Aprendizagem sobre teleconsulta: representações de um grupo de alunos de um curso de Medicina / Learning about teleconsultation: representations of a group of Medical students / Aprendizaje sobre teleconsulta: representaciones de un grupo de alumnos de un curso de Medicina

Com o avançar da tecnologia, passou a fazer parte da graduação médica atual o aprendizado em teleconsultas. Esta pesquisa apresenta as representações de um grupo de alunos de um curso de Medicina localizado na capital do estado de São Paulo sobre suas experiências com a realização de teleconsultas síncronas supervisionadas durante estágio realizado em um ambulatório-escola, durante o segundo semestre de 2021. Trata-se de pesquisa qualitativa que utilizou o software IRaMuTeQ® e "Análise do Conteúdo". Esses educandos pontuam entraves para a utilização das teleconsultas, destacando preocupações com a humanização, segurança da pessoa atendida e qualidade da consulta, mas visualizam potencialidades tais como a facilidade de acesso e a comodidade. Reconhecem a importância da prática durante sua Graduação em um mundo cada vez mais tecnológico, mas trazem inquietações relacionadas à perda do exame físico e à mercantilização da Medicina.

With the progress of technology, teleconsultation has become part of medical degree courses. This article presents the representations of a group of medical students from a university in the capital of the state of São Paulo regarding their experiences with supervised synchronous teleconsultations during an internship in a teaching clinic in the second semester of 2021. We conducted a qualitative study using the software IRaMuTeQ® and content analysis. The students highlighted barriers to the use of teleconsultation, emphasizing concerns with humanization, patient safety and consultation quality, but also perceived strengths such as ease of access and convenience. They recognize the importance of practice on the degree course in an ever more technological world, but raise concerns about the lack of physical examination and the commodification of medicine.

Con el avance de la tecnología, el aprendizaje en teleconsultas pasó a formar parte de la graduación médica actual. Esta investigación presenta las representaciones de un grupo de alumnos de un curso de medicina localizado en la capital del estado de São Paulo sobre sus experiencias con la realización de teleconsultas sincronizadas supervisadas durante una pasantía realizada en un ambulatorio escuela, durante el segundo trimestre de 2021. Se traba de una investigación cualitativa que utilizó el software IRaMuTeQ® y Análisis de Contenido. Estos alumnos puntúan obstáculos para la utilización de las teleconsultas, destacando preocupaciones con la humanización, seguridad de la persona atendida y calidad de la consulta, pero visualizan potencialidades tales como la facilidad de acceso y la comodidad. Reconocen la importancia de la práctica durante su graduación en un mundo cada vez más tecnológico, pero presentan inquietudes relacionadas a la pérdida del examen físico y a la mercantilización de la medicina.

Physical fitness, hormonal profile, nutritional and psychological aspects assessment of transgender women volleyball players submitted to physical tests: protocol paper of a prospective cohort.

To evaluate aerobic capacity, strength and other physiological, nutritional, and psychological variables which may influence the performance of transgender women (TW) athletes and compare them to cisgender women (CW) and cisgender men (CM) athletes, as well as changes in TW performance over the course of a year. Prospective cohort study including three groups: TW, CW and CM volleyball athletes. Subjects will be comprehensively assessed at two different moments: baseline and after 6-12 months of adequate hormonal therapy. Evaluation will comprise clinical, medical, nutritional and psychological interviews, incremental treadmill cardiopulmonary exercise testing, hand grip strength test, vertical jump test, analysis of sleep quality (Pittsburgh Sleep Quality Index), hormonal profile, echocardiogram, analysis of resting energy expenditure, assessment of bone mass and body composition through dual-energy X-ray absorptiometry scans, and untargeted metabolomic analysis. CW and CM matched by age, body mass index and level of physical activity will undergo a similar evaluation. The assessment of the strength, aerobic capacity, haematological, nutritional and psychological status of TW using gold-standard tests will contribute to understanding the impact of oestrogen therapy on the exercise performance of these athletes and how they compare with CW and CM.

Arterial Stiffness in Transgender Men Receiving Long-term Testosterone Therapy.

Context: The effects of androgen therapy on arterial function in transgender men (TM) are not fully understood, particularly concerning long-term androgen treatment. Objective: To evaluate arterial stiffness in TM receiving long-term gender-affirming hormone therapy by carotid-femoral pulse wave velocity (cf-PWV). Methods: A cross-sectional case-control study at the Gender Dysphoria Unit of the Division of Endocrinology, HC-FMUSP, Sao Paulo, Brazil. Thirty-three TM receiving intramuscular testosterone esters as regular treatment for an average time of 14 ± 8 years were compared with 111 healthy cisgender men and women controls matched for age and body mass index. Aortic stiffness was evaluated by cf-PWV measurements using Complior device post-testosterone therapy. The main outcome measure was aortic stiffness by cf-PWV as a cardiovascular risk marker in TM and control group. Results: The cf-PWV after long-term testosterone therapy was significantly higher in TM (7.4 ± 0.9 m/s; range 5.8-8.9 m/s) than in cisgender men (6.6 ± 1.0 m/s; range 3.8-9.0 m/s, P < .01) and cisgender women controls (6.9 ± .9 m/s; range 4.8-9.1 m/s, P = .02). The cf-PWV was significantly and positively correlated with age. Analysis using blood pressure as a covariate showed a significant relationship between TM systolic blood pressure (SBP) and cf-PWV in relation to cisgender women but not to cisgender men. Age, SBP, and diagnosis of hypertension were independently associated with cf-PWV in the TM group. Conclusion: The TM group on long-term treatment with testosterone had higher aging-related aortic stiffening than the control groups. These findings indicate that aortic stiffness might be accelerated in the TM group receiving gender-affirming hormone treatment, and suggest a potential deleterious effect of testosterone on arterial function. Preventive measures in TM individuals receiving testosterone treatment, who are at higher risk for cardiovascular events, are highly recommended.

Cardiopulmonary capacity and muscle strength in transgender women on long-term gender-affirming hormone therapy: a cross-sectional study.

OBJECTIVE: For transgender women (TW) on oestrogen therapy, the effects of prior exposure to testosterone during puberty on their performance, mainly cardiopulmonary capacity (CPC), while exerting physical effort are unknown. Our objective was to evaluate CPC and muscle strength in TW undergoing long-term gender-affirming hormone therapy. METHODS: A cross-sectional study was carried out with 15 TW (34.2±5.2 years old), 13 cisgender men (CM) and 14 cisgender women (CW). The TW received hormone therapy for 14.4±3.5 years. Bioimpedance, the hand grip test and cardiopulmonary exercise testing on a treadmill with an incremental effort were performed. RESULTS: The mean VO2peak (L/min) was 2606±416.9 in TW, 2167±408.8 in CW and 3358±436.3 in CM (TW vs CW, p<0.05; TW vs CM, p<0.0001; CW vs CM, p<0.0001). The O2 pulse in TW was between that in CW and CM (TW vs CW, p<0.05, TW vs CM, p<0.0001). There was a high correlation between VO2peak and fat-free mass/height2 among TW (r=0.7388; p<0.01), which was not observed in the other groups. The mean strength (kg) was 35.3±5.4 in TW, 29.7±3.6 in CW and 48.4±6.7 in CM (TW vs CW, p<0.05; TW vs CM, p<0.0001). CONCLUSION: CPC in non-athlete TW showed an intermediate pattern between that in CW and CM. The mean strength and VO2 peak in non-athlete TW while performing physical exertion were higher than those in non-athlete CW and lower than those in CM.

Análise da variação do perfil metabólico pré e pós cirurgia bariátrica / Analysis of variation in metabolic profile before and after bariatric surgery

INTRODUÇÃO: a obesidade consiste em doença endêmica com elevados níveis de prevalência e incidência ao redor do mundo, sendo por isso considerada como problema de alta relevância em saúde pública. Procedimentos cirúrgicos são considerados mais eficazes na perda de peso sustentada de pacientes obesos quando comparadas à terapia farmacológica e mudanças no estilo de vida. OBJETIVO: avaliar as mudanças ocorridas no perfil endócrino e metabólico em pacientes submetidos à cirurgia bariátrica (gastroenteroanastomose em Y-de-Roux) no Hospital do Servidor Público Municipal de São Paulo. MÉTODOS: foi realizado estudo observacional transversal associado a análise retrospectiva com pacientes submetidos à cirurgia bariátrica no HSPM. Os dados pré-cirúrgicos foram obtidos em prontuário médico enquanto que os pós-cirúrgicos foram obtidos mediante resposta pelos pacientes a questionário formulado especificamente para esta pesquisa e prontuário médico. Foram avaliados peso e IMC pré e pós cirurgia, valores médios de pacientes diabéticos, números de antidiabéticos utilizados, índice de pacientes hipertensos pré e pós cirurgia, número de anti-hipertensivos utilizados pré e pós cirurgia, valores médios do perfil lipêmico pós cirurgia, circunferência abdominal pós cirurgia. Os valores pós cirúrgicos foram descritos e comparados aos valores pré-cirúrgicos utilizando o teste 't-pareado'. RESULTADOS: foram estudados 37 pacientes, sendo 91,9% de mulheres, com mediana de 36 meses após a cirurgia. A média da perda de peso foi de 39,5 kg (DP ± 18). A média de redução do IMC foi de 15 kg/m2 (33% do IMC inicial) (p<0,001). Foi verificada redução significativa no número de medicações anti-diabéticas e anti-hipertensivas utilizadas pelo grupo. CONCLUSÃO: foi ratificado o benefício da cirurgia bariátrica em pacientes que respeitam as indicações previstas para o procedimento. Os resultados obtidos neste estudo concordam, em sua maioria, com os resultados de outras análises prévias

Análise da variação do perfil metabólico pré e pós cirurgia bariátrica

INTRODUÇÃO: a obesidade consiste em doença endêmica com elevados níveis de prevalência e incidência ao redor do mundo, sendo por isso considerada como problema de alta relevância em saúde pública. Procedimentos cirúrgicos são considerados mais eficazes na perda de peso sustentada de pacientes obesos quando comparadas à terapia farmacológica e mudanças no estilo de vida. OBJETIVO: avaliar as mudanças ocorridas no perfil endócrino e metabólico em pacientes submetidos à cirurgia bariátrica (gastroenteroanastomose em Y-de-Roux) no Hospital do Servidor Público Municipal de São Paulo. MÉTODOS: foi realizado estudo observacional transversal associado a análise retrospectiva com pacientes submetidos à cirurgia bariátrica no HSPM. Os dados pré-cirúrgicos foram obtidos em prontuário médico enquanto que os pós-cirúrgicos foram obtidos mediante resposta pelos pacientes a questionário formulado especificamente para esta pesquisa e prontuário médico. Foram avaliados peso e IMC pré e pós cirurgia, valores médios de pacientes diabéticos, números de antidiabéticos utilizados, índice de pacientes hipertensos pré e pós cirurgia, número de anti-hipertensivos utilizados pré e pós cirurgia, valores médios do perfil lipêmico pós cirurgia, circunferência abdominal pós cirurgia. Os valores pós cirúrgicos foram descritos e comparados aos valores pré-cirúrgicos utilizando o teste 't-pareado'. RESULTADOS: foram estudados 37 pacientes, sendo 91,9% de mulheres, com mediana de 36 meses após a cirurgia. A média da perda de peso foi de 39,5 kg (DP ± 18). A média de redução do IMC foi de 15 kg/m2 (33% do IMC inicial) (p<0,001). Foi verificada redução significativa no número de medicações anti-diabéticas e anti-hipertensivas utilizadas pelo grupo. CONCLUSÃO: foi ratificado o benefício da cirurgia bariátrica em pacientes que respeitam as indicações previstas para o procedimento. Os resultados obtidos neste estudo concordam, em sua maioria, com os resultados de outras análises prévias

Influence of late treatment on how chronic myeloid leukemia responds to imatinib.

INTRODUCTION: In Brazil, patients with chronic myeloid leukemia (CML) in the chronic phase were not given first-line imatinib treatment until 2008. Therefore, there was a long period of time between diagnosis and the initiation of imatinib therapy for many patients. This study aims to compare the major molecular remission (MMR) rates of early versus late imatinib therapy in chronic phase CML patients. METHODS: Between May 2002 and November 2007, 44 patients with chronic phase CML were treated with second-line imatinib therapy at the Hematology Unit of the Ophir Loyola Hospital (Belém, Pará, Brazil). BCR-ABL transcript levels were measured at approximately six-month intervals using quantitative polymerase chain reaction. RESULTS: The early treatment group presented a 60% probability of achieving MMR, while the probability for those patients who received late treatment was 40%. The probability of either not achieving MMR within one year of the initiation of imatinib therapy or losing MMR was higher in patients who received late treatment (79%), compared with patients who received early treatment (21%, odds ratio=5.75, P=0.012). The probability of maintaining MMR at 30 months of treatment was 80% in the early treatment group and 44% in the late treatment group (P=0.0005). CONCLUSIONS: For CML patients in the chronic phase who were treated with second-line imatinib therapy, the probability of achieving and maintaining MMR was higher in patients who received early treatment compared with those patients for whom the time interval between diagnosis and initiation of imatinib therapy was longer than one year.

Influence of late treatment on how chronic myeloid leukemia responds to imatinib

INTRODUCTION: In Brazil, patients with chronic myeloid leukemia (CML) in the chronic phase were not given first-line imatinib treatment until 2008. Therefore, there was a long period of time between diagnosis and the initiation of imatinib therapy for many patients. This study aims to compare the major molecular remission (MMR) rates of early versus late imatinib therapy in chronic phase CML patients. METHODS: Between May 2002 and November 2007, 44 patients with chronic phase CML were treated with second-line imatinib therapy at the Hematology Unit of the Ophir Loyola Hospital (Belém, Pará, Brazil). BCR-ABL transcript levels were measured at approximately six-month intervals using quantitative polymerase chain reaction. RESULTS: The early treatment group presented a 60 percent probability of achieving MMR, while the probability for those patients who received late treatment was 40 percent. The probability of either not achieving MMR within one year of the initiation of imatinib therapy or losing MMR was higher in patients who received late treatment (79 percent), compared with patients who received early treatment (21 percent, odds ratio=5.75, P=0.012). The probability of maintaining MMR at 30 months of treatment was 80 percent in the early treatment group and 44 percent in the late treatment group (P=0.0005). CONCLUSIONS: For CML patients in the chronic phase who were treated with second-line imatinib therapy, the probability of achieving and maintaining MMR was higher in patients who received early treatment compared with those patients for whom the time interval between diagnosis and initiation of imatinib therapy was longer than one year.