EXTENSION ACTIVITIES

One of the strengths of PPgCS is its social integration, through assistance and extension activities in the community (all published on the PPgCS web page under the icon “Extension Activities”), systematically developed by 18 (90%) of the 20 permanent staff and one collaborating lecturer .

The description of the actions that demonstrate the integration of PPgCS with the unified Health System, through research and extension projects, is outlined below:

Professors: Edgar M. Carvalho, Lucas P. de Carvalho, Maria Olívia Bacellar, Paulo R. Machado, Nicolaus Albert Schriefer, Léa Castelucci, Argemiro D´Oliveira Júnior and Marcus M. Lessa (8 faculty members):

Corte de Pedra

The Prof. Edgard Santos University Hospital Immunology Researchers (the majority of whom are PPgCS teachers) are Paulo r. Machado, Olivia Bacellar, Albert Schriefer, Lea Castellucci, Lucas Pedreira de Carvalho, Marcus Lessa, Argemiro D ´Oliveira Junior and Edgar Marcelino de Carvalho. They administer and develop teaching activities, research and assistance in the Dr Jackson Lemos Costa health centre located in the village of Corte de Pedra, in the municipality of Tancredo Neves in the southeast of Bahia. This location is a reference centre for the diagnosis and treatment of tegumentary leishmaniasis where more than 1200 cases of the various clinical forms of the disease present every year. There is a strong relationship between the PPgCS and the Corte de Pedra health centre, where in 2015, 12 doctoral students of the program (Augusto Marcelino de Carvalho, Pedro Paulo Carneiro, Lucas Frederico de Almeida, Grace Brito, Clara Figueredo Lima, Rúbia Costa, Tais Menezes Campos, Aline Muniz, Geovana Berghene, Carolina Cincurá, Juliana Almeida, Viviane Magalhães) and 1 master student (Michael Macedo) developed their theses or dissertations at Corte de Pedra.

This location has 7 consulting rooms available with input from infection specialists, clinicians, dermatologists, otorhinolaryngologists and a pathologist. In addition to providing assistance to the general population, the diagnosis of the disease is carried out here by parasitological methods (culture), and by histopathological molecular biology (polymerase chain reaction) and by the delayed hypersensitivity test. Undergraduates of the Faculty of Medicine of Bahia also participate in research activities and learn about the disease at the centre. In addition, conferences and community-focused courses are held on a regular and ad-hoc basis, with the health education aim of explaining not only the means of transmission and control, but also the clinical forms and the importance of adherence to treatment, which characterises an action of education in health.

Another extension service has been established to assist patients with HTLV-1. The human T-cell Lymphotropic Virus type 1 (HTLV-1) has a high prevalence in Bahia where the infection is detected in 1.35% of the population of Salvador. This virus was first described in 1980 and as such, little is known of its natural history. For the purpose of providing assistance to individuals infected with HTLV-1, PPgCS teachers (Edgar Marcelino de Carvalho and Paulo Machado), along with volunteer doctors and postgraduate students created a multidisciplinary HTLV-1 Clinic at the University Hospital. At the moment, this clinic works with approximately 500 individuals infected by this virus with the majority coming from blood banks or having been referred from neurological and infection clinics.

In addition to clinical assistance, research activities are carried out in 4 areas:

1) The natural history of HTLV-1 infection;

2) The association between HTLV1 and tuberculosis;

 3) The role of the immune response, viral factors and helminths as aspects of the disease associated with HTLV-1;

4) The influence of HTLV-1 on immune response to other pathogens.

Professors: Aldina Barral, Camila Indiani de Oliveira, Claudia Ida Brosdyn, Manoel Barral-Netto (Faculty of 4):

The development of clinical research is in fact one of the current health research bottlenecks in Brazil. The Directorate of Science and Technology of the Ministry of Health (DECIT) has undertaken efforts to move the area up the priority agenda of health research policy.

 In this context, a group of researchers from the immunoparasitology laboratory (LIP) (Professors. Aldina Barral, Camila Indiani de Oliveira, Claudia Brodskyn, Manoel Barral-Netto), has been working on research, diagnostic and clinical epidemiology aspects of endemic diseases in the Jiquiriçá Valley, a rural area in the State of Bahia, since 2001. In 2007, a medical service was set up that facilitated the registration and follow-up of patients with some important health problems in the region. The structure was put in place by the municipality of Jiquiriça, and handed over to the group of researchers.

This work is a result of a partnership between researchers, the Municipal Secretary of Health of the municipality of Jiquiriça, and the State Government of Bahia/SESAB.  The location is equipped to work with the most prevalent diseases in the region such as tegumentary leishmaniasis (LT); leprosy; sexually transmitted diseases (STD), acquired immunodeficiency syndrome (AIDS); schistosomiasis, and co-infections among these diseases. The goal is that the unit also develops activities related to health education, and serves as a support for research projects of interest to the region. This activity unites lab and field. The unit was inaugurated in July 2007, and the projects developed in the region rely on the support of the Fundação de Amparo à Pesquisa do Estado da Bahia (FAPESB), the Ministry of health (SVS) and the National Research Council (CNPq). In all the projects that have been developed, beyond  data collection for investigation, assistance and educational activities are carried out. These are important extensions to the core activities that this group of researchers conduct in the rural area of the State of Bahia. This centre also welcomes undergraduate and postgraduate students from PPgCS who carry out research and extension linked activities.

Prof. Álvaro Augusto Cruz (1 faculty member)

Professor Álvaro a. Cruz has been a member of the Board of Directors of the Global Initiative Against Asthma (GINA) and of the Allergic Rhinitis Initiative and its impact on Asthma (ARIA) since 2009. These two international organizations are devoted to publication of evidence-based strategies for the prevention and control of chronic respiratory diseases, resulting in numerous publications. GINA was led for most of this period by Professor Eric D. Bateman, of the University of Cape Town (http://www.knowledgetranslation.co.za/content/staff_e_bateman.html). The ARIA Initiative is led by Professor Jean Bousquet, of the University of Montpelier (http://www.srxa.com/bousquet.html). In addition, Professor Alvaro Cruz has been part of the Planning Group of the Global Alliance against chronic respiratory Diseases (GARD) of the World Health Organization (WHO), since 2009, another initiative that brings together world leaders and results in numerous publications published in international journals by the WHO (also led by Professor Jean Bousquet).

Professor Álvaro Cruz founded the ProAR in 2002. This is an extension program of the Department of Medicine of FAMEB-UFBA and is recognized by several national and international organizations, including the World Health Organization. The central clinic of reference and coordination is part of the Secretariat of the municipality of Salvador, offering assistance to patients with severe asthma and includes the dispensing of medicines, for free, with special attention to health education. Several PPgCS students have developed their dissertations and theses in this area, and the results have been published in several important journals.

Professor Raymundo Paraná Filho (1 faculty member)

Prof. Paraná coordinates the "Hepatology of the Millennium" program of continuing medical education in Hepatology and the Group of viral hepatitis studies involving the Hepatology reference centres of Salvador-BA, Rio Branco-AC, Cruzeiro do Sul-AC and Porto Velho-RO. In this context, training has been offered at the National Program of Viral Hepatitis within the Department of Health Ministry, since 2004, in which professionals are trained in the care of patients with viral hepatitis. In 2011, Professor Paraná set up the Rudolphe Merrieux Bahia/Acre lab, a Molecular Biology Research Laboratory for viral hepatitis. Its aims include the development of in house tests and human resources training. Since 1992, Prof. Paraná has coordinated the training of professionals in the public health service on how to carry out liver biopsy. He also produces texts for the lay population in order to disseminate information and educate and had two texts published in journals and magazines in 2015.

Prof. Paraná coordinates the Bahia hepatitis group, formed by professionals from COM-HUPES (UFBA) and FIOCRUZ. He is the coordinator of this group and provides assistance, research, and extension activities through medical education programs. He works in close cooperation with, and supervises the State reference centres (Feira de Santana, Vitória da Conquista, Juazeiro and Ipiaú) as well as the Western Amazonian reference centres (Porto Velho, Cruzeiro de Sul-AC, Rio Branco-AC). In these places, the personnel are trained in a model of  multidisciplinary assistance. He acts as a supervisor and co-supervisor of Master and PhD courses for 6 colleagues. He provides supervision of complex cases by telemedicine and local visits every 2 months. In Salvador, there are hepatitis clinics at COM-HUPES on Wednesday afternoons, on Thursday afternoons and on Friday mornings (transplant patients). In the “Liberdade” medical centre (a class C district in the city of Salvador) there are two clinics run by professionals from the group for treating patients with HIV and co-infected HCV. Liver biopsies are carried out at the weekends when colleagues from the interior are trained in the procedure. The NGO Group “Will to live,” coordinated by Professor Paraná, is made up of patients treated for hepatitis C or who have transplants. They work in partnership to provide education in the community, as well as providing counselling for patients and families.

Professor Jamary Oliveira Filho (1 faculty member)

The clinic for cerebrovascular diseases was created in 2004, by Professor Jamary, to provide for patients who have suffered an ischemic stroke or haemorrhage, as well as for carriers of several arterial and venous malformations. The clinic operates on Fridays from 13:00 to 19:00 and receives patients on the SUS (National Health Service) referred from hospitals that deal with neurological patients throughout the State. Approximately 400 patients are being monitored all the time, looked after by UFBA medical students and supervised by two professors from the Institute of Health Sciences, Professor Pedro Antonio Pereira de Jesus and Jamary Oliveira Filho. In addition to the free care offered to the population, the clinic offers a series of social activities, such as “Stroke Day”.

Professor. Cristiana M. Nascimento de Carvalho (1 faculty member)

In 2004 Professor Cristiana set up the Paediatric Infectious Diseases outpatient clinic which operates in COM-HUPES on Tuesday mornings and afternoons. At this clinic, the paediatric patients are referred from the SUS for diagnostic investigations and treatment of infectious diseases. They are treated by students from the undergraduate program, Brazilian and foreign volunteers undertaking extension activities (an extra-curricular activity), including residents and post-graduate students from PPgCS.

Professor. Marcus M. Lessa (a faculty member who also participates in the extension activities group led by Professor. Edgar)

Professor Marcus Lessa works with patients in three weekly outpatient clinics for Otolaryngology at COM-HUPES (on Thursday mornings and Thursday and Friday afternoons) and guides ENT surgery at COM-HUPES on Thursday mornings on a weekly basis. In addition, every 2 weeks he attends the Corte de Pedra medical centre, described above, to assess patients with ENT symptoms of tegumentary leishmaniasis. Professor Marcus is involved with continuing education programs for doctors, participating in the organization of events and giving lessons to the open community, extramurals of UFBA, as took place in 2015 and registered as technical production of PPgCS.

Professor Paul n. Rocha (1 faculty member)

Professor Paul n. Rocha guides the treatment of patients undergoing chronic dialysis (haemodialysis especially) attended at the Nephrology Service at COM-HUPES. He is teaching advisor for several academic leagues, including the Academic League of Bahian Medical Clinics -LACLIM, the Academic League of Nephrology of Bahia – LANEB, the Academic League of Intensive Medicine of Bahia – LAMIB. At these leagues he teaches undergraduates in medicine from different institutions.

Prof. Paulo r. Machado (1 faculty member)

The leprosy clinic was set up in 1992 and is coordinated by Professor. Parulo R. Machado. Since then approximately 6 to 8 new cases a month are seen, with an average of 80 to 100 appointments monthly. In this clinic, there is a multidisciplinary team that has alongside dermatologists, nurses, pharmacists, physical therapists and psychologists as well. It is considered to be a reference centre in Bahia for Leprosy and for handling for leprosy reactions. Dermatology residents during R2 and R3, infectious diseases residents and medical students regularly participate in the clinic which has therefore, care, teaching and research and where several projects are developed.

 Prof. Régis a. Campos (visiting faculty member) working with Professor Edgar M. Carvalho mentioned above in another extension activity.

The COM-HUPES Immunology clinics were set up in the 1980s, and have served the community for more than 20 years. These clinics serve low-income patients with immune system disorders, which include primary immunodeficiencies, and have become a reference for patients with these diseases in Bahia. The Immunology clinics also serve patients with illnesses based on allergies such as asthma, allergic rhinitis, atopic dermatitis and urticaria, besides diseases associated with autoimmunity, giving support to other specialties that deal with organ-specific autoimmune diseases and also systemic autoimmune diseases such as systemic lupus erythematosus, syndromes of vasculitis and rheumatoid arthritis. The clinics operate three times a week, with three doctors, lecturers Edgar M.Carvalho and Régis A, Campos who see around 200 patients a month.

In the Tuesday morning clinic, mainly patients with primary immunodeficiencies and principally humoral immunodeficiencies are seen, and this is the only clinic which caters for primary immunodeficiencies in adults and children in Bahia, as well as patients with autoimmune diseases and using immunosuppressants. In the Thursday morning clinic, children and adults with respiratory allergies cutaneous and medicine are overseen. In the Friday morning clinic, newly created in 2012, patients with urticaria are treated. This clinic is intended for monitoring of a cohort of patients with chronic urticaria and some patients with hypersensitivity to the painkillers and anti-inflammatory hormones. Additionally, the out-patient medical Immunology team respond to patients hospitalized in COM-HUPES with suspected diagnosis of immune system disorders. In these clinics, PPgCS students carry out research projects into clinical immunology and allergies.

Prof. Eduardo M. Netto (1 faculty member)

Prof. Eduardo Netto founded the infectious diseases outpatient clinic which takes place on Tuesday afternoons, in 1992. In this clinic an average of 18 patients per week are seen which results in this being a reference point for patients with tuberculosis and HIV. In addition, it is a reference for the care of patients with tuberculosis in other places beyond the lung, tuberculosis patients and co-morbidities such as chronic kidney failure and diseases with immune suppression component. Around 20% of patients have infectious diseases.