Abstract Introduction: Peer learning is a differentiated educational tool, including the traditional tutoring model and the interaction of individuals within the same training level. The general practice (GP) residency programme, updated in 2019, introduced peer learning as part of residents’ weekly schedule. In Lisbon and Tagus Valley region (ARSLVT), peer learning was implemented through the so-called Relational Learning Sessions (SAR). Methods: The present study sought to establish a state point regarding this practice in continental Portugal, in order to promote local adaptations necessary for the residents to reach relational learning’s full potential. Residents from the 54th group of the specialized training programme in GP were included. Data were collected between November 12nd and December 12nd 2020 through an online questionnaire sent via e-mail by the residency coordinators (CIMMGF). Results: Out of a total of 416 residents, 86 answers were obtained, 60 of which were from ARSLVT. At the time data was collected, in the North region, no model of peer learning had been implemented. In ARSLVT all residents had SAR, except for one group of Healthcare Units (ACeS). In the Center, Alentejo, and Algarve, this practice was not uniform between ACeS. In the implemented SAR, there is a wide variety of activities being performed, planning is mostly done according to the CIMMGF recommendations, and the majority of resident doctors recognize its usefulness. However, the impact on clinical activities, the distance between healthcare units, and the lack of support from local residency directors are pointed out as the main difficulties while planning these sessions. The adoption of a rotative schedule, the implementation of online sessions, and the issuing of guidelines might be possible solutions. Conclusion: Aiming for the adjustment and equality of training opportunities, effective local solutions must be sought so that peer learning becomes a fruitful reality for all residents.

Resumo Introdução: A aprendizagem interpares é uma ferramenta educacional diferenciada, incluindo o modelo tradicional de tutoria e a interação de indivíduos com o mesmo grau de formação. O programa de formação especializada em medicina geral e familiar (MGF) introduziu, em 2019, a aprendizagem relacional no horário semanal dos médicos internos. Na Administração Região de Saúde de Lisboa e Vale do Tejo (ARSLVT) foi adotado o modelo das Sessões de Aprendizagem Relacional (SAR). O presente estudo procurou perceber como está a ser implementada esta prática em Portugal continental, de forma a promover adaptações que permitam alcançar todo o seu potencial. Métodos: Foram incluídos os internos do 54.o grupo da formação especializada em MGF. Os dados foram recolhidos entre 12/nov e 12/dez de 2020, através de um questionário online divulgado por correio eletrónico pelas coordenações do Internato Médico de MGF (CIMMGF). Resultados: De um total de 416 internos obtiveram-se 86 respostas, 60 das quais da ARSLVT. À data da recolha dos dados verificou-se que na ARS Norte não tinha sido implementado qualquer modelo formal de aprendizagem relacional. Na ARSLVT apenas um ACeS não realizava SAR. Nas ARS Centro, Alentejo e Algarve, esta prática não era uniforme. Nas SAR implementadas parecem desenvolver-se diversas atividades, o planeamento é maioritariamente feito de acordo com as orientações publicadas e a maioria dos internos reconhece a sua utilidade. São apontadas como principais dificuldades o impacto na atividade assistencial, a distância entre unidades e a ausência de apoio da direção de internato. A adoção de um horário rotativo, a implementação de sessões online e a existência de documentos orientadores são possíveis soluções. Conclusão: Tendo em vista a harmonização do percurso e a igualdade de oportunidades formativas devem ser procuradas estratégias locais efetivas para que a aprendizagem relacional seja uma realidade profícua para todos os internos.

Abstract lntroductíon: Hepatitis C vírus (HCV) is an important cause of liver disease, presenting several clínical manifestations. The discovery of direct acting antivirais has revolutionized the treatment of this infectíon, these new antivirais allowed the eradication of the vírus in more than 95% of the cases. The SARS-CoV-2 pandemic changed the normal functioning of health services, and this could compromise this goal. Methods: Retrospective analysis of patients treated and followed in a distríct hospital between January 1, 2015, and December 31, 2020. Results: We treated 267 patients, 77.9% men, the average age being 50 years old. History of intravenous drug use was de risk factor in 55%. Genotype 1 was the most common (64%), 27% had liver cirrhosis and 32% had been submitted to other treatments. The average of the waiting time for treatment was 3. 19 months, before the pandemic it was 3. 11 months and in 2020 it was 4. 15 months, this difference is statistically significant (p = 0.017). The number of patients treated over the years has been decreasing. The most used treatment was ledispasvirl sofosbuvir. The sustained virological response was 99%. Patients were discharged in 70% of the cases. Discussion: This retrospective study is the first, at national levei, to evaluate the impact of the SARS-CoV-2 pandemic on the treatment of HCV infection. lt showed an increase in the waiting time for treatment in the year 2020. The impact of the SARS-CoV-2 pandemic on this pathology is still unclear. Conclusion: The SARS-CoV-2 pandemic led to an increase in the waiting time for treatment and a decrease in the number of patients with HCV infection treated, making it difficult to eradicate the vírus.

Resumo Introdução: O vírus da hepatite C (VHC) é uma causa importante de doença hepática, apresentando várias evoluções clínicas. A descoberta dos antivirais de ação direta revolucionou o seu tratamento, uma vez que permitem a erradicação do vírus em mais de 95% dos casos. A pandemia de SARSCoV-2 alterou o normal funcionamento dos serviços de saúde, comprometendo esse objetivo. Métodos: Análise retrospetiva dos doentes tratados e seguidos num hospital distrital entre 1 de janeiro de 2015 e 31 de dezembro de 2020. Resultados: Foram 267 doentes, 77,9% homens com idade média de 50 ± 10,3 anos. O fator de risco mais frequente foi o consumo de drogas endovenosas (55%). O genótipo 1 foi o mais comum (64%), 27% apresentavam cirrose hepática, 32% já tinham experimentado outros tratamentos. O tempo médio de espera pelo tratamento foi de 3, 19 meses, antes da pandemia 3, 11 meses e 4, 15 meses em 2020, diferença estatisticamente significativa (p = 0,017). Houve uma diminuição do número de doentes tratados ao longo dos anos. O tratamento mais utilizado foi o ledispasvirlsofosbuvir. A taxa de resposta virológica sustentada foi de 99%. Tiveram alta 70% dos doentes. Discussão: Este estudo retrospetivo é o primeiro, a nível nacional, a avaliar o impacto da pandemia de SARS-CoV-2 no tratamento da infeção por VHC. Mostrou-nos um aumento do tempo de espera pelo tratamento no ano 2020. O impacto da pandemia de SARS-CoV-2 sobre esta patologia ainda não é claro. Conclusão: A pandemia de SARS-CoV-2 levou a um aumento do tempo de espera pelo tratamento e diminuição do número de doentes tratados, dificultando o objetivo da eliminação.

RESUMO Esse estudo teve como objetivo comparar as prevalências de deslocamento passivo para a escola e analisar os fatores sociodemográficos associados em adolescentes de duas cidades brasileiras. Adolescentes das cidades de São José, Santa Catarina, Sul do Brasil (n= 1.024) e Manaus, Amazonas, Norte do Brasil (n= 1.109), de ambos os sexos, de 15 a 18 anos, participaram desse estudo epidemiológico transversal, de base escolar. Um questionário autoadministrado contendo informações sobre o tipo de deslocamento para a escola, a idade, o sexo e a renda familiar foi auto preenchido. Empregou-se a regressão de Poisson para estimativas de razão de prevalência e intervalos de confiança de 95% (IC95%). Os adolescentes catarinenses foram mais passivos no deslocamento para a escola (53,5%; IC95%: 50,1– 56,0) em relação aos amazonenses (37,3%; IC95%: 34,5– 39,7). Ser do sexo feminino e pertencer às famílias com maior renda mensal aumentaram as chances de se deslocar passivamente para a escola nas duas cidades. Ter 16 e 17 anos diminui as chances dos adolescentes de Manaus se deslocarem passivamente para a escola. Medidas para evitar e reduzir o deslocamento passivo devem ser direcionadas principalmente ao sexo feminino e aos adolescentes com maior renda familiar.

ABSTRACT The level of physical activity of adolescents has been a concern for public health agencies, suggesting the maximum use of the physical activities available in daily life. This study aimed to compare the prevalence of passive commuting to school and analyze the sociodemographic factors associated with adolescents from two Brazilian cities. The participants of this cross-sectional, epidemiologic, and school-based study were adolescents boys and girls, aged 15 to 18, from a city of Southern Brazil, São José/Santa Catarina (= 1024), and from a city of Northern Brazil city, Manaus/Amazonas (n= 1109). Participants completed a self-administered questionnaire with information regarding commuting to school, age, gender, and Family income. Poisson regression was used to estimate the prevalence ratios and confidence intervals of 95% (CI95%). The adolescents from Santa Catarina were more passive (53.5%; CI95%: 50.1– 56.0) than adolescents from Amazonas (37.3%; CI95%: 34.5– 39.7) in commuting to school. Female gender and being part of a Family with higher monthly income were associated with increased chances of passively commuting to school in both cities. The ages of 16 and 17 were associated with diminished chances of passively commuting to school in adolescents from Amazonas. Measures to avoid and reduce passive commuting should target, especially, girls and adolescents from higher-income Families.

Abstract Two types of Epstein Barr virus (EBV1/EBV2) have been shown to infect humans. Although their genomes are similar, the regions containing the EBNA genes differ. This study aimed to characterize the EBV genotypes of infectious mononucleosis (IM) cases in the metropolitan region of Belém, Brazil, from 2005 to 2016. A total of 8295 suspected cases with symptoms/signs of IM were investigated by infectious disease physicians at Evandro Chagas Institute, Health Care Service, from January 2005 to December 2016. Out of the total, 1645 (19.8%) samples had positive results for EBV by enzyme immunoassay and 251 (15.3%) were submitted to polymerase chain reaction (PCR) technique, using the EBNA3C region, in order to determine the type of EBV. Biochemical testing involving aspartate aminotransferase, alanine aminotransferase and gamma-glutamyl transferase were also performed. EBV type was identified by PCR in 30.3% (76/251) of individuals; of those, 71.1% (54/76) were classified as EBV1, 17.1% (13/76) as EBV2, and 11.8% (9/76) as EBV1+EBV2. The main symptoms/signs observed with EBV1 infection were cervical lymphadenopathy (64.8%, 35/54), fever (63%, 34/54), headache (20.4%, 11/54), arthralgia (20.4%, 11/54), and exanthema (18.5%, 10/54). EBV2 infection was detected in all but two age groups, with an average age of 24 years. The most common signs/symptoms of EBV2 were fever (76.9%, 10/13), average duration of 18 days, and lymphadenopathy (69.2%, 9/13). In contrast, EBV1+EBV2 coinfections were more frequent in those aged five years or less (20.0%, 2/10). The symptoms of EBV1+EBV2 coinfection included fever (66.7%, 6/9), and cervical lymphadenopathy and headache (33.3%, 3/9) each. The mean values of hepatic enzymes according to type of EBV was significantly different (p<0.05) in those EBV1 infected over 14 years of age. Thus, this pioneering study, using molecular methods, identified the EBV genotypes in 30.3% of the samples, with circulation of EBV1, EBV2, and EBV1+EBV2 co-infection in cases of infectious mononucleosis in the northern region of Brazil.

Abstract INTRODUCTION: Human cytomegalovirus is one of the causes of opportunist infections in immunocompromised patients, and is triggered by factors such as state of viral latency, weakened immune responses, and development of antiviral resistance to ganciclovir, the only drug offered by the public health system in Brazil to treat the infection. The goal of this study was to identify mutations that may be associated with antiviral resistance in immunocompromised patients. METHODS: Molecular analysis was performed in 82 blood samples and subjected to genomic DNA extraction by a silica-based method. Three sequences of the HCMV UL97 gene, which encodes a phosphotransferase protein required for activation of ganciclovir, were amplified by polymerase chain reaction. Pyrosequencing methods were applied to one external 2096-bp segment DNA and two internal sequences between nucleotides 1087 to 1828 to detect mutations in this gene. RESULTS: Approximately 10% of sequences contained mutations between nucleotides 377 and 594, in conserved regions of the UL97 gene, leading to amino acid changes. Eleven coding mutations were identified, including changes leading to amino acid substitutions, E596K and S604F, which were observed in 100% of samples and are described for the first time in Brazil. In addition, one mutation (A594V) that is associated with ganciclovir resistance was detected in a kidney transplant patient. CONCLUSIONS: Further studies to detect mutations associated with HCMV resistance to antiviral drugs are required to demonstrate the need to increase the variety and availability of drugs used to treat viral infections in the public health care system in Brazil.

Malaria remains a major public health problem in Brazil where Plasmodium vivax is the predominant species, responsible for 82% of registered cases in 2013. Though benign, P. vivax infection may sometimes evolve with complications and a fatal outcome. Here, we report a severe case of P. vivax malaria in a 35-year-old Brazilian man from a malaria endemic area, who presented with reversible myocarditis.

Trata-se de um estudo transversal com o objetivo de verificar a prevalência do HPV na cavidade oral de indivíduos sem lesões clinicamente diagnosticáveis e quais são os tipos encontrados neles. Foram analisadas 166 amostras em pacientes maiores de 18 anos de idade, residentes no Estado do Pará, Brasil. As amostras foram coletadas por meio de raspado com escova estéril na cavidade oral. Para a detecção da presença do HPV, foi utilizada a técnica da reação em cadeia da polimerase (PCR). As amostras infectadas pelo HPV foram tipadas para HPV 6, 11, 16, 18, 31, 33, 35, 52 e 58. Os resultados encontrados indicaram a presença de HPV em 40 amostras (24,1%). Três amostras (7,5%) foram positivas para HPV 6; cinco (12,5%), para HPV 18; e uma (2,5%), para HPV 58.

This cross-sectional study aimed to determine HPV prevalence in the oral cavity of individuals without clinically diagnosable lesions and to identify the respective HPV types. A total of 166 samples were analyzed from patients 18 years or older in the State of Pará, Brazil. Samples were collected by sterile brush scraping in the oral cavity. HPV detection used polymerase chain reaction (PCR). Infected samples were typed as HPV 6, 11, 16, 18, 31, 33, 35, 52, and 58. HPV was present in 40 samples (24.1%). Three samples (7.5%) were positive for HPV 6, five (12.5%) for HPV 18, and one (2.5%) for HPV 58.

Se trata de un estudio transversal que tuvo por objetivo evaluar la prevalencia de HPV en la cavidad oral de sujetos sin lesiones orales clínicamente diagnosticables y qué tipos de HPV se encuentran en ellos. Se analizaron 166 muestras en pacientes mayores de 18 años de edad que viven en el estado de Pará, Brasil. Las muestras se recogieron por raspado con cepillo estéril en la cavidad oral. Para detectar la presencia de HPV se usó la técnica de Reacción en Cadena de la Polimerasa (PCR en inglés). En las muestras infectadas por el HPV se ejecutó una nueva PCR para los tipos HPV 6, 11, 16, 18, 31, 33, 35, 52 y 58. Los resultados indicaron la presencia de HPV en 40 muestras (24,1%). Tres muestras (7,5%) fueron positivas en HPV 6, cinco (12,5%) en HPV 18 y una (2,5%) en HPV 58.

Trata-se de um estudo transversal com o objetivo de verificar a prevalência do HPV na cavidade oral de indivíduos sem lesões clinicamente diagnosticáveis e quais são os tipos encontrados neles. Foram analisadas 166 amostras em pacientes maiores de 18 anos de idade, residentes no Estado do Pará, Brasil. As amostras foram coletadas por meio de raspado com escova estéril na cavidade oral. Para a detecção da presença do HPV, foi utilizada a técnica da reação em cadeia da polimerase (PCR). As amostras infectadas pelo HPV foram tipadas para HPV 6, 11, 16, 18, 31, 33, 35, 52 e 58. Os resultados encontrados indicaram a presença de HPV em 40 amostras (24,1%). Três amostras (7,5%) foram positivas para HPV 6; cinco (12,5%), para HPV 18; e uma (2,5%), para HPV 58.

This cross-sectional study aimed to determine HPV prevalence in the oral cavity of individuals without clinically diagnosable lesions and to identify the respective HPV types. A total of 166 samples were analyzed from patients 18 years or older in the State of Pará, Brazil. Samples were collected by sterile brush scraping in the oral cavity. HPV detection used polymerase chain reaction (PCR). Infected samples were typed as HPV 6, 11, 16, 18, 31, 33, 35, 52, and 58. HPV was present in 40 samples (24.1%). Three samples (7.5%) were positive for HPV 6, five (12.5%) for HPV 18, and one (2.5%) for HPV 58.

Se trata de un estudio transversal que tuvo por objetivo evaluar la prevalencia de HPV en la cavidad oral de sujetos sin lesiones orales clínicamente diagnosticables y qué tipos de HPV se encuentran en ellos. Se analizaron 166 muestras en pacientes mayores de 18 años de edad que viven en el estado de Pará, Brasil. Las muestras se recogieron por raspado con cepillo estéril en la cavidad oral. Para detectar la presencia de HPV se usó la técnica de Reacción en Cadena de la Polimerasa (PCR en inglés). En las muestras infectadas por el HPV se ejecutó una nueva PCR para los tipos HPV 6, 11, 16, 18, 31, 33, 35, 52 y 58. Los resultados indicaron la presencia de HPV en 40 muestras (24,1%). Tres muestras (7,5%) fueron positivas en HPV 6, cinco (12,5%) en HPV 18 y una (2,5%) en HPV 58.

Introduction: The genomic heterogeneity of hepatitis C virus (HCV) influences liver disorders. This study aimed to determine the prevalence of HCV genotypes and to investigate the influence of these genotypes on disease progression. Methods: Blood samples and liver biopsies were collected from HCV-seropositive patients for serological analysis, biochemical marker measurements, HCV genotyping and histopathological evaluation. Results: Hepatitis C virus-ribonucleic acid (HCV-RNA) was detected in 107 patients (90.6% with genotype 1 and 9.4% with genotype 3). Patients infected with genotype 1 exhibited higher mean necroinflammatory activity and fibrosis. Conclusions: HCV genotype 1 was the most prevalent and was associated with greater liver dysfunction.

OBJETIVO: Analisar a associação dos polimorfismos do gene interleucina-18 (IL-18) com artrite reumatoide (AR) e com fatores de risco de doenças cardiovasculares (DCV). MÉTODOS: A amostra foi constituída por 97 pacientes com AR e 151 controles saudáveis. Nos primeiros, foram analisados fatores de risco de DCV, tais como níveis do colesterol, hipertensão arterial, tabagismo e fator reumatoide, bem como o nível da proteína C-reativa (CRP). O DNA foi extraído e foram analisados os polimorfismos de nucleotídeo único (SNP) nas posições -607C/A e -137G/C do gene IL-18 em ambos os grupos. O equilíbrio de Hardy-Weinberg (EHW) e o odds ratio (OR) foram realizados, considerando IC 95% e P < 0,05. RESULTADOS: As frequências do alelo -607A nos pacientes com AR e nos controles foram de 0,443 e 0,424 e do alelo -137C foram de 0,304 e 0,291, respectivamente. As frequências do genótipo estavam em EHW, exceto em controles no locus -137 (P = 0,006). Não foi encontrada associação dos polimorfismos do gene IL-18 com AR, nem com fatores de risco de DCV, incluindo o nível do colesterol e de CRP (P > 0,05). Além disso, observaram-se mais indivíduos fumantes entre pacientes com AR em comparação aos controles (OR = 1,691; P = 0,088), e os níveis de CRP eram ligeiramente mais elevados em pacientes fumantes quando comparados aos de pacientes não fumantes (OR = 2,673; P = 0,061). CONCLUSÕES: Ao analisar uma amostra de pacientes com AR no sul do Brasil, não foi encontrada associação dos polimorfismos do gene IL-18 com AR, nem com os fatores de risco de DCV.

OBJECTIVE: To assess the association of the polymorphisms of the interleukin-18 (IL-18) gene with rheumatoid arthritis (RA) and with risk factors for cardiovascular diseases (CVD). METHODS: This sample comprised 97 patients with RA and 151 healthy controls. In the patients, risk factors for CVD were analyzed, such as cholesterol levels, arterial hypertension, smoking habit, C-reactive protein (CRP) level, and rheumatoid factor. DNA was extracted and the single nucleotide polymorphisms (SNP) at the -607C/A and -137G/C positions of the IL-18 gene were assessed in both groups. The Hardy-Weinberg equilibrium (HWE) was calculated and the odds ratio (OR) test performed, considering a 95% CI and P < 0.05. RESULTS: The frequencies of the -607A allele in patients with RA and in controls were 0,443 and 0.424, respectively, and of the -137C allele, 0.304 and 0.291, respectively. The genotype frequencies were in HWE, except for controls in the -137 locus (P = 0.006). Association of the polymorphisms of the IL-18 gene was found with neither RA nor risk factors for CVD, including cholesterol level and CRP (P > 0.05). In addition, more smokers were found among patients with RA as compared with controls (OR = 1.691; P = 0.088), and the CRP levels were slightly higher in patients who smoked than in patients who did not (OR = 2.673; P = 0.061). CONCLUSIONS: In this sample of patients with RA in the South of Brazil, association of the polymorphisms of the IL-18 gene was observed with neither RA nor risk factors for CVD.