Impact of COVID-19 on liver transplant recipients during the first pandemic wave, in a tertiary hospital, in Northeastern Brazil

ABSTRACT Worldwide, transplant programs have suffered a setback during the coronavirus disease 2019 (COVID-19) pandemic and most have temporarily suspended their transplant activities. . We identified 36 liver transplant patients who tested positive for COVID-19. The cases were confirmed by the nucleic acid test (RT-PCR). Epidemiological, demographic, clinical, laboratory, management and outcome data were obtained from the patients' medical records. Fourteen patients (38.9%) required admission to the Intensive Care Unit and/or invasive ventilatory support (severe cases). The mean age of these severe cases was 63.8 years. Regarding the time since the transplant, 71.4% (10/14 patients) had undergone the procedure less than one year before. The immunosuppressive therapy was reduced in patients who required Intensive Care Unit. A total of 12 cases (12/14, 85.7%) required invasive ventilatory support. Eight cases (8/14, 57.1%) required renal replacement therapy. In this group of patients, nine died (64.3 %). In turn, 22 patients had mild to moderate symptoms of COVID-19, not requiring invasive ventilatory support or admission to the Intensive Care Unit. The mean age in these patients was 56.5 years and comorbidities were present in 15 (68.2%) of the cases. In this group, only five patients (5/22, 22.7%) required hospitalization due to complications and there were no deaths This report describes the results of COVID-19 infection in a very specific population, suggesting that liver transplant patients have a significant higher risk of progressing to severeCOVID-19 , with a mortality rate among critically-ill patients above that of the general population.

Factors behind burnout increase in medical students. Are the criteria so important? / Fatores por trás do burnout crescente em estudantes de medicina. Os critérios são tão importantes?

Abstract: Introduction: Medical students' mental health has been a concern to the scientific community, especially as a result of the epidemic of mental comorbidities that have become commonplace among the various social groups in modern society. Objectives: To evaluate the prevalence of Burnout among first- to fourth- year medical students and compare different criteria to define the syndrome. Methods: A total of 511 students from three universities in Brazil answered validated instruments to assess burnout (The Maslach Burnout Inventory) and quality of life (WHOQOL-BREF), and a questionnaire prepared by the authors to assess sociodemographic data Results: There was a prevalence of 31.1% of three-dimensional burnout, 37% of two-dimensional burnout and 44,8% of one-dimensional burnout. There were worse levels of emotional exhaustion among students with two-dimensional burnout, compared to those with only one-dimensional criterion, and worse levels of depersonalization among students with three-dimensional burnout, compared to those with two-dimensional criterion only. The same assessed variables showed correlation with all three criteria. Considering the four domains of quality of life - psychological, physical, environment and social relationships, the psychological and physical domains were the ones that correlated the most to all three aspects of the three-dimensional criteria. Emotional exhaustion was the dimension with the strongest association with three of the four quality of life domains. Conclusions: We question whether the three-dimensional criterion should really be the gold standard to define Burnout.

Resumo: Introdução: A saúde mental dos estudantes de medicina tem sido uma preocupação para a comunidade científica, especialmente como resultado da epidemia de comorbidades mentais que se tornaram comuns entre os vários grupos sociais da sociedade moderna. Objetivos: Este estudo teve como objetivos avaliar a prevalência de burnout em estudantes do primeiro ao quarto ano de um curso de Medicina e comparar as diferentes classificações de critério diagnóstico da síndrome. Métodos: Um total de 511 estudantes de três universidades brasileiras responderam a dois instrumentos validados para avaliar burnout e qualidade de vida, e a um questionário elaborado pelos autores para avaliar dados sociodemográficos e hábitos. Resultados: Houve prevalência de 31,1% de burnout tridimensional, 37% de burnout bidimensional e 44,8% de burnout unidimensional. Constatou-se um maior nível de exaustão no grupo com burnout bidimensional, em comparação ao grupo unidimensional, e verificou-se um maior nível de cinismo naqueles com burnout tridimensional, em comparação ao bidimensional. As variáveis que apresentaram correlação com a síndrome foram as mesmas nos três critérios analisados. Os domínios psicológico e físico foram os mais afetados na qualidade de vida dos escolares com burnout. A exaustão emocional foi a dimensão que apresentou correlações mais fortes com três dos quatro domínios analisados no instrumento WHOQOL-BREF. Conclusão: Observaram-se prejuízos nas diversas áreas relacionadas à qualidade de vida dos alunos. Questionamos se o uso do Maslach Burnout Inventory, por meio da abordagem tridimensional, realmente é o critério ideal a ser utilizado na triagem do burnout.

Clinical assessment and pathophysiology of Bothrops venom-related acute kidney injury: a scoping review

Bothrops are one of the most common medically important snakes found in Latin America. Its venom is predominantly hemotoxic and proteolytic, which means that local lesion (edema and redness) and hemorrhagic symptoms are recurrent in envenoming by this snake. Although hemorrhage is usually the major cause of death, snakebite-related acute kidney injury is another potentially fatal clinical complication that may lead to chronic kidney disease. The present review highlights the main studies on Bothrops venom-related acute kidney injury, including observational, cross-sectional, case-control and cohort human studies available up to December 2019. The following descriptors were used according to Medical Subject Headings (MeSH): on Medline/Pubmed and Google Scholar "acute kidney injury" or "kidney disease" and "Bothrops"; on Lilacs and SciELO "kidney disease" or "acute kidney injury" and "Bothrops". Newcastle-Ottawa quality assessment scale was used to appraise the quality of the cross-sectional and cohort studies included. The selection of more severe patients who looked for health care units and tertiary centers is a risk of bias. Due to the methodological heterogeneity of the studies, a critical analysis of the results was performed based on the hypothesis that the design of the included studies influences the incidence of acute kidney injury. Fifteen human studies (total participants 4624) were included according to stablished criteria. The coagulation abnormalities (hemorrhagic symptoms, abnormal fibrinogen and activated partial thromboplastin time) were associated with acute kidney injury in the most recent studies reported. The findings observed in this review provide up-to-date evidence about the acute kidney injury pathogenesis following Bothrops syndrome. Studies pointed out that coagulation abnormalities comprise the major pathway for acute kidney injury development. This review may improve patient management by primary healthcare providers, allowing earlier diagnosis and treatment of Bothrops venom-related acute kidney injury.(AU)

O Uso da Estratégia Gameficação na Educação Médica / The Use of Gamefication Strategy in Medical Education

RESUMO Introdução O ensino por meio de metodologia ativa vem ganhando cada vez mais destaque no cenário da educação médica, complementando, ou mesmo substituindo, o método de ensino tradicional. Diante disso, o sistema de gameficação, bem aceito por estudantes, inova, uma vez que o aprendizado se torna lúdico e participativo, contribuindo para a formação holística dos acadêmicos. Objetivos: Descrever a realização de uma gincana - composta por quatro fases e de caráter competitivo -, bem como comprovar a eficácia do método como uma forma inovadora de aprendizagem. Ao todo, 16 acadêmicos de Medicina participaram da gincana. Metodologia Caracteriza-se como um estudo de delineamento observacional transversal, com uso de metodologias quantitativas e qualitativas. O estudo é composto pela aplicação de um método de ensino e aprendizado baseado no processo de gameficação, com posterior aplicação de um questionário avaliativo aos alunos, para análise crítica. Resultados Foi observada satisfação dos alunos quanto à atividade, sendo unânime a afirmação de que a técnica utilizada facilita o aprendizado. Entre os integrantes, 87,5% preferiram a aplicação de práticas de metodologias ativas em detrimento das tradicionais, e 81,25% dos participantes apontaram a necessidade de integrar métodos com abordagens lúdicas às suas atividades curriculares. Por outro lado, 12,5% dos estudantes concordaram em que a atividade lúdica aplicada não contribui para o trabalho em equipe e 6,25% preferiram adesão às práticas de metodologia tradicional. Conclusão O método de gameficação desenvolve um ambiente propício ao aprendizado, com grande adesão dos estudantes. Percebe-se também a necessidade de mudança, apoiada pelos alunos, nas formas de ensino utilizadas na graduação, devendo-se buscar metodologias que abranjam o desenvolvimento de múltiplas competências e que possam usar a ludicidade como atrativo para o processo de aprendizado.

ABSTRACT Introduction Education through active methodology is increasingly gaining attention in the medical education scenario, complementing, or even replacing, the traditional teaching method. Bearing this in mind, the system of gamification, a well-accepted one among students, innovates, since the learning process becomes playful and participatory, contributing to the holistic formation of the students. Objectives To describe the accomplishment of a four-round, competitive championship, and to prove the effectiveness of the method as an innovative form of learning. In all, 16 medical students participated in the championship. Methods This was a cross-sectional, observational study, using quantitative and qualitative methodologies. The study consists of the application of a teaching and learning method based on the gamification process and the subsequent application of an evaluation questionnaire to the students for critical analysis. Results Student satisfaction with the activity was observed, with the unanimous assertion that the technique used facilitates learning. 87.5% of the members preferred the application of active methodologies over traditional ones. 81.25% of the participants asserted the need to integrate methods with playful approaches into their curricular activities. On the other hand, 12.5% of the students agreed that the applied leisure activity does not corroborate for teamwork and 6.25% preferred the traditional teaching methods. Conclusion It was demonstrated that the method of gamification develops a propitious environment for the learning process, with substantial student support. The requirement for change in the educational methods used in undergraduate training could also be perceived, as well as support for such changes among students, and hence the need to seek more and more methodologies that support the development of multiple competences and that can use playfulness as an incentive for the learning process.

Acute kidney injury due to systemic Loxoscelism: a cross-sectional study in Northeast Brazil

Abstract INTRODUCTION: Loxoscelism is a clinical condition involving spiders of the genus Loxosceles. One of the most severe complications is acute kidney injury (AKI). This study aimed to investigate AKI and other complications associated with loxoscelism. METHODS: We analyzed cases diagnosed with loxoscelism in an area where most accidents were caused by Loxosceles amazonica from January 2010 to December 2015. AKI was defined according to the KDIGO criteria. RESULTS: Forty-five patients were recorded: 95.6% presented characteristic necrotic skin lesions and 13.3% AKI. CONCLUSIONS: Loxoscelism could cause kidney involvement which is uncommon and could lead to the death of these patients.