The main concerns of European anaesthesiology postgraduate trainees: A European survey

This is the first study intended to identify the European anaesthesiology trainees' main concerns, to initiate a process of improvement of the training in anaesthesiology by the European Society of Anaesthesiology (ESA). The authors developed an electronic survey which addressed seven different concerns: autonomy transition, technical skills, exchange programs, residency costs, residency workload, employment prospects and educational contents/preparation for the European Diploma in Anaesthesiology and Intensive Care (EDAIC). The survey was disseminated by email to all anaesthesiology trainees registered in ESA and all European National Societies were asked to distribute the survey to their graduating trainees. 665 trainees initiated the survey with a completion rate of 54.6%. The trainees' main concerns were in descending order: educational contents, residency costs, employment prospects, residency workload, exchange programs, technical skills and autonomy transition. This report analyzes the three main concerns in more detail. 68% of respondents were unaware of the existence of the ESA e-learning platform. Other means to improve the preparation for the EDAIC such as a multiple-choice questions book should be developed. The main reason for not becoming an ESA Trainee member was the associated cost and 68% of respondents gave up activities or opportunities during their residency due to economic constraints; 56% of respondents considered emigrating for economic reasons and 28% elected Northern/Central Europe. The results of the present survey may provide additional background information for the development of specific improvements in strategies for training in anaesthesiology. (c) 2018 Elsevier Ltd. All rights reserved

Anaesthesia - related fears - a cross - sectional survey among the portuguese population

Introduction: Patients experience preoperative anxiety. The objective of this study was to assess patients’ fears concerning anaesthesia and evaluate possible associations with sociodemographic background and previous anaesthesia. Methods: A survey was filled preoperatively, for 6 months, including anaesthesia-related fears, sociodemographic data, previous anaesthesia and surgery, current surgical and anaesthetic procedure, and preferred anaesthesia technique. Descriptive statistics, principal component analysis, Chi-square test, t-test and ANOVA were used for statistical analysis. Results: 153 questionnaires were collected. The mean age was 58 years, 61.4% were female and 59.5% employed. 47.1% had an anaesthesia consultation before. 49.7% were ASA II. 78.4% had been submitted to surgery before, 81.7% to anaesthesia and 14.5% had regional anaesthesia. In 73.5% general anaesthesia preferred. Half of patients with previous regional anaesthesia favoured this technique. The most relevant fears were “being paralysed because of anaesthesia”, “not waking up” and “waking up during surgery”. The least relevant were “fasting incapacity”, “having nightmares” and “speaking of personal matters”. A statistically significant relation was observed between the fear of “feeling pain after surgery” and having a previous anaesthetic experience. Female and unemployed patients were more concerned with general complications, while male patients gave more importance to awareness and paralysis. Conclusion: Paralysis after anaesthesia, intraoperative awareness and death were the main concerns of our inquiries.info:eu-repo/semantics/publishedVersio

Diretrizes curriculares para os cursos de graduação em Geologia e Engenharia Geológica

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Erros inatos do metabolismo confirmados no Hospital das Clínicas de Ribeirão Preto-SP no período de 2000 a 2008

Os Erros Inatos do Metabolismo (EIM) vêm sendo cada vez mais identificados nos últimos anos. A preocupação com o diagnóstico precoce decorre do foco na prevenção de deficiências, especialmente a mental. Este estudo descritivo teve por objetivo verificar diagnósticos confirmados e modalidades de tratamento utilizadas de janeiro de 2000 a dezembro de 2008. Método: foi realizada busca ativa de casos confirmados nos serviços que atendem esse tipo doença: neurologia (neuropediatria e doenças neuromusculares), pediatria (serviço de gastrologia e hepatologia) e genética clínica, além de levantamento no Serviço de Arquivo Médico do HCFMRP-USP. Foram confirmados 165 pacientes com EIM, com idades de um dia a 22 anos (mediana de um ano); 50 casos foram defeitos na síntese ou catabolismo de moléculas complexas, 65 no metabolismo intermediário, e 50 na produção ou utilização de energia. O tratamento foi instituído para 12 dos 50 pacientes do grupo I sendo reposição enzimática em 11 e transplante de medula óssea em um; todos do grupo II e III receberam orientação  nutricional; 60 do grupo II receberam fórmula dietética industrializada; dos 50 do grupo III, 43 com mitocondriopatias receberam L-carnitina e coenzimas e aqueles com glicogenose, orientação sobre aporte de carbohidratos. A formação de novos recursos humanos, integração com a Rede EIM Brasil e linhas de pesquisa na área são prioridades para melhorar a acuidade na detecção e tratamento de erros inatos do metabolismo.Inborn Errors of Metabolism have been increasingly identified in recent years. The early diagnosis focuses on prevention of disabilities, especially mental retardation. This descriptive study aims to verify confirmed diagnosis and treatment modalities in HCFMRP-USP cases from January of 2000 to December of 2008. A total of 165 patients with ages ranging from one day to 22 years (median one year) were detected. Fifty patients had synthesis or catabolism of complex molecules (group I), 65 intermediary metabolism (group II), and 50 had production or use of energy (group III) defects. Among the patients of group I, 11 had enzyme replacement therapy, and one bone marrow transplantation; for group II and III, in addition to daily nutritional guidance for all of the patients, 60 from group II received industrialized diets; from group III, 43 with mitochondrial diseases received L-carnitine and coenzymes, and those with glycogenosis were focused mainly on the intake of carbohydrates. New human resources, integration with the Network EIM Brazil and lines of research in the area are priorities for improving the accuracy in the detection and treatment of inborn errors of metabolism

Multi-messenger observations of a binary neutron star merger

On 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of ~1.7 s with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg2 at a luminosity distance of 40+8-8 Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 Mo. An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at ~40 Mpc) less than 11 hours after the merger by the One- Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ~10 days. Following early non-detections, X-ray and radio emission were discovered at the transient’s position ~9 and ~16 days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta

Avaliação por imagem das lesões da placa de crescimento Imaging of growth plate injuries

As estruturas responsáveis pelo crescimento do osso incluem a fise (também chamada placa de crescimento) e as epífises. Afecções que acometem pacientes com o esqueleto imaturo, ou seja, com a placa de crescimento ainda aberta, podem interferir no crescimento ósseo, resultando em complicações como parada do crescimento, encurtamento dos membros ou deformidades angulares. Condições traumáticas que resultam muitas vezes em fraturas epifisárias são a causa mais comum das lesões da placa de crescimento. A avaliação cuidadosa desses pacientes pelos métodos de diagnóstico por imagem atualmente disponíveis, sobretudo a radiografia, a tomografia computadorizada e a ressonância magnética, permite o reconhecimento precoce do comprometimento das estruturas relacionadas ao crescimento ósseo, além de tratamento adequado, diminuindo a possibilidade do desenvolvimento de tais complicações.<br>The structures responsible for the growth of bones include the physis (also called growth plate) and the epiphysis. Affections involving patients with immature skeletons, i.e., with a still open growth plate, may affect the bone growth, resulting in complications such as growth arrest, limb shortening and angular deformities. Traumatic conditions, many times resulting in epiphyseal fractures, are the most frequent cause of growth plate injuries. A careful evaluation of these patients by means of currently available imaging methods, especially radiography, computed tomography and magnetic resonance imaging, allows an early diagnosis of the involvement of structures related to the bone growth, besides an appropriate management, reducing the probability of secondary complications