Fatores prognósticos em pacientes com câncer colorretal: análise de sobrevida global e livre de doença / Prognostic factors in patients with colorectal cancer: analysis of overall and disease-free survival

Objetivos: avaliar o impacto de variáveis clínicas e tumorais sobre a sobrevida global e a sobrevida livre da doença em pacientes com câncer colorretal atendidos em um hospital especializado em oncologia, em Curitiba, Paraná, Brasil. Métodos: estudo de coorte retrospectivo com análise do registro hospitalar de câncer e de prontuários de pacientes com câncer colorretal tratados entre 2015 e 2016, com acompanhamento até janeiro de 2022. A curva de Kaplan-Meier e o modelo de Cox, com apresentação do RR e IC95%, foram empregados nas análises. Resultados: foram incluídos no estudo 235 pacientes, dos quais 126 (53,6%) eram do sexo masculino, 204 (86,8%) tinham idade igual ou superior a 50 anos ao diagnóstico e 125 (53,2%) receberam inicialmente o diagnóstico de tumor de cólon. O risco de morte e de recorrência foram maiores em pacientes com estadiamento IV (RR = 2,77; IC95% = 1,57-3,85 e RR = 3,98; IC95% = 1,15-13,79), tumor no reto (RR = 2,04; IC95% = 1,24-3,38 e RR= 2,25; IC95% = 1,40-3,60) e metástase nos linfonodos regionais (RR = 2,26; IC95% = 1,27-4,03 e RR = 2,15; IC95% = 1,24-3,73). O risco de óbito foi elevado em idosos com Índice de Massa Corporal de baixo peso (RR = 3,5; IC95% = 0,9-75). Conclusões: no momento do diagnóstico, fatores tumorais como estadiamento avançado, tumor no reto e a presença de metástase são importantes preditores de mortalidade e recidiva do câncer colorretal, além disso, indicam o Índice de Massa Corporal como potencial variável de pior prognóstico na população idosa com câncer colorretal

Aims: to evaluate the impact of clinical and tumor variables on overall survival and disease-free survival in patients with colorectal cancer treated at a specialized oncology hospital in Curitiba, Paraná. Methods: a retrospective cohort study was carried out with analysis of the câncer hospital registry and medical records of patients with colorectal cancer treated between 2015 and 2016, with follow-up until January 2022. The Kaplan-Meier curve and the Cox model, with presentation of the Hazard Ratio (HR) and confidence interval 95% (95%CI), were used in the analyses. Results: 235 patients were included in the study, 126 (53.6%) males, 204 (86.8%) aged at diagnosis equal to or greater than 50 years and 125 (53.2%) with the initial diagnosis of tumor of colon. The risk of death and recurrence were higher in patients with stage IV (HR = 2.77; 95%CI = 1.57-3.85 and HR = 3.98; 95%CI = 1.15-13.79), tumor in the rectum (HR = 2.04; 95%CI = 1.24-3.38 and HR = 2.25; 95%CI = 1.40-3.60) and regional lymph node metastasis (HR = 2.26; 95%CI = 1.27-4.03 and HR = 2.15; 95%CI = 1.24-3.73). In addition, the risk of death was high in elderly with low weight Body Mass Index (HR =3.5; 95%CI = 0.9-75). Conclusions: at the time of diagnosis, tumor factors such as advanced staging, tumor in the rectum and the presence of metastasis are important predictors of mortality and recurrence of colorectal cancer, in addition, they indicate Body Mass Index as a potential variable of worse prognosis in the elderly population with colorectal cancer

Anxiety and insecurity in medical interns: the impact of the pandemic COVID-19 / Ansiedade e insegurança em estudantes de medicina no internato: o impacto da pandemia da COVID-19

Purpose: We aimed to assess anxiety among medical interns and to identify changes regarding their perspective about the profession during the pandemic period in Brazil, between November 2020 and February 2021.Methods: This is a cross-sectional descriptive study which medical interns answered an online survey question-naire. The assessment was performed using the validated questionnaire General Anxiety Disorder Scale (GAD-7). Results: 162 responses were collected, mean age of 24.9 years, majority female (66.7%); 83.3% had the option of returning to practical assistance. Among these, 35% claimed to have had contact with suspects COVID-19 patients and 13% had a positive test for COVID-19. GAD-7 scores showed that 33.4% were qualified as "Normal", while mild (37%), moderate (22.8%) or severe symptoms of anxiety (6.8%). A GAD-7 score positive for TAG was found in 29.6% of them. Anxiety was significantly associated (p=0.013) with questioning the choice of Medicine as a profession. Conclusions: We found a high frequency of interns with symptoms of anxiety, higher compared to similar studies prior to the pandemic. In addition, medical interns with anxiety were the ones who most questioned the choice of profession (AU)

Objetivo: Objetivou-se avaliar a ansiedade de estudantes de medicina ­ internos e identificar mudanças em relação à perspectiva sobre a profissão durante o período pandêmico no Brasil, entre novembro de 2020 e fevereiro de 2021.Métodos: Trata-se de um estudo transversal descritivo no qual os estudantes internos responderam a um questionário de pesquisa online. A avaliação foi realizada por meio do questionário validado General Anxiety Disorder Scale (GAD-7).Resultados: Participaram 162 estudantes, com média de idade de 24,9 anos, maioria do sexo feminino (66,7%); 83,3% tiveram a opção de retornar ao atendimento prático. Destes, 35% afirmaram ter tido contato com pacientes suspeitos para COVID-19 e 13% tiveram teste positivo para COVID-19. Os escores do GAD-7 mostraram que 37% apresentaram sintomas de ansiedade leve, 22,8% moderado, e 6,8% grave. Um escore GAD-7 positivo para TAG foi encontrado em 29,6% deles. A ansiedade associou-se significativamente (p = 0,013) ao questionamento da escolha da Medicina como profissão.Conclusões: Encontramos alta frequência de internos com sintomas de ansiedade, superior à observada em estu-dos semelhantes anteriores à pandemia. Além disso, os acadêmicos com ansiedade foram os que mais questionar-am a escolha da profissão (AU)

Medical advertising in social networks: awareness and medical school education / Publicidade médica em redes sociais: conhecimento e ensino na graduação de Medicina

ABSTRACT Objective: this study analyzed medicine students' knowledge regarding medical advertising on social media. Method: this is a cross-sectional study carried out between January and May 2022 with 179 medical students from public and private institutions from Curitiba - PR, using a structured questionnaire with nine problem situations on medical advertising. It was established as "sufficient" knowledge ≥70% of the problem-situations based on current professional codes and resolutions. Results: five questions had the highest percentage of correct answers resulting from the acquisition of knowledge from different sources. Most students did not learn about medical marketing in their undergraduate course (84.9%), having already shared patients' pictures on social media (89.9%), and fell the lack of discussions about medical advertising (96.6%). Conclusion: there is a need to direct undergraduate education towards the ethical use of advertising in order to better prepare them for professional practice.

RESUMO Objetivo: este estudo analisou o conhecimento dos estudantes de medicina sobre publicidade médica nas redes sociais. Método: Trata-se de estudo transversal realizado entre janeiro e maio de 2022 com 179 acadêmicos de medicina de instituição pública e privada em Curitiba - PR, por meio de questionário estruturado com nove situações-problemas sobre publicidade médica. Foi estabelecido como conhecimento "suficiente" o acerto ≥70% das situações-problemas com base nos códigos e resoluções profissionais vigentes. Resultados: cinco questões tiveram maior percentual de acerto decorrente da aquisição de conhecimento de diferentes fontes. A maioria dos estudantes não aprendeu sobre publicidade médica na graduação (84,9%), já divulgou imagens de pacientes pelas redes sociais (89,9%), e sente falta de mais discussões sobre publicidade (96,6%). Conclusão: há necessidade de direcionar o ensino da graduação para o uso ético da publicidade visando melhor preparo para o exercício profissional.

Clinical and epidemiological aspects of chronic Chagas disease from Southern Brazil

Abstract INTRODUCTION: Patients with Chagas disease (CD), caused by Trypanosoma cruzi, present a higher risk of developing other chronic diseases, which may contribute to CD severity. Since CD is underreported in the southern state of Paraná, Brazil, we aimed to characterize clinical and epidemiological aspects of individuals chronically infected with T. cruzi in Southern Brazil. METHODS: A community hospital-based study was performed, recording clinical/demographic characteristics of 237 patients with CD from Southern Brazil. To estimate the association between different forms of CD and sociodemographic and clinical variables, multiple logistic regression models were built using the Akaike information criterion. RESULTS: Mean age was 57.5 years and 59% were females. Most patients' (60%) place of origin/birth was within Paraná and they were admitted to the CD outpatient clinic after presenting with cardiac/digestive symptoms (64%). The predominant form of CD was cardiac (53%), followed by indeterminate (36%), and digestive (11%). The main electrocardiographic changes were in the right bundle branch block (39%) and left anterior fascicular block (32%). The average number of comorbidities per patient was 3.9±2.3; systemic arterial hypertension was most common (64%), followed by dyslipidemia (34%) and diabetes (19%); overlapping comorbidities were counted separately. Male sex was associated with symptomatic cardiac CD (OR=2.92; 95%CI: 1.05-8.12; p=0.040). CONCLUSIONS: This study provided greater understanding of the distribution and clinical profile of CD patients in Southern Brazil, indicating a high prevalence of comorbidities among these patients who are a vulnerable group due to advanced age and substantial risk of morbidity.

Beta 2-adrenergic receptor gene association with overweight and asthma in children and adolescents and its relationship with physical fitness / Associação do gene ADRB2 com sobrepeso e asma em crianças e adolescentes e sua relação com a aptidão física

Objective: To investigate the association of Arg16Gly and Gln27Glu polymorphisms of β2-adrenergic receptor gene (ADRB2) with the occurrence of asthma and overweight and the gene's influence on anthropometric, clinic, biochemical and physical fitness variables in children and adolescents. Methods: Subjects were evaluated for allelic frequencies of the β2-adrenergic receptor gene, height, weight, body mass index (BMI), BMI Z-score, waist circumference (WC), pubertal stage, resting heart rate (HRres), blood pressure (BP), total cholesterol (TC), glucose, insulin, high density lipoprotein (HDL-C), low density lipoprotein (LDL-C), triglyceride (TG), Homeostasis Metabolic Assessment (HOMA2-IR), Quantitative Insulin Sensitivity Check Index (QUICKI) and maximal oxygen uptake (VO2max). The participants were divided in four groups: overweight asthmatic (n=39), overweight non-asthmatic (n=115), normal weight asthmatic (n=12), and normal weight non-asthmatic (n=40). Results: Regarding the Gln27Glu polymorphism, higher total cholesterol was observed in usual genotype individuals than in genetic variant carriers (p=0.04). No evidence was found that the evaluated polymorphisms are influencing the physical fitness. The Arg16 allele was found more frequently among the normal weight asthmatic group when compared to the normal weight non-asthmatic group (p=0.02), and the Glu27 allele was more frequently found in the overweight asthmatics group when compared to the normal weight non-asthmatic group (p=0.03). Conclusions: The association of Arg16 allele with the occurrence of asthma and of the Glu27 allele with overweight asthmatic adolescents evidenced the contribution of the β2-adrenergic receptor gene to the development of obesity and asthma.

Objetivo: Investigar a associação dos polimorfismos Arg16Gly e Gln27Glu do gene receptor β2-adrenérgico (ADRB2) com a ocorrência de asma e sobrepeso, bem como a influência do gene sobre variáveis antropométricas, clínicas, bioquímicas e de aptidão física em crianças e adolescentes. Métodos: Os indivíduos foram avaliados quanto à frequência alélica do gene ADRB2, estatura, peso, índice de massa corporal, IMC-escore Z, circunferência abdominal, estágio puberal, frequência cardíaca de repouso, pressão arterial, colesterol total, glicose, insulina, lipoproteína de alta densidade, lipoproteína de baixa densidade, triglicerídeos, Homeostasis Metabolic Assessment (HOMA2-IR), Quantitative Insulin Sensitivity Check Index (QUICKI) e consumo máximo de oxigênio (VO2max). Os participantes foram divididos em quatro grupos: sobrepeso asmático (n=39), sobrepeso não asmático (n=115), peso normal asmático (n=12) e peso normal não asmático (n=40). Resultados: Com relação ao polimorfismo Gln27Glu, foi observado maior valor de colesterol total nos indivíduos do genótipo usual do que naqueles que carregam a variante (p=0,04). Não foi encontrada evidência de que os polimorfismos avaliados influenciem a aptidão física. O alelo Arg16 foi encontrado em maior frequência no grupo de peso normal asmático comparado com o grupo de peso normal não asmático (p=0,02) e o alelo Glu27 foi mais frequentemente encontrado no grupo de sobrepeso asmático comparado com o grupo de peso normal não asmático (p=0,03). Conclusões: A associação do alelo Arg16 com a ocorrência de asma e a associação do alelo Glu27 com adolescentes com sobrepeso asmáticos evidenciam a contribuição do gene ADBR2 para o desenvolvimento da obesidade e da asma.