Prevalence Of Burnout Syndrome In Pediatricians Of Neonatal Care In One City Of Brazil

Introduction: The stress due to the work in the health professionals is becoming an important problem. The medicine promotes high levels of stress, which can result in negative consequences to the professionals. To evaluateObjective: the prevalence of Burnout Syndrome (BS) and associated factors in pediatricians of neonatal care in Mossoró/RN. Methods: It was performed a cross-sectional epidemiological study after approval in Research Ethics Committees and filling the informed consent form. It was applied a questionnaire to the pediatrics, which included biodemographic data and the Maslach Burnout Inventory, that evaluates the presence of BS. The prevalence of BS was 45.0%. ThereResults: was statistical significance for younger physicians, with less time of general and specialist work, higher night workload and the emotional exhaustion item. Know these factors is important to guide prevention and promotionalConclusion: care strategies in the occupational health of these professionals.

Repercussions of the COVID-19 pandemic on breast cancer treatment in a referral hospital in Santos-SP, Brazil

Objective: Considering that breast cancer has the fifth highest mortality rate in the world, this study aims to evaluate the repercussions of the COVID-19 pandemic on the treatment, both surgical and systemic, of patients with cancer in general and those with breast cancer at Hospital Guilherme Álvaro (Santos, Brazil), between March 1st, 2019 and February 28, 2021. Methods: For this purpose, data were collected from both the hospital's surgery record book and electronic medical records of patients who were followed up in the Mastology and Oncology sectors at Hospital Guilherme Álvaro. This information was tabulated, estimating the total number of surgeries, whether: benign elective surgeries, diagnostic surgeries, surgeries of cancer in general, surgeries exclusive to mastology, of cancer in mastology, benign surgery in mastology, and plastic reconstructive surgery. The percentage ratio between these numbers was calculated. Results: A 49% reduction in total surgeries was observed, comparing the period prior to the pandemic (2019­2020) with the pandemic period (2020­2021), with a decrease of 24.6% in the number of general cancer surgeries except for mastology, and 19.6% of surgeries exclusive to mastology. In other words, there was a total reduction of 22.9% in all oncological surgeries. Moreover, there was a decrease of 11.5% in the total number of patients treated with chemotherapy. In 2020, of the 214 new cases, 116 (54.2%) were mastology patients, being 45.8% of other oncology clinics. Conclusion: Thus, it is concluded that the reduction in the number of aesthetic, benign, and reconstructive surgeries was expected, as observed in the decrease in the number of chemotherapies, which could be due to a limitation on medical appointments. The number of diagnostic surgeries remained stable, which could lead to positive outcomes for oncology patients. It is not possible to predict the next repercussions of the COVID-19 pandemic on breast cancer treatment while the pandemic endures, requiring more studies on this topic.

Pseudomyxoma peritonei originating from appendix tumors / Pseudomixoma peritoneal com origem em tumores do apêndice

ABSTRACT Background: Appendix tumors represent about 1% of all gastrointestinal neoplasia, in other words they are quite rare. However, there is a specific type of appendiceal neoplasms (mucinous adenocarcinoma) that spreads to the peritoneum and in almost 20% of the cases, resulting in a disease called pseudomyxoma peritonei. Although, it is a very rare condition, it is nonetheless a very severe one and therefore it is crucial to know how to correctly diagnose and treat it. Objective: This study provides updated data on how to diagnose, classify and treat pseudomyxoma peritonei that originates from appendix tumors. Methods: A bibliographic research was performed on PubMed database, including articles published since 2000, as well as, cross-referencing with the initial research. Discussion: In the past, patients diagnosed with pseudomyxoma peritonei would only undergo palliative measures, so their overall survival rate was greatly reduced. Over the years pseudomyxoma peritonei treatment has evolved and patients are now undergoing treatment which is a combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. This new therapy has allowed an increase of survival chances of up to 5 years in those patients with values between 53% and 88%, depending on the type of tumor. Conclusion: Despite the great progress we have witnessed in recent years, which have led to a large increase in survival rates, more research needs to be done, on what to do when the disease is in an unresectable stage. Finding a less aggressive therapy than cytoreductive surgery + hyperthermic intraperitoneal chemotherapy will be an important step forward.

RESUMO Introdução: As neoplasias do apêndice são bastante raras, representando atualmente cerca de 1% de todas as neoplasias gastrointestinais. O adenocarcinoma mucinoso é um dos subtipos de neoplasia do apêndice e caracteriza-se por metastizar para o peritoneu, em 20% dos casos, facto que se manifesta sob a forma de uma doença designada por Pseudomixoma Peritoneal. Apesar de ser uma condição muito rara, a sua extrema gravidade justifica a importância de a saber diagnosticar e tratar corretamente. Métodos: Foi realizada uma pesquisa bibliográfica na base de dados PubMed, incluindo artigos publicados desde 2000 bem como artigos de pesquisa cruzada com os iniciais. Discussão: No passado, os doentes diagnosticados com Pseudomixoma Peritoneal eram apenas submetidos a medidas paliativas, pelo que a sua sobrevida era muito reduzida. Ao longo dos anos o tratamento do Pseudomixoma Peritoneal foi evoluindo sendo agora os doentes submetidos a uma combinação de cirurgia citoredutiva e quimioterapia hipertérmica intraperitoneal. Esta nova terapêutica tem permitido aumentar a sobrevida aos 5 anos destes pacientes para valores entre os 53% e os 88%, dependendo do tipo de tumor. Conclusões: Apesar dos grandes avanços que se têm verificado, e que culminaram com um grande aumento das taxas de sobrevivência, devem ser feitos mais estudos que encontrem novas abordagens para quando o tumor já é diagnosticado num estado irressecável, bem como terapêuticas menos invasivas.

Redução de incertezas em radioterapia utilizando simulação Monte Carlo: análise espectral aplicada à correção de dose absorvida / Reduction of uncertainties in radiotherapy assessed by Monte Carlo simulation: spectral analysis applied to absorbed dose correction

OBJETIVO: Determinar, por simulação Monte Carlo, os espectros de feixes de cobaltoterapia em profundidade na água e fatores de correção para doses absorvidas em dosímetros termoluminescentes de fluoreto de lítio. MATERIAIS E MÉTODOS: As simulações dos espectros secundários da fonte clínica de cobalto-60 foram realizadas com o código Monte Carlo PENELOPE, em diversas profundidades na água. Medidas experimentais de dose profunda foram obtidas com dosímetros termoluminescentes e câmara de ionização em condições de referência em radioterapia. Os fatores de correção para os dosímetros termoluminescentes foram obtidos através da razão entre as absorções relativas ao espectro de baixa energia e ao espectro total. RESULTADOS: A análise espectral em profundidade revelou a existência de espectros secundários de baixa energia responsáveis por uma parcela significativa da deposição de dose. Foram observadas discrepâncias de 3,2 por cento nas doses medidas experimentalmente com a câmara de ionização e com os dosímetros termoluminescentes. O uso dos fatores de correção nessas medidas permitiu diminuir a discrepância entre as doses absorvidas para, no máximo, 0,3 por cento. CONCLUSÃO: Os espectros simulados permitem o cálculo de fatores de correção para as leituras de dosímetros termoluminescentes utilizados em medidas de dose profunda, contribuindo para a redução das incertezas associadas ao controle de qualidade de feixes clínicos em radioterapia.

OBJECTIVE: To calculate spectra of cobalt-60 beam at water depth and correction factors for absorbed dose measurements obtained with lithium fluoride thermoluminescent dosimeters using Monte Carlo simulation. MATERIALS AND METHODS: The simulations of secondary spectra of clinical cobalt-60 sources were performed with the PENELOPE Monte Carlo code at different water depths. Experimental measurements of deep doses were obtained with thermoluminescent dosimeters and ionization chamber under reference conditions for radiotherapy. Correction factors for the thermoluminescent dosimeters detectors were obtained through the ratio between the relative energy absorption for the low energy spectrum and the total spectrum. RESULTS: Deep spectral analysis has demonstrated the presence of secondary low-energy spectra responsible for a significant portion of the dose deposition. Discrepancies of 3.2 percent were observed among the doses measured with ionization chamber and thermoluminescent dosimeters. The adoption of correction factors has allowed a reduction in the discrepancy among absorbed doses to a maximum of 0.3 percent. CONCLUSION: Simulated spectra allow the calculation of correction factors for reading of thermoluminescent dosimeters utilized in the measurement of deep doses, contributing for the reduction of uncertainties associated with quality control of clinical beams in radiotherapy.

Triagem Auditiva Neonatal: relação entre banho e índice de reteste / Newborn Hearing Screening: the relation between bathing and the retesting rate

Uma das metas de um Programa de Triagem Auditiva Neonatal (TAN) consiste numa porcentagem baixa de retestes. OBJETIVO: Investigar a relação entre o índice de retestes e o banho do neonato. Forma de Estudo: Coorte contemporânea com corte transversal. MATERIAL E MÉTODO: Os resultados das Emissões Otoacústicas Evocadas por Estímulo Transiente (EOET) foram comparados às informações referentes a auxiliar de enfermagem que ministrou o banho no dia do exame (373 neonatos), bem como ao tempo transcorrido entre a pesquisa das EOET e o último banho (350 neonatos). RESULTADOS: Foram constatadas diferenças significantes estatisticamente entre as porcentagens de encaminhamento para reteste quando o banho foi ministrado por algumas auxiliares de enfermagem. Além disso, a porcentagem de retestes diminuiu significantemente quando o tempo transcorrido entre o último banho e a pesquisa das EOET foi superior a 7 horas e 50 minutos. CONCLUSÃO: A umidade do meato acústico externo, ocasionada por uma proteção inadequada contra a entrada de água no momento do banho e o curto intervalo de tempo entre o banho e a pesquisa das EOET podem ser considerados como possíveis fatores geradores de retestes nos programas de TAN.

One of the goals of a Newborn Hearing Screening Program (NHSP) is to have a low retesting rate. AIM: To investigate the association between the retesting rate and the bath of newborn babies. Study design: cross-sectional contemporary cohort. MATERIALS AND METHODS: Transient otoacoustic emissions (TOE) results have been compared to the information received from the nurse's aide who bathed the babies on the day of the test (373 newborns), and the time interval between the TOE study and the last bath (350 newborns). RESULTS: Significant statistical differences were found in relation to the percentage of retesting when babies were bathed by certain nurse's aides. On the other hand, the percentage of retesting decreased significantly when the time interval between the last bath and the TOE study was longer than 7 hours and 50 minutes. CONCLUSION: Moisture of the external acoustic meatus, caused by inappropriate protection against water during bath, and the short interval between the bath and the ETOE study, could be considered as possible factors causing retesting in NHSP programs.

Treatment of phimosis with topical steroids and foreskin anatomy

OBJECTIVES: To correlate topical steroidal treatment of stenosed foreskin with the different degrees of glans exposure and the length of time the ointment is applied. MATERIALS AND METHODS: We studied 95 patients with phimosis, divided according to the degree of foreskin retraction. Group A presented no foreskin retraction, group B presented exposure of only the urethral meatus, group C presented exposure of half of the glans, and group D presented exposure of the glans, which was incomplete because of preputial adherences to the coronal sulcus. Patients were submitted to application of 0.05 percent betamethasone ointment on the distal aspect of the prepuce twice daily for a minimum of 30 days and a maximum of 4 months. RESULTS: Of 95 patients, 10 (10.52 percent) abandoned the treatment and 15 patients in groups C and D were excluded from the study. Among the remaining 70 patients, only 4 patients (5.7 percent) in group A did not obtain adequate glans exposure after treatment. In group A (38 patients), fully retractable foreskins were obtained in 19 patients (50 percent) after 1 month of treatment. In group B (28 patients), fully retractable foreskins were obtained in 18 patients (64.2 percent) after 1 month. CONCLUSIONS: Treatment was successful in 94.2 percent of patients, irrespective of the type of foreskin anatomy. The improvement may require several months of treatment. Patients with impossibility of urethral meatus exposure present around 10 percent treatment failure.

Microinfiltração marginal na parede cervical, sem esmalte, em cavidades classe V utilizando diferentes técnicas restauradoras com resina composta / Microleakage evaluation of class V composite restorarions using different restorative techniques

O objetivo deste estudo foi avaliar in vitro a microinfiltração marginal de rstaurações classe V usando diferentes técnicas restauradoras. Preparos cavitários padronizados foram feitos nas superfícies vestibular e lingual de 28 pré-molares humanos recém-extraídos. Em todos os dentes foi aplicado o adesivo Single Bond (3M Dental), usando as recomendações dos fabricantes. Os dentes foram divididos em quatro grupos. O material restaurador usado em dois grupos foi inserido através da técnica de Bulk com e sem selante de superfície. Os outros dois grupos foram restaurados mediante técnica incremental com e sem selante de superfície. O selante de superfície usado foi Protect-It (Jeneric/Pentron). Os excessos de material foram removidos e as restaurações polidas. Todos os dentes foram submetidos a termociclagem por 500 ciclos (8°+/-2°C e 50°C+/-2°C) por um tempo de 15 segundos, e imersos em solução de nitrato de prata a 50% durante duas horas. Os dentes foram seccionados e submetidos à ação do agente traçador para estimar o grau de penetração para análise através de um microscópio óptico. Os resultados foram analisados mediante o teste não-paramétrico Kruskal-Wallis, em que os quatro grupos apresentaram um certo grau de microinfiltração marginal. Os grupos restaurados com técnica incremental e com a técnica de Bulk, sem selante de superfície, apresentaram maior microinfiltração marginal. Foram observadas diferenças quando os grupos receberam selante de superfície, comparados aos que não receberam, independentemente da técnica de restauração. Assim, pôde-se concluir que o fato que diminuiu a microinfiltração marginal foi a aplicação do selante de superfície

Avaliação histoquímica quantitativa do colágeno na fascia transversalis e na bainha anterior do músculo reto abdominal em doentes com hérnia inguinal / Quantitative histochemical analysis of colagen in fascia transversalis and anterior rectum sheath of patients with inguinal hernias

OBJETIVO: Avaliar a participação do colágeno na etiopatogenia das hérnias inguinais, através da análise quantitativa histoquímica do colágeno na bainha anterior do músculo reto abdominal e na fascia transversalis MÉTODO: Foram operados quarenta doentes do sexo masculino, na faixa etária entre 20 e 60 anos, portadores de hérnia inguinal tipo II e IIIA de Nyhus e realizadas autópsias em dez cadáveres frescos, na mesma faixa etária. Em ambos os grupos, amostras da bainha anterior do músculo reto abdominal e da fascia transversalis foram colhidas, coradas pela técnica histoquímica do picrocírius e submetidas a análise morfométrica quantitativa através de sistema computadorizado com a finalidade de identificar possíveis alterações quantitativas do colágeno, em cada um dos dois tipos de hérnias em comparação com indivíduos sem hérnias. RESULTADOS: Encontramos maior concentração do colágeno na bainha anterior do músculo reto abdominal, em comparação a fascia transversalis em todos os grupos estudados, embora esta diferença tenha sido estatisticamente significante apenas no grupo controle. Não encontramos diferenças na concentração do colágeno, na bainha anterior do músculo reto abdominal e na fascia transversalis, entre os doentes com hérnias tipo II e tipo IIIA de Nyhus. Não encontramos diferenças na concentração do colágeno quando comparamos os grupos com hérnias com o grupo controle. CONCLUSÃO: Não encontramos diferenças na quantidade do colágeno na bainha anterior do músculo reto abdominal e na fascia transversalis entre os pacientes portadores de hérnia inguinal tipo II e IIIA de Nyhus em comparação com indivíduos sem hérnias.

BACKGROUND: To evaluate the role of colagen in etiopathogeny of inguinal hernias through quantitative histochemical analysis of the abdominal rectum sheaths and fascia transversalis. METHODS: Forty male patients with Nyhus type II and IIIa inguinal hernias, were operated, age ranged from 20 to 60 years, and ten control subjects with the same age were autopsied. Samples were collected from rectum sheaths and fascia transversalis from each group, and collored by the histochemical technique Picrocirius and morphometric analysis, which was carried out by using the image representation technique. These studies focused mainly on identify the possible quantitative changes in collagen in each of the two types of hernias compared to individuals without hernias. RESULTS: We found an increased collagen concentration in rectum sheath when compared to fascia transversalis in all groups studied. These diferences, however, was only estatistically significant in control group. We found no difference in collagen concentration in rectum sheaths and fascia transversalis from pacients with Nyhus type II or IIIa hernias. No diference in collagen concentration was found in hernias'group compared to control group. CONCLUSION: There was no statistically significant difference between the amount of collagen of abdominal rectum sheaths and of the fascia transversalis among patients with Nyhus type II and IIIa inguinal hernias and the amounts found in individuals without hernias.

Leiomioma de reto tratado por ressecçäo transretal / Leiomyoma of rectum treated by transrectal resection

Relato de um caso de leiomioma de reto com diagnóstico histopatológico pré-operatório tratado por ressecçäo local transretal no Hospital Municipal Miguel Couto, Rio de Janeiro, com follow-up de um ano. Este raro tumor deve ser lembrado no diagnóstico diferencial das lesöes retais que levam a proctalgia, mudanças do hábito intestinal e outros sintomas locais. Exames simples como toque retal, anuscopia e biópsia, podem ser concludentes no diagnóstico. O diagnóstico histopatológico, no intuito de se diferenciar lesöes benígnas das malígnas, requer patologista com especial interesse nesse tipo tumoral