Theoretical and practical approach of spirituality in institutionalized patients.

A rela??o entre medicina e espiritualidade ? alvo de estudos da atualidade, cujos resultados evidenciam associa??o positiva com comportamentos saud?veis. No entanto, h? uma lacuna de tal abordagem na forma??o em sa?de. O presente projeto de extens?o objetiva construir com estudantes de medicina substrato te?rico e viv?ncias pr?ticas na abordagem da espiritualidade de pacientes institucionalizados atrav?s de question?rios validados como o FICA. As interven??es com as atividades registradas e discutidas com os professores visam ofertar cuidado humanizado e valorizar a integralidade dos sujeitos. A an?lise qualitativa dos dados revelou aus?ncia de abordagem pr?via da espiritualidade dos pacientes, cuja maioria manifestou interesse nessa interven??o. ? relevante para o m?dico saber o momento e a forma adequada dessa abordagem visando ? singularidade de cada caso.The relationship between medicine and spirituality is subject of current studies, whose results show a positive association with healthy behaviors. However, there is a lack of such approach in healthcare education. The objectives of this extension project were to build together with medical students theoretical and practical experiences in approaching the spirituality of institutionalized patients through validated questionnaires, such as FICA. The interventions with the activities record and discussion with professors aim to offer humanized care and to value the integrality of these individuals. Qualitative data analysis revealed a lack of previous approach to the spirituality of the patients, whom (most of them) expressed interest in this intervention. It is relevant for the physician to know the timing and appropriate way of this approach aiming at the uniqueness of each case

Atendimento médico remoto à atenção à Saúde da Mulher por meio da rede social Instagram durante a pandemia da Covid-19 promovido por professores e acadêmicos do curso de Medicina da Universidade Federal de Ouro Preto – MG.

A infecção pelo novo coronavírus é de surgimento recente, por isso não há conhecimento específico sobre o tema que permita a elaboração de protocolos médicos assistenciais específicos para pacientes ginecológicas, gestantes e puérperas. Em relação à atenção à Saúde da Mulher, as orientações atuais derivam da analogia com infecções causadas por vírus da mesma família que o coronavírus. As publicações sugerem que a evolução dessa infecção na gestação não é diferente do mesmo grupo da faixa etária, ou seja, não há dados de que o novo vírus cause outros problemas durante a gravidez ou que afete a saúde do feto e do recém-nascido. Deve-se contribuir, portanto, para promover informação médica acessível ao maior número de pessoas. Por isso, o projeto visa à criação da página Ginecologia e Obstetrícia - UFOP no Instagram, em que serão divulgadas informações a respeito da pandemia da Covid-19 em relação à ginecologia e obstetrícia

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Functional performance of upper limb and quality of life after sentinel lymph node biopsy of breast câncer.

A biópsia de linfonodo sentinela (BLS) é um procedimento cirúrgico minimamente invasivo para o tratamento do câncer de mama, o qual pode reduzir a morbidade de membros superiores (MMSS). Objetivos: Investigar as possíveis deficiências e o desempenho funcional de MMSS em atividades de vida diária (AVDs) e a qualidade de vida relacionada à saúde (QVRS) entre mulheres submetidas à BLS em hospital da região sudeste do Brasil e estudar a associação entre essas variáveis. Métodos: Trata-se de estudo descritivo, transversal e correlacional do qual participaram 45 mulheres (58,9±9,3 anos). A avaliação das disfunções foi realizada por meio da medida da perimetria e da amplitude de movimento (ADM) de ombros, do relato e da quantificação da intensidade da dor/desconforto, utilizando Escala Visual Analógica (EVA). O questionário Disabilites of Arm Shoulder and Hand (DASH) foi utilizado para medir o desempenho funcional de MMSS durante as AVDs. Para avaliar a QVRS, foram utilizados os questionários European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire - Cancer 30 (EORTC QLQ-C30) e a escala de Sintomas do Braço (SB) do European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire - Breast Cancer Module 23 (EORTC BR-23). Resultados: Houve alta prevalência (75%) de sintomas que acometem MMSS (dor ou desconforto no braço ou ombro) ou mama. Apesar disso, os sintomas foram de leve intensidade. Apenas 4,4% apresentaram linfedema. Não houve limitação da ADM de ombros, e houve pouca limitação no desempenho funcional de MMSS, o que esteve associado com a escala SB do EORTC BR-23. As disfunções e o desempenho funcional de MMSS não interferiram na percepção sobre a QVRS, que foi considerada boa. Conclusão: Nesta amostra, observou-se pouca disfunção e limitação do desempenho funcional de MMSS nas AVDs, sem influenciar a QVRS.Sentinel lymph node biopsy (SLNB) is commonly used for the treatment of breast cancer with minimal surgical intervention as well as with low morbidity rates of upper limbs. Objectives: The aim of the present study was to investigate possible impairments and functional performance of the upper limb on activities of daily living (ADL) and health related quality of life (HRQL) among women treated through SLNB in a Brazilian hospital and to study the association among these variables. Methods: Forty-five women (58.9±9.3 years) participated in this descriptive, cross-sectional and correlational study. The visual analogue scale (VAS) was used to quantify pain intensity/discomfort, arm circumference and shoulder range of motion (ROM) measurement were used to measure upper limb impairments. The Disabilites of Arm Shoulder and Hand questionnaire (DASH) was used to quantify functional performance of upper limb during ADL and European Organisation for Research and Treatment of Cancer - Quality of Life Questionnaire - Cancer 30 (EORTC-QLQ-C30) and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire - Breast Cancer Module 23 (EORTC-BR23) were used to characterize HRQL. Results: Results revealed a 75% prevalence of symptoms affecting upper limb (pain or discomfort in arm, shoulder) or breast, although the severity of the symptoms was only mild. Only 4.4% exhibited lymphedema and no ROM restriction was observed. There was little limitation in functional performance of the upper limb, which was associated with Arm Symptoms scale (EORTC BR-23). Impairments and functional performance of upper limb did not interfere on HRQL perception, which was considered to be good. Conclusion: SLNB caused small impairments and limitation on the functional performance of the upper limb during ADL and did not influence HRQL in our sample

Microcalcificações mamárias suspeitas de malignidade.

O câncer de mama ocupa lugar de destaque no mundo ocidental por ser a maior causa de morte por câncer na população feminina. Medidas específicas para a prevenção primária do câncer de mama são de aplicação limitada na população em geral. Na prevenção secundária, esforços têm sido direcionados ao diagnóstico precoce. Neste cenário, encontra-se a mamografia, considerada o método mais sensível para detectar precocemente o câncer de mama. Microcalcificações mamárias são frequentemente detectadas nas mamografias de rastreamento e, embora a maioria seja benigna, algumas podem representar câncer. Assim, muitas biópsias originadas do rastreamento mamográfico visam a investigar microcalcificações suspeitas de malignidade. Neste sentido, há necessidade de caracterizá-las adequadamente, já que a conduta a ser seguida baseia-se na análise precisa destas. Diante disso, desenvolveu-se este trabalho na perspectiva de revisar as características dessas microcalcificações, contribuindo para a melhora na interpretação diagnóstica e na conduta clínica frente ao encontro destas na mamografia. Os artigos que serviram de sustentação para o presente estudo foram localizados por meio das bases de dados Medline, Lilacs, e Pubmed, utilizando os descritores “mamografia”, “neoplasia mamaria” e “calcinose”. Concluiu-se que, nas calcificações tipicamente malignas, os segmentos da mama devem ser biopsiados. Naquelas suspeitas de malignidade, se mesmo após exaustivo estudo de suas características pela mamografia não apresentarem sinais suficientes que indiquem doença benigna, devem ser investigadas a partir de um estudo anatomopatológico. Entretanto, inconsistências na classificação das microcalcificações de acordo com a morfologia, o nível de suspeição e a recomendação final do BI-RADS™ persistem e mais estudos da relação radiológicopatológica serão importantes na melhora da especificidade dessas variáveis.Breast cancer is one of the leading causes of death by cancer among women in the Western world. The application of specific primary breast cancer prevention measures is limited for the general population. In the secondary prevention measures, efforts have been directed at early diagnosis. In this scenario, mammography is widely used as the most efficient means for breast cancer early detection. Mammary microcalcifications are often detected through screening mammography. Although most of them are benign, some may be cancerous. Thus, many biopsies originated from screening mammography programs aim to investigate microcalcifications suspected of malignancy. Therefore, it is necessary to appropriately qualify these microcalcifications, considering that the procedure to be followed is based on their precise analysis. In view of these facts, the present study has been based on the possibility of revising the characteristics of these microcalcifications, and contributing to improve the clinical practice as well as their diagnostic interpretation through mammography. The articles used to support this study have been researched in the online Medline, Lilacs and Pubmed databases, using keywords such as “mammography”, “breast neoplasms”, “calsinosis”. It has been concluded that in typically malignant microcalcifications, breast segments must be biopsied. In those suspected of malignancy, even after extensive study of their features, if they do not present enough signs of benignity in mammography, they must be investigated by a histopathological study. However, inconsistencies in microcalcification´s classification persist depending on morphology, suspicion level and final recommendations from BI-RADS™. Thus, more studies on the radiological-pathological relationship are important to improve the specificity of these variables