Objetivo: Conhecer a percepção de graduando de enfermagem acerca da formação sobre as competências gerenciais e educacionais para os serviços de saúde. Métodos: Estudo descritivo-exploratório, de abordagem qualitativa, com acadêmicos do último ano do curso de Enfermagem no ano de 2017 de uma Universidade Pública do sul do Brasil. Resultados: Participaram do estudo 23 graduandos com idade média de 26 anos e predominância do sexo feminino. Os participantes responderam um questionário com caracterização sociodemográfica e questões relacionadas à sua formação para o desenvolvimento das competências gerenciais e educacionais. Considerou-se todos os domínios das competências gerenciais essenciais, com destaque para liderança. Alguns apontaram outras habilidades como a boa relação do trabalho em equipe, bom preparo teórico e prático, envolvimento, comprometimento com o serviço e comportamento ético. Evidenciou-se, ainda, que os acadêmicos reconhecem a importância da graduação para a construção de suas competências gerenciais educacionais. Conclusão: Uma vez que o curso possibilita a ampliação do conhecimento teórico sobre a temática, vivência prática e o desenvolvimento do pensamento crítico, conclui-se que os formandos consideraram ter aprendido sobre as competências gerenciais e educacionais durante a graduação e as destacaram de extrema importância para a atuação do enfermeiro nos serviços de saúde.

Introduction: Cryptococcoma is a rare CNS infection caused by Cryptococcus neoformans, with a granulomatous lesion. It’s even rarer in immunocompetent patients. Diagnosis requires histopathological analysis and treatment with amphotericin B, often with surgical resection. The aim is to report four cases of cerebral cryptococcoma In Immunocompetent Patients. This is a case report study. The information of this work was obtained through review of the medical record. Case report: We report on four cases of cerebral cryptococcoma in immunocompetent patients. All cases presented with images of expansive lesions and compatible histopathological analysis. The first case was a 62-year-old man with dysphasia and decreased strength on the right side, and underwent total surgical resection, followed by 23 days of amphotericin B treatment. The second case was a 62-year-old woman who presented with orofacial dyskinesia and decreased strength on the right side, and underwent stereotactic surgery, followed by antifungal treatment. After 10 days of hospitalization, the patient developed respiratory insufficiency, progressed to cardiorespiratory arrest and brain death. The third case was a 54-year-old woman who presented with a skin infection caused by Cryptococcus. During treatment with fluconazole, the patient experienced altered sensory perception and left hemiparesis. Surgical resection of the lesion was performed, followed by 30 days of antifungal treatment. The fourth case was a 54-year-old man who presented with pulsatile headache and right hemiparesthesia, and underwent stereotactic neurosurgery, followed by 12 days of amphotericin B treatment. Conclusion: Cryptococcus neoformans infection in the CNS, manifested in the form of cryptococcoma, although rare, should be considered as a differential diagnosis for brain expansive lesions in immunocompetent individuals.

Background:Yellow Fever (YF) is an endemic disease, in specific areas of Brazil. Since 1942, no new urban cycle cases have been observed. Yet, in early 2017, outbreaks of YF were reported in many states, outside the endemic areas, where YF was not considered a risk. Hence, new and some fatal cases have been reported including in highly populated areas close to the city of São Paulo. As it has been widely broadcasted, population searching for vaccination significantly increased and cases of inadvertent vaccination have been registered.Objectives:To analyze the consequences of inadvertent YF primo-vaccination in patients with immune mediated inflammatory diseases (IMID).Methods:Observational study (12/2017–01/2018).54 rheumatologists from private practice at different areas of São Paulo included specific YF information in their patients’ orientations and actively searched for IMID patients that have received YF vaccination (YFV) inputting the data in a web-based questionnaire.Results:56 patients received YFV; female 42 (75%), mean (±SD) age= 56±14 yr, median disease duration= 7 yr (6 months-45 yr), Diagnosis: RA (n=39; 72%), PsA (n=5), AS (n=4), 2 SLE, 3 vasculitis, 2 SS, one ReA and 2 UA. Treatment: 30 (54%) were considered under current strong immunosuppression (CE≥20 mg, MTX>20 mg, leflunomide, tofacitinib and biologic agents (BA); 18 (32%) were on biologic agents (9 anti-TNF, 2 abatacept, 3 tocilizumab, 1 rituximab, 1 patient each secukinumab and tofacitinib). Remaining patients were receiving csDMARDs isolated or in combination, with or without low CE (≤10 mg).Vaccination: 54 (96%) cases were primo YFV and 43 (80%) related inadvertent YFV. Adverse events (AE): 7 patients (13%) had AE after a median of 4 days (hours-60 days);3 of them were on BA, corresponding to 17% of the total subjects on various BA. Severity of AE:4 patients had mild AE (local pain, vertigo, fever, headache, myalgia), in 2 of them, symptoms promptly resolved while 2 needed medical assistance (one was on tocilizumab). Of the 3 remaining cases, one had severe reaction one hour after YFV (probably anaphylaxis); Finally, 2 patients had severe AE requiring hospitalization: one had meningitis (RTX+MTX) and other (ADA+MTX), abdominal pain, myalgia, fever, headache, vertigo and increased liver enzymes. No fatal events were observed. Concerning the vaccine effect on disease activity, only 5 (9%) patients related worsening of the disease after YFV, but 2 of them also presented AE.Conclusions:The small number of reports precludes any conclusion about rate/severity of AE and YFV in immunosuppressed rheumatic patients. Nevertheless, it emphasized the necessary awareness and careful analysis of the risk-benefice of YFV in this population. The interference of YFV on IMID disease activity seems to be marginal. On the other hand, this descriptive analysis clearly demonstrated persistence of patient’s unfamiliarity with concepts of immunosuppression and its consequences, disclosing another unmet need in the management of patients with RD.Disclosure of Interes...