Cardiology referral during the COVID-19 pandemic

OBJECTIVES: This study presents the cardiology referral model adopted at the University of Sa˜o Paulo-Hospital das Clı´nicas complex during the initial period of the coronavirus disease (COVID-19) pandemic, main reasons for requesting a cardiologic evaluation, and clinical profile of and prognostic predictors in patients with COVID-19. METHODS: In this observational study, data of all cardiology referral requests between March 30, 2020 and July 6, 2020 were collected prospectively. A descriptive analysis of the reasons for cardiologic evaluation requests and the most common cardiologic diagnoses was performed. A multivariable model was used to identify independent predictors of in-hospital mortality among patients with COVID-19. RESULTS: Cardiologic evaluation was requested for 206 patients admitted to the ICHC-COVID. A diagnosis of COVID-19 was confirmed for 180 patients. Cardiologic complications occurred in 77.7% of the patients. Among these, decompensated heart failure was the most common complication (38.8%), followed by myocardial injury (35%), and arrhythmias, especially high ventricular response atrial fibrillation (17.7%). Advanced age, greater need of ventilatory support on admission, and pre-existing heart failure were independently associated with inhospital mortality. CONCLUSIONS: A hybrid model combining in-person referral with remote discussion and teaching is a viable alternative to overcome COVID-19 limitations. Cardiologic evaluation remains important during the pandemic, as patients with COVID-19 frequently develop cardiovascular complications or decompensation of the underlying heart disease

Ligas acadêmicas e sua importância no Ensino, Pesquisa e Extensão

As Ligas Acadêmicas (LAs) são entidades essencialmente estudantis na qual os alunos se organizam para se aprofundarem em estudos de determinados temas da área médica, apoiando-se no tripé universitário de ensino, pesquisa e extensão. Tem-se observado nos últimos anos uma difusão e aumento do número de LAs, um fenômeno que se constata existir em todo o território nacional. Objetivos: Discutir a importância das LAs no ensino, pesquisa e extensão, além de descrever aspectos positivos e negativos destas entidades e os fatores que motivam os estudantes a nelas ingressarem. Metodologia: Foi realizado um levantamento da literatura existente sobre LAs, incluindo todos os artigos referentes ao tema, independente do ano de publicação. Artigos não disponíveis integralmente para leitura foram excluídos desta revisão. Resultados: Na última década, o número de estudantes que participam de LAs aumentou de maneira considerável. Percentual importante de acadêmicos procuram as Ligas para melhorar o currículo. Parcela considerável de LAs não promove estágios ou pesquisas, resumindo-se apenas a aulas teóricas. As LAs podem influenciar seus membros na escolha da futura especialidade. Discussão: Muitas LAs que atuam de forma não condizente com o propósito do tripé universitário, repetem vícios do ensino tradicional, baseado no conhecimento horizontalizado. A falta de supervisão adequada nos estágios promovido pelas LAs é um ponto negativo importante que deve ser combatido. Por outro lado, observa-se que existem LAs que atuam de maneira adequada, servindo como ambiente de aprendizado e socialização para os acadêmicos de medicina, e, portanto devem ser encorajadas. Conclusão: As LAs são uma realidade nas faculdades de medicina de todo o país. Sua existência deve ser notada como pauta de discussões docentes e métodos avaliativos e mensuradores devem ser criados a fim de que elas funcionem como promotoras do conhecimento e socialização

Pulmonary Embolism Mortality in Brazil from 1989 to 2010: Gender and Regional Disparities

AbstractBackground:A significant variation in pulmonary embolism (PE) mortality trends have been documented around the world. We investigated the trends in mortality rate from PE in Brazil over a period of 21 years and its regional and gender differences.Methods:Using a nationwide database of death certificate information we searched for all cases with PE as the underlying cause of death between 1989 and 2010. Population data were obtained from the Brazilian Institute of Geography and Statistics (IBGE). We calculated age-, gender- and region-specific mortality rates for each year, using the 2000 Brazilian population for direct standardization.Results:Over 21 years the age-standardized mortality rate (ASMR) fell 31% from 3.04/100,000 to 2.09/100,000. In every year between 1989 and 2010, the ASMR was higher in women than in men, but both showed a significant declining trend, from 3.10/100,000 to 2.36/100,000 and from 2.94/100,000 to 1.80/100,000, respectively. Although all country regions showed a decline in their ASMR, the largest fall in death rates was concentrated in the highest income regions of the South and Southeast Brazil. The North and Northeast regions, the lowest income areas, showed a less marked fall in death rates and no distinct change in the PE mortality rate in women.Conclusions:Our study showed a reduction in the PE mortality rate over two decades in Brazil. However, significant variation in this trend was observed amongst the five country regions and between genders, pointing to possible disparities in health care access and quality in these groups