Visão de estudantes de medicina sobre os resultados da pandemia de Covid-19 no currículo paralelo / Medical students' perspective about the results of the Covid-19 pandemic in the parallel curriculum / Visión de estudiantes de medicina sobre los resultados de la pandemia de Covid-19 en el curriculum paralelo

A pandemia de Covid-19 impactou significativamente a educação médica, em especial o currículo paralelo, que engloba diversas atividades extracurriculares, tais quais: ligas acadêmicas, estágios, projeto de extensão, iniciação científica, monitoria e disciplinas optativas. Este estudo pretende analisar o resultado da pandemia de Covid-19 sobre o currículo paralelo sob a ótica de acadêmicos de Medicina. Trata-se de um estudo exploratório-descritivo, com recorte transversal, por meio de questionário online via Google Forms® com perguntas na escala tipo Likert. A amostra foi composta por 340 estudantes de Medicina, cursando do 4º ao 12º período, de Curitiba, Paraná. A modalidade onlinefacilitou a submissão de trabalhos científicos, bem como a acessibilidade a eventos médicos, que obtiveram maior adesão dentre as atividades avaliadas. Destaca-se a participação em pesquisas científicas, em especial pelos alunos do ciclo básico/clínico. Logo, a maioria dos participantes concordam que existem adaptações a serem mantidas no período pós pandemia.

The Covid-19 pandemic has significantly impacted medical education, especially the parallel curriculum, which encompasses several extracurricular activities, such as academic leagues, internships, extension projects, undergraduate research projects, teaching assistance, and elective courses. This study aims at analyzing the result of the Covid-19 pandemic on the parallel curriculum from the perspective of medical students. This is an exploratory-descriptive, cross-sectional study, using an online questionnaire via Google Forms® with Likert-type scale questions. The sample consisted of 340 Medicine students, from the 4th to the 12th terms, from Curitiba, Paraná. The online modality facilitated the submission of scientific papers, as well as the accessibility to medical events, which had the highest adherence among the evaluated activities. Participation in scientific research stands out, especially for students in the basic/clinical cycle. Therefore, most participants agree that there are adaptations to be maintained in the post-pandemic period.

La pandemia de Covid-19 impactó la educación médica, especialmente en el currículo paralelo, que incluye actividades extracurriculares, como: ligas académicas, pasantías, proyectos de extensión, iniciación científica, seguimiento y optativas. Este estudio pretende analizar el resultado de la pandemia de Covid-19 en el currículo paralelo desde la perspectiva de los estudiantes de medicina. Se trata de un estudio exploratorio-descriptivo, transversal, utilizando un cuestionario online a través de Google Forms® con preguntas en escala tipo Likert. La muestra se compone por 340 estudiantes de medicina del 4º al 12º período, en Curitiba, Paraná. La modalidad online facilitó el envío de trabajos científicos y la accesibilidad a eventos médicos, ue obtuvo mayor adhesión entre las actividades evaluadas. Cabe destacar la participación en la investigación científica, especialmente de los estudiantes del ciclo básico/clínico. Así, la mayoría de los participantes está de acuerdo de que hay adaptaciones que deben mantenerse en el período posterior a la pandemia.

Hormone therapy in the treatment of breast cancer and main outcomes in sexuality

Hormone-dependent breast cancer has growth factors that respond positively to the hormones estrogen and progesterone. Thus, adjuvant endocrine therapy causes decreased or undetectable serum levels of these hormones. However, this treatment can have side effects that compromise the sexual health of patients, such as dyspareunia, vaginal dryness and decreased libido. In this scenario, the objective of this work was to document the main outcomes in sexuality in women after treatment for hormonepositive breast cancer. Thus, this is an integrative literature review, in which the following databases were used: U.S. National Library of Medicine (PubMed), Virtual Health Library (BVS), SCOPUS and Scientific Electronic Library Online (SCIELO), using the descriptors: "sexuality", "antineoplastic agents, hormonal" and "breast neoplasms", joined by the Boolean operator "AND". Full articles published in the last 5 years (2017-2022) were included; written in Portuguese or English. Articles dealing with non-hormone-dependent or metastatic breast cancer, or with patients younger than 18 years, or articles that did not answer the research question were excluded. In total, 26 articles were identified, of which 7 comprised the final sample of this review. A total of 3,850 women participated in the included studies. The main sexual dysfunctions found were: dyspareunia, hot flashes, decreased libido, vaginal dryness, breast tenderness, self-image concerns and hair loss. The symptom vaginal dryness was the most prevalent, mentioned in 71.4% of the articles included. In view of the adverse effects listed in this review, there is a need to carry out more studies on this topic, since the diagnosis of this comorbidity brings clinical, psychological, emotional, sociocultural and economic outcomes for the patient. Thus, a multidisciplinary team must assertively address these complaints to improve the overall quality of life of these women (AU)

Cutaneous melanoma diagnosis delay: socioeconomic and demographic factors influence

SUMMARY OBJECTIVE: Malignant cutaneous melanoma is the most aggressive type of skin cancer, and its early detection and prompt initiation of treatment play an important role in reducing disease-associated morbidity and mortality. Many factors influence the diagnosis of melanoma, and its recognition is essential for the development of strategies for its early detection. This study was carried out to Identify the main variables related to the delay in diagnosis of Malignant Cutaneous Melanoma and correlate them with the time interval for making the definitive diagnosis. METHODS: Retrospective analysis of 103 patient records from January 2015 to December 2020 correlating social, economic, demographic, and cultural factors with the time elapsed between the onset of symptoms and the diagnosis of malignant cutaneous melanoma. RESULTS: The average time to seek medical services from the onset of symptoms was 29.54 months. The mean time for a referral from the primary to the referral service was 1.35 months, and the factors that contributed to a faster diagnosis were lesion Breslow (>1 mm), lesion growth, income range (≤1.5 minimum wages), lower phototypes (I and II), not having gone to the Basic Healthcare Units, profession (household), smoking, and type of housing. CONCLUSIONS: Our findings demonstrate that there is still a great delay in the recognition of signs and symptoms related to the diagnosis of malignant cutaneous melanoma in our country, influenced by several socioeconomic and demographic factors.

Evaluation of pain and opioid consumption in local preemptive anesthesia and the erector spine plane block in thoracoscopic surgery: A randomized clinical trial / Avaliação da dor e consumo de opioides em anestesia preemptiva local e do plano eretor da espinha em cirurgia torácica videotoracoscópica: Um ensaio clínico randomizado

ABSTRACT Objective: assess pain and opioid consumption in patients undergoing anesthetic techniques of spinal erector plane block and local anesthetic block in video-assisted thoracic surgery in the immediate postoperative period. Methods: ninety-two patients undergoing video assisted thoracic surgery were randomized to receive ESPB or BAL before starting the surgical procedure. Using the numerical verbal scale, the primary outcome assessed was the patient's pain in the immediate postoperative period (POI). The secondary outcome comprises the assessment of opioid consumption in the IPP by quantifying the medication used in an equianalgesic dose of morphine expressed in milligrams, in the immediate post-anesthetic recovery period, 6h, 12h, and 24h after surgery. Results: the EVN scores in the LBA and ESPB group in the POI had a mean of 0,8 (±1,89) vs 0,58 (±2,02) in the post-anesthesia care room (REPAI), 1,06 (±2,00) vs 1,30 (±2,30) in 6 hours of POI, 0,84 (±1,74) vs 1,19 (±2,01) within 12 hours of POI and 0,95 (±1,88) vs 1 ( ±1,66) within 24 hours of POI, all with p>0.05. Mean opioid consumption in the BAL and ESPB groups in the POI was 12.9 (± 10.4) mg vs 14.9 (±10.2) mg, respectively, with p = 0.416. Sixteen participants in the ESPB group and seventeen in the BAL group did not use opioids during the first 24 hours of the PO analyzed. Conclusion: local anesthesic block and ESP block techniques showed similar results in terms of low pain scores and opioid consumption during the period evaluated.

RESUMO Objetivo: avaliar a dor e o consumo de opioides dos pacientes submetidos a técnicas anestésicas de bloqueio do plano eretor da espinha (ESPB) e bloqueio anestésico local (LBA) em cirurgia torácica vídeo assistida no período pós-operatório imediato (POI). Métodos: noventa e dois pacientes submetidos a cirurgia torácica videotoracoscópica foram randomizados aleatoriamente para receberem ESPB ou LBA antes do início do procedimento cirúrgico. O desfecho primário avaliado foi a dor do paciente no POI através da escala verbal numérica. O desfecho secundário avaliou o consumo de opioides através da quantificação da medicação usada em dose equianalgésica de morfina expressa em miligramas, no período de recuperação pós-anestésica imediata, 6h, 12h e 24h após a cirurgia. Resultados: os escores da Escala Verbal Numérica de dor (EVN) no grupo LBA e ESPB no POI, respectivamente, tiveram média de 0,8 (±1,89) vs 0,58 (±2,02) na sala de recuperação pós anestesia (REPAI), 1,06 (±2,00) vs 1,30 (±2,30) em 6 horas do POI, 0,84 (±1,74) vs 1,19 (±2,01) em 12 horas do POI e 0,95 (±1,88) vs 1 ( ±1,66) em 24 horas do POI, todos com p>0,05. O consumo médio de opioides no grupo LBA e ESPB foi de 12,9 (±10,4) mg vs 14,9 (±10.2) mg, respectivamente, com p=0.416. Dezesseis participantes do grupo ESPB e dezessete do grupo LBA não utilizaram opioides durante as primeiras 24 horas do PO. Conclusões: as técnicas de bloqueio LBA e ESPB apresentaram resultados semelhantes em termos de baixos escores de dor e consumo de opioides durante o período avaliado.

Correlação entre Trihalometanos e o Desenvolvimento do Câncer de Bexiga / Correlation between Trihalomethanes and the Development of Bladder Cancer / Correlación entre Trihalometanos y el Desarrollo del Cáncer de Vejiga

Introdução: Os trihalometanos (THM) constituem um grupo de subprodutos gerados pela desinfecção da água por meio da cloração. Desde a primeira vez em que foram reportados, em 1974, são alvos de estudos que buscam estabelecer uma relação positiva entre a exposição dos humanos a esses compostos e o desenvolvimento de câncer. Objetivo: Revisão da literatura científica disponível sobre a presença de THM na água e sua relação com o desenvolvimento do câncer de bexiga. Método: Levantamento bibliográfico da revisão feito nas bases de dados ScienceDirect e PubMeb. Os descritores utilizados foram ''trihalomethane'', ''disinfection by-products'' e ''bladder cancer'' dos Descritores em Ciências da Saúde (DeCS) da Biblioteca Virtual em Saúde. Os artigos selecionados foram publicados nos últimos cinco anos. Resultados: A amostra final desta revisão foi constituída por 31 artigos, sendo a maioria deles publicados em jornais e revistas sobre meio ambiente. Analisaram-se estudos descritivos, metanálises e outros estudos individuais com delineamento experimental, encontrando uma associação positiva, mas controversa, entre os THM e o câncer, associada a diferentes mecanismos. A relação mais consistente tem sido entre a exposição crônica e o câncer de bexiga. Conclusão: Os estudos reconhecem que existem riscos significativos à saúde relacionados aos THM, no entanto, evidências que esclareçam os mecanismos de ação e o papel que outros fatores de risco possuem, juntamente com os THM, ainda permanecem incertas. Palavras-chave: Trihalometanos; Subprodutos da Desinfecção; Neoplasias da Bexiga Urinária

Introduction: The trihalomethanes (THM) are one of the by-products created from the chlorination process, the most applied technique for water disinfection. Since the first time they were reported in 1974, studies attempted to find a positive correlation between human's exposure to THM and cancer. Objective: Review the available scientific literature reported about the presence of THM in drinking water's treatment and its relation with the carcinogenic process of bladder cancer. Method: The present study consists of an integrative literature review. The articles were searched in the ScienceDirect and PubMed databases utilizing the following keywords obtained from the Subject Descriptors in Health Science (Virtual Health Library): "trihalomethanes", "disinfection by-products" and "bladder cancer". Results: In total, 31 articles were selected for this review, most of them published in environmental or toxicological journals. The authors analyzed descriptive studies, meta-analysis and other experimental studies, finding a positive, but controversial relationship between the t THM exposures, specifically the chronic, and the carcinogenic process associated with many pathological mechanisms. Conclusion: The studies recognized the potential risk of the THM exposure in humans, however, more evidence is needed for a better understanding of THM's toxicological aspects and the influence of other health risk factors in the carcinogenicity process

Introducción: Los trihalometanos (THM) constituyen un grupo de subproductos generado por la desinfección del agua mediante cloración. Desde la primera notificación en 1974, son objeto de estudios que buscan establecer una relación positiva entre la exposición humana a estos compuestos y el desarrollo de cáncer. Objetivo: Revisión de la literatura científica disponible sobre la presencia de THM en la agua y su relación con el desarrollo del cáncer de vejiga. Método: El estudio bibliográfico de la revisión se realizó em las bases de datos ScienceDirect y PubMeb. Los descriptores utilizados fueron ''trihalomethane'', ''disinfection byproducts'' e ''bladder cancer'' ­ de Descriptores de Ciencias de la Salud (DeCS) de la Biblioteca Virtual en Salud. Los artículos seleccionados han sido publicados en los últimos 5 años. Resultados: La muestra final de esta revisión consistió en 31 artículos, la mayoría publicados en periódicos y revistas ambientales. Se analizaron estudios descriptivos, metaanálisis y otros estudios individuales con diseño experimental, encontrando una asociación positiva, pero controvertida, entre los THM y el cáncer asociado con diferentes mecanismos. La relación más consistente ha sido entre la exposición crónica y el cáncer de vejiga. Conclusión: Los estudios reconocen que existen riesgos significativos para la salud relacionados con los THM, sin embargo, las pruebas que aclaran los mecanismos de acción y el papel que otros factores de riesgo tienen, junto con los THM, siguen siendo inciertos