Perfil dos médicos formados na FMUSP e ingresso na residência médica

A graduação em medicina no Brasil tem impacto no Sistema Único de Saúde (SUS) do país. Dentre as universidades brasileiras, a Faculdade de Medicina da USP (FMUSP) merece destaque como centro formador de especialistas. Considerando esse cenário, buscou-se descrever o perfil dos egressos da graduação da FMUSP entre os anos de 1998 e 2018 e sua trajetória de ingresso na residência médica. Trata-se de um estudo observacional de delineamento transversal baseado na análise de bases de dados secundárias. Dos 3.637 registros analisados, 38,8% eram mulheres, proporção que aumentou ao longo do tempo. A média de idade na graduação foi de 24,2 anos. A maioria dos egressos nasceu (89%) e permaneceu (91%) no Estado de São Paulo, 82,5% fez residência no HC FMUSP, 3,7% fez residência em outra instituição e 13,8% não ingressou em nenhuma residência médica até 2019. Dentre os que fizeram alguma residência, 69,6% entraram direto (no ano seguinte após a graduação), 22,6% aguardaram 1 ano, 4,9% aguardaram 2 anos e 2,9% aguardaram 3 anos ou mais. Considerando todos os egressos, 58,6% entraram direto na residência médica do HC FMUSP. Em suma, a residência HC FMUSP foi a principal responsável pela especialização dos graduandos e abrigou a maior parte dos alunos que buscaram alguma especialização logo em seguida à conclusão da graduação.Medical schools in Brazil have an impact on the country’s public health care system (SUS). Among Brazilian universities, the “Faculdade de Medicina da Universidade de São Paulo” (FMUSP) has a central role as a training center for specialists. This way, we sought to describe the profile of FMUSP graduates and their trajectory pursuing specialization between the years of 1998 and 2018. This is an observational cross-sectional study based on the analysis of secondary databases. Of the 3,637 records analyzed, 38.8% were women, a proportion that has increased over time. The average age at graduation was 24.2 years. Most graduates were born (89%) and stayed (91%) in the State of São Paulo, 82.5% did their medical residency at the “Hospital das Clínicas da FMUSP”, 3.7% did a medical residency in another institution and 13.8% did not get in any medical residency until 2019. Among those who did a specialization, 69.6% entered the residency right after graduation from medical school, 22.6% waited 1 year, 4.9% waited 2 years and 2.9% waited 3 years or more. Considering all graduates, 58.6% entered the medical residency at HC FMUSP right after graduation. To sum up, the HC FMUSP residency program was responsible for the specialization of the vast majority of doctors and most of those students entered residency shortly after graduation

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Who and where are the doctors trained by the residence of the Hospital das Clínicas of the University of São Paulo?

Introduction: The Hospital das Clínicas da Universidade de São Paulo (HCFMUSP) has an essential role in the formation of specialist doctors. However, the residents’ profile from the biggest medical complex of Latin America is still unclear. Objective: To describe the general characteristics and the geographic distribution of the medical residents from HCFMUSP. Also, compare the “Faculdade de Medicina da Universidade de São Paulo” (FMUSP) graduated residents with the other institutions’ graduated residents’ profile. Methodology: This is a descriptive cross-sectional study based on secondary data from professional records and medical training. The geographic information was plotted using map of points and the tabulations presented were performed with IBM 24.0 SPSS® software. The differences between the FMUSP and non FMUSP groups were analyzed using the chi-square test for categorical variables and the t-test for continuous variables. A p-value of less than 0.05 was considered significant. Results: The study considered 8468 doctors who were attending or had completed Medical Residency at Hospital das Clínicas da Universidade de São Paulo between 1999 and 2019. Of these, 47.5% were women. The average age at admission was 26.8 years. 77.1% of physicians graduated in public schools. The most sought specialties were Internal Medicine (11.2%), General Surgery (8.7%) and Pediatrics (7.7%). The majority was born (58.0%) and lives (71.9%) in São Paulo state. Moreover, it is observed that residents were concentrated in the main capitals of Brazil in 2019. About the graduation school of the residents, it was found that 66.2% are from non FMUSP medical schools and about 25% came from the Northeast region. Discussion: In the residence programs, not only the offer of vacancies have to be considered, but the physicians’ characteristics, profile, trajectory, origin and graduation school too, since these factors can be determinant in the specialty choice and in their future decision about insertion and location of the professional exercise. Conclusion: This study has shown that the demographic characteristics and information about the trajectories and choices of resident physicians are relevant to the evaluation of the training institution and to the planning policies for the medical workforce.Introdução: O Hospital das Clínicas da Universidade de São Paulo (HCFMUSP) exerce importante papel na formação de médicos especialistas. Contudo, o perfil dos residentes do maior complexo médico da América Latina ainda é pouco estudado. Objetivo: Buscou-se descrever as características gerais e a distribuição geográfica dos médicos residentes HCFMUSP, bem como comparar aqueles graduados na Faculdade de Medicina da Universidade de São Paulo (FMUSP) e os que se graduaram em outras instituições de ensino. Metodologia: Trata-se de um estudo transversal descritivo baseado em dados secundários de registros profissionais e de formação dos médicos. Para analisar a localização e a distribuição geográfica dos médicos foram utilizados mapas de pontos e as tabulações apresentadas foram realizadas com o Software IBM 24.0 SPSS ®. Para comparações entre grupos distintos de médicos foi usado o teste de qui-quadrado para variáveis categóricas e o teste de t para variáveis contínuas. Um valor de p inferior a 0,05 foi considerado significativo. Resultados: O estudo considerou 8468 médicos que cursavam ou haviam concluído a Residência Médica no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo entre os anos de 1999 e 2019. Desses, 47,5% eram mulheres. A média de idade de ingresso foi de 26,8 anos. 77,1% dos médicos residentes foram graduados em escolas públicas. As especialidades mais escolhidas foram Clínica Médica (11,2%), Cirurgia geral (8,7%) e Pediatria (7,7%). A maioria dos residentes nasceu (58,0%) e reside (71,9%) no estado de São Paulo. Além disso, observa-se que os residentes, estavam, em 2019, concentrados principalmente nas capitais. Quanto à escola de graduação dos Residentes, 66,2% graduaram-se em outras escolas (não FMUSP). Neste grupo, 65%, graduaram-se em escolas médicas públicas e aproximadamente 25% vieram da região Nordeste. Discussão: Nos programas de Residência Médica devem ser consideradas a oferta de vagas, mas também as características, perfis e trajetórias dos médicos, assim como a origem e a escola de graduação, fatores que podem ser determinantes nas escolhas de especialidades e nas decisões futuras sobre inserção e localização do exercício profissional. Conclusão: O estudo mostrou que características sociodemográficas e informações sobre trajetórias e escolhas dos médicos Residentes são relevantes para a avaliação da instituição formadora e para subsidiar políticas de planejamento sobre força de trabalho médico

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat