Can dynamic ultrasonography replace urodynamics in the follow-up of patients with myelomeningocele? A prospective concurrent study.

AIMS: To evaluate the accuracy of dynamic ultrasonography (DUS), as a feasible alternative diagnostic method to identify detrusor overactivity (DO) in patients with neurogenic bladder. METHODS: We performed concurrent analysis of 81 pairs of urodynamic study (UDS) and DUS, in 63 patients with myelomeningocele (MMC), from June 2014 to February 2017. The assessment focused on bladder behavior during the filling phase, DO evaluation, DO with leakage, compliance, and maximum cystometric capacity (MCC). RESULTS: Patient age ranged from 3 months to 34 years (median, 84 months); 47.6% were male. Overall, 9.5% of patients had chronic kidney disease, 20.6% had recurrent urinary tract infection, 19.05% had vesicoureteral reflux, and 69.8% had constipation. Anticholinergic therapy was used by 41.3% of patients. DO was observed in 45.67% of patients and DO with leakage in 42.6%. Mean bladder compliance was 10.39 mL/cmH2 O and normal MCC was 56.79%. DUS had 91.89% sensitivity in identifying DO, 88.64% specificity, 87.18% positive predictive value, 92.86% negative predictive value, and 90.12% accuracy, with a kappa coefficient of 0.8 (P < 0.001). CONCLUSION: MMC follow-up is essential because urinary parameters can change during patient growth. The standard examination is invasive and has related complications, making noninvasive evaluation a desirable alternative, like DUS. Our data suggest that DO and MCC can be evaluated using DUS in patients with MMC. UDS should be performed in patients with abnormal findings on ultrasound evaluation or those with worsening of urinary tract function.

How do medical students defend themselves against anxiety?

OBJETIVO: A formação médica é geradora de ansiedade, tornando os estudantes de medicina vulneráveis a transtornos psiquiátricos, em particular os transtornos de ansiedade. Para lidar com a ansiedade o estudante de medicina lança mão de vários mecanismos de defesa. Objetivou-se avaliar a associação entre a presença de sintomas de ansiedade e o estilo defensivo em alunos de uma escola médica pública federal. MÉTODO: Trata-se de um estudo observacional transversal, de uma amostra de estudantes de medicina, do primeiro e sexto ano, devidamente matriculados e frequentando regularmente as aulas. No presente estudo utilizou-se um questionário sócio-demográfico, o Inventário Beck de Ansiedade e o questionário de estilo defensivo (DSQ-40). RESULTADOS: Responderam aos questionários 232 alunos, 110 do primeiro ano e 122 do sexto, representando 67,4% do total de alunos matriculados. Em relação aos mecanismos de defesa na amostra, as analises multivariadas mostraram que mecanismos de defesa neuróticos e imaturos estavam associados à presença de ansiedade (p < 0,001). CONCLUSÃO: Os dados encontrados no estudo apontam que alunos do curso médico que apresentaram sintomas de ansiedade utilizaram significativamente mais mecanismos de defesa neurótiocos e imaturos do que os que não tinham esses sintomas. Planos de prevenção, atenção e estratégias de apoio psicológico deveriam ser desenvolvidos para esse grupo, pois os mecanismos de defesa não parecem ser adaptativos em estudantes de medicina enfrentando ansiedade.(AU)

OBJECTIVE: Medical training is a generator of anxiety, making medical students vulnerable to psychiatric disorders. To deal with anxiety, medical students make use of several defense mechanisms. The aim was to assess the association between the presence of symptoms of anxiety and the defense style in students of a federal public medical school. METHOD: This is a cross-section observational study, of a sample of medical students, of the first and sixth years, duly enrolled and regularly attending classes. For the present study a socio-demographic questionnaire, the Beck Anxiety Inventory and the Defense Style Questionnaire (DSQ-40) were used. RESULTS: The questionnaires were answered by 232 students, 110 from the first year and 122 of the sixth year, representing 67.4% of the total amount of students. In relation to the defense mechanisms in the sample, the multivariate analysis showed that neurotic and immature defense mechanisms were associated with the presence of anxiety (p<0.001). CONCLUSION: The data found in this study indicate that medical students who showed symptoms of anxiety, used more neurotic or immature defense mechanisms than students who did not present these symptoms. Prevention and attention plans, as well as psychological support strategies should be developed for this group, because defense mechanisms do not appear to be adaptive in medical students experiencing anxiety.(AU)

Stress and coping in a sample of medical students in Brazil

Background Medical training is a stressing situation, making medical students vulnerable to psychiatric disorders, such as depression and anxiety. Objective The study aimed to assess the prevalence of stress and coping in students of a public medical school in Brazil, comparing the groups from the first and sixth years of training. Methods Through a cross-sectional, observational study, a sample of 232 first and sixth-year regularly registered medical students has been evaluated. Students filled a socio-demographic questionnaire, the Lipp Inventory of Stress Symptoms (ISSL), and the Coping Strategies Inventory (CSI). Results From the total sample of 232 students, 110 were first-year students and 122 sixth-year students. Stress symptoms were significantly higher in first-year students (49.1%) than in the sixth-year group (33.6%; p = 0.018). Variables significantly associated with stress were: year of the training (1st year > 6th year), income (lower > higher income), satisfaction with the training (dissatisfied > satisfied) and the use of escape/avoidance copying strategy (positive association). Discussion Considering the higher stress symptoms among first-year medical students and the positive association of the escape/avoidance copying strategy with stress, strategies must be developed to enable students starting medical school to be better at coping with this stressful situations.