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Resumo: Introdução: Além de demorada, a mentoria em Medicina ocorre em vários níveis e é complexa, pois pode incluir várias combinações de ensino, prática clínica, atendimento ao paciente e pesquisa. Relato de experiência: Trata-se de um relato de experiência individual de uma mentorada em um programa de residência médica em patologia do Hospital Universitário Getúlio Vargas, de Manaus, no Amazonas. Descrevem-se os benefícios individuais e coletivos de uma mentoria fora de um programa formal, orientada pelo discernimento e pela maturidade de relacionamento entre mentor e mentorada. Discussão: Discentes de programa de residência médica podem se beneficiar sobremaneira, pessoal e profissionalmente, de mentorias bem conduzidas. Conclusão: No relacionamento de mentoria, são imprescindíveis qualidades como respeito mútuo, discernimento e abnegação, para que o mentorado cresça e desenvolva uma identidade profissional independente, ainda que atrelada à relação de mentoria, e amadurecida, em seu pleno desenvolvimento, a fim de que ele seja um novo mentor e novos alunos sejam beneficiados.

We present postmortem evidence of invasive pulmonary aspergillosis (IPA) in a patient with severe COVID-19. Autopsies of COVID-19 confirmed cases were performed. The patient died despite antimicrobials, mechanical ventilation, and vasopressor support. Histopathology and peripheral blood galactomannan antigen testing confirmed IPA. Aspergillus penicillioides infection was confirmed by nucleotide sequencing and BLAST analysis. Further reports are needed to assess the occurrence and frequency of IPA in SARS-CoV-2 infections, and how they interact clinically.

The involvement of Mycobacterium tuberculosis in the central nervous system (CNS) is an uncommon and devastating manifestation of tuberculosis. We report a case of disseminated tuberculosis presenting as meningoencephalitis, hypothalamic involvement with extension to the hypophysis, and secondary insipidus diabetes diagnosed at autopsy.

Pathology must aim at a correct and complete diagnosis for the patient, which is timely, useful, and understandable to the physician assistant. However, in daily practice, there are multiple possibilities of errors in the pathology laboratory, with several impacts on patient care and prognosis. In this chapter, we discuss the different concepts of error and diagnostic concordances in pathology, at which point in the diagnostic process the errors are more frequent, and propose solutions to minimize the chance of their occurrence.

Submitted by Viviane Silva (lagoliveira@gmail.com) on 2022-08-25T22:05:27Z No. of bitstreams: 3 Disserta????o_VivianeLagodeOliveiraSilva_PPGCIS_UFAM.pdf: 2517420 bytes, checksum: 6f1dc55f7bbea23f294ab8bee75cd0c4 (MD5) CartaEncaminhamentoAutodep??sito_VivianeLagodeOliveiraSilva.pdf: 118558 bytes, checksum: 3013b6b30b3c50f839ba27c04820c795 (MD5) ATA_VivianeLagodeOliveiraSilva_PPGCIS_UFAM.pdf: 208685 bytes, checksum: 3519fd17256292c92baf44eb0342c383 (MD5) Approved for entry into archive by PPGCS Ci??ncias da Sa??de (ppgmcsaude@ufam.edu.br) on 2022-08-30T18:43:06Z (GMT) No. of bitstreams: 3 Disserta????o_VivianeLagodeOliveiraSilva_PPGCIS_UFAM.pdf: 2517420 bytes, checksum: 6f1dc55f7bbea23f294ab8bee75cd0c4 (MD5) CartaEncaminhamentoAutodep??sito_VivianeLagodeOliveiraSilva.pdf: 118558 bytes, checksum: 3013b6b30b3c50f839ba27c04820c795 (MD5) ATA_VivianeLagodeOliveiraSilva_PPGCIS_UFAM.pdf: 208685 bytes, checksum: 3519fd17256292c92baf44eb0342c383 (MD5) Approved for entry into archive by Divis??o de Documenta????o/BC Biblioteca Central (ddbc@ufam.edu.br) on 2022-08-31T22:07:31Z (GMT) No. of bitstreams: 3 Disserta????o_VivianeLagodeOliveiraSilva_PPGCIS_UFAM.pdf: 2517420 bytes, checksum: 6f1dc55f7bbea23f294ab8bee75cd0c4 (MD5) CartaEncaminhamentoAutodep??sito_VivianeLagodeOliveiraSilva.pdf: 118558 bytes, checksum: 3013b6b30b3c50f839ba27c04820c795 (MD5) ATA_VivianeLagodeOliveiraSilva_PPGCIS_UFAM.pdf: 208685 bytes, checksum: 3519fd17256292c92baf44eb0342c383 (MD5) Made available in DSpace on 2022-08-31T22:07:31Z (GMT). No. of bitstreams: 3 Disserta????o_VivianeLagodeOliveiraSilva_PPGCIS_UFAM.pdf: 2517420 bytes, checksum: 6f1dc55f7bbea23f294ab8bee75cd0c4 (MD5) CartaEncaminhamentoAutodep??sito_VivianeLagodeOliveiraSilva.pdf: 118558 bytes, checksum: 3013b6b30b3c50f839ba27c04820c795 (MD5) ATA_VivianeLagodeOliveiraSilva_PPGCIS_UFAM.pdf: 208685 bytes, checksum: 3519fd17256292c92baf44eb0342c383 (MD5) Previous issue date: 2022-08-11 PROCAD - Programa de Coopera????o Acad??mica na Amaz??nia FAPEAM - Funda????o de Amparo ?? Pesquisa do Estado do Amazonas CAPES - Coordena????o de Aperfei??oamento de Pessoal de N??vel Superior Despite access to highly active antiretroviral therapy (HAART), many people living with Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome (PLWHA) require care in Intensive Care Units (ICU). Thus, it is important to establish the prognosis of these individuals at admission to direct care. There are several mortality predictor scores, however, there is a lack of data on which of these is most suitable for PLWHA in the ICU. Objective: To compare the performance of prognostic scores in PLWHA admitted to the ICU in the first 24 hours and 72 hours of hospitalization. Method: Retrospective cohort study. Clinical and laboratory data were collected from 103 adult PLWHA, in the first 24 and 72 hours of ICU admission, in order to extract data for 10 prognostic scores. To compare the performance of the scores, logistic regression was used; discrimination was determined by comparing the areas under the curves (AUC) Receiver Operating Characteristic (ROC), using the method proposed by DeLong et al. (1988). The calibration of the models was evaluated using the Hosmer-Lemeshow test. Statistical analysis was performed using R-Statistics, version 4.0.5. Results: During the 24 hours after ICU admission, seven prognostic scores were evaluated, of which five had modest and similar discriminatory power, with the 24h MPM II having the highest discrimination (AUC: 0.665), followed by ODIN (AUC: 0.649), MPM II Admission (AUC: 0.641), APACHE II (AUC: 0.619) and SAPS III (AUC: 0.617), with no statistically significant difference between them (p-value > 0.050). All models had adequate calibration (p-value > 0.050). In the 72 hours, three prognostic scores were analyzed. MPM II 72h showed good discriminatory power (AUC: 0.802), while SOFA and MODS presented acceptable discriminatory power (AUC: 0.712; AUC: 0.780, respectively). There was a significant difference (p-value < 0.050) in the AUC of the SOFA score for the others, but there was no difference between the AUC of the MPM II 72h and the AUC of the MODS (p-value > 0.050). All models calibrated properly (p-value > 0.050). Conclusion: After comparing the discriminatory performance of seven prognostic scores within 24 hours of admission, there was no difference between them. However, the 24h MPM II showed greater sensitivity and accuracy. At 72 hours after admission, three prognostic scores were compared. MODS and MPM II 72h showed better discriminatory power than SOFA. In addition, the MPM II 72h demonstrated greater sensitivity and accuracy in PLWHA admitted to the ICU. A despeito do acesso ?? terapia antirretroviral altamente ativa (HAART), muitas pessoas vivendo com o V??rus da Imunodefici??ncia Humana e a S??ndrome da Imunodefici??ncia Adquirida (PVHA) necessitam de cuidados em Unidades de Terapia Intensiva (UTI). Dessa forma, ?? importante estabelecer o progn??stico desses indiv??duos ?? admiss??o para direcionar os cuidados. Existem diversos escores preditores de mortalidade, todavia, h?? escassez de dados sobre qual desses ?? mais indicado para PVHA em UTI. Objetivo: Comparar o desempenho de escores progn??sticos em PVHA admitidas em UTI nas primeiras 24 horas e 72 horas de interna????o. M??todo: Estudo de coorte retrospectiva. Foram coletados os dados cl??nicos e laboratoriais de 103 PVHA adultas, nas primeiras 24 e 72 horas de interna????o na UTI, a fim de extrair dados para 10 escores progn??sticos. Para comparar o desempenho dos escores foi utilizada regress??o log??stica; a discrimina????o foi determinada pela compara????o das ??reas sob as curvas (AUC) Receiver Operating Characteristic (ROC), utilizando o m??todo proposto por DeLong et al. (1988). A calibra????o dos modelos foi avaliada por meio do teste de Hosmer-Lemeshow. A an??lise estat??stica foi realizada no R-Statistics, vers??o 4.0.5. Resultados: Durante as 24 horas ap??s a admiss??o na UTI, sete escores progn??sticos foram avaliados, dos quais cinco apresentaram poder discriminat??rio modesto e semelhante, sendo que o MPM II 24h obteve a maior discrimina????o (AUC: 0,665), seguido pelo ODIN (AUC: 0,649), MPM II Admiss??o (AUC: 0,641), APACHE II (AUC: 0,619) e SAPS III (AUC: 0,617), sem diferen??a estatisticamente significante entre eles (valor-p > 0,050). Todos os modelos tiveram calibra????o adequada (valor-p > 0,050). Nas 72 horas foram analisados tr??s escores progn??sticos. O MPM II 72h apresentou bom poder discriminat??rio (AUC: 0,802), enquanto o SOFA e o MODS apresentaram poder discriminat??rio aceit??vel (AUC: 0,712; AUC: 0,780, respectivamente). Houve diferen??a significativa (valor-p < 0,050) da AUC do escore SOFA para os demais, mas n??o houve diferen??a entre a AUC do MPM II 72h e a AUC do MODS (valor-p > 0,050). Todos os modelos calibraram adequadamente (valor-p > 0,050). Conclus??o: Ap??s comparar o desempenho discriminat??rio de sete escores progn??sticos nas 24 horas ap??s a admiss??o, n??o houve diferen??a entre eles. Entretanto, o MPM II 24h apresentou maior sensibilidade e acur??cia. Nas 72 horas ap??s a admiss??o, tr??s escores progn??sticos foram comparados. MODS e MPM II 72h apresentaram melhor poder discriminat??rio que o SOFA. Al??m disso, o MPM II 72h demonstrou maior sensibilidade e acur??cia em PVHA admitidas na UTI.