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Resumo: Introdução: Para que se possa superar os modelos curriculares tradicionais nos cursos de enfermagem e medicina, uma das propostas tem sido organizar a formação a partir de currículo integrado e metodologias ativas de ensino-aprendizagem. A parceria ensino-serviço tem se mostrado uma estratégia importante para a implementação dessa organização currícular, estando sustentada nas propostas das Diretrizes Curriculares Nacionais. Dessa forma, torna-se importante compreender os processos envolvidos na constituição das parcerias com os serviços de saúde. Objetivo: analisar a construção da parceria ensino-serviço na Atenção Primária à Saúde em um município do Estado de São Paulo nos currículos de Enfermagem e Medicina na percepção dos gestores, preceptores e docentes. Método: pesquisa qualitativa realizada com gestores da academia e serviço, preceptores e docentes. Os dados foram coletados por meio de entrevistas semi- estruturada com onze gestores, oito docentes e nove preeptores do serviço. Utilizou-se a análise de conteúdo, modalidade temática no processamento dos dados. Resultados: identificou-se que a parceria ensino-serviço é essencial no currículo integrado na matriz dialógica de competência e há necessidade de pactuações entre os parceiros. Há desafios na construção das pactuações para que ocorra a formação e a participação dos profissionais como preceptores. Proposto o fortalecimento e consolidação da parceria por meio de documentos, gestão participativa, retomada de reuniões periódicas e Educação Permanente em Saúde entre a academia e o serviço. Conclusão: O processamento das entrevistas em cada segmento e entre os segmentos pesquisados (gestores, preceptores e docentes), oportunizou a compreensão dos olhares de forma articulada. A parceria é vista como importante para a formação no mundo do trabalho e os desafios a serem enfrentados para a sua consolidação envolvem a pactuação por meio de gestão participativa.

INTRODUCTION Repulsive guidance molecule a (RGMa) is a key protein that negatively regulates neuronal regeneration as its inhibition enhances axonal growth and promotes functional recovery in animal models of spinal cord injury. However, the role of RGMa in traumatic brain injury (TBI) remains elusive. This study aimed to clarify TBI-responsive RGMa expression in a murine model. METHODS Adult male C57BL/6J mice were subjected to controlled cortical impact. Brains were extracted 6 hours and 1, 3, 7, 14 and 21 days after injury (n = 6 in each group). Changes in the messenger RNA (mRNA) expression of RGMa and its receptor, neogenin, were evaluated by quantitative polymerase chain reaction in the damaged area of the cortex and contralateral cortex, along with expression measurement of inflammation-related molecules. Neurological deficit was also assessed by the cylinder test. RESULTS Neurological score was consistently lower in the TBI group compared to the sham group throughout the experimental period. The mRNA expressions of representative inflammatory cytokine TNF-α and chemokine receptor CCR2 were remarkably increased in the injured cortex on day 1 and gradually decreased over time, although remaining at higher values at least until day 14. The mRNA expressions of RGMa and neogenin were significantly suppressed in the damaged cortex until day 3. Interestingly, RGMa expression was suppressed most on day 1 and recovered over time. CONCLUSION In the acute phase of TBI, gene expression of inflammatory cytokines significantly increased, and gene expressions of RGMa and neogenin significantly decreased in the inflammatory milieu of the damaged area. Despite the subsequent remission of inflammation, RGMa gene expression recovered to the normal level 1 week after TBI. Intrinsic regenerative response to acute brain injury might be hampered by the following recovery of RGMa expression, hinting at the possibility of functional RGMa inhibition as a new, effective maneuver against TBI.

O Delirium é um distúrbio de atenção e consciência agudo com alta incidência em Unidade de Terapia Intensiva (UTI), sendo um marcador de mau prognóstico. Devido a importância do tema, objetivou-se realizar uma revisão sobre a temática do manejo do delirium em UTI. Paciente com delirium apresenta alterações de consciência, atenção e cognição e em alguns casos sintomas hiperativos. Associado ao ambiente de UTI, existem outros fatores precipitantes para a ocorrência do delirium, como extremos de idades, desnutrição e outras comorbidades. Apesar de sua alta incidência em UTI, o delirium permanece subdiagnosticado mesmo com escores mundiais de triagem, como o Confusion Assessment Method for the Intensive Care Unit . O manejo do delirium depende de um diagnóstico precoce, associado a prevenção, sendo realizada com manejo da dor, estímulos cognitivos, prevenção de constipação, entre outros. O tratamento farmacológico é realizado com uso de antipsicóticos como haloperidol, olanzapina e quetiapina. Além disso, o tratamento não farmacológico é essencial, promovendo melhor estimulação sensorial do paciente.

Electrocardiography (ECG) is used to screen for pulmonary hypertension (PH). However, it is unclear which parameters of ECG are the most useful for screening.ECG parameters related to right ventricular hypertrophy criteria were examined in 145 ECGs of subjects who were suspected to have PH and underwent right heart catheterization (RHC) (age 58.4 ± 17.5 years, 112 women, mean pulmonary arterial pressure [MPAP] 35.4 ± 13.3 mmHg). Based on the results of RHC, 108 subjects had PH (56 pulmonary arterial hypertension [PAH] and 52 chronic thromboembolic pulmonary hypertension [CTEPH]).Fourteen of 17 ECG parameters in the present study were significantly associated with PH on univariate analysis. On multivariable logistic regression analysis, S wave depth in lead V5 (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.10-1.47) and depth of T wave inversion in lead V4 (OR 1.21, 95% CI 1.03-1.46) were independent predictors of MPAP ≥ 25 mmHg, and the cut-off values determined by receiver operating characteristic curve analyses were 0.42 mV and -0.28 mV, respectively.In conclusion, a deeper S wave in lead V5 and the presence of a wider extent of negative T waves in the precordial leads may be clinically simple and useful ECG parameters for screening for PH.

Introduction: The hypothyroidism during pregnancy can lead to alterations in fetal neurological formation and has metabolic impact on pregnant women. If not diagnosed and treated it can cause complications during pregnancy and childbirth, besides causing changes in fetal formation. The TSH test is not part of routine examinations of the pregnancy monitoring care in Brazilian public health system (SUS). The test is not requested in low-risk pregnant women like those at high risk. The Overt Hypothyroidism (no subclinical) is prevalent in 0.3% to 0.5% of pregnant women and is asymptomatic in 70% of these patients. Thus, in order to avoid risks to the mother and fetus health due absence of early diagnosis, it would be ideal for pregnancy monitoring care examinations in the public health system to request a TSH test, especially in high-risk pregnancies. Method: A cross-sectional observational study was approved by the Ethics Committee (CAAE 22906619.2.0000.0062) to review 83 medical records of high-risk pregnant women in a Brazilian public hospital, State of São Paulo, Brazil in 2020. Inclusion criteria: All patients who are being followed up in high-risk childbirth or are hospitalized in the high-risk sector on the maternity during the year 2020. Complete medical records containing the data proposed to be researched and results of exams to be analyzed in the research. Results: The study included the review of 83 medical records of high-risk pregnant women with average age of 30 years old, average gestational age of 31 weeks and average weight of 84 kg. From these 11.4% (n = 10) declared that they had hypothyroidism and 2.4% (n = 2) hyperthyroidism in the first consultation. The 47% (n = 39) had their TSH measured during pregnancy, of which TSH had changed 30.8% (n = 12), 5.1% (n = 2) with suppressed TSH and 25.6% (n = 10) with TSH above the limit for pregnancy. Of the pregnant women who had a diagnosis prior to the pregnancy of hypothyroidism, only 1 did not have their TSH collected during pregnancy. Of the pregnant women who had hyperthyroidism, all had TSH collected during pregnancy, but kept TSH suppressed and free T4 at the upper limit throughout the pregnancy. 10% (n = 8) had gestational bleeding, of which only 25% (n = 2) had TSH measured at some point during pregnancy, of these, one had an altered TSH, but no medication was prescribed or the test repeated. Conclusion: Recognizing that the evolution of pregnancy depends on the normal thyroid eixo, we believe that for high-risk pregnant women they should have their thyroid eixo evaluated in the first trimester.

A 63-year-old Japanese woman with an adrenal tumor was transferred to our hospital due to cardiogenic shock. Right and left ventriculography showed severe hypokinesis of the middle segment and the apex in both ventricles, and an endomyocardial biopsy demonstrated a small number of necrotic myocytes and cellular infiltration. She was diagnosed with pheochromocytoma and quickly recovered after treatment with an α-blocker. The functional disability of both the right and left ventricles with less myocardial damage due to an excessive level of catecholamine seemed to be related to the early recovery the present patient with catecholamine-induced cardiomyopathy due to pheochromocytoma., Internal Medicine, 56(6), pp.665-671; 2017

BACKGROUND The ability of iMap-intravascular ultrasound (IVUS) tissue characterization to detect thin-cap fibroatheroma (TCFA) identified on optical coherence tomography (OCT) has not yet been fully elucidated. METHODS AND RESULTS We evaluated 86 coronary lesions from 73 patients with stable angina pectoris using iMap-IVUS and OCT. We defined OCT-derived TCFA (OCT-TCFA) as lipid-rich plaque with a

Macroscopic assessment of the pubic symphysis is commonly used for age estimation because its surface changes over time. However, postmortem computed tomography (PMCT), a method several forensic medical departments and institutes have begun to adopt, has the potential to simplify the information gathering process from the pelvic bone without requiring soft tissue removal. Some studies have previously evaluated the use of three-dimensional images of the pubic symphysis, but because of variance in the graphics processing among image analysis software packages, certain differences have been observed between these studies. Therefore, in this study, the PMCT findings of 199 subjects of known age and sex were retrospectively reviewed to examine the feasibility of age estimation using planar images of the pubic bones and soft tissue. The coronal and axial sectional images were observed at the center of the symphyseal surface, and the pubic bone length and thickness of the connective tissue of the pubic symphysis were measured at each slice. Our results revealed a significant positive correlation between the length of the pubic bone of the coronal section and age, suggesting that the use of a cutoff value for pubic bone length might be feasible for age estimations. In addition, the thickness of the connective tissue tended to narrow over time. Although the prediction interval range of planar images obtained by PMCT was major and is not usable in practice at this moment, it may still be a useful tool if used in conjunction with other findings obtained by PMCT.

Em 2007, o Conselho de Defesa do Patrimônio Histórico, Arqueológico, Artístico e Turístico (Condephaat) deliberou pelo tombamento do conjunto arquitetônico do \"Quadrilátero da Saúde\", ou seja, o reconhecimento do valor cultural e sua importância para a história do Estado de São Paulo. No final do século XIX, situava-se numa região considerada alheia à cidade, entre o sítio urbano original e o povoamento de Pinheiros. Já no século XX, o crescimento da cidade incorporou essa área, que hoje corresponde a um perímetro delimitado pelas ruas Teodoro Sampaio, Oscar Freire e as Avenidas Rebouças e Doutor Arnaldo, agregando um número crescente de edificações voltadas à saúde pública, tais como a Faculdade de Medicina, a Escola de Enfermagem e a Faculdade de Saúde Pública da Universidade de São Paulo, o Edifício Central e o Instituto de Ortopedia do Hospital das Clínicas, o Instituto Oscar Freire, o Instituto Adolfo Lutz, o Centro de Saúde Pública Geraldo Paula Souza e os remanescentes do Antigo Hospital do Isolamento. Configurada a partir de um processo contínuo de inserção de novos edifícios de modo a construir um conjunto coeso e definido no âmbito urbano, constitui-se em área específica da cidade, cuja construção dos espaços permite análise das mais diferentes soluções arquitetônicas. Neste sentido, ao traçar uma relação entre conteúdo programático e solução formal dos edifícios, com a inserção de dados - políticos, econômicos, sociais - originários de conhecimento de bibliografia existente, buscou-se contribuir para a ampliação de um repertório ainda pouco conhecido e abrir espaço para a discussão sobre os reflexos que o ideal modernizador da São Paulo do início do século XX teria causado na produção arquitetônica deste território. In 2007, the Conselho de Defesa do Patrimônio Histórico, Arqueológico, Artístico e Turístico (Condephaat) recognized the architectural ensemble known as \"Health Block\", for its cultural value and its importance for the history of the State of São Paulo. In the late nineteenth century, it was located in a region regarded as being outside the city, between the original urban site and the Pinheiros settlement. In the twentieth century, the city growth has incorporated this area, which today corresponds to a complex delimited by Teodoro Sampaio and Oscar Freire streets and Rebouças and Dr. Arnaldo avenues, gathering a growing number of buildings designed for public health, such as the School of Medicine, School of Nursing and School of Public Health of University of São Paulo, the Main Building and the Institute of Orthopedics of Hospital das Clínicas, the Oscar Freire Institute, the Adolfo Lutz Institute, the Geraldo Paula Souza Public Health Center and the remainings of the former Isolation Hospital. Configured from the continuous addition of new buildings to compose a cohesive ensemble defined in the urban environment, it is a specific area of the city, whose construction of spaces allows an analysis of many different architectural solutions. By tracing a relationship between program content and formal solution of the buildings, with the inclusion of political, economic and social data originating from existing literature, this work seeks to contribute to the expansion of a still largely unknown repertoire and to open a space for discussion about the consequences that the ideal of modernization of São Paulo\'s early twentieth century architectural production have brought to this territory.

This paper analyzes the documentation procedure that, in 2007, designated the Quadrilatero da Saude (Health Block) as heritage and landmark in the history of the implementation of the public health system in the State of Sao Paulo. It is located in a region regarded as being outside the city in the late nineteenth century, between the original urban site and the settlement of Pinheiros. In the twentieth century, the city’s growth has incorporated this area, which now corresponds to a perimeter in the central region bounded by streets Teodoro Sampaio, Oscar Freire and avenues Reboucas and Doutor Arnaldo, joining a growing number of buildings related to public health. The documentation examined – specifically two technical reports used by the Historical, Archeological, Artistical and Tourism Heritage Protection Council (Condephaat) as basis for listing the site – revealed a clear split between architectural spatial analysis and historical contextualization. In addition to noting this split between the two speeches, the intent was to verify to what extent they complement, overlap or oppose each other.

We measured the affinity of more than 20 sugars with concanavalin A (ConA) by an optical biosensor (surface plasmon resonance sensor) using asialofetuin (ASF) as an immobilized binding partner of ConA. We determined kinetic parameters of the effects of sugars on the dissociation of ConA from ASF quantitatively, and the structural requirements of the functional groups of sugars for binding with ConA. We found that the affinity of ConA for sugars is dependent on its conformation induced by interaction with the binding partner. In addition, the results showed that optical biosensor system is well mimics the interaction of ConA with sugars in biomembrane.

The addition of alcohols to dichloromethane solution of Mo(V)O(tpp)Br (tpp = meso-tetraphenylporphinato) causes three-step reactions. The products in the first, second and third stages of the reactions are solvated, alcohol and alkoxo complexes, respectively. t-Butyl alcohol does not afford the corresponding alcohol complex. The most important factor controlling the formation of alcohol complexes is the bulkiness of the alcohol molecules.