A dopamine receptor D2 genetic polymorphism associated with transition to mental disorders in a cohort of individuals with at-risk mental state for psychosis

Objectives: To test the association of 45 single nucleotide polymorphisms (SNPs) with transition to psychiatric disorders in a cohort of individuals at ultrahigh risk (UHR) mental state for psychosis. Methods: Through general population screening, 88 non-help-seeking UHR subjects and 130 healthy control individuals were genotyped for 45 SNPs related to psychosis. They were followed for a mean of 2.5 years, and conversion to psychotic and to general psychiatric disorders was assessed. Genotype frequencies between controls, converters, and non-converters were analyzed. Results: There were no differences in sociodemographics between controls and UHR. Also, UHR converters and non-converters had no differences in their baseline symptoms scores. The dopamine receptor D2 gene (DRD2) SNP rs6277 was significantly more common among UHR who transitioned to psychosis (p < 0.001) and to UHR who transitioned to any psychiatric disorders (p = 0.001) when compared to UHR who did not transition. The rs6277 T allele was related to psychiatric morbidity in a dose-response fashion, being significantly more frequent in UHR converters than UHR non-converters and control subjects (p = 0.003). Conclusion: Our findings suggest that rs6277 could potentially constitute a genetic marker of transition to psychiatric disorders in subjects with at-risk mental states, warranting further investigation in larger samples.

Influence of migration on the thought process of individuals at ultra-high risk for psychosis

Objective: To assess the influence of migration on the psychopathological presentation of individuals at ultra-high risk for psychosis (UHR) in São Paulo, Brazil. Methods: This study is part of the Subclinical Symptoms and Prodromal Psychosis (SSAPP) project, a cohort study in São Paulo, Brazil, designed to follow individuals at UHR. After screening with the Prodromal Questionnaire (PQ) and a clinical interview, the Global Assessment of Functioning (GAF) was administered, a neuropsychological assessment was performed, sociodemographic and migration data were obtained. We then analyzed UHR individuals who had migration data to see if migration had any effect on their cognition and psychopathology. Chi-square tests were used for categorical variables, and Student's t test or analysis of variance (ANOVA) were used for nonparametric and parametric distributions, respectively. Results: The sample was composed of 42 at-risk subjects, of whom 5 had a migration history in the past two generations. Those with migration history showed significantly more formal thought disturbances (p = 0.012) and sleeping problems (p = 0.033) compared to those without. Conclusions: Our data reinforce migration as a risk factor for psychosis in developing countries as well, and highlights the importance of studying the specific effect of this factor in UHR psychopathology.

Conduta cirúrgica do derrame pleural parapneumônico em adultos / Surgical treatment for parapneumonic pleural effusion in adults

Cerca de 40% dos pacientes portadores de pneumoniadesenvolverão derrame pleural parapneumônico (DPP), o que está associado a considerável morbimortalidade. O DPP possui três fases: exsudativa, fibrino-purelenta e de organização, que representam o progresso da doença. Apesar das várias opções de tratamento existentes, a conduta terapêutica não está bemestabelecida, visto que para cada fase a eficácia de cada método é variável. Procurou-se, nesta revisão de literatura, analisar as diversas opções disponíveis e os critérios que determinam suaindicação. De modo geral, o uso da toracocentese terapêutica deve ser restrito a casos de DPP simples pequenos, que ocupam até metade do hemitórax. Já a toracostomia com drenagem fechada apresenta indicação mais ampla: DPP simples volumosos ouDPP complicados e empiema livres na cavidade. Para tais casos com múltiplas loculações, a decorticação vídeo-assistida (VATS) constitui o tratamento ideal. Por fim, a decorticação por toracotomia está indicada em casos mais crônicos com encarceramentopulmonar, embora existam evidências de que a VATS também pode ser empregada nesses casos e, em caso de necessidade, convertida no intra-operatório para toracotomia. Em relação aos agentes fibrinolíticos, os dados existentes sobre sua eficácia sãocontraditórios, de modo que seu uso ainda é restrito...

At least, 40% of all patients with pneumonia will have a parapneumonic pleural effusion (PPE), which is associated to considerable morbidity and mortality. The PPE has three phases: exsudative, fibrinopurulent and organizing, which represent the development of the disease. Despite the great number of therapeutic methods, the PPE management is not well established, because for each phase the success rate of each technique is variable. The objective of this review of literature was to analyzeeach method available and its indications. Briefly, the use oftherapeutic thoracocentesis is restricted to small simple PPE, which are limited to half of the hemithorax. On the other hand, tube thoracostomy has a wider indication: large simple effusions and free-flowing complicated PPE or empyema. For multiloculated cases, the Video-assisted Thoracoscopic Surgery (VATS) is recommendable. Finally, the decortication through thoracotomy isindicated for chronic cases with lung entrapment, although there areevidences that VATS can be used too and, if needed, converted tothoracotomy in the operation room. Regarding thrombolytics, the data available about its efficacy is controversial, thereby its use isstill very restricted...

Cardiothoracic Surgery League from University of São Paulo Medical School: twelve years in medical education experience / Doze anos de experiência em Educação Médica da Liga de Cirurgia Cardiotorácica da Universidade de São Paulo

INTRODUCTION: Academic Leagues (Academic Interest Group) are entities that belong to medical schools and their hospitals. Their goals are research, medical education and health care. The cardiothoracic Surgery League (Liga de Cirurgia Cardiotorácica - LCCT), University of São Paulo Medical School, was founded 12 years ago, aimed at providing undergraduate medical students an opportunity to expand knowledge in cardiothoracic surgery and to take part in scientific studies in the field. OBJECTIVE: To evaluate the experience gained through LCCT implementation. METHODS: Current students and former members of LCCT were submitted to a specific evaluation form, delivered personally or by email, which provided data on the general opinion regarding LCCT's activities, the reasons for answers provided and choice of medical specialties. Furthermore, LCCT's total scientific production was evaluated. Results: Most undergraduate medical students 51/65 (78.5 percent) and former members 94/121 (77.7 percent) completed the form. The interest in Cardiothoracic Surgery was the most common reason for joining LCCT 44/161 (27.3 percent). Most students 32/51 (62.7 percent) - reported their initial expectations were partially met. Almost every member would recommend a fellow medical student to join LCCT 50/51 (98 percent) and 25/51 (49 percent) of them participated in a scientific project linked to LCCT. In total, 47 scientific papers were published having LCCT's medical students as authors or co-authors during the existence of the league. Of the former members who chose a surgical career, 7/52 (13.4 percent) chose thoracic or cardiovascular surgery. CONCLUSION: LCCT has met its goals, since most current and former members recognized its role in their medical training, besides it is a good way to produce scientific initiation.

INTRODUÇÃO: Ligas acadêmicas são entidades pertencentes a faculdades de Medicina e seus hospitais. Compartilham os objetivos: pesquisa, ensino e assistência à saúde. Há doze anos, fundou-se a Liga de Cirurgia Cardiotorácica (LCCT) pela Faculdade de Medicina da USP, com o objetivo de fornecer aos estudantes de Medicina a oportunidade de ter conhecimento mais profundo em Cirurgia Cardiovascular e para participar de iniciação científica nesse campo. OBJETIVO: Avaliar a experiência adquirida nos 12 anos de existência da LCCT. Métodos: Membros atuais e antigos da LCCT responderam a um formulário entregue pessoalmente ou por e-mail, fornecendo opinião geral (e suas razões) sobre atividades da LCCT e escolha de especialidades médicas. O total de produção científica da LCCT foi também contabilizado. RESULTADOS: A maioria dos atuais estudantes 51/65 (78,5 por cento) e ex-membros 94/121 (77,7 por cento) respondeu ao formulário. O interesse em Cirurgia Cardiovascular foi o motivo mais apontado para ingressar na LCCT, representrando 44/161 (27,3 por cento). A maioria dos estudantes - 32/51 (62,7 por cento) - relatou que suas perspectivas iniciais foram parcialmente preenchidas. Quase todos os membros recomendariam a um colega participar da liga 50/51 (98 por cento) e 25/51 (49 por cento) deles participaram de uma iniciação científica vinculada à LCCT. No total, 47 trabalhos científicos com alunos da LCCT como autores ou coautores foram publicados. Dentre os exmembros que optaram por uma carreira cirúrgica, 7/52 (13,4 por cento) deles escolheram Cirurgia Torácica ou Cardiovascular. CONCLUSÃO: LCCT cumpriu seus objetivos, os alunos reconheceram a colaboração da LCCT na sua formação médica, além de ter se mostrado um bom meio de realizar iniciação científica.