Níveis disfuncionais de ansiedade relacionada ao Coronavírus em estudantes de medicina: Dysfunctional levels of Coronavirus-related anxiety in medical students

As preocupações com a saúde mental das pessoas afetadas pela pandemia de coronavírus não foram abordadas adequadamente. Isso é surpreendente, uma vez que tragédias em massa, particularmente aquelas que envolvem doenças infecciosas, muitas vezes desencadeiam ondas de medo e ansiedade elevados que são conhecidos por causar perturbações maciças no comportamento e no bem-estar psicológico de muitos na população. Assim, o objetivo desse trabalho é demonstrar os níveis disfuncionais de ansiedade relacionada ao coronavírus em estudantes de medicina. Para isso, foi realizado uma revisão sistemática sobre a temática

ATLANTIC EPIPHYTES: a data set of vascular and non-vascular epiphyte plants and lichens from the Atlantic Forest

Epiphytes are hyper-diverse and one of the frequently undervalued life forms in plant surveys and biodiversity inventories. Epiphytes of the Atlantic Forest, one of the most endangered ecosystems in the world, have high endemism and radiated recently in the Pliocene. We aimed to (1) compile an extensive Atlantic Forest data set on vascular, non-vascular plants (including hemiepiphytes), and lichen epiphyte species occurrence and abundance; (2) describe the epiphyte distribution in the Atlantic Forest, in order to indicate future sampling efforts. Our work presents the first epiphyte data set with information on abundance and occurrence of epiphyte phorophyte species. All data compiled here come from three main sources provided by the authors: published sources (comprising peer-reviewed articles, books, and theses), unpublished data, and herbarium data. We compiled a data set composed of 2,095 species, from 89,270 holo/hemiepiphyte records, in the Atlantic Forest of Brazil, Argentina, Paraguay, and Uruguay, recorded from 1824 to early 2018. Most of the records were from qualitative data (occurrence only, 88%), well distributed throughout the Atlantic Forest. For quantitative records, the most common sampling method was individual trees (71%), followed by plot sampling (19%), and transect sampling (10%). Angiosperms (81%) were the most frequently registered group, and Bromeliaceae and Orchidaceae were the families with the greatest number of records (27,272 and 21,945, respectively). Ferns and Lycophytes presented fewer records than Angiosperms, and Polypodiaceae were the most recorded family, and more concentrated in the Southern and Southeastern regions. Data on non-vascular plants and lichens were scarce, with a few disjunct records concentrated in the Northeastern region of the Atlantic Forest. For all non-vascular plant records, Lejeuneaceae, a family of liverworts, was the most recorded family. We hope that our effort to organize scattered epiphyte data help advance the knowledge of epiphyte ecology, as well as our understanding of macroecological and biogeographical patterns in the Atlantic Forest. No copyright restrictions are associated with the data set. Please cite this Ecology Data Paper if the data are used in publication and teaching events. © 2019 The Authors. Ecology © 2019 The Ecological Society of Americ

INCIDÊNCIA E EVOLUÇÃO DE LESÕES GRANULOMATOSAS APÓS IMUNOTERAPIA COM BACILO CALMETTE-GUÉRIN

Introdução: Imunoterapia intravesical com bacilo Calmette-Guérin (BCG) é uma estratégia consolidada no tratamento de neoplasias do trato urinário, e apesar de rara a BCG tem o potencial de causar doença sistêmica. A patogênese da doença relacionada ao BCG pode ser uma infecção ativa ou uma reação de hipersensibilidade, porém a incidência e o tratamento dessa intercorrência ainda são controversos. O objetivo desse estudo foi descrever as complicações infecciosas relacionadas a imunoterapia com BCG em uma coorte de pacientes oncológicos. Métodos: Foram incluídos todos os pacientes que receberam BCG intravesical de janeiro de 2017 a dezembro de 2022. Foram avaliados todos os pacientes com exame anatomopatológico (AP) após o início da BCG. Os dados foram extraídos do prontuário eletrônico e relatório de microbiologia. Os desfechos foram lesão granulomatosa no AP e óbito no período de estudo. Foram avaliadas características do paciente e do tratamento. A análise estatística foi realizada por regressão logística e regressão de Cox. Resultados: No período avaliado, 270 pacientes realizaram 2456 sessões de BCG, 231 (84%) tiveram AP após o início da BCG; 30% eram do sexo feminino e a mediana de idade foi de 66 (41-87) anos. A neoplasia mais frequente foi carcinoma urotelial, 94%, a mediana de sessões de BCG foi de 8 dias, e 73% usaram a dose de 40 mg de BCG. Vinte (9%) pacientes apresentaram AP com reação granulomatosa, 10 prostatites, 7 cistites, 1 infecção de testículo e 1 rim/psoas, apenas os dois últimos receberam tratamento anti-tuberculostático. Entre os com lesão granulomatosa, 14 realizaram imunohistoquímica, 2 foram positivos e apenas um recebeu tratamento. Os pacientes com lesão granulomatosa tiveram menos sessões de BCG que o resto da coorte (p = 0,04, OR 0,87 [0,76-0,98]). Trinta e sete pacientes (16%) evoluíram a óbito durante o período do estudo, 33 não apresentavam alteração no AP e 4 apresentavam lesões granulomatosas - com mortalidade de 15,6% e 20,0%, respectivamente. O único fator de risco para óbito foi quimioterapia posterior à BCG (p < 0,001), e o número de sessões de BCG foi um fator protetor (p 0,002). Conclusão: O achado de lesão granulomatosa após imunoterapia com BCG é frequente, no entanto, o tratamento dessas lesões não se mostrou necessário na maioria dos casos

Evaluation of the Incidence of Bladder Perforation After Transurethral Bladder Tumor Resection in a Residency Setting

Purpose: To evaluate prospectively the actual bladder perforation incidence during transurethral resection of bladder tumor (TURB) performed by residents and to identify possible predisposing factors to such condition. Patients and Methods: Thirty-four patients with bladder tumor were submitted to TURB in our academic institution in April 2006, and were prospectively studied. Procedures were all done by senior residents under an attending direct supervision. All patients had a cystograms performed after the procedure by the injection of 400 mL of saline-diluted contrast solution with low-pressure infusion through the Foley catheter. The cystograms were evaluated blindly by a single radiologist. All patients were examined by cystoscopy and/or CT every 3 months for the first 2 years postoperatively. Results: The cystogram showed contrast leaking compatible with bladder perforation in 17 (50%) cases. None of the perforations were recognized intraoperatively by the surgeon. All perforations were extraperitoneal and managed conservatively. There was no significant correlation between the incidence of bladder perforation and the patient age (p = 0.508), the tumor stage (p = 0.998), the tumor grade (p = 0.833), the number of lesions (p = 0.394), and the tumor size (p = 0.651). The only factor that had impact on the development of bladder perforation was tumor localization at the bottom of the bladder (p = 0.035; OR, 6750; 95% CI, 1.14, 39.8). Conclusion: Asymptomatic perforations of the bladder wall occur very frequently after a TURB procedure performed by residents in training and, most of the time, are not noticed by the surgeon. Localization of the tumor at bladder dome was the only factor that negatively influenced perforation rates

Scoring system for prediction of overall survival in patients with renal cell carcinoma T3aN0M0

Abstract Objective We aim to create a new score to predict postoperative overall survival in patients with nonmetastatic T3aN0 renal cell carcinoma. Methods We reviewed the clinical data of adult patients who underwent radical nephrectomy for renal cell carcinoma between December 2007 and January 2022 in a single tertiary oncological institution. Clinical characteristics, clinical‐pathological staging and histopathological characteristics were analysed. Survival analyses were determined using the Kaplan–Meier curve. A nomogram was established using Cox proportional hazard regression to identify the prognostic factors affecting the overall survival. The area under the curve, calibration curves and decision curve analysis were used to evaluate prognostic efficacy. Results We analyzed 362 patients classified as pT3aN0M0 stage with a median follow‐up of 40 months. According to Cox univariate and multivariate analyses, weight loss greater than 5% in 6 months before surgery, stage V chronic kidney disease after radical nephrectomy, sarcomatoid pattern, and coagulative tumor necrosis were identified as predictors of overall survival. We developed a score and performed internal and external validation. The time‐dependent receiver operating characteristic curve, area under the curve value and calibration curve analysis showed good prediction ability of the score. The nomogram can effectively predict and stratify overall survival after radical nephrectomy in patients with pT3aN0M0 renal cell carcinoma. Conclusion Patients with pT3aN0MO renal cell carcinoma exhibited different characteristics, and those with unfavourable characteristics deserve greater attention during follow‐up. This nomogram provides an accurate prediction of overall survival after radical nephrectomy

Association Between Integrin Expression and Prognosis in Localized Prostate Cancer

BACKGROUND. Integrins and other adhesion molecules are essential for maintaining the epithelial phenotype. Some studies have reported correlations between abnormalities in their expression and carcinogenesis, but their role in prostate cancer is unclear. Our aim was to study the expression profile of integrins in surgical specimens of prostate cancer and associate their expression patterns with patient outcomes. METHODS. We selected 111 patients with localized prostate cancer who had undergone radical prostatectomy. Of these patients, 60 had no tumor recurrence after a median follow-up of 123 months. Integrin expression was evaluated by immunohistochemistry in a tissue microarray containing two tumor samples per patient. A semiquantitative analysis was employed. We measured the association between the expression of eight integrins and tumor recurrence. RESULTS. Multivariate analysis showed that expression of alpha 3 and alpha 3 beta 1 was related to worse outcome. When alpha 3 expression was strong and alpha 3 beta 1 expression was positive, the odds of recurrence were 3.0- and 2.5-fold higher, respectively. Only 19% and 28% of patients were recurrence-free in a mean period of 123 months of follow up when their tumors showed strong alpha 3 or positive alpha 3 beta 1 immuno-expression, respectively. CONCLUSIONS. We have shown that the expression of integrin alpha 3 beta 1 was independently associated with tumor recurrence after radical prostatectomy, suggesting that this integrin is a potential prognostic marker. Prostate 70: 1189-1195, 2010. (C) 2010 Wiley-Liss, Inc.Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (Fapesp)[06/57373-0

V diretriz da Sociedade Brasileira de Cardiologia sobre tratamento do infarto agudo do miocárdio com supradesnível do segmento ST

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V diretriz da Sociedade Brasileira de Cardiologia sobre tratamento do infarto agudo do miocárdio com supradesnível do segmento ST

Resumo não disponíve