Regional Portal Research Articles

TRATAMENTO DA LEISHMANIOSE TEGUMENTAR NO BRASIL

Objective: To describe the efficacy of treatment for tegumentary leishmaniasis in Brazil, its CE and alternative treatments. Methods: This is a qualitative, retrospective and cross-sectional study carried out through an integrative literature review. The regional portal of the Virtual Health Library (VHL) and the National Library of Medicine of the United States (PubMed) were used. Articles published in the last 10 years (2014-2024); Controlled clinical trial type, free and full text. After reading the articles and using the criteria, a total of 20 articles were maintained. Results: It was observed that in Brazil they are used for the first line of treatment for TL, which are high-cost drugs that present limitations in patient management due to toxicity, need for parenteral administration and hospitalization. New treatment alternatives, such as miltefosine, pentoxifylline, liposomal amphotericin B, thermotherapy, and tamoxifen, have been used with similar cure rates and lower CE and could be recommended as a treatment option. Conclusion: The CE of the treatments interfere with the follow-up of the therapy, and it is necessary to use new drugs to bring comfort to the patients, increase efficacy and adherence.

Kinesiotherapy and Quality of Life after Breast Cancer Surgery: A Systematic Review with Meta-analysis.

To determine whether kinesiotherapy improves the quality of life of women with breast cancer following surgery. This meta-analysis was conducted according to the Cochrane and PRISMA recommendations. A search was conducted of the PubMed, Cochrane, and the Virtual Health Library Regional Portal databases to identify randomized and observational studies that compared the performance versus non-performance of kinesiotherapy protocols in patients who had undergone breast cancer surgery. The outcomes evaluated were overall health status, physical functioning, emotional functioning, and social functioning. Statistical analyses were conducted using RevMan version 5.4.1. Heterogeneity was evaluated using the I2 statistic. Twelve studies with a total of 867 patients were included. Of these, 669 women (77.2%) underwent mastectomy. Five studies conducted a before-after evaluation and seven studies evaluated intervention versus non-intervention in two different groups. Of the outcomes evaluated, overall health status (standardized mean difference [SMD] 0.45; 95%CI: 0.09-0.82; p=0.01; I2=75%), physical functioning (SMD 0.89; 95%CI: 0.39-1.39; p=0.0005; I2=91%), social functioning (0.67; 95%CI: 0.26-1.09; p=0.001; I2=89%) and emotional functioning (SMD 0.90; 95%CI: 0.40-1.40; p=0.0004; I2=92%) showed significant results in favor of kinesiotherapy. Kinesiotherapy had a positive effect on the outcomes of overall health status and physical, social, and emotional functioning compared to controls. Therefore, kinesiotherapy appears to help recover quality of life in patients submitted to surgery for breast cancer.

Evaluation of Conflicts of Financial Interest in Publications on the Consumption of High-Intensity Sweeteners and Body-Weight Changes: A Systematic Review.

Diseases related to excessive sugar consumption have become a public health concern. However, there may be a direct association between the consumption of artificial sweeteners and changes in body weight. The aim was to evaluate potential industry financial conflicts of interest in publications on the relationship between high-intensity sweetener consumption and changes in body weight in observational and intervention studies. The systematic review used the Medline, Embase, Cochrane, Scopus, and the VHL (Virtual Health Library) Regional Portal, including the LILACS databases. The PICOS strategy were used in the search strategy for intervention studies and for observational studies used the exposure factor as the criterion. Inclusion criteria were observational and intervention studies in adults, without population or health status restrictions, without restriction on the year of publication, but restricted to full articles in Portuguese, English, and Spanish. Exclusion criteria were humans younger than 18 years, cross-sectional studies, and animal and in vitro studies. There were extracted effect estimates, odds ratios, and linear associations, quantifying the effects per unit of intake of high-intensity sweeteners. The risk of bias in the intervention studies was assessed using the Cochrane Collaboration Risk of Bias tool (RoB). The Newcastle Ottawa Scale was used for observational studies (case-control and cohort). Most clinical trials favor using artificial sweeteners and receive contributions from the food industry. Observational studies, for the most part, show that the use of artificial sweeteners is unfavorable. In these studies, there was no sponsorship from the food industry, only from regulatory bodies. This result suggests that studies that had the support of the food industry had their influence on their outcomes. PROSPERO registration no: CRD42016036204.

Privatization and Oligopolies of the Renal Replacement Therapy Sector on Contemporary Capitalism: A Systematic Review and the Brazilian Scenario.

Worldwide the assistance on renal replacement therapy (RRT) is carried out mainly by private for-profit services and in a market with increase in mergers and acquisitions. The aim of this study was to conduct an integrative systematic review on privatization and oligopolies in the RRT sector in the context of contemporary capitalism. The inclusion criteria were scientific articles without language restrictions and that addressed the themes of oligopoly or privatization of RRT market. Studies published before 1990 were excluded. The exploratory search for publications was carried out on February 13, 2024 on the Virtual Health Library Regional Portal (VHL). Using the step-by-step of PRISMA flowchart, 34 articles were retrieved, of which 31 addressed the RRT sector in the United States and 26 compared for-profit dialysis units or those belonging to large organizations with non-profit or public ones. The main effects of privatization and oligopolies, evaluated by the studies, were: mortality, hospitalization, use of peritoneal dialysis and registration for kidney transplantation. When considering these outcomes, 19 (73%) articles showed worse results in private units or those belonging to large organizations, six (23%) studies were in favor of privatization or oligopolies and one study was neutral (4%). In summary, most of the articles included in this systematic review showed deleterious effects of oligopolization and privatization of the RRT sector on the patients served. Possible explanations for this result could be the presence of conflicts of interest in the RRT sector and the lack of incentive to implement the chronic kidney disease care line. The predominance of articles from a single nation may suggest that few countries have transparent mechanisms to monitor the quality of care and outcomes of patients on chronic dialysis.

Reduction in the Number of Diagnoses of Upper Digestive Tract Cancer during the Covid-19 Pandemic: An Integrative Literature Review

Introduction: In 2019, the World Health Organization was alerted about cases of infection with COVID-19. Due to the measures taken to prevent contamination, many pre-scheduled consultations, treatments and exams were suspended or cancelled. Objectives: This study aims to identify literature data on upper digestive tract cancer diagnosis numbers in patients that had performed endoscopy during the COVID-19 pandemic, along with a pre-pandemic control group. Methods: A literature review was performed through searches on the SciELO, Science Direct, PubMed, and BVS Regional Portal platforms. After applying the inclusion and exclusion criteria, 8 articles were selected for the study. Results: All articles reported a decrease in diagnoses of upper digestive tract cancer (reduction ranged from 76.3% to 19.28%) and in endoscopies performed (reduction ranged from 87.5% to 43.1%) during the pandemic. Conclusion: The COVID-19 pandemic reduced the accessibility of resources and; consequently, increased the number of underdiagnoses of pathologies with no direct relationship with the coronavirus. Thus, a significant reduction in the number of diagnoses of upper digestive tract cancer was observed due to the decline in the number of endoscopies performed.

Frequency of Multidrug-Resistant Microorganisms Associated with Bacterial Coinfections in Hospitalized Patient with Covid-19: A Literature Review

Patients with a doença do coronavírus 2019 (COVID-19) may be at risk of associated bacterial co-infections, and the involvement of multidrug-resistant (MDR) microorganisms in these cases can lead to an increase in morbidity and mortality rates. The objective of this study was to describe the frequency of the main MDR microorganisms associated with bacterial co-infections in patients hospitalized with COVID-19. To this end, we carried out a search in the PubMed and Regional Portal of the Virtual Health Library (VHL) databases, from December 2019 to September 2023, with the keywords COVID-19, co-infection and multidrug-resistant microorganism. Of the 535 articles initially found, only 14 were selected for analysis. Gram-negative bacteria were most frequently involved in bacterial co-infections in patients with COVID-19 (70%). Among these, Klebsiella pneumoniae and Acinetobacter baumannii predominated, with 85.71% and 78.57%, respectively. Among gram-positive bacteria, Staphylococcus aureus (71.42%) was the most common. Among MDR microorganisms, the prevalent species were carbapenem-resistant gram-negative bacilli (32%) and methicillin-resistant S. aureus (85.7%). Furthermore, a higher frequency of MDR microorganisms was observed in patients with COVID-19 in intensive care units (ICU). Thus, the findings of the present study indicate the need for attention to infections caused by multidrug-resistant microorganisms in critically ill patients with COVID-19.

Measures of Health Care Providers' Knowledge, Clinical Skills, or Prejudice Toward Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and Other Sexual and Gender Minority Populations: A Scoping Review.

Purpose: Assessing health care providers' knowledge, clinical skills, and prejudice toward lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexual and gender minority populations (LGBTQIA+) can help identify areas for improvement in health care provider training. The aim of this study was to map the range of studies that report measures of health care providers' knowledge, clinical skills, or prejudice toward LGBTQIA+ populations. Methods: A scoping review adopting the Joanna Briggs Institute methodology was conducted. Electronic database searches were conducted in CINAHL via EBSCO Host, Epistemonikos, LILACS via Virtual Health Library Regional Portal, PubMed, Scopus, and Web of Sciences. The samples of other reviews were screened. Studies that validated, translated, and/or cross-culturally adapted measures of the knowledge, clinical skills, and prejudice of health care providers and students toward LGBTQIA+ individuals were selected. Scholars were consulted to ensure that no relevant studies were missing. Data were extracted by two independent reviewers and presented in tabular form along with narrative summaries. Results: This scoping review identified 27 measures that have been validated, translated, and/or adapted with health care providers or students as the target population, distributed across 33 studies. Conclusions: Psychometric studies involving LGBTQIA+ patients and health care professionals have increased in recent years, with North American countries being the most frequent location. However, a growing number of studies are being conducted in Latin American countries such as Brazil and Colombia.

Educação emocional e desenvolvimento de competências emocionais em estudantes de cursos da área da saúde: revisão integrativa

Health undergraduate education is characterized by exhausting study periods and impactful clinical scenarios. This situation contributes to the development of numerous psychopathologies and reduced academic performance. However, the development of Emotional Competencies (EC) through Emotional Education (EE) plays a significant role in promoting the physical and psychological well-being of health undergraduates. This study examined the role of EE in the development of EC in healthcare students. An integrative literature review was conducted between August and September 2021 involving the Virtual Health Library: VHL (BIREME) - with access to MEDLINE, LILACS and IBECS, PubMed, PsycINFO, SciELO (Scientific Electronic Library Online - Regional Portal), Scopus and Web of Science databases. The search retrieved 385 articles, of which four were included in the review. The study results showed the intrinsic relationship between EE and the development of EC in health undergraduates. In addition, EC were associated with better academic performance, higher levels of Emotional Intelligence (EI) and greater professional opportunities.

THE OVERLOAD OF THE FAMILY OF THE PERSON WITH SCHIZOPHRENIA: a systematic review

Introduction: Schizophrenia is one of the mental disorders classified as highly incapacitating, promoting a greater exclusion of this individual from his tasks performed, and from his social life. The definition of this diagnosis, although necessary, causes changes not only for this individual, but also affects his family. Objective: This article aims to investigate the occurrence of overload in family caregivers of individuals diagnosed with schizophrenia. Methods: The research consists of a systematic review of the literature with a qualitative, descriptive and exploratory approach. For the survey of articles in the literature, the following databases were consulted, Scielo, PePsic and the VHL Regional Portal, using the descriptors schizophrenia, burden and caregiver, and the keyword “family”, the search operator used was “and”. Results: The results found, in the selected articles, agree and point to the difficulties experienced by caregivers in the social, economic and health fields, causing high levels of burden. Conclusions: We conclude that by understanding more about the psychological impacts of family members when receiving the diagnosis of schizophrenia from their family members, we make it possible, in addition to greater knowledge of the topic about the total impact on the family, to plan strategies to minimize the impacts in family organization and structure, promoting better quality in the face of the reality of the mental disorder.

Teeth Damage during General Anesthesia.

Dental injuries during anesthesia, especially when advanced airway management is required, represent a legal problem. Factors such as poor dental condition and excessive pressure during intubation contribute to dental damage. The maxillary central incisors are commonly affected. The objective of this review is to know the incidence of dental injuries in adults undergoing anesthesia that requires airway management. The search was performed in MEDLINE (through Pubmed), ClinicalTrials.gov, Scopus, LILACS (through the Virtual Health Library Regional Portal), and SciELO for all available literature on the subject up to December 2022. Inclusion criteria involved articles that studied patients aged 18 years or older who underwent general anesthesia requiring airway management with tracheal intubation or insertion of a laryngeal mask airway. Of all the articles, nine report dental injury associated with the type of airway management. Only one article does not have dental injury. This study addresses dental injuries related to tracheal intubation during general anesthesia. Although techniques are used to prevent them, these injuries still occur. Laryngoscopy, especially with support on the upper central incisors, can cause damage to the teeth. It is important that the anesthesiologist is aware of dental trauma and that orotracheal intubation or the placement of the laryngeal mask airway is performed systematically and rigorously, always considering the patient's dentition to choose the best approach in each specific situation.

Influence of Low-Intensity Pulsed Ultrasound Parameters on the Bone Mineral Density in Rat Model: A Systematic Review.

Bone recovery typically depends on the age of organisms or the prevalence of metabolic disorders such as osteoporosis, which is a metabolic condition characterized by decreased bone strength and bone mineral density (BMD). Therefore, low-intensity pulsed ultrasound (LIPUS), a non-invasive method for osteogenic stimulation, presents promising results. However, heterogeneity in animal study designs is a typical characteristic. Hence, we conducted a systematic review to evaluate the effectiveness of LIPUS in the recovery of experimental bone defects using rat models. We examined the areal and volumetric BMD to identify LIPUS doses to be applied and evaluated the accuracy reported by previous studies. The Virtual Health Library regional portal, PubMed, Embase, EBSCOhost, Scopus and CAPES were reviewed for animal studies that compared fracture treatments based on LIPUS with sham or no treatments using rat models and reported BMD as an outcome. The tool provided by the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) and the Collaborative Approach to Meta-Analysis and Review of Animal Data from Experimental Studies (CAMARADES) checklist were used to assess the bias and quality of such studies. Of the six studies reviewed, the most frequently used LIPUS dose had an ultrasonic frequency of 1.0MHz, repetition rate of 0.1kHz and pulse duration of 2000μs. An intensity (ISATA) of 30mW/cm2 was the most preferred for bone recovery. However, the BMD could not solely irrefutably evaluate the effectiveness of LIPUS in bone recovery as the results were discordant with each other. The discrepancies in experimental methodologies, low-quality classifications and high risk of bias in the selected studies, however, did not validate the undertaking of a meta-analysis. On the basis of the BMD results, no sufficient evidence was found to recommend the use of LIPUS for bone recovery in rat models. Thus, this systematic review indicates that the accuracy of such reports must be improved to improve their scientific quality to facilitate a transition of LIPUS applications from pre-clinical research to clinic use.

Pharmacokinetics of Curcumin Delivered by Nanoparticles and the Relationship with Antitumor Efficacy: A Systematic Review.

Curcumin is a polyphenolic compound, derived from Curcuma longa, and it has several pharmacological effects such as antioxidant, anti-inflammatory, and antitumor. Although it is a pleiotropic molecule, curcumin's free form, which is lipophilic, has low bioavailability and is rapidly metabolized, limiting its clinical use. With the advances in techniques for loading curcumin into nanostructures, it is possible to improve its bioavailability and extend its applications. In this review, we gather evidence about the comparison of the pharmacokinetics (biodistribution and bioavailability) between free curcumin (Cur) and nanostructured curcumin (Cur-NPs) and their respective relationships with antitumor efficacy. The search was performed in the following databases: Cochrane, LILACS, Embase, MEDLINE/Pubmed, Clinical Trials, BSV regional portal, ScienceDirect, Scopus, and Web of Science. The selected studies were based on studies that used High-Performance Liquid Chromatography (HPLC) as the pharmacokinetics evaluation method. Of the 345 studies initially pooled, 11 met the inclusion criteria and all included studies classified as high quality. In this search, a variety of nanoparticles used to deliver curcumin (polymeric, copolymeric, nanocrystals, nanovesicles, and nanosuspension) were found. Most Cur-NPs presented negative Zeta potential ranging from -25 mV to 12.7 mV, polydispersion index (PDI) ranging from 0.06 to 0.283, and hydrodynamic diameter ranging from 30.47 to 550.1 nm. Selected studies adopted mainly oral and intravenous administrations. In the pharmacokinetics analysis, samples of plasma, liver, tumor, lung, brain, kidney, and spleen were evaluated. The administration of curcumin, in nanoparticle systems, resulted in a higher level of curcumin in tumors compared to free curcumin, leading to an improved antitumor effect. Thus, the use of nanoparticles can be a promising alternative for curcumin delivery since this improves its bioavailability.

RISK FACTORS OF ACUTE MYOCARDIAL INFARCTION AND THE NURSE’S PERFORMANCE

Introduction: The highest morbimortality of acute myocardium infarction is directly related to the lifestyle adopted by the population. Therefore, the main modifiable risk factors for the development of pathologies are: arterial hypertension, diabetes mellitus, Hypercholesterolemia, smoking, obesity, and sedentary lifestyle. Furthermore, they can be effectively controlled through the prevention and monitoring from CNCDs in primary care, by means of HIPERDIA program’s and nursing appointment. Objective: To analyze, through a literature review, the role of nurses in the prevention and monitoring of CNCDs within primary health care. Methodology: This is an integrative review study, which used publications indexed in the electronic database of the regional portal of the VHL (Virtual Health Library), between 2016 and 2021. Results: 18 articles were used, corresponding to the factors of AMI risk, health education, nursing consultation and HIPERDIA. Conclusion: The high incidence and lethality of AMI, resulting from risk factors such as SAH and DM, in addition to lifestyle habits, was evidently portrayed by the selected articles. Furthermore, nurses who work in primary care need to intervene in the highlighted factors and exercise their role as a health educator, highlighting the importance of adopting a healthy lifestyle, in order to prevent patients from developing health issues, being referred to other levels of care and, consequently, generating more costs for the Unified Health System (SUS).

Penggunaan Deksametason pada Pasien COVID-19: Systematic Review dan Meta-analisis

COVID-19 is associated with disseminated lung damage in patients, Dexamethasone can reduce lung injury caused by inflammation and there reduce the progression to respiratory failure and prevent death. This systematic review aimed to determine the benefits and safety of Dexamethasone in COVID-19 treatment. The study was performed by a comprehensive literature search which were published in several databases i.e., PubMed, Science Direct, VHL Regional Portal, and ClinicalTrials.gov within the search time of 28 November 2020. Inclusion criteria were articles on the study on COVID-19 patients who received Dexamethasone, observational and experimental studies on the outcomes use evaluation of Dexamethasone. Exclusion criteria are the articles that do not provide control in controlled studies and do not show clear research results on the use of Dexamethasone. An initial search from four databases by entering keywords resulted in 1,046 articles. After screening articles duplication we obtained 835 studies. Finally, 6 articles were obtained after we screened for the article that it can be obtained its full text and 5 articles joined in articles included in the meta-analysis. The analysis showed that Dexamethasone in Covid-19 patients could reduce the incidence of death within 28 days with RR of 0.78 (95% CI 0.57–0.97 P=0.13) compared with Methylprednisolone, Dexamethasone was compared without corticosteroids with RR 0.89 (95% CI 0.82-0.97 P=0.01). Dexamethasone also reduced mechanical ventilator use during treatment with RR 0.95 (95% CI = 0.86-1.05 P = 0.28) compared without corticosteroids. The conclusion from these results: the use of Dexamethasone can reduce the number of deaths in COVID-19 patients, especially severe and critically ill category patients.

Fibrosis as a Risk Factor for Cutaneous Squamous Cell Carcinoma in Recessive Dystrophic Epidermolysis Bullosa: A Systematic Review.

Recessive dystrophic epidermolysis bullosa (RDEB) is a severe subtype of epidermolysis bullosa caused by changes in collagen VII with a high risk of early development of cutaneous squamous cell carcinoma (cSCC). This review aimed to discuss the relationship between the recurrent healing process, the appearance of fibrosis, and malignant epithelial transformation in RDEB. We searched PubMed, the Regional Portal of the Virtual Health Library, and Embase for articles on the relationship between blistering, recurrent scarring, and fibrosis in the context of cSCC and RDEB. That alterations of collagen VII result in blister formation, scar deficiency associated with inflammation, and increased expression of transforming growth factor β. These events promote the differentiation of myofibroblasts and the expression of profibrotic proteins, leading to structural changes and the establishment of a microenvironment favorable to carcinogenesis. Patients with RDEB and areas of recurrent scarring and fibrosis may be more prone to the development of cSCC.

Internet of Things as support to reduce hospital errors related to medication administration

Objective: The high potential of digital technologies to reduce medication errors in patients hospitalized or under hospital care was explored in this investigation. The study identifies common types of medication errors and their probable causes. Furthermore, examines the technological innovation solutions available that have not yet been applied in this context, specifically the Internet of Things usage to reduce medication errors through a practical example. Methods: A rapid review was applied, exploring the papers from two databases. The analysis was limited to the period from 2017 to 2021, resulting in 147 articles from the VHL Regional Portal – Virtual Health Library and 257 articles from the PubMed database. Results: There were analyzed 40 studies. An error mapping related to the theme was made. Also, the technology application and their effectiveness were identified in the studies. According to the research, inattention or distraction due to the excessive journey of work was pointed out as the main reason that leads to medication errors with the systems employed. Conclusion: There are several opportunities to improve hospital procedures with new technological approaches. By implementing innovative technologies, hospital medication errors can be managed more efficiently and reduce costs and waste with errors medication.

Factors that influence the provision of home-based rehabilitation services for people needing rehabilitation: a qualitative evidence synthesis.

To increase people's access to rehabilitation services, particularly in the context of the COVID-19 pandemic, we need to explore how the delivery of these services can be adapted. This includes the use of home-based rehabilitation and telerehabilitation. Home-based rehabilitation services may become frequently used options in the recovery process of patients, not only as a solution to accessibility barriers, but as a complement to the usual in-person inpatient rehabilitation provision. Telerehabilitation is also becoming more viable as the usability and availability of communication technologies improve. To identify factors that influence the organisation and delivery of in-person home-based rehabilitation and home-based telerehabilitation for people needing rehabilitation. We searched PubMed, Global Health, the VHL Regional Portal, Epistemonikos, Health Systems Evidence, and EBM Reviews as well as preprints, regional repositories, and rehabilitation organisations websites for eligible studies, from database inception to search date in June 2022. SELECTION CRITERIA: We included studies that used qualitative methods for data collection and analysis; and that explored patients, caregivers, healthcare providers and other stakeholders' experiences, perceptions and behaviours about the provision of in-person home-based rehabilitation and home-based telerehabilitation services responding to patients' needs in different phases of their health conditions. DATA COLLECTION AND ANALYSIS: We used a purposive sampling approach and applied maximum variation sampling in a four-step sampling frame. We conducted a framework thematic analysis using the CFIR (Consolidated Framework for Implementation Research) framework as our starting point. We assessed our confidence in the findings using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. MAIN RESULTS: We included 223 studies in the review and sampled 53 of these for our analysis. Forty-five studies were conducted in high-income countries, and eight in low-and middle-income countries. Twenty studies addressed in-person home-based rehabilitation, 28 studies addressed home-based telerehabilitation services, and five studies addressed both modes of delivery. The studies mainly explored the perspectives of healthcare providers, patients with a range of different health conditions, and their informal caregivers and family members. Based on our GRADE-CERQual assessments, we had high confidence in eight of the findings, and moderate confidence in five, indicating that it is highly likely or likely respectively that these findings are a reasonable representation of the phenomenon of interest. There were two findings with low confidence. High and moderate confidence findings Home-based rehabilitation services delivered in-person or through telerehabilitation Patients experience home-based services as convenient and less disruptive of their everyday activities. Patients and providers also suggest that these services can encourage patients' self-management and can make them feel empowered about the rehabilitation process. But patients, family members, and providers describe privacy and confidentiality issues when services are provided at home. These include the increased privacy of being able to exercise at home but also the loss of privacy when one's home life is visible to others. Patients and providers also describe other factors that can affect the success of home-based rehabilitation services. These include support from providers and family members, good communication with providers, the requirements made of patients and their surroundings, and the transition from hospital to home-based services. Telerehabilitation specifically Patients, family members and providers see telerehabilitation as an opportunity to make services more available. But providers point to practical problems when assessing whether patients are performing their exercises correctly. Providers and patients also describe interruptions from family members. In addition, providers complain of a lack of equipment, infrastructure and maintenance and patients refer to usability issues and frustration with digital technology. Providers have different opinions about whether telerehabilitation is cost-efficient for them. But many patients see telerehabilitation as affordable and cost-saving if the equipment and infrastructure have been provided. Patients and providers suggest that telerehabilitation can change the nature of their relationship. For instance, some patients describe how telerehabilitation leads to easier and more relaxed communication. Other patients describe feeling abandoned when receiving telerehabilitation services. Patients, family members and providers call for easy-to-use technologies and more training and support. They also suggest that at least some in-person sessions with the provider are necessary. They feel that telerehabilitation services alone can make it difficult to make meaningful connections. They also explain that some services need the provider's hands. Providers highlight the importance of personalising the services to each person's needs and circumstances. This synthesis identified several factors that can influence the successful implementation of in-person home-based rehabilitation and telerehabilitation services. These included factors that facilitate implementation, but also factors that can challenge this process. Healthcare providers, program planners and policymakers might benefit from considering these factors when designing and implementing programmes.

Comedogenic lupus: a rare variant of chronic cutaneous lupus erythematosus – case series

BackgroundComedogenic lupus is an uncommon variant of cutaneous lupus, clinically characterized by the presence of comedones, papules and erythematous-infiltrated plaques, cysts and scars in photo-exposed areas, mimicking acne vulgaris and acneiform eruptions. ObjectivesTo report clinicopathological characteristics of patients with comedogenic lupus in a tertiary dermatology service over a 15-year period and review cases described in the literature. MethodsRetrospective study of patients with clinical and histopathological diagnoses of comedogenic lupus between the years 2006 and 2021. The literature search was carried out in the PubMed and VHL Regional Portal databases, using the terms: “comedogenic lupus” and “acneiform lupus” in Portuguese and English. ResultsFive patients were diagnosed during the described period, all female, with a mean age of 56.6 years. Smoking was observed in three cases, as well as pruritus. The most affected site was the face, especially the pre-auricular, malar and chin regions. Follicular plugs, epidermal thinning and liquefaction degeneration of the basal layer were predominant histopathological findings. Hydroxychloroquine was used as the first-line treatment; however, other medications were used, such as dapsone, methotrexate, tretinoin cream, and topical corticosteroids. The literature search identified 17 cases, with a mean age of 38.9 years, 82% of which were women. Only 23% had a diagnosis of systemic lupus erythematosus. Hydroxychloroquine was the most recommended systemic medication. Study limitationsRetrospective, single-center study. The literature search was carried out in two databases. ConclusionsDermatologists should be aware of acneiform conditions with poor response to the usual treatment. Early diagnosis and treatment reduce the risk of unaesthetic scars.

Eficacia farmacológica del Aloe vera en la cicatrización de heridas: una revisión narrativa

Aloe Vera has different therapeutic effects, including wound healing. The objective of this review is to determine the potential efficacy of the topical use of Aloe Vera in the healing of skin wounds. A bibliographic search of preclinical and clinical studies was carried out from 1999 to 2020, which included the therapeutic use of Aloe vera in the healing of: burns, surgical wounds, lactation disorders, anal fissure and anal fistula; in the databases of the VHL regional portal, PubMed and Google Scholar. It was obtained that the topical administration of Aloe vera was effective in the healing of the mentioned wounds by mainly increasing epithelization and collagen content. In conclusion, the evidence suggests that the properties and pharmacological presentation, chemical components and the effectiveness of Aloe vera to reduce the healing time of wounds make this plant a great therapeutic alternative; however, more studies are required regarding its antimicrobial property.

CONSULTORIA COLABORATIVA E EDUCAÇÃO INCLUSIVA: UMA REVISÃO SISTEMÁTICA DE ESTUDOS BRASILEIROS

ABSTRACT The research deals with a systematic review of Brazilian studies. The objective was to analyze the articles developed on collaborative consulting from the perspective of school inclusion, considering the year and area of publication of the articles, the type of work they carry out, the consultants involved, the methodology used and the students’ characteristics of Special Education (PAEE). The descriptors used were: collaborative consulting; inclusion; school inclusion and special education, together with the Boolean operators “AND”. The searches were carried out on the CAPES journal portal, Google Scholar and the VHL Regional Portal. A total of 409 articles were identified and 25 of them met the eligibility criteria. The articles were read in full and categorized based on a protocol developed for this investigation. The studies showed the contribution of recent research about the subject, mainly produced by researchers associated with UFSCar.