Online learning and COVID-19: a meta-synthesis analysis

The COVID-19 pandemic demanded a quick shift from presential to e-learning processes. Unlike planned e-learning programs, medical schools have had to quickly deliver the entire medical curriculum using remote strategies. This study aimed to perform a meta-synthesis of previous pandemic situations and describe the experience of the São Paulo University School of Medicine. We searched the Cochrane Central Register of Controlled Trials, Medline, EMBASE, Lilacs, Scopus, Web of Science, and ERIC, using the following keywords: ("SARS" OR "severe acute respiratory syndrome" OR "severe acute respiratory syndrome" OR "Middle East Respiratory Syndrome Coronavirus" OR "middle east respiratory syndrome*" OR "MERS-CoV" OR "Mers" OR "Middle Eastern Respiratory Syndrome*" OR "MERS-CoV*" OR "coronavirus" OR "Coronavirus Infections" OR "coronavirus*" OR "COVID-19" OR "2019-nCoV" OR "SARS-CoV-2") AND ("online education" OR "Education, Distance" OR "e-learning" OR "course online" OR "flipped classroom") AND ("lockdown" OR "social distance" OR "quarantine"). The endpoints were the online platforms used for online learning, the model of class, recorded versus online interaction, duration of online lectures, and students' and teachers' perceptions of online learning. We retrieved 38 records; only seven articles studied online education methods related to the pandemic and social distancing rules. The most frequently used online platform was Zoom®. The studies examined both synchronous and asynchronous approaches. There was no evidence regarding duration and students' and teachers' attitude. This study suggests that the online learning shift was feasible; however, because of the nature of the education shift (pandemic), future studies must further analyze the educational structure.

Influência do posicionamento do retalho linfonodal vascularizado na resposta ao tratamento cirúrgico do linfedema secundário ao câncer de mama / Influence of vascularized lymph node transfer (VLNT) flap positioning on the response to breast cancer-related lymphedema treatment

RESUMO Objetivo: analisar a experiência terapêutica inicial do transplante de linfonodos vascularizados em pacientes portadoras de linfedema de membros superiores secundário ao tratamento do câncer de mama e verificar se o posicionamento do transplante influencia o resultado cirúrgico. Métodos: ensaio prospectivo, comparativo, de duas modalidades terapêuticas em 24 pacientes portadoras de linfedema de membro superior após tratamento de câncer mamário, classificados como graus 2 e 3, segundo a Sociedade Internacional de Linfedema. Os dois tipos de procedimentos realizados foram: 1) reconstrução total da mama com retalho de perfurante da artéria epigástrica inferior (DIEP- deep inferior epigastric perforator flap) associado ao retalho linfonodal, em pacientes sem reconstrução mamária prévia ou com histórico de perda da reconstrução (posicionamento axilar); 2) retalho linfonodal inguinal isolado foi realizado em pacientes com reconstrução mamária finalizada ou sem o desejo de realizar a reconstrução da mama (posicionamento no punho). Resultados: a porcentagem de redução do volume do membro afetado foi de 20,1% (p=0,0370). O número de episódios infecciosos (celulites) também sofreu redução significativa, de 41% no período pré-operatório para 12,5% no pós-operatório (p=0,004). Não foram observadas diferenças entre os grupos proximal e distal. Conclusão: o transplante de linfonodos afetou positivamente a evolução pós-operatória de pacientes portadoras de linfedema secundário ao câncer de mama. Não foram observadas diferenças em relação ao posicionamento do retalho.

ABSTRACT Objective: to evaluate the initial therapeutic experience of transplantation of vascularized lymph nodes in patients with lymphedema of the upper limbs secondary to the treatment of breast cancer, and to verify if the positioning of the transplant influences the surgical result. Methods: we conducted a prospective, comparative test of two therapeutic modalities, with 24 patients with lymphedema of the upper limb after breast cancer treatment, classified as grades 2 and 3, according to the International Lymphedema Society. The two types of procedures performed were: 1) total breast reconstruction with - deep inferior epigastric perforator (DIEP) flap associated with lymph node flap, in patients with no previous breast reconstruction or loss of previous reconstruction (axillary positioning); 2) isolated inguinal lymph node flap performed in patients with completed breast reconstruction or without the desire to perform the breast reconstruction (wrist positioning). Results: the reduction percentage of the affected limb volume was 20.1% (p=0.0370). The number of infectious episodes (cellulites) also decreased significantly, from 41% in the preoperative period to 12.5% in the postoperative one (p=0.004). There were no differences between the proximal and distal groups. Conclusion: the transplantation of lymph nodes positively affected the postoperative evolution of patients with lymphedema secondary to breast cancer. We observed no differences in relation to flap positioning.

Avaliação do índice de infecção de implantes mamários utilizados na reconstrução de mama do Instituto do Câncer do Estado de São Paulo / Evaluation of the infection rate of implants used for breast reconstruction at the Cancer Institute of the State of São Paulo

INTRODUÇÃO: A utilização de implante mamário é a forma de reconstrução de mama mais comumente realizada. Apesar de suas vantagens, a infecção do implante, seja este expansor tecidual ou prótese mamária, pode ser um problema significativo, incluindo a necessidade de sua retirada. O objetivo deste trabalho é avaliar o índice de infecção de implantes mamários utilizados na reconstrução de mama de pacientes operadas no Instituto do Câncer do Estado de São Paulo (ICESP), bem como sua correlação com aspectos clínicos, oncológicos e cirúrgicos. PACIENTES E MÉTODOS: Estudo retrospectivo de 120 pacientes submetidas à reconstrução mamária com implante mamário no ICESP, no período de fevereiro de 2009 a março de 2010. RESULTADOS: O índice de infecção foi de 24,3% e esteve relacionado estatisticamente a reconstrução imediata (88,9%), diabetes mellitus (25%), IMC acima de 30 (52,8%), HAS (52,8%) e sofrimento de pele da mastectomia (27,8%). Nota-se que 44% dos implantes infectados foram retirados, sendo a maioria expansores colocados em reconstrução imediata. CONCLUSÕES: A reconstrução mamária com implante é uma forma segura e eficaz de tratamento. Deve-se, entretanto, estar atento aos subgrupos de pacientes mais propensas ao desenvolvimento de infecção, para otimizar a sua prevenção e atentar ao seu tratamento precoce.

INTRODUCTION: Placement of breast implants is the most commonly used form of breast reconstruction. Despite its advantages, infection of the implant, either in the tissue expander or mammary prosthesis, can be a significant problem, including the need to remove it. The objective of this work is to evaluate the infection rate of breast implants used for breast reconstruction in patients submitted to surgery at the Cancer Institute of the State of São Paulo (ICESP), as well as its correlation with clinical, oncological, and surgical factors. PATIENTS AND METHODS: This is a retrospective study on 120 patients submitted to breast reconstruction with breast implants at the ICESP from February 2009 to March 2010. RESULTS: The infection rate (24.3%) was statistically related to immediate reconstruction (88.9%), diabetes mellitus (25%), body mass index >30 (52.8%), systemic arterial hypertension (52.8%), and skin injury due to mastectomy (27.8%). Of the infected implants, 44% were removed, most of which were expanders placed during immediate reconstruction. CONCLUSIONS: Breast reconstruction with implants is the safest and most effective form of treatment. However, consideration should be given to patients who are prone to the development of infection, in order to optimize its prevention and attempt to perform its treatment at an early stage.

Evaluation of nerve regeneration in diabetic rats

PURPOSE: To compare sciatic nerve regeneration between non-diabetic (control) and streptozotocin-induced diabetic Wistar rats. METHODS:Four subgroups were evaluated. CN: Non-diabetic rats submitted to neurorrhaphy (n=9); DN: Diabetic rats submitted to neurorrhaphy (n=9); CG: Non-diabetic rats submitted to nerve grafting (n=10); DG: Diabetic rats submitted to nerve grafting (n=9). The nerve regeneration was evaluated by walking track analysis (sciatic functional index), electrophysiological test, histomorphometric analysis and triceps surae muscle weight. RESULTS:At 60 days post-surgery, functional recovery of DN was similar to that of the non-diabetic rats (CN, CG), but DG didn't achieve the same. Evoked potential amplitudes showed no statistically significant differences among subgroups. Triceps surae muscle was heavier in CN. No statistically significant differences were observed between the control and diabetes subgroups with respect to histomorphometric analysis. CONCLUSION: After 60 days, DN had a functionally similar recovery to that of the control animals, whereas nerve grafting in diabetic rats didn't allow the same. The muscle atrophy was lower in CN. In the rest of evaluations, as electrophysiological and histomorphometric, diabetic rats were not different from control ones.