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Abstract Arboviruses are endemic in several countries and represent a worrying public health problem. The most important of these diseases is dengue fever, whose numbers continue to rise and have reached millions of annual cases in Brazil since the last decade. Other arboviruses of public health concern are chikungunya and Zika, both of which have caused recent epidemics, and yellow fever, which has also caused epidemic outbreaks in our country. Like most infectious diseases, arboviruses have the potential to affect the kidneys through several mechanisms. These include the direct action of the viruses, systemic inflammation, hemorrhagic phenomena and other complications, in addition to the toxicity of the drugs used in treatment. In this review article, the epidemiological aspects of the main arboviruses in Brazil and other countries where these diseases are endemic, clinical aspects and the main laboratory changes found, including changes in renal function, are addressed. It also describes how arboviruses behave in kidney transplant patients. The pathophysiological mechanisms of kidney injury associated with arboviruses are described and finally the recommended treatment for each disease and recommendations for kidney support in this context are given.

ABSTRACT Objective: To assess whether the use of ELMO, a helmet for noninvasive ventilation created in Brazil, had a positive impact on the prognosis of patients with hypoxemic respiratory failure caused by severe COVID-19. Methods: This is a retrospective study of 50 critically ill COVID-19 patients. Epidemiological, clinical, and laboratory data were collected on ICU admission, as well as before, during, and after ELMO use. Patients were divided into two groups (success and failure) according to the outcome. Results: ELMO use improved oxygenation parameters such as Pao2, Fio2, and the Pao2/Fio2 ratio, and this contributed to a gradual reduction in Fio2, without an increase in CO2, as determined by arterial blood gas analysis. Patients in the success group had significantly longer survival (p < 0.001), as determined by the Kaplan-Meier analysis, less need for intubation (p < 0.001), fewer days of hospitalization, and a lower incidence of acute kidney injury in comparison with those in the failure group. Conclusions: The significant improvement in oxygenation parameters, the longer survival, as reflected by the reduced need for intubation and by the mortality rate, and the absence of acute kidney injury suggest that the ELMO CPAP system is a promising tool for treating ARDS and similar clinical conditions.

Abstract Objective: to evaluate the use of a renal health application by kidney transplant recipients. Method: a retrospective, observational study with a sample composed of individuals registered in the kidney transplant section of the application from July of 2018 to April of 2021. Demographic data, data entry, time of use, weight, blood pressure, blood glucose, creatinine, medication schedules, appointments, and tests were the variables collected. Descriptive analysis of the data was performed. Results: eight hundred and twenty-three downloads of the application were identified, and 12.3% of those were registered as kidney transplant recipients, the majority from southeastern Brazil (44.9%), 36±11 years old, and female (59.1%). Of the sample, 35.1% entered information such as creatinine (62%), weight (58.2%), and blood pressure (51.8%). Most used the application for one day (63.3%) and 13.9% for more than one hundred days. Those who used it for more than one day (36.7%) recorded weight (69%), medication intake (65.5%) and creatinine (62%), and scheduled appointments (69%). Conclusion: the kidney transplant recipient section of the Renal Health application generated interest in the young population, but showed low adherence throughout the assessed months. These results offer a relevant perspective on the implementation of mHealth technologies in kidney transplantation.

Abstract Acute kidney injury (AKI) is a common finding in Neotatal Intensive Care Units (NICU). Sepsis is one the main causes of AKI in preterm newborns. AKI has been associated with significant death rates. Early detection of the condition is the first step to improving prevention, treatment, and outcomes, while decreasing length of hospitalization, care costs, and morbimortality. AKI may progress to chronic kidney disease (CKD), a condition linked with dialysis and greater risk of cardiovascular disease. This review article aims to discuss cases of AKI in preterm newborns with sepsis, the use of biomarkers in lab workup, and the use of non-conventional biomarkers for the early identification of AKI.

ABSTRACT Objectives: to identify the scientific evidence about the clinical complications and manifestations of congenital syphilis and aspects related to its prevention. Methods: integrative review after a search in the databases LILACS and MEDLINE, carried out in March 2018, using the descriptors “syphilis, congenital”, “complications”, and “signs and symptoms”, leading to the selection of 27 researches. Results: the publications found were published from 1966 to 2017, and most of them were from Latin America and Africa. Negative outcomes, laboratory changes, and the clinical manifestations in congenital syphilis, whether early or delayed, were, respectively: low weight at birth, anemia, hepatosplenomegaly, and dental alterations. The lack of treatment of the pregnant women in the prenatal was the most common occasion in which the opportunity to prevent the complications of congenital syphilis was lost. Conclusions: the scientific evidences analyzed showed serious complications of congenital syphilis that could be avoided if early opportunities of diagnosing and treating the pregnant women are not lost during the prenatal.

Objetivo: Descrever o desenvolvimento de novas estratégias de comunicação para promoção da saúde no âmbito da doença renal crônica (DRC). Métodos: Pesquisa de natureza aplicada, pois objetiva a produção de conhecimentos direcionados à solução de problemas específicos por meio de ferramentas práticas e da análise das hipóteses levantadas. As ferramentas foram desenvolvidas pela parceria entre o Programa de Pós-Graduação em Saúde Coletiva e o Núcleo de Aplicação em Tecnologia da Informação da Universidade de Fortaleza. O estudo intitulado “Renal Health” foi dividido em três fases consecutivas: Fase 1 - Desenvolvimento do aplicativo Renal Health; Fase 2 - Construção de conteúdos e plataformas digitais vinculadas ao aplicativo; e Fase 3 – Teste de impacto clínico e adesão ao aplicativo. No presente momento, o estudo encontra-se com a fase 1 concluída e com a fase 2 em andamento. Resultados: Foi desenvolvido o aplicativo Renal Health para uso em dispositivos móveis, em plataforma Android, com interfaces para a população geral, ou seja, pessoas que não fazem tratamento para DRC, pacientes renais crônicos em hemodiálise e transplantados renais. A fase 2 do estudo encontra-se em desenvolvimento, ocorrendo por meio de reuniões entre as equipes de pesquisadores e dos setores saúde e tecnologia para a compilação dos conteúdos e delineamento do projeto gráfico das plataformas digitais. Conclusão: A comunicação entre os profissionais de saúde e os portadores de DRC é passível de contínuo aperfeiçoamento, dada a variedade das modalidades de tratamento e suas peculiaridades. O aplicativo Renal Health e as plataformas digitais se propõem a apoiar ambos nesse processo.

This study assesses the socio-political values of colleges students (n = 605) Portugal/Brazil, employing a questionnaire on socio-political dimension Values. The results revealed significate differences about fundamental values. We find indifference/scepticism in Portuguese and Brazilian students practice, essentially with regard to the causes of social inequalities. In Brazil are connect from bad luck, laziness and inactivity and in Portugal a short instruction distinguish. This research empowers the implementation of programmes of education for citizenship in academic context.

Este estudo analisa os valores sociopolíticos dos universitários (n=605) Portugal/Brasil, mediante um Questionário sobre Valores na dimensão sociopolítica. Os resultados revelaram diferenças quanto a valores fundamentais. Constatamos indiferença/descrença política nos estudantes portugueses e brasileiros, essencialmente no respeitante às causas das desigualdades sociais. No Brasil são decorrentes da pouca sorte, preguiça e inatividade laboral e em Portugal particularizam a pouca instrução. Esta pesquisa viabiliza a implementação de programas de educação para a cidadania em contexto académico.

OBJETIVO: A população idosa está aumentando em todo o mundo, assim como a necessidade de cuidados intensivos para os idosos. Existem poucos estudos que investiguem os fatores de risco para óbito em pacientes idosos gravemente enfermos. Este estudo teve o objetivo de investigar os fatores associados ao óbito em uma população de pacientes idosos gravemente enfermos admitidos a uma unidade de terapia intensiva no Brasil. MÉTODOS: Estudo retrospectivo de coorte que incluiu todos os pacientes idosos (idade ≥ 60 anos) admitidos a uma unidade de terapia intensiva em Fortaleza, Brasil, de janeiro a dezembro de 2007. Foi realizada uma comparação entre os sobreviventes e os não sobreviventes, e os fatores de risco para óbito foram investigados por meio de análise univariada e multivariada. RESULTADOS: Foi incluído um total de 84 pacientes, com uma média de idade de 73 ± 7,6 anos, sendo 59% do gênero feminino. A mortalidade foi de 62,8%. A principal causa de morte foi disfunção de múltiplos órgãos (42,3%), seguido por choque séptico (36,5%) e choque cardiogênico (9,7%). As complicações durante a permanência na unidade de terapia intensiva associadas com óbito foram insuficiência respiratória (OR = 61; pBACKGROUND: The elderly population is increasing all over the world. The need of intensive care by the elderly is also increasing. There is a lack of studies investigating the risk factors for death among critically ill elderly patients. This study aims to investigate the factors associated with death in a population of critically ill elderly patients admitted to an intensive care unit in Brazil. METHODS: This is a retrospective cohort study including all elderly patients (>60 years) admitted to an intensive care unit in Fortaleza, Brazil, from January to December 2007. A comparison between survivors and nonsurvivors was done and the risk factors for death were investigated through univariate and multivariate analysis. RESULTS: A total of 84 patients were included, with an average age of 73 ± 7.6 years; 59% were female. Mortality was 62.8%. The main cause of death was multiple organ dysfunction (42.3%), followed by septic shock (36.5%) and cardiogenic shock (9.7%). Complications during intensive care unit ICU stay associated with death were respiratory failure (OR=61, p

ABSTRACT Chronic kidney disease (CKD) represents one of today’s main public health problems. Serum creatinine measurement and estimation of the glomerular filtration rate (GFR) are the main tools for evaluating renal function. There are several equations to estimate GFR, and CKD-EPI equation (Chronic Kidney Disease – Epidemiology) is the most recommended one. There are still some controversies regarding serum creatinine measurement and GFR estimation, since several factors can interfere in this process. An important recent change was the removal of the correction for race from the equations for estimating GFR, which overestimated kidney function, and consequently delayed the implementation of treatments such as dialysis and kidney transplantation. In this consensus document from the Brazilian Societies of Nephrology and Clinical Pathology and Laboratory Medicine, the main concepts related to the assessment of renal function are reviewed, as well as possible existing controversies and recommendations for estimating GFR in clinical practice.

Introdução: A vida das pessoas com Doença Renal Crônica (DRC) é alterada em diversos aspectos. Dentre eles, o trabalho destaca-se como um dos que sofrem profundas consequências e comprometimento na sua continuidade. Embora existam estudos sobre as limitações impostas pelo tratamento da DRC nas atividades profissionais, a percepção dos pacientes em relação a essas limitações ainda é pouco explorada na literatura. Objetivo: Conhecer as percepções dos pacientes renais crônicos, em hemodiálise e transplantados renais, sobre as limitações impostas pelo tratamento nas suas atividades profissionais. Métodos: Estudo qualitativo, realizado com 21 pacientes com DRC (13 em tratamento de hemodiálise e 8 transplantados renais). A coleta de dados se deu por meio de entrevistas, a partir de um roteiro semiestruturado, e submetidas à análise de conteúdo, na modalidade temática. Resultados: Foram identificados três temas de análise: 1. Diagnóstico e acesso ao tratamento; 2. Limitações nas atividades diárias e no trabalho e 3. Mudanças relacionadas ao trabalho e apoio familiar. Entre os pacientes com hemodiálise, a necessidade de realizar sessões frequentes foi citado como um dificultador para a retomada das atividades laborais. Mesmo entre os pacientes transplantados, as limitações físicas e os cuidados pós-cirúrgicos afetaram a produtividade e a capacidade de retorno ao trabalho da maneira habitual. Conclusões: As mudanças experimentadas pelos entrevistados após o início do tratamento da DRC afetaram sua capacidade de retornar ao trabalho, e o apoio familiar foi considerado essencial para facilitar esse processo. A pesquisa qualitativa se mostrou uma ferramenta importante no entendimento de como as mudanças na vida do paciente renal crônico após o início do tratamento afetam sua capacidade de retornar ao trabalho.

Objetivo: Investigar as características sociodemográficas, ocupacionais e de morbidade dos servidores que tiveram licenças por transtorno mental e comportamental (TMC), bem como as associações dessas características com o afastamento precoce. Métodos: Estudo longitudinal (coorte retrospectiva), realizado no Instituto Federal de Educação do Ceará (IFCE), com vistas ao delineamento do perfil epidemiológico dos servidores afastados por TMC (n=250), no período de 2010 a 2018, e as associações das características epidemiológicas (sexo, grupo do cargo, local de trabalho, tempo na instituição, estado civil, faixa etária e remuneração) com o afastamento precoce, através das curvas de sobrevivência de Kaplan-Meier. Resultados: Ocorreram 684 afastamentos por TMC em 250 servidores (incidência de 4,9%), resultando em 22.409 dias perdidos de trabalho (DAW) e efeitos financeiros de aproximadamente R$ 6.845.220. Houve um aumento na quantidade de afastamentos, de DAW e da taxa de incidência de servidores afastados ao longo do período do estudo. O grupo dos transtornos do humor (F30-F39) da CID-10 apresentou-se como a principal causa de afastamento por TMC (n=367; 53,6%) e DAW (13.057). A análise de sobrevida mostrou afastamento precoce nos servidores do interior, solteiros, com faixa etária de 18 a 39 anos, tempo de serviço na instituição de até 9 anos e classe econômica C. Conclusão: Houve crescimento no IFCE, entre 2010 e 2018, dos afastamentos, dos DAW e da incidência de servidores afastados por TMC, com predominância dos transtornos do humor, os quais geraram efeitos financeiros elevados para a instituição. Evidenciou-se associação positiva entre algumas características sociodemográficas e o afastamento precoce por TMC.

ABSTRACT Introduction: Supplementation with probiotics for patients with chronic kidney disease (CKD) may be associated with decreased systemic inflammation. Objective: To assess the impact of oral supplementation with probiotics for patients with CKD on hemodialysis. Method: This double-blind randomized clinical trial included 70 patients on hemodialysis; 32 were given oral supplementation with probiotics and 38 were in the placebo group. Blood samples were collected at the start of the study and patients were given oral supplementation with probiotics or placebo for three months. The probiotic supplement comprised four strains of encapsulated Gram-positive bacteria: Lactobacillus Plantarum A87, Lactobacillus rhamnosus, Bifidobacterium bifidum A218 and Bifidobacterium longum A101. Patients were given one capsule per day for 3 months. Blood samples were taken throughout the study to check for inflammatory biomarkers. Non-traditional biomarkers Syndecan-1, IFN-y, NGAL, and cystatin C were measured using an ELISA kit, along with biochemical parameters CRP, calcium, phosphorus, potassium, PTH, GPT, hematocrit, hemoglobin, glucose, and urea. Results: Patients given supplementation with probiotics had significant decreases in serum levels of syndecan-1 (239 ± 113 to 184 ± 106 ng/mL, p = 0.005); blood glucose levels also decreased significantly (162 ± 112 to 146 ± 74 mg/dL, p = 0.02). Conclusion: Administration of probiotics to patients with advanced CKD was associated with decreases in syndecan-1 and blood glucose levels, indicating potential improvements in metabolism and decreased systemic inflammation.

ABSTRACT Introduction: Chronic kidney disease (CKD) has been increasing significantly. There is evidence that a large part of the population does not have enough knowledge on the subject. Objective: To investigate the level of knowledge about CKD in the general population, its risk factors and means of prevention. Methods: We ran a cross-sectional study in the population of Fortaleza, Ceará – Brazil, between 2017 and 2020, with the application of a questionnaire on CKD, risk factors and prevention. Results: we interviewed 735 volunteers, with a mean age of 38 years, of which 55% were female. Only 17.2% correctly responded to the concept of CKD, and 5.8% knew the concept of creatinine. Low water intake was the most cited risk factor by respondents (79.3%). The main risk factors and direct causes of CKD (diabetes and hypertension) were mentioned less frequently (13.2% and 15.1%, respectively). Men were more correct regarding risk factors and ways to prevent CKD. Older respondents answered more correctly the questions about the definition of CKD (n = 22; 28.6%) and creatinine (n = 7; 9.0%). With regards to education there was a statistically significant correlation in all the questions (p < 0.05). Conclusion: There is little knowledge about CKD in the general population. Higher level of education is associated with better knowledge. More health education actions are needed so that the population becomes better acquainted with CKD and, consequently, can adopt more adequate prevention and control measures.

ABSTRACT OBJECTIVE: To analyze the factors associated with prematurity in reported cases of congenital syphilis in the city of Fortaleza, Ceará, Brazil. METHODS: Cross-sectional study conducted in ten public maternity hospitals in Fortaleza, Ceará, Brazil. A total of 478 reported cases of congenital syphilis were included in 2015, and data were collected from notification forms, from mothers’ and babies’ medical records and from prenatal cards. For the bivariate analysis, Pearson’s chi-squared and Fisher’s exact tests were used, considering p < 0.05. Multiple logistic regression was conducted, presenting odds ratio (OR) with a 95% confidence interval. RESULTS: We found 15.3% prematurity in pregnant women with syphilis. The titration of the VDRL test > 1:8 at delivery (OR 2.46; 95%CI: 1.33–4.53; p = 0.004) and the non-treatment of the pregnant women or treatment with drugs other than penicillin during prenatal care (OR 3.52; 95%CI: 1.74–7.13; p< 0.001) were associated with higher chances of prematurity. CONCLUSION: The prematurity due to congenital syphilis is a preventable condition, provided that pregnant women with syphilis are treated appropriately. Weaknesses in prenatal care are associated with this outcome, which highlights the importance of public policies oriented to improve the quality of prenatal care.

Objective: To assess clinical and laboratory data, and acute kidney injury (AKI) in HIV‐infected children using and not using highly active antiretroviral therapy (HAART) prior to admission. Methods: A retrospective study was conducted with HIV‐infected pediatric patients (

Objective: To describe the epidemiological profile of women admitted to a tertiary hospital in Northeastern Brazil with Hypertensive Disorders of Pregnancy (HDP). Methods: A retrospective cross-sectional study was carried out at the Hospital Geral César Cals (César Cals General Hospital), a tertiary care center of the Sistema Único de Saúde – SUS (Brazil’s National Health System) in Fortaleza, Ceará, Brazil. The study included 1,865 pregnant women admitted with HDP from January 2006 to December 2013 regardless of age, education, marital status, place of birth, place of residence and outcome (discharge, death and ongoing pregnancy). Results: Pregnant women were predominantly aged 17-35 years (n=1484, 79.6%), mixed-race (n=1464, 78.5%), single (n= 775, 41.6%), housewives (n=1269, 68.0%), lived in Fortaleza (n=1198, 64.3%) and had complete elementary education (n=766, 41%). Overweight (n= 1408, 75.4%), first pregnancy (n=827, 44.3%) and multiparity (n=686, 36.7%) were the main risk factors for HDP. Regarding fetal status, 30.9% (n=576) were preterm. The main HDP complications were: HELLP syndrome (n=60, 3.2%), bleeding disorders (n=15, 0.8%) and acute respiratory failure (n=13, 0.6%). Conclusion: The pregnant women assessed presented risk factors for HDP, reinforcing the idea that the health status and the disease and health process are directly influenced by socioeconomic and demographic characteristics of the population.

Abstract Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used medications associated with nephrotoxicity, especially when used chronically. Factors such as advanced age and comorbidities, which in themselves already lead to a decrease in glomerular filtration rate, increase the risk of NSAID-related nephrotoxicity. The main mechanism of NSAID action is cyclooxygenase (COX) enzyme inhibition, interfering on arachidonic acid conversion into E2 prostaglandins E2, prostacyclins and thromboxanes. Within the kidneys, prostaglandins act as vasodilators, increasing renal perfusion. This vasodilatation is a counter regulation of mechanisms, such as the renin-angiotensin-aldosterone system works and that of the sympathetic nervous system, culminating with compensation to ensure adequate flow to the organ. NSAIDs inhibit this mechanism and can lead to acute kidney injury (AKI). High doses of NSAIDs have been implicated as causes of AKI, especially in the elderly. The main form of AKI by NSAIDs is hemodynamically mediated. The second form of NSAID-induced AKI is acute interstitial nephritis, which may manifest as nephrotic proteinuria. Long-term NSAID use can lead to chronic kidney disease (CKD). In patients without renal diseases, young and without comorbidities, NSAIDs are not greatly harmful. However, because of its dose-dependent effect, caution should be exercised in chronic use, since it increases the risk of developing nephrotoxicity.

OBJETIVO: Investigar os fatores associados à lesão renal aguda e o prognóstico em pacientes com doença pulmonar. MÉTODOS: Foi realizado estudo prospectivo com cem pacientes consecutivos admitidos em uma unidade de terapia intensiva respiratória em Fortaleza (CE). Foram investigados fatores de risco para lesão renal aguda e mortalidade em um grupo de pacientes com doenças pulmonares. RESULTADOS: A média de idade foi de 57 anos, sendo 50% do gênero masculino. A incidência de lesão renal aguda foi maior nos pacientes com PaO2/FiO2

Este artigo tem por escopo analisar o grau de satisfação dos usuários de um serviço público-privado de saúde do Nordeste do Brasil, bem como o nível de conhecimento sobre seus direitos e a procura pelo Judiciário para garanti-los. Foram avaliadas as respostas dadas a um questionário aplicado junto a 67 pacientes atendidos pelo Núcleo de Assistência Médica Integrada, da Universidade de Fortaleza, conveniado ao Sistema Único de Saúde (SUS). Os pacientes entrevistados mostraram satisfação com os serviços oferecidos, considerando-os como bons ou excelentes. O principal problema evidenciado foi a dificuldade de acesso a medicações fornecidas pelo SUS e a falta de conhecimento dos direitos relacionados à saúde. Observou-se uma baixa procura pela Justiça para questões ligadas à saúde, o que pode se explicar, por um lado, pelo reduzido grau de conhecimento dos direitos relacionados a tal campo e pela baixa escolaridade da maior parte dos entrevistados. A melhora do grau de satisfação pode contribuir para reduzir a judicialização, muito embora usuários mais bem informados possam se mostrar mais exigentes e recorrer mais à Justiça. Soluções alternativas de resolução de conflitos, como a mediação e a justiça restaurativa, podem contribuir para diminuir a busca pelo Judiciário.

A leptospirose é a zoonose mais importante do mundo. Os pacientes são tipicamente homens jovens. Vários fatores estão envolvidos na insuficiência renal aguda (IRA) na leptospirose, incluindo ação nefrotóxica direta da leptospira, hiperbilirrubinemia, rabdomiólise e hipovolemia. Os principais achados histológicos são nefrite intersticial aguda e necrose tubular aguda. A IRA na leptospirose é geralmente não oligúrica e hipocalêmica. Alterações da função tubular precedem a queda na taxa de filtração glomerular, o que poderia explicar a alta frequência de hipocalemia. O tratamento antibiótico é eficaz nas fases precoces e tardias e/ou graves. Para pacientes críticos com IRA na leptospirose, as seguintes condutas são recomendadas: hemodiálise precoce e diária; baixa infusão de volume (devido ao risco de hemorragia pulmonar), e estratégias de proteção pulmonar. A mortalidade na IRA associada à leptospirose está em torno de 22%.

The aim of this study was to evaluate renal function in patients with psoriasis using immunobiologicals. A prospective study was conducted with 15 patients with confirmed diagnosis of psoriasis who were starting to use immunobiologicals. The mean age was 41±11 years, with 60% females. The mean time of disease was 11±6.6 years. Significant changes in creatinine and creatinine clearance were not observed in the course of the study. There was an increase in transaminases and a decrease in magnesium levels.

ABSTRACT Background: In the review of curriculum matrices, the elaboration of learning strategies that combine theory and practice is extremely important, allowing the building of new concepts and learning methods by the students. Team-based learning (TBL) is growing in academic centers and refers to the pedagogic strategy grounded in constructivism. The aim of this research was to describe the application of TBL in a Public Health graduate program. Methods: TBL was applied in a class with 22 students in the discipline “Quantitative Research in Health” of the Public Health graduate program (Master degree) at the University of Fortaleza, Brazil, in 2016. The discipline was structured in 8 lessons, approaching the thematic of quantitative research. Before each class the students were required to study the contents at home, a test was done for each subject in the beginning of each class (individually and then in teams of 5 or 6 students) and then a brief review was performed by the professor, where the students could ask questions and solve any doubt. At the end of the semester an evaluation questionnaire was applied with objective questions and a qualitative survey. Results: The application of TBL was done in a class with 22 students of the Public health Master Program, aged 22 to 36 years, and 83.3% were female. The method was well received by the students. All the evaluations and discussions went on without any problem. There were some complaints about the requirement to study at home prior to the classes. Students’ evaluation of the discipline and the TBL method was satisfactory with answers’ average score of 4.7 (scale 0-5). The lowestscore was achieved by the question number 11 (4.3) about the students motivation for their study at home. The comparison with the evaluation of the previous semester (where a traditional method was applied) evidenced higher scores for the TBL method. Conclusions: The application of TBL was satisfactory and the main difficulty presented by students was the requirement for previous study at home. TBL was better evaluated than the traditional method.

RESUMO Objetivo: Investigar os fatores prognósticos em pacientes graves com meningite bacteriana adquirida na comunidade e lesão renal aguda. Métodos: Estudo retrospectivo com inclusão de pacientes em um hospital terciário dedicado a doenças infecciosas localizado em Fortaleza (CE), com diagnóstico de meningite bacteriana adquirida na comunidade complicada por lesão renal aguda. Investigaram-se os fatores associados a óbito, ventilação mecânica e uso de vasopressores. Resultados: Incluíram-se 41 pacientes, com média de idade de 41,6 ± 15,5 anos, 56% dos quais do sexo masculino. O tempo médio entre a admissão à unidade de terapia intensiva e o diagnóstico de lesão renal aguda foi de 5,8 ± 10,6 dias. A mortalidade global foi de 53,7%. Segundo os critérios KDIGO, 10 pacientes foram classificados como estágio 1 (24,4%), 18 como estágio 2 (43,9%) e 13 como estágio 3 (31,7%). A classificação em estágio KDIGO 3 aumentou de forma significante a mortalidade (OR = 6,67; IC95% = 1,23 - 36,23; p = 0,028). A presença de trombocitopenia não se associou com aumento da mortalidade, porém foi um fator de risco para a ocorrência da classificação KDIGO 3 (OR = 5,67; IC95% = 1,25 - 25,61; p = 0,024) e para necessidade de utilizar ventilação mecânica (OR = 6,25; IC95% = 1,33 - 29,37; p = 0,02). Os pacientes que necessitaram de ventilação mecânica 48 horas após o diagnóstico de lesão renal aguda tiveram níveis mais elevados de ureia (44,6 versus 74mg/dL; p = 0,039) e sódio (138,6 versus 144,1mEq/L; p = 0,036). Conclusão: A mortalidade de pacientes graves com meningite bacteriana adquirida na comunidade e lesão renal aguda é alta. A severidade da lesão renal aguda se associou com mortalidade ainda mais elevada. A presença de trombocitopenia se associou com lesão renal aguda mais grave. Níveis mais elevados de ureia podem prever mais precocemente a ocorrência de lesão renal aguda de maior gravidade.

Abstract Obesity has been pointed out as an important cause of kidney diseases. Due to its close association with diabetes and hypertension, excess weight and obesity are important risk factors for chronic kidney disease (CKD). Obesity influences CKD development, among other factors, because it predisposes to diabetic nephropathy, hypertensive nephrosclerosis and focal and segmental glomerulosclerosis. Excess weight and obesity are associated with hemodynamic, structural and histological renal changes, in addition to metabolic and biochemical alterations that lead to kidney disease. Adipose tissue is dynamic and it is involved in the production of "adipokines", such as leptin, adiponectin, tumor necrosis factor-α, monocyte chemoattractant protein-1, transforming growth factor-β and angiotensin-II. A series of events is triggered by obesity, including insulin resistance, glucose intolerance, dyslipidemia, atherosclerosis and hypertension. There is evidence that obesity itself can lead to kidney disease development. Further studies are required to better understand the association between obesity and kidney disease.

Considerando as novas diretrizes curriculares da educação médica, há necessidade de humanizar a prática médica, sendo importante discutir a relação paciente-aluno de Medicina. O objetivo deste trabalho foi avaliar as percepções dos pacientes internados em hospital-escola durante as aulas práticas do módulo de Habilidades Médicas V (Semiologia/Clínica Médica) do curso de Medicina da Universidade de Fortaleza. Foi realizado um estudo transversal, com aplicação de um questionário que abordou questões socioeconômicas, diagnóstico, tempo de internação e percepções dos pacientes sobre sua participação nas aulas práticas com a presença de estudantes de Medicina. A maioria dos pacientes aceita de maneira satisfatória participar das aulas práticas e sente-se bem em ajudar os futuros médicos.

ABSTRACT Objective To analyze, from the examination of decisions issued by Brazilian courts, how Evidence-Based Medicine was applied and if it led to well-founded decisions, searching the best scientific knowledge. Methods The decisions made by the Federal Courts were searched, with no time limits, at the website of the Federal Court Council, using the expression “Evidence-Based Medicine”. With regard to decisions issued by the court of the State of São Paulo, the search was done at the webpage and applying the same terms and criterion as to time. Next, a qualitative analysis of the decisions was conducted for each action, to verify if the patient/plaintiff’s situation, as well as the efficacy or inefficacy of treatments or drugs addressed in existing protocols were considered before the court granted the provision claimed by the plaintiff. Results In less than one-third of the decisions there was an appropriate discussion about efficacy of the procedure sought in court, in comparison to other procedures available in clinical guidelines adopted by the Brazilian Unified Health System (Sistema Único de Saúde) or by private health insurance plans, considering the individual situation. The majority of the decisions involved private health insurance plans (n=13, 68%). Conclusion The number of decisions that did consider scientific evidence and the peculiarities of each patient was a concern. Further discussion on Evidence-Based Medicine in judgments involving public healthcare are required.

Abstract Introduction: Acute kidney injury (AKI) is a complication still poorly studied in the setting of obstetric patients, which is associated with increased mortality. Objective: The aim of this study was to investigate the frequency and risk factors of AKI among critically ill obstetric patients. Methods: A cross-sectional study was conducted with all patients admitted to an intensive care unit (ICU) due to obstetric complications, in Fortaleza, Brazil, in the period between January 2012 and December 2014. AKI was defined according to AKIN criteria. Results: A total of 389 patients were included, aged between 13 and 45 years. The main causes of ICU admission were pregnancy-related hypertensive syndromes (54.5%), hemorrhage and hemorrhagic shock (12.3%), heart diseases (9.0%), respiratory insufficiency (8.2%) and sepsis (5.4%). AKI was found in 92 cases (24%), and this was the most frequent complication. General mortality was 7.5%, and mortality due to AKI was 21% (p = 0.0007). In the multivariate analysis, risk factors for AKI were cesarian delivery (95% CI = 0.23-0.85, p = 0.01) and thrombocythopenia (95% CI = 1.50-4.36, p = 0.001). AKI was an independent risk factor for death (OR = 6.64, 95% CI = 3.11-14.15, p < 0.001). Conclusion: AKI was the main complication among critically ill obstetric patients and it was associated with increased mortality. Most cases were associated with pregnancy-related hypertensive disorders, which are complications that can be easily identified and treated during prenatal care.

Abstract Mortality from violent causes has significantly increased in Brazil, as well as the number of deceased-donor organ transplantation. Although the increase in the number of transplants correlates with higher organ availability, through the increase in potential donors, this is not the unique aspect to be considered. The effective and articulated action of transplantation network seems to be decisive to this outcome.