosity in relation to patient care. It is an exploratory, descriptive, quantitative research, based on Spirituality and Brazilian Medical Education, developed in two Medical Schools of Ceará, Brazil. A total of 437 medical students answered a questionnaire, which was processed by descriptive analysis. The results showed that medical students know the meaning and relevance of spirituality and religiosity in the patient care process, however, they do not feel ready to approach the matter in a more complete way because of limitations in academic training. It is concluded that these students need to learn more about the subject for an effective approach to the patient and, therefore, it is important that medical schools add this subject to their curricula.

Resumen Este estudio tuvo como objetivo investigar los saberes de los estudiantes de medicina sobre espiritualidad y religiosidad en el cuidado del paciente. Se trata de una investigación exploratoria, descriptiva, cuantitativa, basada en la Spirituality and Brazilian Medical Education, desarrollada en dos Facultades Médicas de Ceará, Brasil. Los 437 participantes completaron un cuestionario procesado posteriormente por análisis descriptivo. Los resultados señalaron que estos estudiantes conocen los significados y la relevancia de la espiritualidad y la religiosidad en la asistencia al paciente, pero todavía no se sienten preparados para un abordaje completo, en virtud de las limitaciones del aprendizaje en la formación académica. Se concluye que necesitan aprender más sobre la temática para un abordaje efectivo del asunto con el paciente. Para ello, es importante que las facultades médicas añadan este tema a la matriz curricular.

O presente documento traz diretrizes construídas conjuntamente pela Associação Brasileira de Educação Médica (ABEM) e a Sociedade Brasileira de Medicina de Família e Comunidade (SBMFC) com a intenção de apoiar as escolas médicas de forma objetiva e prática, na elaboração de projetos político-pedagógicos no contexto da Atenção Primária à Saúde. Um marco reconhecido na política educacional brasileira é a publicação das Diretrizes Curriculares Nacionais, as quais flexibilizam as organizações curriculares, possibilitando a construção de projetos político-pedagógicos contemporâneos e consonantes com o Sistema Único de Saúde brasileiro. A Atenção Primária à Saúde é o ponto de convergência entre estas duas políticas, descentralizando o ensino da Medicina dos hospitais para toda a rede de saúde no Brasil. Destaca-se a imperiosidade de que o ensino na Atenção Primária à Saúde esteja presente longitudinalmente, ao longo de todo o curso, de preferência com inserções significativas (de aprendizado real e a partir do trabalho), mas que, sobretudo, deva fazer parte do núcleo de ensino da prática clínica do futuro médico.

These are a set of guidelines built by the Brazilian Association of Medical Education (ABEM) and the Brazilian Society of Family and Community Medicine (SBMFC) with the aim of supporting medical schools in a practical and objective manner, when elaborating pedagogical-political projects on Primary Health Care (PHC). The advent of the Brazilian National Curricular Guidelines for Medical Education, which are approved by the Ministry of Education in 2001 have since improved the teaching of undergraduate medical students on PHC, but there are still wide variations in implementation and quality of it in medical curricula. These guidelines by ABEM/SBMFC partnership can exert considerable influence on medical curricula by establishing minimum requirements and core competencies for PHC in Brazil.

Sessenta amostras de fragmentos de tecidos com lesões sugestivas de tuberculose provenientes de abatedouros bovinos, conservadas em solução saturada de borato de sódio, foram submetidas a quatro tratamentos: descontaminação através dos métodos NaOH 4% (Método Petroff), H2SO4 12% e HPC (Cloreto de hexadecilpiridínio) 1,5%, e solução salina (controle). O método HPC apresentou a menor proporção de contaminação (3%), em relação ao controle (88%, p<0,001), NaOH (33%, p<0,001) e H2SO4 (21,7%, p=0,002). Em relação ao sucesso no isolamento, o método HPC apresentou o melhor resultado (40%), em relação ao controle (3%, p<0,001), NaOH (13%, p=0,001) e H2SO4 (1,7%, p<0,001). Os resultados indicam que o HPC é uma alternativa à utilização do método Petroff.

Sixty samples of tissue fragments with lesions suggestive of tuberculosis from bovine abattoirs, kept in saturated solution of sodium borate, were subjected to four treatments: 4% NaOH (Petroff Method), 12 % H2SO4 and 1.5% HPC (1-Hexadecylpyridinium Chloride) decontamination, and physiological saline solution (control). The HPC method showed the lowest contamination rate (3%) when compared to control (88%, p<0.001), NaOH (33%, p<0.001) and H2SO4 (21.7%, p<0.002). Regarding the isolation success, the HPC method was better (40%) than the control (3%, p<0.001), NaOH (13%, p=0.001) and H2SO4 (1.7%, p<0.001) methods. These results indicate that HPC is an alternative to the Petroff method.