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This article shows the most recent data on the evolution of the number of resident physicians and vacancies from R1 to R5, as well as the number of programs and institutions accredited by the National Commission for Medical Residency (CNRM). It also discusses the types and modalities of evaluation of medical residency, with a focus on the assessment of competencies throughout in-service training, which were incorporated into the most recent CNRM resolution, at the end of 2023, which amended and updated the 2006 directives. Finally, it shows the experience of six Medical Societies that conduct periodic evaluation of resident physicians, presented at a Brazilian Medical Association event.

This reflection article can be divided into two complementary parts. The first shows the current context of medical education in Brazil, bringing the most recent data on the number of undergraduate students and its growing gap in relation to the reduced number of vacancies in medical residency, which, despite being the most appropriate modality to train specialists, has been overlooked by the excessive number of lato sensu graduate courses. The second part discusses the possibilities of evaluating medical training, which is terminal in Brazil, enabling the newly graduated physician to claim the professional registration and to practice medicine, being evaluated only by their own medical course. It also reviews the historical evolution and pros and cons of evaluating medical education for doctors trained both locally and abroad.

The different areas and work environments in the hospital sector have a complex set of occupational risk factors that can negatively impact the health of pregnant workers. Illness among this workforce results in sick leave due to work-related diseases and pregnancy, with high absenteeism. The main objective of this study was to review the available literature on the gestational and occupational risks to which pregnant health workers are exposed, causes of absenteeism, and issues related to maternity protection and work in the hospital sector. The authors used online databases to identify papers published in English from 2015 to 2020, based on the PRISMA Extension for Scoping Reviews and three steps of Snowballing. The study reviewed 18 peer-reviewed scientific articles that address pregnancy, work, absenteeism, and maternity protection. Most studies used a quantitative approach (12) and cohort studies in particular (6). The distribution of articles by themes was as follows: pregnancy, health and safety at work (11); pregnancy, health conditions, and absenteeism (13); and work and maternity protection (10). Some inferences were possible from the themes raised. However, the results revealed a gap and the need for specific studies for healthcare workers in the hospital sector, focusing on maternity. This review contributes to more in-depth studies on developing programs, actions, and legislation to protect maternity in hospital working environments., Competing Interests: Conflicts of interest: None

Tuta absoluta is one of the largest threats to tomato agriculture worldwide. Native to South America, it has rapidly spread throughout Europe, Africa, and Asia over the past two decades. To understand how T. absoluta has been so successful and to improve containment strategies, high-quality genomic resources and an understanding of population history are critical. Here, we describe a highly contiguous annotated genome assembly, as well as a genome-wide population analysis of samples collected across Latin America. The new genome assembly has an L50 of 17 with only 132 contigs. Based on hundreds of thousands of single nucleotide polymorphisms, we detect three major population clusters in Latin America with some evidence of admixture along the Andes Mountain range. Based on coalescent simulations, we find these clusters diverged from each other tens of thousands of generations ago prior to domestication of tomatoes. We further identify several genomic loci with patterns consistent with positive selection and that are related to insecticide resistance, immunity, and metabolism. This data will further future research toward genetic control strategies and inform future containment policies., (© The Author(s) 2023. Published by Oxford University Press on behalf of Society for Molecular Biology and Evolution.)

The emergence of physiological monitoring technologies has produced exceptional opportunities for real-time collection and analysis of workers' physiological information. To benefit from these safety and health prognostic opportunities, research efforts have explored the applicability of these devices to control workers' wellbeing levels during occupational activities. A systematic review is proposed to summarise up-to-date progress in applying physiological monitoring systems for occupational groups. Adhering with the PRISMA Statement, five databases were searched from 2014 to 2021, and 12 keywords were combined, concluding with the selection of 38 articles. Sources of risk of bias were assessed regarding randomisation procedures, selective outcome reporting and generalisability of results. Assessment procedures involving non-invasive methods applied with health and safety-related goals were filtered. Working-age participants from homogeneous occupational groups were selected, with these groups primarily including firefighters and construction workers. Research objectives were mainly directed to assess heat stress and physiological workload demands. Heart rate related variables, thermal responses and motion tracking through accelerometry were the most common approaches. Overall, wearable sensors proved to be valid tools for assessing physiological status in working environments. Future research should focus on conducting sensor fusion assessments, engaging wearables in real-time evaluation methods and giving continuous feedback to workers and practitioners.

During operational activities, military personnel face extremely demanding circumstances, which when combined lead to severe fatigue, influencing both their well-being and performance. Physical exertion is the main condition leading to fatigue, and its continuous tracking would help prevent its effects. This review aimed to investigate the up-to-date progress on non-invasive physiological monitoring to evaluate situations of physical exertion as a pre-condition to fatigue in military populations, and determine the potential associations between physiological responses and fatigue, which can later result in decision-making indicators to prevent health-related consequences. Adhering to the PRISMA Statement, four databases (Scopus, Science Direct, Web of Science and PubMed) were used for a literature search based on combinations of keywords. The eligibility criteria focused on studies monitoring physiological variables through non-invasive objective measurements, with these measurements being developed in military field, combat, or training conditions. The review process led to the inclusion of 20 studies. The findings established the importance of multivariable assessments in a real-life context to accurately characterise the effects of military practices. A tendency for examining heart rate variables, thermal responses, and actigraphy measurements was also identified. The objectives and experimental protocols were diverse, but the effectiveness of non-invasive measurements in identifying the most fatigue-inducing periods was demonstrated. Nevertheless, no assessment system for standardised application was presented. Future work may include the development of assessment methods to translate physiological recordings into actionable information in real-time and mitigate the effects of fatigue on soldiers' performance accurately.

Chrysodeixis includens (Walker, [1858]) is one of the most important defoliator of soybean in Brazil because of its extensive geographical distribution and high tolerance to insecticides compared with other species of caterpillars. Because of this, we conducted bioassays to evaluate the efficacy of pyrethroid λ-cyhalothrin on a C. includens resistant strain (MS) and a susceptible (LAB) laboratory strain. High throughput RNA sequencing (RNA-seq) of larval head and body tissues were performed to identify potential molecular mechanisms underlying pyrethroid resistance. Insecticide bioassays showed that MS larvae exhibit 28.9-fold resistance to pyrethroid λ-cyhalothrin relative to LAB larvae. RNA-seq identified evidence of metabolic resistance in the head and body tissues: 15 cytochrome P450 transcripts of Cyp6, Cyp9, Cyp4, Cyp304, Cyp307, Cyp337, Cyp321 families, 7 glutathione-S-transferase (Gst) genes, 7 α-esterase genes from intracellular and secreted catalytic classes, and 8 UDP-glucuronosyltransferase (Ugt) were overexpressed in MS as compared with LAB larvae. We also identified overexpression of GPCR genes (CiGPCR64-like and CiGPCRMth2) in the head tissue. To validate RNA-seq results, we performed RT-qPCR to assay selected metabolic genes and confirmed their expression profiles. Specifically, CiCYP9a101v1, CiCYP6ae149, CiCYP6ae106v2, CiGSTe13, CiCOE47, and CiUGT33F21 exhibited significant overexpression in resistant MS larvae. In summary, our findings detailed potential mechanisms of metabolic detoxification underlying pyrethroid resistance in C. includens., (© The Author(s) 2020. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Patients with chronic pancreatitis (CP) present malabsorption and changes in nutritional status. In this prospective, randomized, controlled, double-blinded, intervention study, developed at the Clinic of Pancreas, we aimed to assess whether the use of symbiotics changes the nutritional status, the biochemical data and the intestinal rate of these patients. The intervention consisted of administering 12 g/day of symbiotics composed of Lactobacillus casei, Lactobacillus rhamnosus, Lactobacillus acidophilus, Bifidobacterium bifidum and fructooligosaccharides to the intervention group and 12 g/day of medium absorption complex carbohydrate to the control group. The project was approved by the Ethics Committee of College of Technology and Science - FTC under the number process 0528-2008; reg. 498 e was registered under ClinicalTrials.gov. We evaluated 60 patients and the intervention lasted for 3 months, with monthly monitoring. A statistically significant reduction was observed in the results by day in relation to the initial frequency (x = 2.3) and the use of symbiotics in the second (x = 1.47) and third (x = 1.37) months (p = 0.001). In the control group, there was no significant change in this frequency (p = 0.157). The results showed an increase in the levels of hemoglobin (p < 0.001), hematocrit (p = 0.001), red blood cells (p < 0.001), total lymphocyte count (p < 0.002), serum magnesium (p < 0.001), albumin (0.001) and total serum cholesterol reduction (p < 0.001) with the use of symbiotics. The changes were not observed in the nutritional status of both groups., Conclusion: The use of symbiotics improved the clinical and laboratory profiles of the evaluated patients with CP, favoring the best clinical outcome, and may be a therapeutic option because of the low cost and therapeutic effectiveness in this population., (Copyright © 2017 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Perforating dermatoses are a group of skin diseases characterized by transepidermal elimination of dermal material. The disease is divided into two groups: the primary group and the secondary group. The classical or primary perforating dermatoses are subdivided into four types according to the eliminated dermal materials: Kyrle disease, perforating reactive collagenosis, elastosis perforans serpiginosa, and perforating folliculitis. The secondary form is known as acquired perforating dermatosis. The term was proposed in 1989 by Rapini to designate the perforating dermatoses affecting adult patients with systemic disease, regardless of the dermal materials eliminated. This report describes a case of the disease with elimination of collagen and elastic fibers in a patient with chronic renal failure.

Background & Aims: High concentration of 1,25(OH)2D3 (50-100 nM), which cause hypercalcemia in vivo, induce the hormone transcriptional targets and exert antiproliferative effects in cultured breast cancer lineages, however, no studies investigated whether these effects might be reproduced in tumor specimens in vivo. Our aim was to evaluate the effects of calcitriol supplementation on the proliferative index (Ki67 expression) and gene expression profile of post-menopausal breast cancer samples., Methods & Results: Tumor samples were collected from 33 patients, most of whom (87.5%) presenting 25(OH)D3 insufficiency, before and after a short term calcitriol supplementation (0.50 μg/day PO, for 30 days). Tumor dimension remained stable in ultrasound evaluations. A slight reduction in Ki67 immunoexpression was detected, however in only 10/32 post-calcitriol samples an expressively low proliferative index [Ln (%Ki67+) < 1] was achieved. Gene expression from 15 matched pre/post-supplementation samples was analyzed by microarray (U133 Plus 2.0 GeneChip, Affymetrix) and 15 genes were over-expressed in post-supplementation tumors, including FOS and EGR1, which were previously shown to be regulated by vitamin D. However, these results were not confirmed in another four breast cancer samples., Conclusions: Calcitriol supplementation is neither sufficient to expressively elicit an antiproliferative response nor to induce the hormone transcriptional signaling pathway in breast cancer specimens., (Copyright © 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Scalable expansion of cells for regenerative cell therapy or to produce large quantities for high-throughput screening remains a challenge for bioprocess engineers. Laboratory scale cell expansion using t-flasks requires frequent passaging that exposes cells to many poorly defined bioprocess forces that can cause damage or alter their phenotype. Microcarriers offer a potential solution to scalable production, lending themselves to cell culture processes more akin to fermentation, removing the need for frequent passaging throughout the expansion period. One main problem with microcarrier expansion, however, is the difficulty in harvesting cells at the end of the process. Therefore, therapies that rely on cell delivery using biomaterial scaffolds could benefit from a microcarrier expansion system whereby the cells and microcarriers are transplanted together. In the current study, we used bioactive glass microcarriers doped with 5% TiO₂ that display a controlled rate of degradation and conducted experiments to assess biocompatibility and growth of primary fibroblast cells as a model for cell therapy products. We found that the microcarriers are highly biocompatible and facilitate cell growth in a gradual controlled manner. Therefore, even without additional biofunctionalization methods, Ti-doped bioactive glass microcarriers offer potential as a cell expansion platform.

Context: Intestinal parasites induce detectable histopathological changes, which have been studied in groups with known diagnosis of parasitic disease. There is no available study with a larger base without previous diagnosis., Objective: To describe clinical and histopathological findings of parasitosis diagnosed by endoscopic biopsy in patients submitted to upper digestive endoscopy., Methods: Recorded biopsies archive at "Complexo Hospitalar Professor Edgar Santos" , a general teaching Hospital in the state of Bahia, Northeast Brazil, from January 1995 to January 2009, were reviewed. One thousand ten duodenal biopsy reports were found. Reports positive for parasites had their specimens reviewed and photographed. All blocks of biopsy selected as case were retrieved and reviewed by an experienced pathologist. Clinical, laboratorial and endoscopic data were collected., Results: Eleven biopsies showed parasites, including cases of Cryptosporidium sp. and Strongyloides stercoralis. Vomiting (91%), abdominal pain (78%), diarrhea (78%) and weight loss (78%) were usual symptoms. Seventy-five percent had duodenal mucosa changes on endoscopy, while 25% have no changes. Anemia and low serum albumin were important laboratorial data. HIV infection association was observed. Villus atrophy and reactive epithelium were usual in Strongyloides cases., Conclusions: No endoscopic or histopathologic finding was pathognomonic. One percent of duodenal endoscopic biopsies showed parasites.

Aim: Surgical trauma can provoke systemic alterations including changes in hepatic protein synthesis. Thus, it is important to point out the influence of this phenomenon on serum albumin concentration. The objective of the present work was to assess the effect of surgical trauma on serum albumin concentration during the immediate postoperative period in gastrointestinal procedures., Methods: The study was conducted on 150 randomized adult patients submitted to elective major surgeries (Group 1) and to medium size surgeries (Group 2) of the gastrointestinal system, identified according to sex, age and skin color. Blood samples for the determination of serum albumin concentration were obtained on the day preceding and following the surgical procedure., Results: There was a reduction in serum albumin both in Group 1 (P < 0.0001) and Group 2 (P < 0.0001), with no difference between sexes or patient skin colors for major surgeries. However, women showed a lower reduction in serum albumin than men in medium-sized surgeries. Also, the reduction of albumin was lower in black-skinned patients than in colored and lower in the latter than in white-skinned patients. With respect to age range, a greater reduction of albumin was observed in both groups among patients over 65 years, followed by younger patients (< 45 years) and by patients aged 45 to 65 years., Conclusion: Medium-sized and majors operations provoked an acute reduction in albuminemia, which was less intense among women, among the patients aged 45 to 65 years and among dark-skinned patients.

Purpose: To assess the effect of surgical trauma on serum albumin concentration during the immediate postoperative period., Methods: 200 consecutive adult patients submitted to elective major surgeries (Group 1) and to medium size surgeries (Group 2) were identified according to gender, age and skin color. Blood samples for the determination of serum albumin concentration were obtained on the day preceding and the one following the surgical procedure. Pre- and postoperative albumin data were compared by the paired t test. The gender was compared by the Student t test. The skin color and the age were compared by the repeated measured one-way ANOVA and the Tukey-Kramer tests. The level of significance was set at P < 0.05., Results: There was a reduction in serum albumin in Group 1 (p < 0.0001) and Group 2 (p < 0.0001), with no difference between gender or skin colors for major surgeries. However, women showed a lower reduction than men in serum albumin in medium-sized surgeries. In medium-sized surgeries, black patients had the lowest reduction in albuminemia. The greater reduction in albuminemia occurred in patients older than 65 years old., Conclusion: Medium-sized and majors operations provoked an acute reduction in albuminemia, which was more intense in aged white men.

Aim: To evaluate the classification and severity of Crohn's disease in different racial groups., Methods: Patients with Crohn's disease from the outpatient clinic of the University Hospital Prof. Edgard Santos were enrolled in the study. This hospital is a reference centre for inflammatory bowel disease. Race was determined using self-identification. The Vienna's classification was applied for all subjects. The severity of Crohn's disease was determined according to the number of surgical procedures, hospital admissions in the last year and treatment with steroids and immunosuppressors. Statistical analysis was calculated using t test for means, chi2 or F for proportions. A P value < 0.05 was considered to be significant., Results: Sixty-five patients were enrolled. Non-white patients were more frequently diagnosed with Crohn's disease in the age less than 40 years than white patients. The behaviour of disease was similar in both groups with a high frequency of the penetrating form. There was a tendency for non-white patients to have a greater frequency of hospital admissions in the last year compared to white subjects. Non-whites also had a higher rate of colonic and upper gastrointestinal involvement, and were also more frequently on treatment with immunossupressors than white patients although this difference was not statistically significant., Conclusion: Non-white patients with Crohn's disease had an earlier diagnosis and appeared to have had a more severe disease presentation than white patients.

Objectives: The polymorphisms in cytokine genes have allowed for the understanding of the genetic determinants of diseases. The aims of this study were to describe and compare the frequencies of polymorphisms on the interleukin (IL)-6, IL-10, tumor necrosis factor (TNF)-alpha, transforming growth factor (TGF)-beta1, and interferon (IFN)-gamma genes between patients with chronic pancreatitis (CP) and healthy individuals from Bahia, Brazil., Methods: Twenty-eight individuals were evaluated at a university gastroenterology outpatient service (4 women and 24 men), all diagnosed with CP based on clinical and radiologic aspects. The control group was composed of 94 (11 women and 83 men) blood donors. The polymorphisms studied were TNF-alpha (-308G/A), TGF-beta1 (codon 10C/T, codon 25C/G), IL-10 (-1082A/G; -819T/C; -592A/C), IL-6 (-174G/C), and IFN-gamma (+874T/A)., Results: A statistically significant difference was observed in the frequency of the polymorphisms between the group of patients with CP and the group of healthy individuals with the polymorphism of the TGF-beta1 gene on codon 10. No statistically significant differences were found for the allele and genotypic frequencies on the genes that code TNF-alpha, IFN-gamma, IL-10, and TGF-beta1 codon 25, and IL-6 between the control and case groups., Conclusion: The genotypes corresponding to the high TGF-beta1 producer phenotypes can be associated with the fibrogenesis shown with CP.

Questionnaires answered by 476 students (age 15-20 yrs) attending a local school in the neighborhood of Pedra 90 in Cuiabá -MT were analyzed in order to study the characteristics of feline and canine populations in the region. The results showed that 371 (78%) of the 476 families kept 513 dogs and 307 cats. Of 573 dogs, 289 (56.3%) were male and 224 (43.7%) were female. Of 307 cats, 182 (59.28%) were male and 125 (40.72%) were female. The owners of 474 (92.4%) dogs and 267 (86.9%) cats reported that their pets had been vaccinated against rabies.