Objective The objectives of this paper are to objectively measure habitual physical activity levels in patients with primary Sjögren's syndrome (pSS) with mild disease activity and to determine to which extent it may be associated with physical capacity and function and clinical features. Methods In this cross-sectional study, 29 women with pSS were objectively assessed for habitual physical activity levels (using accelerometry) and compared with 20 healthy women (CTRL) frequency-matched for physical activity levels, age, body mass index, and body fat percentage with regard to physical capacity and function, fatigue, depression, pain, and health-related quality of life. Results pSS showed 8.5 min/day of moderate-to-vigorous physical activity (MVPA) when only MVPA accumulated in bouts ≥ 10 min was considered; when considering total MVPA (including bouts < 10 min), average levels were 26.3 min/day, with 62% of pSS patients achieving the recommendation (≥ 21.4 min/day). Moreover, pSS showed lower VO, lower muscle strength and function, higher fatigue, and poorer health-related quality of life when compared with CTRL ( p < 0.05). These differences (except for aerobic capacity) were sustained even when only individuals achieving the minimum of 21.4 min/day of total MVPA in both groups were compared. Finally, MVPA time was significantly correlated with aerobic conditioning, whereas total counts and sedentary time were associated with lower-body muscle strength and the bodily-pain domain of SF-36 in patients with pSS. Conclusion When compared to physical activity-matched healthy controls, pSS patients showed reduced physical capacity and function, increased fatigue and pain, and reduced health-related quality of life. Except for aerobic conditioning, these differences were sustained when only more physically active participants were compared, indicating that minimum recommended levels of physical activity for the general population may not be sufficient to counteract pSS comorbidities.

Metabolic syndrome (MetS) has been described in autoimmune diseases. However, there are scarce data about MetS and adipocytokine profile in primary Sjögren's syndrome (pSS). Seventy-one female pSS patients (American-European Consensus Group Criteria, 2002) aged 18-65 years and 71 age-, race-matched control women were enrolled in this case-control study. Clinical data were collected by a standardized protocol. Blood levels of glucose, cholesterol, low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), triglycerides, interleukin-1beta (IL-1beta)/IL-6, B-cell activating factor (BAFF), insulin, and leptin/adiponectin/visfatin/resistin were determined. Patients and controls were comparable regarding body mass index (BMI), smoking, sedentariness, and menopause (p > 0.05). MetS (39.4 vs. 16.9 %, p = 0.005), hypertension (p = 0.004), and dyslipidemia (p = 0.002) were more frequent in patients than controls. IL-1beta, IL-6, BAFF, resistin, and adiponectin levels were higher in patients than controls (p < 0.05). pSS patients with MetS (n = 28) had higher BMI, waist circumference, cholesterol, LDL-C, triglycerides, insulin, leptin and HOMA-IR values, and greater hypertension and diabetes rates than pSS patients without MetS (n = 43) (p < 0.05). Current and/or previous prednisone use (75.0 vs. 62.8 %, p = 0.313), current (3.0 ± 4.5 vs. 1.6 ± 3.2 mg/day, p = 0.299), and cumulative prednisone doses (p = 0.495) were similar in both groups. Otherwise, IL-1beta level was higher in MetS patients than in non-MetS patients (p = 0.012), and this finding was confirmed (p = 0.048) by multivariate analysis with adjustments for age, ethnicity, prednisone use, current and cumulative prednisone doses, and duration of use. We identified high MetS frequency and abnormal adipocytokine profile in pSS. The association of MetS with elevated IL-1beta level suggests that inflammation plays an important role in its pathogenesis.

The purposes of this study were to determine the prevalence of metabolic syndrome (MetS) in patients with ankylosing spondylitis (AS) receiving anti-TNFα therapy and evaluate the association of the two conditions with clinical and laboratory findings and predictors of cardiovascular risk. In this cross-sectional study, 63 patients diagnosed with AS according to the modified New York criteria and treated with TNFα blockers and 33 healthy controls were submitted to clinical examination and anthropometric measurements. Glucose levels, lipid profile, and inflammatory markers were registered. The Framingham score (FS), atherogenic index of plasma (AIP), and waist-to-height ratio (WHtR) were calculated. MetS was diagnosed according to the revised National Cholesterol Education Program - Adult Treatment Panel III guidelines. The prevalence of MetS was higher among AS patients than controls (27 vs. 9.1%, p = 0.04). AS patients also had greater body mass index (27.6 kg/m ± 4.5 vs. 24.5 kg/m ± 2.7; p = 0.001) and WHtR (0.59 ± 0.08 vs. 0.49 ± 0.05; p < 0.01). Patients with MetS had higher FS (9.66 (4.08-20.5) vs. 2.54 (1.56-6.75); p < 0.001), WHtR (0.6444 ± 0.0706 vs. 0.5729 ± 0.0759; p = 0.001), and AIP (0.68 ± 0.46 vs. 0.34 ± 0.24; p = 0.02) than patients without MetS. When stratifying patients with and without MetS according to disease activity, the former had stronger predictors of cardiovascular risk than the latter, regardless of disease activity. MetS was more prevalent in AS patients than in controls. Predictors of cardiovascular risk were stronger in MetS patients than in non-MetS patients.

Introduction: The pandemic caused by the SARS-CoV-2 virus has accelerated an educational revolution, with implications for health care and medical education, generating some insecurities and uncertainties. The article reports the experience of Centro Universitário Christus (Unichristus) about the changes that occurred in the practical scenarios of clinical experiences during the first semester of 2020, marked by social distancing. Experience Report: The services at Clínica Escola de Saúde (CES) were suspended and the associated hospitals stopped receiving students, making the experience of real-life scenarios unfeasible, resulting in the beginning of a project characterized by care of patients with coronavirus infection through telemedicine. The face-to-face nursing team’s participation occurred concomitantly, while students attending the eighth semester of the medical course were present at the consultation through screen sharing using the Google Meet ® program. After the consultation was concluded, there was a discussion about the case and other relevant aspects, similarly to what would happen with a face-to-face experience. In parallel with the project, students also attended lectures that addressed aspects of the disease from primary to tertiary level of health care. Discussion: Patients received care and students were taught through a flexible, innovative, accessible and safe media, following a worldwide trend, generating opportunities for professional development and innovations in medical education. The experience with telemedicine can be complemented by e-learning, allowing the development of a new hybrid teaching model. Conclusion: The current circumstances may result in some educational loss, such as the impossibility to perform physical examinations and to interact better with the health care team and patients; however the technological resources can result in opportunities for changes, improvement and development of teaching methodologies, in line with the current generation of digital natives.

This study was the first to assess bone microarchitecture in pSS and demonstrated that cortical deterioration is the most important abnormality observed in pSS patients with VFs. This novel finding shows that this compartment contributes to vertebral fragility, suggesting that this non-invasive evaluation may be useful in the clinical practice.

O grande desafio das escolas médicas durante a pandemia da COVID-19 foi fazer a transição, em curto período, do ensino presencial da Aprendizagem Baseada em Problemas (ABP) para o ensino remoto de emergência (ERE). Este trabalho teve como objetivo relatar os resultados da implementação da ABP no ERE no curso de Medicina de um Centro Universitário em Fortaleza. Trata-se de um estudo de corte transversal, descritivo e quantitativo. Um formulário eletrônico no formato Google Docs, enviado a todos os docentes após conclusão das atividades de tutoria do primeiro semestre letivo de 2020, avaliou sua percepção quanto à eficácia da ABP no ERE, às dificuldades de adaptação à modalidade de ERE, à sobrecarga cognitiva das sessões tutoriais e aos fatores interferentes na interação tutor-aluno online. Os tutores assinaram um termo de consentimento e o anonimato foi garantido. Responderam ao formulário 89 tutores, 60,7% do sexo feminino, idade média de 40,9 anos e mediana do tempo de experiência como tutor de dois anos. Quanto à eficácia do ABP no ERE, 49,4% dos tutores julgaram ser menor em relação ao ensino presencial; 70,8% não tinha nenhuma/mínima experiência com tecnologias educacionais antes da pandemia; 46,1% tiveram dificuldades de adaptação na modalidade de ERE; 69,6% evidenciaram a sobrecarga cognitiva dos discentes e 74,1% concordaram com a necessidade de diminuição da carga horária da tutoria. Os principais fatores que interferiram na interação tutor-aluno foram interrupção da rede de internet, câmera desligada e comunicação não verbal deficiente. Portanto, a utilização de ABP no ERE deve ser realizada de forma modificada, com diminuição das horas de atividades síncronas, com melhor capacitação dos tutores e alunos quanto às TICs, melhor conhecimento das avaliações interativas online e das medidas profiláticas da fadiga zoom.

RESUMO INTRODUÇÃO Feedback é uma informação provida pelo professor para melhorar o desempenho do estudante. Embora seja uma importante ferramenta de ensino e seja desejada pelos discentes, ainda é utilizada de maneira insuficiente. OBJETIVO Este estudo criou um manual para uso de feedback estruturado com base nos resultados de grupos focais que verificaram a percepção dos alunos do internato de Medicina sobre o tema. MÉTODOS Trinta e um alunos do internato de Medicina de uma instituição de ensino superior participaram de entrevistas de grupo focal sobre suas impressões relativas ao feedback. Os dados foram analisados pela Análise de Conteúdo de Bardin. RESULTADOS Os alunos compreendem o que é feedback e o vivenciam por meio das metodologias ativas de ensino. Reconhecem sua importância para o aprendizado, mas se queixam da baixa frequência desse instrumento. Sobre como gostariam de receber o feedback e as virtudes inerentes aos docentes e discentes para o sucesso do mesmo, notou-se o alinhamento de suas ideias com o que diz a literatura. CONCLUSÃO Os alunos conhecem feedback e o vivenciam na prática, reconhecendo sua importância para o aprendizado e sendo receptivos a ele. Desenvolveu-se um manual com estratégia de feedback estruturado voltado ao uso em ambulatórios didáticos na graduação em Medicina.

key words unitermos abstractCandida albicans and other species are usually involved in opportunistic infections in patients with acquired immunological deficiency syndrome (AIDS). The virulence mechanisms by which this yeast expresses its pathogenicity include adherence patterns, ability to form pseudomycelia and production of extracellular enzymes, among others. The objective of this research was to verify the frequency of Candida and the production of proteinase and phospholipase in 52 strains of Candida albicans from the oral cavity of patients infected by HIV treated at Hospital São José, AIDS reference and training center in Fortaleza, Ceará. Samples were collected of patients, with or without oral lesions characteristic of candidosis. From 100 patients, 80% presented positivity for Candida: 65% (52) were identified as C. albicans, 27.5% (22) as C. tropicalis, 2.5% (2) as C. glabrata, 2.5% (2) as C. krusei and 2.5% (2) as C. guilliermondii. Among the strains of C. albicans isolated from the oral cavity, proteinase and phospholipase were detected in 69.2% and 73%, respectively. The results suggested that C. albicans was the most frequent species observed, with intermediate expression of proteinase and phospholipase. Candida albicans HIV Phospholipase Proteinase resumoCandida albicans e outras espécies são usualmente envolvidas em infecções de pacientes com a síndrome da imunodeficiência adquirida (AIDS). Os mecanismos de virulência pelos quais a levedura expressa sua patogenicidade incluem padrões de aderência, habilidade por formar pseudomicélio, produção de enzimas extracelulares e outros. O objetivo deste trabalho foi verificar a freqüência de Candida e a produção de proteinase e fosfolipase em 52 cepas de Candida albicans da cavidade oral de pacientes infectados pelo HIV atendidos no Hospital São José, hospital de referência e centro de treinamento em AIDS em Fortaleza, Ceará. Neste trabalho foram coletadas amostras de pacientes com ou sem lesões características de candidose. Dos cem pacientes 80% apresentaram positividade para Candida, sendo 65% (52) identificados como C. albicans, 27,5% (22) como C. tropicalis, 2,5% (2) como C. glabrata, 2,5% (2) como C. krusei e 2,5% (2) como C. guilliermondii. Entre as cepas de C. albicans isoladas da cavidade oral foram detectadas proteinase e fosfolipase em 69,2% e 73%, respectivamente. Os resultados sugerem que a C. albicans foi a espécie mais freqüentemente observada, com intermediária expressão de proteinase e fosfolipase. Candida albicans HIV Fosfolipase ProteinasePrimeira submissão em 15/08/05