Renata Fernandes Rabello

RESUMO Introdução: A escravidão deixou desigualdades que ainda afetam o acesso à saúde e à educação. No curso de Medicina, ações afirmativas ampliaram o acesso, mas persistem desafios de permanência e legitimação dos estudantes negros e indígenas no meio acadêmico. Objetivo: Este estudo teve como objetivo compreender, na perspectiva da aprendizagem colaborativa, situações de discriminação étnico-racial e estratégias de enfrentamento do racismo no ensino médico. Método: Trata-se de um estudo qualitativo com abordagem etnográfica que utilizou a observação participante e o grupo focal para coletar informações sobre as situações de discriminação étnico-racial e as estratégias de enfretamento do racismo na medicina. Foram realizadas três vivências acadêmicas, nas quais os participantes registraram em papéis-cartões suas experiências e propuseram soluções, com duração aproximada de uma hora cada. Reuniram-se 33 participantes, sendo 16 autodeclarados pardos ou pretos e dois indígenas das etnias Mundurucu e Borari. A análise e interpretação dos relatos seguiram os pressupostos teóricos da aprendizagem colaborativa, utilizando a técnica de análise temática de Minayo. O protocolo do estudo foi aprovado pelo Comitê de Ética em Pesquisa com Seres Humanos: Parecer nº 5.736.372. Resultado: Evidenciaram-se formas sutis de racismo, marcadas pela naturalização da discriminação e pela lógica da negação, manifestadas por meio de microagressões, negação de identidades, dificuldades de ocupação e circulação em espaços médicos, além da reprodução de imagens estereotipadas sobre pessoas negras e indígenas. Em contrapartida, destacaram-se estratégias individuais e coletivas de enfrentamento, como a denúncia e o estímulo ao diálogo antirracista, a educação para relações étnico raciais, a aplicação de punições legais e a conscientização da população sobre o significado de ser negro ou indígena. Conclusão: O racismo ainda permeia o ambiente universitário e de saúde, impactando negativamente a vivência de estudantes negros e indígenas. Ao mesmo tempo, aponta caminhos de resistência que reafirmam a importância das ações afirmativas, da consciência racial e da transformação na educação médica. Conclui-se que é imprescindível integrar o debate étnico-racial na formação em saúde, a fim de promover uma educação inclusiva e socialmente comprometida.

Introduction: Slavery has left inequalities that still affect access to healthcare and education. In Medicine, affirmative actions have expanded access, yet challenges remain regarding the retention and legitimization of Black and Indigenous students in academic settings. Objective: To understand, from a collaborative learning perspective, situations of racial and ethnic discrimination and strategies to confront racism in medical education. Method: This qualitative study employed an ethnographic approach, utilizing participant observation and focus groups to gather insights into racial and ethnic discrimination and strategies to combat racism in Medicine. Three academic experiences were conducted, during which participants documented their experiences on index cards and proposed solutions, each session lasting approximately one hour. Thirty-three participants were involved, including 16 self-identified as Black or mixed-race and 2 Indigenous individuals from the Mundurucu and Borari ethnic groups. Data analysis followed collaborative learning theoretical frameworks, employing Minayo’s thematic analysis technique. The study protocol was approved by the Research Ethics Committee under opinion number 5,736,372. Results: The study revealed subtle forms of racism characterized by the normalization of discrimination and a logic of denial, expressed through microaggressions, identity denial, challenges in occupying and navigating medical spaces, and the perpetuation of stereotypical images of Black and Indigenous individuals. Conversely, it highlighted individual and collective strategies to combat racism, such as reporting incidents, promoting anti-racist dialogue, education on racial and ethnic relations, legal penalties, and raising awareness among the population about the experiences of being Black or Indigenous. Conclusion: Racism continues to permeate university and healthcare environments, negatively impacting the experiences of Black and Indigenous students. Nevertheless, the study identifies pathways of resistance that underscore the importance of affirmative actions, racial consciousness, and transformative approaches in Medical Education. Integrating ethnic-racial discourse into health education is crucial for fostering inclusive and socially engaged learning environments.

Animals can serve as reservoirs for multidrug-resistant (MDR) enterococci with potential pathogenicity. Close contact between dogs and their owners may facilitate the interspecies transmission of these bacterial agents, potentially impacting human health. While Enterococcus faecium and Enterococcus faecalis are the main species implicated in healthcare-associated infections (HAIs), non–faecium and non–faecalis (NFF) enterococci, though less prevalent, may also contribute to infections. This study aimed to assess the antimicrobial resistance phenotypes and genotypes and virulence potential of NFF enterococci isolated from asymptomatic dogs. A total of 114 NFF enterococcal isolates were obtained from rectal swabs of dogs, between 2015 and 2017, in Rio de Janeiro, Brazil. Antimicrobial resistance was assessed using disk diffusion and agar gradient diffusion methods, and resistance and virulence genes were determined by polymerase chain reaction (PCR). The highest resistance frequencies were observed for rifampicin (38.6%), tetracycline (27.2%), and erythromycin (15.8%). One vancomycin-resistant E. gallinarum strain (MIC > 512 µg/mL) was isolated, and it also exhibited resistance to teicoplanin. High-level resistance to streptomycin (HLR-S) was found in E. canintestini (22.2%), E. gallinarum (8.5%), and E. avium (7.1%) strains. Most E. raffinosus strains were resistant to ampicillin (55%) and penicillin G (55%), and this was the only species resistant to ampicillin. MDR strains accounted for 14.9% of the strains, with MDR colonization more frequent in purebred dogs, suggesting a possible breed-related association. The resistance genes detected included ant(6)-Ia, tet(M), tet(L), erm(B), and the van operon. Virulence genes were detected in a limited number of strains: esp (11.4%), gelE (2.6%), asa1 (0.9%), and hyl (0.9%). The presence of esp was significantly associated with E. canintestini (44.4%), and E. avium (42.9%). Further studies are needed to evaluate the public health implications of these findings.

Multidrug-resistant (MDR) Staphylococcus aureus has been increasingly isolated from pigs and people in close contact with them, especially livestock-associated methicillin-resistant S. aureus (LA-MRSA). In this cross-sectional study, we investigated S. aureus colonization in pigs and farm workers, their resistance profile, and genetic background to estimate interspecies transmission potential within farms from Rio de Janeiro state, Brazil, between 2014 and 2019. We collected nasal swabs from 230 pigs and 27 workers from 16 and 10 farms, respectively. Five MDR strains were subjected to whole genome sequencing. Fourteen (6.1%) pigs and seven (25.9%) humans were colonized with S. aureus, mostly (64–71%) MDR strains. Resistance to clindamycin, erythromycin, penicillin, and tetracycline was the most common among the pig and human strains investigated. MDR strains shared several resistance genes [blaZ, dfrG, fexA, lsa(E), and tet(M)]. Pig and human strains recovered from the same farm shared the same genetic background and antimicrobial resistance profile. LA-MRSA ST398-SCCmecV-t011 was isolated from pigs in two farms and from a farm worker in one of them, suggesting interspecies transmission. The association between pig management practices and MDR S. aureus colonization might be investigated in additional studies.

Group B Streptococcus (GBS) is a major cause of contagious bovine mastitis (CBM) in Brazil. The GBS population is composed of host-generalist and host-specialist lineages, which may differ in antimicrobial resistance (AMR) and zoonotic potential, and the surveillance of bovine GBS is crucial to developing effective CBM control and prevention measures. Here, we investigated bovine GBS isolates (n = 156) collected in Brazil between 1987 and 2021 using phenotypic testing and whole-genome sequencing to uncover the molecular epidemiology of bovine GBS. Clonal complex (CC) 61/67 was the predominant clade in the 20th century; however, it was replaced by CC91, with which it shares a most common recent ancestor, in the 21st century, despite the higher prevalence of AMR in CC61/67 than in CC91, and high selection pressure for AMR from indiscriminate antimicrobial use in the Brazilian dairy industry. CC103 also emerged as a dominant CC in the 21st century, and a considerable proportion of herds had two or more GBS strains, suggesting poor biosecurity and within-herd evolution due to the chronic nature of CBM problems. The majority of bovine GBS belonged to serotype Ia or III, which was strongly correlated with CCs. Ninety-three isolates were resistant to tetracycline (≥8 μg/mL; tetO = 57, tetM = 34 or both = 2) and forty-four were resistant to erythromycin (2.0 to >4 μg/mL; ermA = 1, ermB = 38, mechanism unidentified n = 5). Only three isolates were non-susceptible to penicillin (≥8.0 μg/mL), providing opportunities for improved antimicrobial stewardship through the use of narrow-spectrum antimicrobials for the treatment of dairy cattle. The common bovine GBS clades detected in this study have rarely been reported in humans, suggesting limited risk of interspecies transmission of GBS in Brazil. This study provides new data to support improvements to CBM and AMR control, bovine GBS vaccine design, and the management of public health risks posed by bovine GBS in Brazil.

Resumo A Síndrome Respiratória Aguda Grave (SRAG) constitui-se como uma das doenças respiratórias mais preocupantes, sendo caracterizada por um quadro gripal associado à taquipneia ou à hipoxemia e saturação inferior a 95% em ar ambiente. No contexto da pandemia do novo coronavírus (SARS-CoV-2) observou-se um crescimento exponencial nos casos sendo a pessoa idosa o grupo populacional mais afetado. Diante do exposto, este estudo teve como objetivo descrever os casos de SRAG, assim como os fatores sociodemográficos e de saúde associados ao óbito na população idosa de um município do norte do estado do Rio Grande do Sul, Brasil. Trata-se de um estudo epidemiológico, realizado a partir da análise de dados do Sistema de Informação de Vigilância Epidemiológica da Gripe. As informações foram disponibilizadas pela Secretaria Municipal de Saúde do município de Passo Fundo entre 01 de janeiro a 31 de dezembro de 2020. A estatística descritiva compreendeu a distribuição das frequências absolutas (n) e relativas (%) das variáveis de interesse. Na análise dos fatores associados estimouse razões de odds brutas e ajustadas por meio da Regressão Logística. Foi observado um total de 1.268 notificações por SRAG em idosos, sendo 72% causadas pela covid-19. A letalidade observada foi alta (40,9%), principalmente entre homens e de baixa escolaridade, sendo a presença de algum fator de risco determinante para o óbito, destacando-se a doença renal crônica. Espera-se que as associações evidenciadas neste trabalho possam auxiliar nas políticas de saúde direcionadas à saúde da pessoa idosa, sobretudo pelo fortalecimento das ações na rede de atenção primária.

Severe Acute Respiratory Syndrome (SARS) is one of the most worrying respiratory diseases, characterized by a flu-like condition associated with tachypnea or hypoxemia, with saturation below 95% in ambient air. In the context of the new coronavirus (SARSCoV- 2) pandemic, exponential growth in cases was observed, with the elderly being the most affected population group. This study aimed to describe SARS cases, as well as socio-demographic and health-associated factors in the elderly population of a city in the north of Rio Grande do Sul state, Brazil. This is an epidemiological study carried out by Influenza Epidemiological Surveillance Information System. The information was made available by the Municipal Health Department of the Passo Fundo between January 1st and December 31st, 2020. In the descriptive analysis, the distribution of absolute (n) and relative (%) frequencies of the variables of interest was performed. Crude and adjusted odds ratios were estimated using Logistic Regression. A total of 1,268 SARS notifications were observed in the elderly, 72% of which were caused by covid-19. The lethality was high (40.9%), mainly among men and those with low education, with the presence of at least one risk factor, especially chronic kidney disease. It is expected that the associations highlighted in this study can help to develop health policies aimed at the health of the elderly, especially by strengthening actions in primary health care.

This study aimed to identify the Staphylococcus species responsible for bovine mastitis in dairy herds in northern Brazil, to investigate the capacity of biofilm production, and to analyze the association of biofilm production with multiresistance and intensity of California Mastitis Tests (CMT) reactions that can make treatment more difficult and cause misdiagnoses, respectively. Milk samples were collected from 23 dairy farms located in five municipalities in the state of Acre. A total of 339 crossbred cows were tested by CMT, with 109 animals (229 udder ceilings) reacting to the test. After bacterial isolation in blood agar, the catalase-positive and gram-positive cocci were submitted for identification by MALDI-TOF MS. Of 103 strains identified as staphylococci, Staphylococcus chromogenes (58.3%) and Staphylococcus aureus (19.4%) were the most prevalent species. Biofilm production was quantitatively evaluated using a microplate adherence test. Among the Staphylococcus strains, 71.8% were biofilm producers. Most strains of S. chromogenes (68.3%) had the capacity to produce biofilms, ranging from weak (43.3%), moderate (13.3%), and strong (11.7%) producers. Among S. aureus strains, 50% were non-biofilm producers, and none were strong producers. Our data showed an association between biofilm production capacity and multidrug resistance. In addition, there was a reduction in the response to the CMT test, which can mask the diagnosis.