Moonlighting and physician residents' compensation: is it all about money? A cross-sectional Brazilian study

ABSTRACT BACKGROUND: Moonlighting is a largely discussed, however under-explored, subject among physician residents. OBJECTIVES: To analyze the frequency of moonlighting and its related factors. DESIGN AND SETTING: This cross-sectional study enrolled medical residents from all geographical regions of Brazil. METHODS: A web-based structured closed-ended survey was applied that explored the frequency and type of moonlighting, residency programs characteristics, and psychological distress. The questionnaire was published on social networks. RESULTS: The completion rate was 71.4% (n = 1,419) and 37.7% were males aged 28.8 ± 3.2 (mean ± standard deviation) years, and 571 (40.2%) were post-graduate year (PGY) 1. There were residents from 50 medical specialties (the most common training area was clinical, 51.9%). A total of 80.6% practiced moonlighting, with an average weekly workload of 14.1 ± 9.4 h, usually overnight or in weekend shifts. Factors related to it were being PGY-2 or higher (adjusted odds ratio = 3.90 [95% confidence interval = 2.93-5.18], logistic regression), lower weekly residency duty hours (0.98 [0.97-0.99]), and a higher salary (1.23 [1.08-1.40]). In contrast, perception of a "fair/adequate" compensation was influenced by age (1.02 [1.01-1.02]), not being single (1.05 [1.01-1.10]), and residency duty hours (1.51 [1.22-1.88]). Depression, anxiety, diurnal somnolence scores, and work-personal life conflicts were not correlated with moonlighting status. CONCLUSION: Moonlighting frequency is high, and it is related to higher PGY, briefer residency duty hours, and the perception that remuneration should be higher. This study provides insights into the motivations for moonlighting and effort-reward imbalance.

Chylous ascites secondary to Hodgkin's lymphoma in a HIV/aids patient: case report and literature review

Study design: case report. Case report: Man, 42 years old, diagnosed with aids two years ago, had developed enlarging in abdominal volume six months from admission. Computed tomography imaging showed free liquid in peritoneal cavity and increased retroperitoneal and mesenteric lymph nodes, besides splenomegaly. Ascitic fluid had milky appearance and high triglycerides levels. Hodgkin's lymphoma (mixed cellularity) was confirmed by histopathological analysis of a video-laparoscopic lymph node biopsy, Ann Arbor IIIS staging. Chemotherapy and continuation of highly active antiretroviral therapy resulted in weight gain and reduction of abdominal volume. Chylous ascites is a rare condition, which has a vast differential diagnosis. Discussion: In our review, the majority (15/18, 83%) of chylous ascites in HIV/aids-patients are due to infectious causes (mainly Mycobacterium avium complex and tuberculosis infection), in highly immunocompromised patients (mean TCD4=87cell/mL). To the best of our knowledge, this is the first case of chylous ascites secondary to Hodgkin's lymphoma in a patient with aids. (AU)

Tipo de estudo: relato de caso. Relato de caso: Homem, 42 anos, diagnosticado com aids há dois anos, desenvolveu aumento de volume abdominal há seis meses da admissão. Tomografia computadorizada mostrou líquido livre na cavidade peritoneal, além de linfonodos mesentéricos e esplenomegalia. O líquido ascítico tinha aspecto leitoso e alto nível de triglicerídeos. Após amplo diagnóstico diferencial, diagnosticamos linfoma de Hodgkin tipo celularidade mista por biópsia linfonodal via videolaparoscópica, Ann Arbor IIIS. Quimioterapia e continuação da terapia antirretroviral de alta potência resultaram em ganho de peso e redução do volume abdominal. Ascite quilosa é uma entidade rara, que possui vários diagnósticos diferenciais. Discussão: Em nossa revisão, a maioria (15/18, 83%) dos casos de ascite quilosa em paciente com HIV/aids deveu-se a causa infecciosa (especialmente pelo Mycobacterium avium complex e tuberculose), em pacientes gravemente imunocomprometidos (linfócitos T-CD4 médio=84células/mm3). Até onde sabemos, este é o primeiro caso de ascite quilosa secundária a linfoma de Hodgkin em paciente com aids. (AU)

Age-related cerebral ventricular volume changes in healthy elderly humans / Alterações volumétricas dos ventrículos cerebrais relacionadas a idade em idosos saudáveis

Introduction: Normal aging is associated with morphological alte-rations in brain. Ventricular system is located deep inside brain and reflect the overall process of parenchymal atrophy. Once neurode-generative disorders course with more prominent dilatation of brain ventricles, to establish normative volumetric parameters from Brazi-lian healthy old individuals is necessary, and it may be an additional tool on differentiation from the normal to pathological. Objective: To investigate brain ventricular volume changes in Brazilian healthy el-derly people. Methods: Transversal study using magnetic resonance imaging (1.5T) of the brain from 21 elderly healthy volunteers (67±6 years old). Data were assessed with manual segmentation techni-que. Regions of interest were the brain ventricles and intracranial volumes. Old (60-69 years old, 15 women) and Older (>69 years old) groups were created for analysis. Results: Volume of all ventricular compartments significantly increased (p<.001) with age, with excep-tion of the fourth ventricle. The third and lateral ventricles increased between groups 2.1- and 2.8-fold, respectively. Mean total ventricular volume was 1.2±.4% of intracranial volume in Old and 3.2±1.8% in Ol-der group (p<.001), which represents 15±6ml and 40±24ml (p=.001), respectively. We observed a moderate to strong positive correlation between ventricular volume and age, with the best correlation in the third ventricle (r=.710). Total intracranial volume diminished with age, but without statistical significance. Conclusions: Brain ventricles vo-lume increased significantly with age in healthy old individuals, with exception of the fourth ventricle. (AU)

Introdução: O envelhecimento normal está associado a alterações morfológicas do cérebro. O sistema ventricular está localizado pro-fundamente no encéfalo e reflete o processo global de atrofia do pa-rênquima. Uma vez que doenças neurodegenerativas cursam com dilatação mais proeminente dos ventrículos cerebrais, estabelecer parâmetros volumétricos de normalidade em nossa população idosa saudável se faz necessário, podendo ser uma ferramenta a mais para diferenciar o normal do patológico. Objetivo: Investigar alterações volumétricas dos ventrículos cerebrais em brasileiros idosos sau-dáveis. Métodos: Estudo transversal com imagens de ressonância magnética (1,5T) do encéfalo de 21 idosos saudáveis (68±6 anos, 15 mulheres). Os dados foram examinados por técnicas de segmenta-ção manual. As regiões de interesse foram os ventrículos cerebrais e o volume intracraniano. Criamos os subgrupos Idosos (60-69 anos) e Mais idosos (>69 anos) para a análise. Resultados: O volume de todos os ventrículos aumentou com a idade (p<0,001), com exceção do quarto ventrículo. O terceiro e os ventrículos laterais aumentaram 2,1 e 2,8 vezes, respectivamente, entre os grupos. O volume ventri-cular médio foi de 1,2±0,4% do volume intracraniano nos Idosos e de 3,2±1,8% nos mais idosos, o que representa 15±6ml e 40±24ml, respectivamente. Observamos correlação positiva de moderada a forte entre volume ventricular e idade, com a melhor correlação no terceiro ventrículo (r=0,710). O volume intracraniano diminui com a idade, sem significância estatística. Conclusão: os ventrículos cere-brais aumentam significativamente com o envelhecimento em idosos saudáveis, exceto o quarto ventrículo. (AU)