EFICIÊNCIA DA UTILIZAÇÃO DO OXIGÊNIO DISSOLVIDO COMO PRINCIPAL INDICADOR DA QUALIDADE DAS ÁGUAS SUPERFICIAIS DA BACIA DO CÓRREGO MOEDA, TRÊS LAGOAS/MS

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Intervenção preventiva em distúrbios de imagem corporal, transtorno alimentar e dismorfia muscular:: um estudo com homens brasileiros cisgêneros gays e bissexuais

Sexual and gender minority men present high body dissatisfaction, eating disorder and muscle dysmorphia symptoms, which compromise the physical health and psychosocial functioning. The PRIDE Body Project is a dissonance-based intervention developed to prevent these psychopathologies in cisgender gay and bisexual men. However, its efficacy was not tested among Brazilian. Thus, the present study aimed to evaluate initial indicators of efficacy of the PRIDE Body Project in reducing appearance-ideal internalization, eating disorder and muscle dysmorphia symptoms in Brazilian cisgender gay and bisexual men. This is a quasi-experimental study, carried out with 74 Brazilian cisgender gay and bisexual men, with high body dissatisfaction. The subjects were invited to participate through advertising in strategic locations in the city of Governador Valadares/MG, as well as through websites and social media. The participants filled out, pre- and post-intervention, a sociodemographic questionnaire and measures of appearance-ideal internalization, eating disorder and muscle dysmorphia symptoms. The PRIDE Body Project consists of two sessions with two hours each and a weekly interval in between. During the sessions, the participants were encouraged to perform a series of written, verbal and behavioral activities. The age of the participants varied between 18 and 30 years (M = 24.68 ± 2.84 years) and the Body Mass Index (BMI) from 18.29 to 50.70 (M = 25.34 ± 5.51). Regarding race/ethnicity, they identify themselves as Brown (n = 35; 47.30%), Black (n = 20; 27.03%) and White (n = 19; 25.67%). A significant reduction was observed between the pre- and post-intervention time-points on appearance-ideal internalization, eating disorder and muscle dysmorphia symptoms. The effect size ranged from medium to large (Cohen’s d ≥ 0.63). The PRIDE Body Project showed preliminary indicators of efficacy in reducing appearance-ideal internalization, eating disorder and muscle dysmorphia symptoms in Brazilian cisgender gay and bisexual men. It is suggested the implementation of this intervention in the academic, clinical and epidemiological field.Los hombres pertenecientes a minorías sexuales y de género presentan alta insatisfacción corporal, síntomas de trastornos alimentarios y dismorfia muscular, problemas que comprometen la salud física y el funcionamiento psicosocial. PRIDE Body Project es una intervención basada en la disonancia cognitiva diseñada para prevenir estas psicopatologías en hombres cisgénero homosexuales y bisexuales. Sin embargo, aún no tiene eficacia comprobada para la población brasileña. Por lo tanto, el objetivo del presente estudio fue evaluar los indicadores de eficacia de referencia del PRIDE Body Project en la reducción de la internalización de la apariencia ideal, los síntomas de los trastornos alimentarios y la dismorfia muscular en hombres cisgénero gay y bisexuales brasileños. Se trata de un estudio cuasi-experimental, realizado con 74 hombres adultos, gays cisgénero y bisexuales brasileños, con alta insatisfacción corporal. Los sujetos fueron invitados a participar a través de publicidad en lugares estratégicos de la ciudad de Governador Valadares/MG, así como a través de sitios de internet y redes sociales. Los participantes completaron, antes y después de la intervención, un cuestionario sociodemográfico e instrumentos para evaluar la interiorización de la apariencia ideal, síntomas de trastornos alimentarios y dismorfia muscular. El PRIDE Body Project consta de dos sesiones de aproximadamente dos horas cada una con un descanso semanal entre ellas. Durante las sesiones, se animó a los participantes a realizar una serie de actividades escritas, verbales y conductuales. La edad de los participantes varió de 18 a 30 años (M = 24,68 ± 2,84 años) y el Índice de Masa Corporal (IMC) de 18,29 a 50,70 (M = 25,34 ± 5,51) . En cuanto al color/raza, se autoidentificaron como Pardos (n = 35; 47,30%), Negros (n = 20; 27,03%) y Blancos (n = 19; 25,67%). Se observó una reducción significativa entre el tiempo previo y posterior a la intervención para la interiorización de la apariencia ideal, los síntomas de los trastornos alimentarios y la dismorfia muscular. El tamaño del efecto varió de medio a grande (d de Cohen ≥ 0,63). El PRIDE Body Project ha demostrado indicadores tempranos de eficacia en la reducción de la internalización de la apariencia ideal, los síntomas del trastorno alimentario y la dismorfia muscular en hombres brasileños cisgénero homosexuales y bisexuales. Se sugiere la implementación de esta intervención en el ámbito académico, clínico y epidemiológico.Homens de minoria sexual e de gênero apresentam elevada insatisfação corporal, sintomas de transtornos alimentares e dismorfia muscular, problemas que comprometem a saúde física e o funcionamento psicossocial. O PRIDE Body Project é uma intervenção, baseada na dissonância cognitiva, criada para prevenir essas psicopatologias em homens cisgêneros gays e bissexuais. Contudo, ainda não apresenta eficácia comprovada para população brasileira. Assim, o objetivo do presente estudo foi avaliar indicadores iniciais de eficácia do PRIDE Body Project na redução da internalização da aparência ideal, sintomas de transtornos alimentares e dismorfia muscular em homens brasileiros cisgênero gays e bissexuais. Trata-se de um estudo quase experimental, realizado com 74 homens adultos, brasileiros cisgêneros gays e bissexuais, com elevada insatisfação corporal. Os sujeitos foram convidados a participar por meio da divulgação em locais estratégicos da cidade de Governador Valadares/MG, assim como por meio de sites da internet e redes sociais. Os participantes preencheram, antes e após a intervenção, um questionário sociodemográfico e instrumentos para avaliação da internalização da aparência ideal, sintomas de transtornos alimentares e dismorfia muscular. O PRIDE Body Project consiste de duas sessões com duração de aproximadamente duas horas cada e intervalo semanal entre elas. Durante as sessões os participantes foram encorajados a realizar uma série de atividades escritas, verbais e comportamentais. A idade dos participantes variou de 18 a 30 anos (M = 24,68 ± 2,84 anos) e o Índice de Massa Corporal (IMC) de 18,29 a 50,70 (M = 25,34 ± 5,51). Em relação a cor/raça eles se auto identificaram como Pardo (n = 35; 47,30%), Preto (n = 20; 27,03%) e Branco (n = 19; 25,67%). Foi observada uma redução significante entre o momento pré e pós-intervenção para a internalização da aparência ideal, sintomas de transtornos alimentares e dismorfia muscular. O tamanho de efeito variou de médio a grande (d de Cohen ≥ 0,63). O PRIDE Body Project demonstrou indicadores iniciais de eficácia na redução da internalização da aparência ideal, sintomas de transtornos alimentares e dismorfia muscular em homens brasileiros cisgêneros gays e bissexuais. Sugere-se a implementação dessa intervenção no âmbito acadêmico, clínico e epidemiológico

Síndrome de Burnout e os médicos: uma revisão jurídica adequada à nova realidade potencializada pela pandemia/ Burnout Syndrome and physicians:a legal review adequate to the new reality amplified by the pandemic

Contexto: A síndrome de Burnout (SB) é a resposta ao estresse crônico advindo da situação laboral. Nota-se que os médicos são susceptíveis a desenvolver a SB, já que diariamente são expostos a intensas emoções, cargas horárias extensas e situações estressantes, que acarretam perda na qualidade do atendimento e desdobramentos legais, potencializados pela pandemia de COVID-19. Objetivo: Descrever as consequências e as implicações jurídicas da SB para os médicos, agravadas devido a pandemia. Métodos: Foi realizada uma revisão bibliográfica com o objetivo de avaliar a SB em médicos na pandemia de COVID-19. A seleção de artigos foi feita por meio das bases de dados SciELO e PubMed no período de 12 de março de 2021 a 7 de abril 2021. Também foram utilizadas outras referências para a fundamentação dos aspectos jurídicos envolvidos nas consequências da SB. Discussão: A SB é constituída por três dimensões: exaustão emocional, despersonalização e baixa realização pessoal no trabalho. Essas dimensões culminam em uma maior chance de erros provocados pelos médicos acometidos pela SB, uma vez que provoca consequências no ambiente profissional e social, gerando impactos jurídicos desfavoráveis a esses profissionais, no âmbito do direito civil e penal. Conclusão: É necessária a ampliação da discussão, a fim de que o médico que venha sofrer as consequências de um processo penal ou cível, possa apresentar como meio de defesa, desde que comprovado, o acometimento de seu estado mental pela SB. Ademais, devem ser implementadas medidas propositivas, como suporte psicológico, capacitação de gestores de saúde e maior participação do estado, visando a identificação precoce da SB

Discrepancies in breast cancer’s oncological outcomes between public and private institutions in the southeast region of Brazil: a retrospective cohort study

BackgroundBrazil is a middle-income country with inequalities in its healthcare system. The disparities between public and private services affect the diagnosis and treatment of patients with breast cancer. The aim of this study is to assess whether disease-free survival (DFS) and overall survival (OS) are different in public and private specialized centers.Patient and methodsA retrospective cohort study with 1,545 breast cancer patients diagnosed from 2003 to 2011 at Barretos Cancer Hospital—BCH (public group, N = 1,408) and InORP Oncoclinicas (private group, N = 137) was conducted. A 1:1 propensity score matching (PSM) analysis was used to adjust the differences between the groups’ characteristics (n = 137 in each group).ResultsThe median age at diagnosis was 54.4 years. Estimated DFS rates at 1, 5, and 10 years were 96.0%, 71.8%, and 59.6%, respectively, at BCH and 97.8%, 86.9%, and 78%, respectively, at InORP (HR: 2.09; 95% confidence interval [CI], 1.41–3.10; p < 0.0001). Estimated OS rates at 1, 5, and 10 years were 98.1%, 78.5%, and 65.4%, respectively, at BCH and 99.3%, 94.5%, and 91.9%, respectively, at InORP (HR: 3.84; 95% CI, 2.16–6.82; p < 0.0001). After adjustment by PSM, DFS and OS results in 1, 3, and 5 years remained worse in the public service compared to the private service.ConclusionPatients treated in a public center have worse DFS and OS after a follow-up period of more than 5 years. These results were corroborated after carrying out the PSM

Smartphone-based evaluation of static balance and mobility in long-lasting COVID-19 patients

BackgroundSARS-CoV-2 infection can lead to a variety of persistent sequelae, collectively known as long COVID-19. Deficits in postural balance have been reported in patients several months after COVID-19 infection. The purpose of this study was to evaluate the static balance and balance of individuals with long COVID-19 using inertial sensors in smartphones.MethodsA total of 73 participants were included in this study, of which 41 had long COVID-19 and 32 served as controls. All participants in the long COVID-19 group reported physical complaints for at least 7 months after SARS-CoV-2 infection. Participants were evaluated using a built-in inertial sensor of a smartphone attached to the low back, which recorded inertial signals during a static balance and mobility task (timed up and go test). The parameters of static balance and mobility obtained from both groups were compared.ResultsThe groups were matched for age and BMI. Of the 41 participants in the long COVID-19 group, 22 reported balance impairment and 33 had impaired balance in the Sharpened Romberg test. Static balance assessment revealed that the long COVID-19 group had greater postural instability with both eyes open and closed than the control group. In the TUG test, the long COVID-19 group showed greater acceleration during the sit-to-stand transition compared to the control group.ConclusionThe smartphone was feasible to identify losses in the balance motor control and mobility of patients with long-lasting symptomatic COVID-19 even after several months or years. Attention to the balance impairment experienced by these patients could help prevent falls and improve their quality of life, and the use of the smartphone can expand this monitoring for a broader population

Effect of High vs Low Doses of Chloroquine Diphosphate as Adjunctive Therapy for Patients Hospitalized With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection: A Randomized Clinical Trial.

There is no specific antiviral therapy recommended for coronavirus disease 2019 (COVID-19). In vitro studies indicate that the antiviral effect of chloroquine diphosphate (CQ) requires a high concentration of the drug.To evaluate the safety and efficacy of 2 CQ dosages in patients with severe COVID-19. This parallel, double-masked, randomized, phase IIb clinical trial with 81 adult patients who were hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was conducted from March 23 to April 5, 2020, at a tertiary care facility in Manaus, Brazilian Amazon. - Patients were allocated to receive high-dosage CQ (ie, 600 mg CQ twice daily for 10 days) or low-dosage CQ (ie, 450 mg twice daily on day 1 and once daily for 4 days). - Label: Main Outcomes and Measures Primary outcome was reduction in lethality by at least 50% in the high-dosage group compared with the low-dosage group. Data presented here refer primarily to safety and lethality outcomes during treatment on day 13. Secondary end points included participant clinical status, laboratory examinations, and electrocardiogram results. Outcomes will be presented to day 28. Viral respiratory secretion RNA detection was performed on days 0 and 4. Out of a predefined sample size of 440 patients, 81 were enrolled (41 [50.6%] to high-dosage group and 40 [49.4%] to low-dosage group). Enrolled patients had a mean (SD) age of 51.1 (13.9) years, and most (60 [75.3%]) were men. Older age (mean [SD] age, 54.7 [13.7] years vs 47.4 [13.3] years) and more heart disease (5 of 28 [17.9%] vs 0) were seen in the high-dose group. Viral RNA was detected in 31 of 40 (77.5%) and 31 of 41 (75.6%) patients in the low-dosage and high-dosage groups, respectively. Lethality until day 13 was 39.0% in the high-dosage group (16 of 41) and 15.0% in the low-dosage group (6 of 40). The high-dosage group presented more instance of QTc interval greater than 500 milliseconds (7 of 37 [18.9%]) compared with the low-dosage group (4 of 36 [11.1%]). Respiratory secretion at day 4 was negative in only 6 of 27 patients (22.2%). - Label: Conclusions and Relevance The preliminary findings of this study suggest that the higher CQ dosage should not be recommended for critically ill patients with COVID-19 because of its potential safety hazards, especially when taken concurrently with azithromycin and oseltamivir. These findings cannot be extrapolated to patients with nonsevere COVID-19

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.  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.   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.  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.  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.     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.    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

Minimal Symptom Expression' in Patients With Acetylcholine Receptor Antibody-Positive Refractory Generalized Myasthenia Gravis Treated With Eculizumab

The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension