Preditores de qualidade de vida relacionada à saúde durante a residência médica em uma amostra randomizada e estratificada de médicos residentes

OBJECTIVE: To evaluate the quality of life during the first three years of training and identify its association with sociodemographicoccupational characteristics, leisure time and health habits. METHOD: A cross-sectional study with a random sample of 128 residents stratified by year of training was conducted. The Medical Outcome Study -short form 36 was administered. Mann-Whitney tests were carried out to compare percentile distributions of the eight quality of life domains, according to sociodemographic variables, and a multiple linear regression analysis was performed, followed by a validity checking for the resulting models. RESULTS: The physical component presented higher quality of life medians than the mental component. Comparisons between the three years showed that in almost all domains the quality of life scores of the second year residents were higher than the first year residents (p < 0.01). The mental component scores remained high for third year residents (p < 0.01). Predictors of higher quality of life were: second or third year of residency, satisfaction with the training program, sufficient time for leisure, and care of critical patients for less than 30 hours per week. CONCLUSION: The mental component of quality of life was the most impaired component, indicating the importance of caring for residents' mental health, especially during their first year and when they are overloaded with critical patients.OBJETIVO: Avaliar a qualidade de vida do médico residente durante os três anos do treinamento e identificar sua associação com as características sociodemográficas-ocupacionais, tempo de lazer e hábitos de saúde. MÉTODO: Foi realizado um estudo transversal com amostra randomizada de 128 residentes, estratificada por ano de residência. O Medical Outcome Study-Short Form 36 foi aplicado; as distribuições percentis dos domínios de qualidade de vida de acordo com variáveis sociodemográficas foram analisadas pelo teste de Mann-Whitney e regressão linear múltipla, bem como estudo de validação pós-regressão. RESULTADOS: O componente físico da qualidade de vida apresentou medianas mais altas do que o mental. Comparações entre os três anos mostraram que quase todos os domínios de qualidade de vida tiveram escores maiores no segundo do que no primeiro ano (p < 0,01); em relação ao componente mental observamos maiores escores no terceiro ano do que nos demais (p < 0,01). Preditores de maior qualidade de vida foram: estar no segundo ou terceiro ano, satisfeito com o treinamento, ter tempo suficiente para lazer e atender paciente critico por menos do que 30 horas semanais. CONCLUSÃO: O componente mental da qualidade de vida foi o mais prejudicado, indicando a importância do cuidado da saúde mental, especialmente durante o primeiro ano do treinamento, e quando eles estão sobrecarregados por pacientes críticos.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Universidade Federal de São Paulo (UNIFESP) Department of PsychiatryNational Health Agency Department of PlanningDepartment of Health of the State of São PauloUniversidade Federal de São Paulo (UNIFESP) Department of PediatricsUNIFESP, Department of PsychiatryUNIFESP, Department of PediatricsSciEL

Effects of moderate exercise and nutritional guidance on body composition of obese adolescents assessed by bone densithometer (dexa)

This study was developed to evaluate the effects of moderate physical activity, associated to nutritional guidance, on body composition of obese adolescents. Eleven adolescents (7 = 12.8 year old) took part in an aerobic training (cicloergometer - 60% V0 2 max), with two sessions/week, during nine months. Body composition was assessed by the DEXA method, before and after the training period. The initial and final values of antropometrics and body composition variables were: BMI (33.3 ± 5.2; 31.8 ± 6.9* kg/m2); percentual body fat (48.5 ± 6.7; 47.2 ± 5.1*%); fat free mass (FFM) (40.6 ± 4.9; 42.5 ± 5.4* kg). These results indicated a significant increase in the FFM and decreases in body fat and BMI. This may mean that exercise and nutritional guidance had a positive effect. Adaptations observed in this study suggest that aerobic exercise combined with nutritional guidance promote important adaptations on adolescent obese body composition, which attenuated the adverse effects of obesityEste estudo foi desenvolvido com a finalidade de avaliar o efeito da atividade física moderada, associada à orientação nutricional, sobre a composição corporal de adolescentes obesos, para esse propósito, 11 adolescentes (7 = 12,8 anos) foram submetidos a exercício aeróbio (cicloergômetro - 60% FC máx), em duas sessões semanais, durante nove meses, sendo avaliada a composição corporal por Densitometria Óssea antes e após o período de treinamento. Os valores iniciais (I) e finais (F) para as variáveis antropométricas e da composição corporal foram: IMC (I: 33,3 ± 5,2; F: 31,8 ± 6,9* kg/m2); percentual de gordura corporal (I: 48,5 ± 6,7; F: 47,2 ±5,1* %); peso de massa magra (I: 40,6 ± 4,9; F- 42,5 ± 5,4* kg). Tais resultados indicam que, houve um aumento significativo no peso da massa magra e reduções na porcentagem de gordura corporal e no índice de Massa Corpórea (IMC). Isto sugere um provável efeito do programa de treinamento e da orientação nutricional. As adaptações observadas no presente estudo nos permitem sugerir que o exercício aeróbio e a orientação nutricional podem promover importantes adaptações sobre a composição corporal de adolescentes obesos, atenuando os efeitos adversos decorrentes da obesidad

Compromiso perinatal en gestantes con tuberculosis, Hospital Universitario "Dr. José Eleuterio González", en Monterrey, Nuevo León, México 2004-2012

The aim of the present study was to investigate the maternal and perinatal outcomes of pregnancies associated with tuberculosis and compared with pregnant women unaffected by tuberculosis. Materials and methods. A retrospective, observational, comparative and prevalence study took place at the Hospital Universitario "Dr. José Eleuterio González", in Monterrey, Nuevo León, Mexico. A review of clinical history of pregnant women with tuberculosis in a 8-year period, from December 2004 to October 2012 was made. Both maternal and perinatal results were compared with those of pregnant women unaffected by tuberculosis, undergoing the same parity and of the same age. Results. The prevalence of pregnant women with tuberculosis was 0.26%. A statistically significant correlation was found in patients with tuberculosis and premature birth (Rho= -0.395, p=0.034), weight decrease in newborns (Rho=-0.301, p=0.007) and a tendency to present a APGAR decrease at 1 minute, with poor recovery at 5 minutes (Rho= -0.233, p=0.04); the aforementioned results were obtained by using Spearman correlation (IC95%).The maternal mortality in pregnant women with tuberculosis was 11.5% (Fisher=0.032). Conclusion. Tuberculosis during pregnancy is related to adverse perinatal outcomes. In this study it was associated with preterm birth, intrauterine growth restriction, low APGAR and increases in maternal deaths.El objetivo de este estudio es investigar los resultados perinatales adversos en gestantes con tuberculosis y compararlos con gestantes sin tuberculosis. Material y métodos.&nbsp;Se realizó un estudio retrospectivo, observacional,comparativo, de prevalencia, en el Hospital Universitario “Dr. José Eleuterio González”, en Monterrey, Nuevo León, México, en el cual se revisaron los expedientes clínicos de pacientes gestantes con tuberculosis en un periodo de tiempo de 8 años de Diciembre 2004 a Octubre del 2012; Los resultados tanto maternos y perinatales obtenidos fueron comparados con mujeres gestantes sin tuberculosis que tenían la misma paridad y edad. Resultados. La prevalencia de gestantes con tuberculosis fue del 0.26%. Observamos una correlación estadísticamente significativa entre la presencia de tuberculosis y parto pretérmino(Rho= -0.395, p=0.034), disminución en el peso de los productos (Rho= -0.301, p=0.007) y una tendencia a presentar una disminución del APGAR al minuto, con pobre recuperación a los 5 minutos (Rho= -0.233, p=0.04); lo anterior con el método de Spearman (IC95%). La mortalidad materna en el grupo de pacientes con tuberculosis fue del 11.5% (Fisher=0.032). Conclusiones.&nbsp;La tuberculosis durante el embarazo se asocia con resultados perinatales adversos, en nuestro estudio se asoció con parto pretérmino, retraso en el crecimiento intrauterino, APGAR bajo e incremento en la mortalidad materna

Description of Genetic Variants in BRCA Genes in Mexican Patients with Ovarian Cancer: A First Step towards Implementing Personalized Medicine

Abstract Gynecologic cancers are among the leading causes of death worldwide, ovarian cancer being the one with the highest mortality rate. Olaparib is a targeted therapy used in patients presenting mutations in BRCA1 and BRCA2 genes. The aim of this study was to describe BRCA1 and BRCA2 gene variants in Mexican patients with ovarian cancer. Sequencing of BRCA1 and BRCA2 genes from tumors of 50 Mexican patients with ovarian cancer was made in a retrospective, non-randomized, and exploratory study. We found genetic variants in 48 of 50 cases. A total of 76 polymorphic variants were found in BRCA1, of which 50 (66%) had not been previously reported. Furthermore, 104 polymorphic variants were found in BRCA2, of which 63 (60%) had not been reported previously. Of these polymorphisms, 5/76 (6.6%) and 4/104 (3.8%) were classified as pathogenic in BRCA1 and BRCA2, respectively. We have described the genetic variants in BRCA1 and BRCA2 of tumors from Northeast Mexican patients with sporadic ovarian cancers. Our results showed that the use of genetic testing helps recognize patients that carry pathogenic variants which could be beneficial for personalized medicine treatments. Keywords: BRCA; ovarian cancer; personalized therapy; sequencin

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Diretriz da Sociedade Brasileira de Cardiologia sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas

This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.&nbsp; Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities. &nbsp; Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.&nbsp; The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.&nbsp; The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.&nbsp; &nbsp;&nbsp; Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.Esta diretriz teve como objetivo principal atualizar os conceitos e formular as normas de conduta e evidências científicas que as suportam, quanto ao diagnóstico e tratamento da CDC, com especial ênfase na base de racionalidade que a embasou. A DC no século XXI mantém padrão epidemiológico de endemicidade em 21 países da América Latina. Investigadores e gestores de países endêmicos e não endêmicos indigitam a necessidade de se adotarem políticas abrangentes, de saúde pública, para controle eficaz da transmissão inter-humanos da infecção pelo T. cruzi, e obter-se nível otimizado de atendimento aos indivíduos já infectados, com foco em oportunização diagnóstica e terapêutica. Mecanismos patogênicos e fisiopatológicos da CDC foram revisitados após atualização aprofundada e ficou bem consolidada a noção de que necrose e fibrose sejam estimuladas pela persistência parasitária tissular e reação imune adversa, como mecanismos fundamentais, coadjuvados por distúrbios autonômicos e microvasculares. Alguns deles recentemente constituíram alvos potenciais de terapêuticas. A história natural das fases aguda e crônica foi revista, com realce para a transmissão oral, a forma indeterminada e as síndromes crônicas. Metanálises recentes de estudos observacionais estimaram o risco de evolução a partir das formas aguda e indeterminada e de mortalidade após instalação da cardiomiopatia crônica. Condutas terapêuticas aplicáveis aos indivíduos com a FIDC foram abordadas especificamente. Todos os métodos para detectar alterações estruturais e/ou funcionais com variadas técnicas de imageamento cardíaco também foram revisados, com recomendações de uso nos vários cenários clínicos. Estratificação de risco de mortalidade fundamentada no escore de Rassi, com estudos recentes de sua aplicação, foi complementada por métodos que detectam fibrose miocárdica. A metodologia atual para diagnóstico etiológico e as consequentes implicações do tratamento tripanossomicida mereceram enfoque abrangente e aprofundado. Também o tratamento de pacientes em risco ou com insuficiência cardíaca, arritmias e eventos tromboembólicos, baseado em recursos farmacológicos e complementares, recebeu especial atenção. Capítulos suplementares subsidiaram as condutas aplicáveis a diversos contextos especiais, entre eles o da co-infecção por T. cruzi/HIV, risco durante cirurgias, em grávidas, na reativação da infecção após transplante cardíacos, e outros.&nbsp;&nbsp;&nbsp; Por fim, dois capítulos de grande significado social, abordando a estruturação de serviços especializados para atendimento aos indivíduos com a CDC, e revisando os conceitos de cardiopatia grave e suas implicações médico-trabalhistas completaram esta diretriz.&nbsp

Pratos e mais pratos: louças domésticas, divisões culturais e limites sociais no Rio de Janeiro, século XIX

Reply to ten comments on a paper published in the last issue of this journal. The discussion follows along six main lines: History museums, identity, ideology and the category of nation; the need of material collections and their modalities: patrimonial, operational, virtual; theater versus laboratory; visitors and their ambiguities; Public History: the museum and the academy.Resposta aos comentários de dez especialistas que contribuíram no debate de texto publicado no último número desta revista. A discussão orientou-se segundo seis tópicos principais: museus históricos, identidade, ideologia e a categoria de nação; a necessidade de acervos materiais e suas modalidades: acervo patrimonial, operacional, virtual; teatro versus laboratório; o público e suas ambigüidades; História Pública: o museu e a Academia