Knowledge gap about immune checkpoint inhibitors among rheumatologists and medical students: a survey.

Previous studies found that physicians working in developed countries in Europe and in the USA declared insufficient knowledge concerning immune-related adverse events (irAE) following use of immune checkpoint inhibitors (ICI) in cancer treatment. We determined this knowledge gap among rheumatologists and medical students (MS) in Brazil. A web-based structured survey or a direct interview was applied to 1428 board-certified Brazilian rheumatologists and an adapted questionnaire was sent to 840 undergraduate MS attending the last 2 years of Medical Schools in Fortaleza-CE, Brazil, in September 2019. 228 (15.9%) rheumatologists and 145 (17.2%) MS answered the survey; 136 (60%) rheumatologists worked at Institutions with Oncology service. Rheumatologists had 22.6 ± 12.6 years of medical practice, most [116 (50.9%)] worked in private practice and 9 (3.9%) were on training. Fifty-three (23.4%) declared being familiar [40 (17.6%)] or very familiar [13 (5.8%)] with irAE. Almost two-thirds declared having never managed irAE and about a third (38.6%) felt confident in managing such patients. Knowledge among rheumatologists was similar regardless of having more or less than 10 years of practice (P = 0.758). Less than 5% MS declared being familiar with ICI and most have never heard of irAE. There is a large gap concerning knowledge about ICI and irAE among rheumatologists and MS in Brazil. Continuing medical education strategies are needed to improve this knowledge.

Attitudes and perceptions of teachers and medical students regarding suicide / Atitudes e percepções de professores e estudantes de medicina em relação ao suicídio

Abstract: Introduction: The World Health Organization (WHO) estimates that there are around one million deaths by suicide a year worldwide, more than the total sum of deaths caused by wars and homicides, which results in one death every 40 seconds. Despite the existence of several scientific publications on suicide prevention, there have been studies showing that health professionals are not trained to adequately care for individuals at risk of suicide. Objective: This study aimed to understand the attitudes and perceptions of medical school students and teachers regarding suicide. Methods: This is a cross-sectional, descriptive study, with a quantitative and qualitative approach, approved by the Research Ethics Committee, which assessed a sample of 180 students attending the 8th and 11th semesters and 57 teachers from different semesters of the evaluated medical courses. The data were obtained by applying the Suicide Behavior Attitude Questionnaire (SBAQ), in addition to a sociodemographic questionnaire. The data were submitted to descriptive and analytical statistics. Results: Regarding professional capacity, the scores were low for both students (median 5.5) and teachers (median 5.25). Students who had seen someone exhibiting suicidal behavior (p = 0.002) and those attending the more advanced semesters (p = 0.04) felt more confident when treating patients at risk of suicide. There was a significant difference regarding the Right to Suicide factor among students who said they were religious (p = 0.001), as also among the teachers who attended religious services with a higher frequency (p = 0.02). Conclusions: We conclude that students and teachers have had little experience with suicide in the assessed medical courses, which contributes to low level of training and the feeling of insecurity, indicating the need to give more importance to the subject in the undergraduate medical school, aiming to allow the acquisition of knowledge and skills for a competent and preventive medical practice regarding suicide.

Resumo: Introdução: A estimativa da Organização Mundial da Saúde (OMS) é que haja cerca de um milhão de mortes por suicídio por ano no mundo, mais do que a soma total de mortes em guerras e homicídios, que resulta em uma morte a cada 40 segundos. Apesar da existência de diversas publicações científicas sobre a prevenção do suicídio, existem estudos que mostram que os profissionais de saúde não são capacitados para cuidar adequadamente de pessoas em risco de suicídio. Objetivo: Este estudo teve como objetivo compreender as atitudes e percepções de alunos e professores do curso de medicina em relação ao suicídio. Métodos: Trata-se de um estudo transversal, descritivo, com abordagem quantitativa e qualitativa, aprovado pelo Comitê de Ética em Pesquisa, que avaliou uma amostra de 180 alunos do 8º e 11º semestres e 57 professores de diferentes semestres dos cursos médicos avaliados. Os dados foram obtidos por meio da aplicação do Suicide Behavior Attitude Questionnaire (SBAQ), além de um questionário sociodemográfico. Os dados foram submetidos à estatística descritiva e analítica. Resultados: Em relação à capacidade profissional, as pontuações foram baixas tanto para alunos (mediana 5,5) quanto para professores (mediana 5,25). Alunos que viram alguém apresentando comportamento suicida (p = 0,002) e os que frequentavam o semestre mais avançado (p = 0,04) sentiram-se mais confiantes no atendimento de pacientes com risco de suicídio. Houve diferença significativa quanto ao fator Direito ao Suicídio entre os alunos que se disseram religiosos (p = 0,001), assim como entre os professores que frequentavam serviços religiosos com maior frequência (p = 0,02). Conclusões: Concluímos que alunos e professores tiveram pouca experiência com suicídio nos cursos de medicina avaliados, o que contribui para o baixo nível de formação e o sentimento de insegurança, indicando a necessidade de dar mais importância ao assunto na graduação em medicina, visando permitir a aquisição de conhecimentos e habilidades para uma prática médica preventiva e competente em relação ao suicídio.

Mesenteric cyst presenting with acute abdomen pain and bowel obstruction: Case report and brief literature review.

Mesenteric cysts were first described in 1507 and since then remain as a rare intraabdominal pathology. The etiology of this kind of tumor is still unclear and the classification remains controversial. They are usually asymptomatic, but can also cause acute abdominal pain and sometimes need emergency surgical approach. Clinical history, physical exam and complementary tests do not always provide diagnosis, which in many cases is made after surgery. Surgical management with complete excision of the cyst is the gold standard treatment. Laparoscopy technique should be preferred whenever is possible. The knowledge of these rare tumors is important for considering the correct approach. The goals of this article is to describe a case report of mesenteric cyst presented with acute abdominal pain at the emergency and do a brief literature review about this entity.