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The aim of this study was to translate into Portuguese and to assess the reliability of an instrument for the diagnosis of diabetic distal polyneuropathy (DPN). The process for translation and adaptation into Portuguese of the Neuropathy Symptom Score (NSS) and the Neuropathy Disability Score (NDS) was performed following internationally standardized procedures. The instruments were applied by 2 raters in 57 consecutive subjects. Spearman correlation was used to evaluate the reliability and Cronbachs' alpha to evaluate the internal consistency of the items. Both, ECN and ESN, showed a good reliability (r= 0.77, p< 0.0001 and r= 0.76, p< 0.0001, respectively). ESN showed a good internal consistency (alpha= 0.74). The diagnosis of DPN, defined as the combination of the two scores (ECN+ESN) also showed a good reliability (r= 0.63, p< 0.0001). The Portuguese versions of the ESN and the ECN seem to be adequate for the diagnosis of DPN in this population.

The purpose of this survey was to evaluate the experience of Brazilian psychiatrists in treatment, formal training, attitudes, and knowledge with respect to epilepsy (and associated mental disorders). One hundred fifty-seven Brazilian psychiatrists completed a specially developed questionnaire. Most (95%) had previously treated patients with epilepsy and mental disorders. About one-third (35%) admitted a lack of any formal training in epilepsy, and only 46% confirmed having received some formal training in mental disorders related to epilepsy. Eighty percent were dissatisfied with their knowledge. Three knowledge-based questions were answered correctly by only 10%. Almost half (48%) admitted that among psychiatrists, prejudice exists toward patients with epilepsy. Difficulties with treatment (50%) and lack of knowledge of epilepsy (50%) were considered the main causes of such prejudice. These data indicate an urgent need for improvement in education on epilepsy and associated mental disorders, as well as inclusion of formal epilepsy training in psychiatry residency programs.

Unlabelled: This study aims to describe the emotional manifestation of hypertension patients. A qualitative and quantitative methodology was used to examine emotional manifestations of stress in hypertensive patients., Methods: the instrument for the evaluation of stress in hypertensive patients was adapted for this study, using the part about emotional manifestations. The study population consisted of 136 hypertensive patients who were attending a hypertension clinic at the Cardiology and Nephrology Division of the Medical Clinic Department of the Ribeirão Preto "Hospital das Clínicas" HCFMRP-USP. This study was submitted to and approved by the ethics committee. Examining emotional manifestations is very important for hypertensive patients and appeared in 52% of hypertensive patients with stress symptoms. This research contributes to teaching, research and care delivery to hypertensive patients.

Cyclophilins are peptidyl-prolyl cis-trans isomerases involved in catalyzing conformational changes and accelerating the rate of protein folding and refolding in several cellular systems. In the present study, we analyzed the expression pattern and intracellular distribution of the cellular isomerase cyclophilin A (CypA) during vaccinia virus (VV) infection. An impressive increase in CypA stability was observed, leading to a practically unchanged accumulation of CypA during infection, although its synthesis was completely inhibited at late times. By confocal microscopy, we observed that CypA went through an intense reorganization in the cell cytoplasm and colocalized with the virosomes late in infection. CypA relocation to viral factories required the synthesis of viral postreplicative proteins, and treatment of infected cells with cyclosporine (CsA) prevented CypA relocation, clearly excluding the virosomes from CypA staining. Immunoelectron microscopy of VV-infected cells showed that CypA was incorporated into VV particles during morphogenesis. Biochemical and electron microscopic assays with purified virions confirmed that CypA was encapsidated within the virus particle and localized specifically in the core. This work suggests that CypA may develop an important role in VV replication.

Visceral larva migrans syndrome by Toxocara affects mainly children between 2 and 5 years of age, it is generally asymptomatic, and the seroprevalence varies from 3 to 86% in different countries. A total of 399 schoolchildren from 14 public schools of the Butantã region, São Paulo city, Brazil, were evaluated by Toxocara serology (enzyme-linked immunosorbent assay). Epidemiological data to the Toxocara infection obtained from a protocol were submitted to multiple logistic regression analysis for a risk profile definition. Blood was collected on filter paper by finger puncture, with all samples tested in duplicate. Considering titers > or = 1/160 as positive, the seroprevalence obtained was 38.8%. Among infected children, the mean age was 9.4 years, with a similar distribution between genders. A significant association was observed with the presence of onychophagia, residence with a dirty backyard, living in a slum, previous wheezing episodes, school attended, and family income (p < 0.05). All data, except "living in a slum", were considered to be determinant of a risk profile for the acquisition of Toxocara infection. A monthly income > or = 5 minimum salaries represented a protective factor, although of low relevance. Toxocara eggs were found in at least one of the soil samples obtained from five schools, with high prevalence of Toxocara infections, indicating the frequent soil contamination by this agent.

We report the accidental needlestick inoculation of a laboratory worker with vaccinia virus. Although the patient had previously been vaccinated against smallpox, severe lesions appeared on the fingers. Western blot and polymerase chain reaction-restriction fragment length polymorphism were used to analyze the virus recovered from the lesions. The vaccinia virus-specific immunoglobulin G levels were measured by enzyme-linked immunosorbent assay. Our study supports the need for vaccination for laboratory workers that routinely handle orthopoxvirus.

Objective: To evaluate epidemiological, clinical and laboratorial aspects of patients with Down syndrome, who present recurrent and/or severe infections, as well as to evaluate the presence of immunodeficiency in this population., Methods: Patients with Down syndrome diagnosed by chromosome analysis with recurrent and/or severe infections, followed at the Allergy and Immunology Unit of Children's Institute from 1990 to 1999, were submitted to an epidemiological, clinical and laboratorial protocol, including immunological aspects., Results: Sex distribution was 1.6 M:1 F, with age ranging from 1 to 12 years and 10 months (average = 2y7m). Forty patients reported recurrent infections and five, sepsis. Out of all patients with recurrent infection, 31 fulfilled the repeated infection criteria, with pneumonia and rhinopharyngitis as the most common infections. Congenital heart diseases were found in 62.2% of cases, more frequent in the repeated pneumonia group. Immunological evaluation showed two cases with IgG2 deficiency, two with low lymphocytes CD4+ count, and two cases with reduced blastogenic response to mitogens. Five cases had reduced NK cells function. Seropositivity for CMV was found in 22 of 36 cases analyzed (61.1%)., Conclusions: Although the data found in this study are valid for this specific population, the authors point out the necessity of the immunodeficiency research in Down syndrome patients with maintenance of infection besides the appropriated control of associated diseases.

We describe a case report of disseminated cutaneous sporotrichosis as the initial presentation of AIDS in a 24-year-old HIV-positive male patient. He presented multiple ulcerated skin lesions distributed over the face, thorax, legs and arms. Biopsy of one of the cutaneous lesions was suggestive of sporotrichosis and culture isolated Sporothrix schenckii. Itraconazole was started and the lesions progressively resolved after 15 days of medication. The patient was discharged with this medication but he did not return for follow-up. He died three months later in another hospital. Therapy of sporotrichosis in HIV-infected patients remains unclear and the response to therapy is variable. Itraconazole is highly concentrated in the skin and is one of the options for treatment of disseminated sporotrichosis.

Background: PCR detection of CSF Herpes virus DNA is an important tool in the diagnosis of CNS infections. Use of this test has been shown to have an impact on patient management as measured by shortened patient stays, specific therapeutic intervention, reduction of empirical expensive therapy administration, all of which should translate into significant health care savings., Objective: The present study aimed at implementing, and evaluating both clinically and analytically the performance of several commercially available PCR based assays for the detection of Herpes virus infections of the CNS., Study Design: A total of 314 patients with suspected CNS Herpesvirus infection were investigated, between 1999 and 2001, by Stair primers PCR. Starting on January 2002, two commercially available real-time-PCR systems were implemented and tested using the Stair primers PCR assay as golden standard and three external control proficiency panels along with serial dilutions of positive clinical samples., Results: Sensitivity of the assay was determined to be <200 copies per ml for HSV and <1250 copies per ml for CMV. Positive results were obtained for 17 patients (6 HSV-1, 1 HSV-2, 1 EBV, 1 CMV, 6 VZV and 2 HHV-6) whose clinical and analytical findings were consistent with the PCR results. A real-time-PCR procedure was introduced in 2002 with similar sensitivity, but a more rapid response., Conclusion: Conventional end-point PCR proved useful to the diagnosis of CNS herpes virus infection, with an impact on the clinical intervention. However, the use of Real-Time-PCR has greatly enhanced these advantages, making results available at a much earlier time, thus significantly reducing the need for empirical treatment.

Immunologic disorders related to anticonvulsant therapy have been described in the last three decades, including cellular and humoral alterations that result in recurrent infections; however, the physiopathologic mechanisms are not completely understood. This report describes a patient with complex partial epilepsy and hypogammaglobulinemia while in treatment with carbamazepine, with significant improvement in clinical signs and laboratory tests after substitution to sodium valproate. The authors stress the importance of clinical and laboratory evaluation of patients in continuous anticonvulsant therapy, including immunoglobulins levels and peripheral blood evaluations.

Background: CMV is a major clinical problem in transplant recipients. Thus, it is important to use sensitive and specific diagnostic techniques to rapidly and accurately detect CMV infection and identify patients at risk of developing CMV disease. In the present study, CMV infection after liver transplantation was monitored retrospectively by two molecular biology assays - a quantitative PCR assay and a qualitative NASBA assay. The results were compared with those obtained by prospective pp65 antigenemia determinations., Materials and Methods: 87 consecutive samples from 10 liver transplanted patients were tested for CMV by pp65 antigenemia, and CMV monitor and NASBA pp67 mRNA assay., Results: CMV infection was detected in all patients by antigenemia and CMV monitor, whereas NASBA assay identified only 8/10 patients with viremia. Furthermore, CMV infection was never detected earlier by molecular biology assays than by antigenemia. Only 5/10 patients with CMV infection developed CMV disease. Using a cut off value of 8 cells/50,000, antigenemia was found to be the assay that better identified patients at risk of developing CMV disease. However, the kinetics of the onset of infection detected by NASBA and CMV monitor seemed to have better identified patients at risk of developing CMV disease. Furthermore, before onset of disease, CMV pp67 mRNA was found to have similar or better negative and positive predictive values for the development of CMV disease., Conclusions: The present data, suggests that the concomitant use of antigenemia and pp67 mRNA assay gives the best identification of patients at risk of developing CMV disease.

Leadership and communication are strategies that enable nurses to improve the management of nursing care within the hospital context. The present study aimed at reporting a Continuing Education Program developed by nurses from a private hospital on leadership and communication and to present the application of situational leadership in their professional practice. The technique of critical incidents was applied in data collection. The subjects evaluated positively the contributions of the Program and authors found the viability of the application of situational leadership in nursing daily practice.

In the present study, the experimental model of Mycobacterium leprae infection in the foot pads of BALB/c mice was used to investigate the effects of BCG administration on tumor necrosis factor-alpha (TNF-alpha) production and granuloma development. It was observed that mice intravenously infected with BCG 7 months after M. leprae inoculation into the foot pads presented a more effective mycobacteria clearance, revealed by a significant reduction of BCG-colony forming units in the spleen and by the reduction of acid-fast bacilli (AFB) in the foot pads. BCG infection at the peak of M. leprae infection also modulated the granulomatous response to M. leprae by converting mononuclear granulomas into an epithelioid-cell granuloma. Furthermore, lower TNF-alpha serum levels were detected in M. leprae-infected mice when compared to mice infected with M. leprae + BCG. An analysis of the TNF-alpha gene expression in the spleen by semiquantitative reverse transcription-polymerase chain reactions (RT-PCR) demonstrated that co-infection with BCG induced an earlier expression of TNF-alpha mRNA than in M. leprae-infected mice. The numbers of TNF-alpha-positive cells and apoptotic cells were also enhanced in epithelioid versus non-epithelioid granulomas. As a whole, the data suggest that co-infection of M. leprae-infected mice with BCG modulates TNF-alpha synthesis which, in turn, leads to induction of protective epithelioid granuloma formation in the foot pads and subsequent mycobacterial clearance. Macrophage differentiation into epithelioid cells, in association with the enhancement of TNF-alpha production at the granuloma site, may represent a triggering signal that induced apoptosis in these cells, leading to mycobacterial elimination. Moreover, the rate of apoptosis in epithelioid granulomas may well be related to the extent of immunopathologically mediated tissue damage.

Leadership and communication are themes of importance for the development of Nurse's work so that the upbringing of this professional needs to begin in the undergraduate course and continue through professional life. The present study aimed to identify the knowledge of students of the 4th year of the Nursing School of a public University about leadership na communication. In order to achieve this goal, the authors elaborated an instrument and submitted it to apparent and content validation, pilot test and statistic treatment. Data was collected through the application of the instrument to 67 students in October of 1998. The analysis of the results indicated that the students showed knowledge about leadership and communication, although they did not affirm that what they had learned it in the Undergraduate Course about it was enough.

Introduction: Vibroacoustic disease (VAD) occurs in workers exposed for more 10 yr to large pressure amplitude and low frequency (LPALF) noise (> or = 90dB, < or = 500 Hz). In its initial stages (2 yr exposure), VAD is associated with an increase in infections of the respiratory tract. The purpose of this study is to investigate whether exposure of mice to LPALF noise leads to immunological changes as expressed by the number of different lymphocyte subpopulations in the animals' spleen., Methods: Flow cytometry analysis of spleen lymphocytes was performed in BALB/c mice that had been exposed to occupationally simulated LPALF noise (8 h x d(-1), 5 d x wk(-1)) for a total of 1272 h (approximately 8 mo). The following surface phenotypes of splenic lymphocytes were quantified: IgM, CD4, CD8. Quantification of splenic lymphocytes from non-exposed, age-matched, control BALB/c mice was also performed., Results: Noise-exposed BALB/c mice had decreased T cells, involving both helper (CD4+) and cytotoxic (CD8+) lymphocytes, and also of IgM+ B lymphocytes., Conclusion: The data indicate that relatively short term exposure (3 mo) to LPALF noise induces a decrease in spleen lymphocytes in mice which is particularly significant (p < 0.003) in CD8+ T lymphocytes. The data suggest that exposure to LPALF noise causes changes in the immune system of mice. This is in agreement with previous human studies where VAD patients presented an enhancement in the number of circulating CD8+ lymphocytes.

Introduction: We investigated the effect of low frequency noise on the natural history of autoimmune diseases using hybrid New Zealand Black (NZB) and White (NZW) male mice that are prone to spontaneously develop systemic lupus erythematosus after 6 mo of age., Methods: We exposed 3-mo-old mice to periods of low frequency noise (> or = 90 dB SPL, < or = 500 Hz) for a total of 216 h; the animals were studied up to 12 mo of age and data were compared with results obtained with age-matched controls., Results: We found that noise exposure caused an earlier expression of proteinuria, a change that was associated with acceleration of kidney lesions and increased mortality. At 8 mo of age, after 3 mo of chronic exposure to noise, the exposed mice presented significantly higher numbers of splenic IgM+ lymphocytes and CD8+ T cells than the age-matched controls., Conclusion: Exposure of lupus-prone mice to low frequency noise accelerates the expression of the autoimmune disease and it affects the immune system by raising the number of splenic IgM+ B lymphocytes and CD8+ T cells.

Introduction: Some workers employed by the aviation industry are exposed to large pressure amplitude and low frequency (LPALF) noise (> or =90 dB SPL, < or = 500 Hz) and have developed vibroacoustic disease (VAD), a whole-body noise-induced pathology. Since VAD patients have an increased prevalence of respiratory and skin infections, we investigated whether these individuals had any quantitative changes in the number of peripheral blood cell populations. Also, we investigated whether different types of noise environments are related to cell quantification., Methods: Quantification of peripheral blood cell populations was performed in venous blood samples of 34 VAD-diagnosed patients, and 41 controls. Leukocytes, monocytes, granulocytes, and surface phenotypes of CD8+ and CD4+ T lymphocytes were considered., Results: We found that VAD patients showed a statistically significant elevation in the number of circulating CD8+ and CD4+ T lymphocytes when compared with the control population, but not when compared among different noise-environments. Monocyte and granulocyte populations did not register significant differences., Conclusion: VAD patients present enhancement in the number of circulating cytotoxic T lymphocytes (CD8+ and CD4+ T cells) thus indicating that this environmental disease is associated with quantitative changes in immune cells.

Hereditary angioedema is caused by a defect in C1 inhibitor activity (C1INH). Its occurrence is rare and it is associated with an autosomal dominant mode of inheritance. We describe seven patients (4M:3F), age from 12 to 50 years old, who are affected by hereditary angioedema; four of them belong to the same family. The main clinical manifestations were: angioedema of face, hands and feet (6/7) and abdominal pain (2/7). No triggering factors were associated with symptoms in 4/7 patients and trauma (2/7) and menses (1/7) were reported in the other three ones. One patient was submitted to laparotomy for partial intestinal resection, before diagnosis. Laboratory complement analysis revealed the absence of hemolytic function of complement, reduced C4 (6/7) and low C1INH levels. All patients received Danazol (100 mg/day) with clinical control. Hereditary angioedema has to be considered in the differential diagnosis of angioedema, since an early diagnosis of this immunodeficiency, leading to specific treatment in order to decrease the complications.

We have investigated the effect of inflammation on host resistance against infection by Mycobacterium avium, an atypical mycobacteria species that is responsible for life-threatening opportunistic infections in AIDS patients. Inflammation was induced in BALB/c mice by two intraperitoneal injections of mineral oil (Freund's incomplete adjuvant, FIA). The BALB/c strain was chosen because it is naturally susceptible to Myco. avium infection. One week after the second FIA injection, the BALB/c mice were infected intravenously with 2.6 x 10(6) Myco. avium bacilli; at this time, the mice showed systemic granulocytosis because of the FIA injections. The kinetics of the murine infection was determined during 3 months by quantification of Myco. avium loads in the major target organs (liver and spleen) of the mycobacteria. The FIA treatment resulted in a significant decrease in the growth of Myco. avium in the infected BALB/c mice. This enhancement in host resistance to Myco. avium infection lasted for 2-3 months. In contrast with BALB/c animals, C3H mice (naturally resistant to Myco. avium infection) did not show an increased anti-Myco. avium action in association with the FIA treatment. The antimycobacterial effect of the FIA injections in BALB/c mice was compared with that produced by the injection of mycobacterial antigens (heat-killed Myco. tuberculosis) added to the mineral oil (i.e. Freund's complete adjuvant, FCA). The FCA treatment resulted in strong and sustained enhancements in the microbicidal capacities of BALB/c, and also of C3H mice. Data obtained with mutant athymic BALB/c mice revealed that the anti-Myco. avium effect of the FCA treatment was T cell-dependent. Our results indicate that: (i) non-immune inflammatory stimulation (FIA) of Myco. avium-susceptible hosts is able to cause a significant, albeit transient, increase in the resistance to Myco. avium infection; (ii) this protective effect is enhanced if heat-killed mycobacteria are added to the phlogistic agent (FCA), i.e. if a T cell-dependent response is induced; and (iii) systemic increase in the number of circulating granulocytes may help host defence against Myco. avium infection.

We have used the MRL/lpr murine model of spontaneous lupus to investigate three questions in infection immunity: (1) does mycobacterial infection have any effect on the mortality of the autoimmunity-prone lpr mice?; (2) does the infection modify the progression of kidney disease of lpr lupus?; and (3) does the lpr gene change the resistance of mice to mycobacteria? Experimental infections were induced by intraperitoneal inoculation of 10(7) viable bacilli of Mycobacterium avium in 3 months old MRL/lpr mice and also in congeneic MRL/+ mice (lacking the lpr gene). MRL mice were sacrificed 1, 2.5 and 4 months after the M. avium injection. We found that infection caused lowering of urine protein concentration in lpr mice as compared with age-matched lpr controls. Mycobacteriosis also induced a marked decrease in the mortality of lpr animals, e.g. 85% of infected lpr mice reached the age of 7 months whereas only 10% of control lpr mice reached the same age. MRL/lpr mice showed, after 1 and 2.5 months of infection, higher mycobacterial loads than the congeneic non-lpr MRL mice; after 4 months of infection, however, differences in M. avium loads between the two groups of MRL mice became not statistically significant. We conclude that: (1) mycobacterial infection increases the life span of lpr mice; (2) the infection slows down the progression of kidney disease in the lupus-prone lpr animals; (3) the autoimmunity gene lpr is associated with a transient decrease in host resistance to mycobacteria.

New Zealand (NZ) mouse strains comprise both autoimmune and non-autoimmune animals: NZ black (NZB) mice and the F1 hybrid (NZB/W) of NZB and NZ white (NZW) mice show spontaneous autoimmune disease by 6 months of age and die before the first year of age from renal disease, while NZW mice do not show autoimmune disorders. We investigated whether the autoimmunity-prone NZ animals (NZB and NZB/W) differ from the non-autoimmune NZW mice in susceptibility/resistance to mycobacterial infection. The three groups of NZ mice were infected by intraperitoneal inoculation of 10(8) colony forming units (cfu) of Mycobacterium avium. The M. avium infection was induced in 3-month-old mice (i.e., before NZB and NZB/W mice develop autoimmune disease) and studied for 4 months. Infected NZB and NZB/W mice showed evidence of renal disease at 2 and 4 months of infection (but not at 1 month). The non-autoimmune NZW mice were found to be susceptible to M. avium since they allowed massive proliferation (4-5 log growth) of the bacilli in liver and spleen. In contrast, both groups of autoimmunity-prone mice (NZB and NZB/W) were resistant to M. avium since their mycobacterial loads remained below the value of the initial inoculum. We conclude that in NZ mice the acquisition of autoimmunity genes is associated with expression of natural resistance to mycobacterial infection. This is consistent with the view that autoimmunity genes may have been evolutionarily selected because of their association with increased resistance of the host to infections by intracellular parasites.

Autores: Pâmela de Paula Vicente, Fabiana de Abreu, Ana Carla Cavalcanti, Elaine Cortez. Descritores: Insuficiência cardíaca; Saúde mental; Enfermagem INTRODUÇÃO A Insuficiência Cardíaca (IC) é uma doença crônica que acomete cerca de 2% da população mundial, e em 2007 no Brasil, foi responsável pelo maior número de casos de internação no Sistema Único de Saúde (SUS) no total de internados por doença cardiovascular. Assim, a IC é hoje um dos maiores problemas em saúde pública, e um dos seus principais desafios é o de reduzir o número de pacientes portadores de IC que são internados sucessivas vezes por descompensação da doença, o que tem gerado elevados custos financeiros ao Sistema de Saúde, visto que o alto índice de reinternações pode ser causado por uma dificuldade do paciente em aderir corretamente à terapêutica implementada. Em vista disso, além do tratamento farmacológico, que a cada dia tem evoluído, o tratamento não-farmacológico tem demonstrado possuir uma importância cada vez maior, sendo comprovada a necessidade do enfermeiro atuando nesse cenário, já que o mesmo é quem detém o manejo das intervenções não-farmacológicas. Partindo do ponto de que o perfeito bem estar físico e mental de qualquer indivíduo depende de uma manutenção eficaz de sua saúde mental, esta última é um aspecto importante a ser considerado nos pacientes com IC, pois em muitos casos nos pacientes, está debilitada, desgastada e precisando de um suporte, pelo fato de serem pessoas que devem adquir hábitos novos, os quais muitas vezes são indesejáveis. Destaca-se que, a promoção da saúde mental tem como objetivo reestruturar uma condição mental e pessoal visando uma composição íntegra do paciente em entender o que se passa e o porquê, transpondo mais calma, tranqüilidade e segurança a quem se encontra em condições que não gostaria. OBJETIVO Sabendo que a promoção à saúde mental dos portadores de Insuficiência cardíaca crônica ainda é um aspecto do tratamento que tem sido negligenciado, percebendo a importância e um papel diferenciador desta promoção, este trabalho tem o objetivo de discutir a saúde mental do paciente com IC e refletir sobre a formação e o cuidado de enfermagem na perspectiva da promoção da saúde mental. METODOLOGIA A pesquisa foi exploratória, com abordagem qualitativa e realizada na Biblioteca Virtual de Saúde (BVS) nas bases de dados do BDENF e do LILACS. Realizou-se após a coleta dos dados a pré-leitura e a leitura seletiva seguindo os critérios estabelecidos de inclusão que foram: publicações nacionais, publicadas entre os anos 2000 e 2010 e que e que expressassem em seu conteúdo o tema abordado no objetivo deste trabalho. Desta feita, elegeu-se como bibliografia potencial dez(10) produções científicas. Após a seleção, realizou-se a análise temática, e emergiram duas categorias, são elas: o impacto biopsicossocial das mudanças no estilo de vida do paciente com insuficiência cardíaca; e reflexão sobre a formação e o cuidado de enfermagem tendo como foco a promoção da saúde mental. RESULTADOS Pode-se observar através dos resultados que a saúde mental tem um papel relevante na qualidade de vida das pessoas durante o processo saúde-doença, além de ser um fator crucial na avaliação do prognóstico do paciente, sendo um impacto importante que deve ser considerado. Constituem um desafio real não só para a formação, mas para a implementação do cuidado de enfermagem, a melhor compreensão e avaliação não só da qualidade de vida, como também, das variáveis psicossociais, como por exemplo, nos transtornos mentais que acometem esses pacientes e na indicação de um suporte social que tem se tornado um significativo determinante na evolução dos portadores de IC. CONCLUSÃO Conclui-se que há necessidade de mais estudos e medidas onde se possa avaliar no paciente com IC, o nível de sua saúde mental no qual abrange diversas variáveis tais como, qualidade de vida, ansiedade, depressão, medo, insegurança, dentre outros e incorporá-los na avaliação do paciente, na definição de tratamento, no cuidado prestado, e na avaliação da eficácia da terapêutica, a fim de interferir de forma positiva e eficaz na adaptação do paciente a sua nova condição de vida, e contribuir para a sua saúde de forma humanizada e integral, de forma a considerar a saúde mental como aspecto imprescindível para o sucesso do cuidado interal ao paciente com IC. REFERÊNCIAS 1 Rocha LA, Silva LF: Adaptação psicossocial de pessoas portadoras de insuficiência cardíaca: diagnósticos e intervenções de enfermagem. Rev. Eletr. Enf. [Internet]. 2009;11(3):484-93.2009 2 Figueiredo NMA, (org). Método e metodologia na pesquisa científica. São Caetano do Sul (SP); Yendis; 2007 3 Figueiredo NMA, (org). Método e metodologia na pesquisa científica. 2ª edição São Paulo: Difusão; 2007 4 Polit DF, Beck CT, HUngler BP, Fundamentos de pesquisa em enfermagem: Métodos, avaliação e utilização. Porto Alegre: Artmed; 2004 5 Costa MAF, Costa MFB. Metodologia da pesquisa: conceitos e técnicas. Rio de Janeiro (RJ): Interciência; 2001 6 Ferreira MCS; Gallani MCBJ. Insuficiência Cardíaca: antiga síndrome, novos conceitos e a atuação do enfermeiro. Rev. bras. enferm;58(1):70-73.2005 7 Rezende LK; Mendes IJM; Santos BMO. Suporte social para idosos portadores de insuficiência cardíaca. Rev. ciênc. farm. básica apl;28(1):107-111. 2007 8 Soares DA; Toledo JAS; Santos LFa dos; Lima RMB; Galdeano LE. Qualidade de vida dos portadores de Insuficiência Cardíaca. Acta paul. enferm;21(2):243-248. 2008 9 Silva JG; Gurgel AA; Frota MA; Vieira LJES; Valdés MTM. Promoção da saúde: possibilidade de superação das desigualdades. Rev. enferm. UERJ;16(3):421-425.2008 10 Rocha LA, Silva LF: Adaptação psicossocial de pessoas portadoras de insuficiência cardíaca: diagnósticos e intervenções de enfermagem. Rev. Eletr. Enf. [Internet]. 2009;11(3):484-93.2009 11 Bochi EA e col. Sociedade Brasileira de Cardiologia. III Diretriz Brasileira de Insuficiencia Cardíaca Crônica. Arq Bras Cardiol 2009, 93 (1 supl 1) :1~71. 12 Bennet, SJ. Reliability and validity of the compliance belief Seales among patients with hearth failure. Hearth & Lung 2001;30(3):177-85 Colucci WS, Braunwald E, Zipes DP, Libby P. Tratado de medicina Cardiovascular. 6ª ed. São Paulo: Roca;2003. p. 539-68 13 Seidl EMF, Zannon CMLC. Qualidade de vida e saúde: Aspectos conceituais e metodológicos. Cad Saúde Publica; Rep Public Health. 2004;20(2):580-8 14 Dantas RAS, Sawada NO, Malerbo MB. Pesquisas sobre qualidade de vida: revisão da produção cientifica das universidades do estado de são Paulo. 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Leishmania infantum , a zoonotic vector-born parasite, is endemic in the Mediterranean region, presenting mostly as visceral (VL), but also as cutaneous (CL) and mucosal leishmaniasis (ML). This study aimed to describe the epidemiological and clinical aspects of the CL and ML cases diagnosed in mainland Portugal between 2010 and 2020. Collaboration was requested from every hospital of the Portuguese National Health System. Cases were screened through a search of diagnostic discharge codes or positive laboratory results for Leishmania infection. Simultaneously, a comprehensive literature search was performed. Descriptive statistics and hypothesis testing were performed using IBM ® SPSS ® Statistics. A total of 43 CL and 7 ML cases were identified, with a predominance of autochthonous cases (86%). In CL, immunosuppressed individuals constituted a significant proportion of patients (48%), and in this group, disseminated CL (22%) and simultaneous VL (54%) were common. In autochthonous cases, lesions, mostly papules/nodules (62%), were frequently observed on the head (48%). The approach to treatment was very heterogeneous. ML cases were all autochthonous, were diagnosed primarily in older immunosuppressed individuals, and were generally treated with liposomal amphotericin B. The findings suggest a need for enhanced surveillance and reporting, clinical awareness, and diagnostic capacity of these forms of leishmaniasis to mitigate underdiagnosis and improve patient outcomes. A holistic One Health approach is advocated to address the multifaceted challenges posed by leishmaniases in Portugal and beyond.

Background: Operative management of severe trauma requires excellent communication among team members. The surgeon and anesthesiologist need to interact efficiently, exchanging vital information. The Definitive Surgical Trauma Care (DSTC) and Definitive Anesthesia Trauma Care (DATC) courses provide an excellent opportunity for teamwork training. Our goal was to study the impact of the joint DSTC–DATC courses in candidates' self-reported assessment in communication skills and techniques in a simulated intraoperative trauma scenario. Methods: Study population consists of 93 candidates (67 surgeons and 26 anesthesiologists) participating in four consecutive joint DSTC–DATC courses in May and June 2019 in Brazil (3) and in Portugal (1). Median age was 30 years; 53 (60%) of subjects were male (46 senior residents and 47 specialists). All participants attended joint lectures, case discussions and surgical skills session, emphasizing intraoperative communication. Post-course survey on several aspects of perioperative communication (responses on a Likert scale) was conducted with participants being asked which aspects of intraoperative communication they valued the most. Results: All participants responded to the survey. Results displayed an increase in the self-assessed importance of team briefing and intraoperative communication, particularly routine periodic communication, rather than only at critical moments. Postoperative team debriefing was also valued as highly relevant. Closed-loop and direct, by-name communication were highly rated. Self-reported communication skills improved significantly during the course. Conclusions: Joint training in the DSTC–DATC courses improved candidates' perception and skills on proficient intraoperative communication. Further studies should address both the durability of these changes and the potential impact on patient care. [ABSTRACT FROM AUTHOR]