COVID-19 e a incidência de AVC isquêmico pós-infecção: uma revisão integrativa da literatura / COVID-19 and the incidence of post-infection ischemic stroke: an integrative literature review

O SARS-CoV-2 é um vírus que surgiu em 2019, sendo responsável por causar uma síndrome respiratória que foi denominada COVID-19. O vírus possui uma proteína, chamada proteína Spike, que interage com as ACE2, estando presente no trato respiratório e nas células endoteliais, causando inflamação, apoptose e efeitos pró-trombóticos que ativam a via de coagulação. Dessa maneira, presume-se que o estado de hipercoagulabilidade do vírus e a inflamação endotelial estejam relacionados à fisiopatologia do AVC isquêmico pós-infecção. O objetivo desta revisão foi analisar a fisiopatologia e a etiologia dos AVCs associados à infecção pelo vírus SARS-CoV-2 e seus fatores de risco. Foi realizada uma busca por trabalhos prévios nas plataformas PubMed e BVS, e um total de 26 artigos científicos foram incluídos após a aplicação de critérios de inclusão e exclusão. Através dos estudos analisados, observou-se a correlação do aumento da incidência do AVC pós-infecção pelo SARS-CoV-2, e os fatores de risco presentes principais foram hipertensão arterial, fibrilação atrial, diabetes mellitus, dislipidemia e insuficiência cardíaca. Em conclusão, a infecção por SARS-CoV-2 possui relação com o aumento da incidência de AVC, possivelmente por seu mecanismo trombótico e inflamatório dos endotélios.

SARS-CoV-2 is a virus that emerged in 2019, being responsible for causing a respiratory syndrome that was named COVID-19. The virus has a protein, called Spike protein, which interacts with ACE2, which are present in the respiratory tract and endothelial cells, causing inflammation, apoptosis and prothrombotic effects that activate the coagulation pathway. Thus, it is presumed that the hypercoagulable state of the virus and endothelial inflammation are related to the pathophysiology of postinfection ischemic stroke. The aim of this review was to analyze the pathophysiology and etiology of strokes associated with SARSCoV-2 virus infection and their risk factors. A search for previous works was carried out on PubMed and VHL platforms, and a total of 26 scientific articles were included after applying inclusion and exclusion criteria. Through the studies analyzed, a correlation was observed between the increased incidence of stroke after infection with SARS-CoV-2, and the main risk factors present were arterial hypertension, atrial fibrillation, diabetes mellitus, dyslipidemia and heart failure. In conclusion, SARS-CoV-2 infection is related to the increased incidence of stroke, possibly due to its thrombotic and endothelial inflammatory mechanism.

Clinical validation of the terminological subset for people with chronic kidney disease undergoing conservative treatment.

OBJECTIVE: To clinically validate a terminological subset of the International Classification for Nursing Practice (ICNP®) to care for people with chronic kidney disease undergoing conservative treatment. METHOD: Prospective study of clinical validation assessment of 117 nursing diagnoses/outcomes statements and 199 nursing intervention statements. It was operationalized through the following steps: implementation of the Nursing Process in an outpatient clinic in Southeast Brazil; preparation of case studies; analysis of agreement between specialist nurses. The Kappa. Kruskal-Wallis coefficient of agreement and intraclass correlation coefficient (ICC) were used. RESULTS: The sample consisted of 50 people with chronic kidney disease. Diagnoses/outcomes and interventions were evaluated with almost perfect/perfect agreement and excellent ICC. The Kruskal-Wallis test showed that there was no significant difference between the assessments. The study allowed the clinical validation of a subset with 110 nursing diagnoses/outcomes and 195 nursing interventions. CONCLUSION: Care for people with chronic kidney disease undergoing conservative treatment based on the proposed subset has become applicable to clinical practice.

Family caregivers' satisfaction with telerehabilitation and follow-up intervention for older people with dementia: Randomized clinical trial.

The present study aimed to assess caregiver satisfaction with a telerehabilitation program and remote monitoring for older adults with dementia and their caregivers during the COVID-19 pandemic, as well as to identify the factors influencing caregiver satisfaction. This study adopted a mixed-methods approach and was part of a randomized clinical trial, with blinded assessors, comprising two groups: the Intervention Group (IG) receiving a telerehabilitation program involving standardized physical exercises for older adults with dementia, along with caregiver guidelines for the caregiver; and the Control Group (CG) receiving remote monitoring. At baseline, factors related to older adults with dementia and their caregivers were measured. After 12 weeks, caregiver satisfaction with the interventions was assessed. The final sample consisted of 64 pairs of family caregivers and older people with dementia. Caregivers in the IG showed higher satisfaction levels with the intervention, Internet-based treatment, and healthcare received compared to caregivers in the CG. Both groups expressed positive views towards the treatment, with excellent ratings for audio and video quality, and a preference for Internet-based treatment over face-to-face. In the IG, only the amount of time dedicated to caregiving influenced satisfaction with the intervention, whereas in the CG, cognitive and functional performance of the older people influenced satisfaction with remote monitoring. Our findings suggest the potential of the program in providing effective care for older people with dementia and their caregivers.

Clinical validation of the terminological subset for people with chronic kidney disease undergoing conservative treatment / Validación clínica del subconjunto terminológico para personas con enfermedad renal crónica en tratamiento conservador / Validação clínica do subconjunto terminológico para pessoas com doença renal crônica em tratamento conservador

ABSTRACT Objective: To clinically validate a terminological subset of the International Classification for Nursing Practice (ICNP®) to care for people with chronic kidney disease undergoing conservative treatment. Method: Prospective study of clinical validation assessment of 117 nursing diagnoses/outcomes statements and 199 nursing intervention statements. It was operationalized through the following steps: implementation of the Nursing Process in an outpatient clinic in Southeast Brazil; preparation of case studies; analysis of agreement between specialist nurses. The Kappa. Kruskal-Wallis coefficient of agreement and intraclass correlation coefficient (ICC) were used. Results: The sample consisted of 50 people with chronic kidney disease. Diagnoses/outcomes and interventions were evaluated with almost perfect/perfect agreement and excellent ICC. The Kruskal-Wallis test showed that there was no significant difference between the assessments. The study allowed the clinical validation of a subset with 110 nursing diagnoses/outcomes and 195 nursing interventions. Conclusion: Care for people with chronic kidney disease undergoing conservative treatment based on the proposed subset has become applicable to clinical practice.

RESUMEN Objetivo: Validar clínicamente un subconjunto terminológico de la Clasificación Internacional para Práctica de Enfermería (CIPE®) para la atención de personas con enfermedad renal crónica sometidas a tratamiento conservador. Método: Estudio prospectivo que evaluó la validación clínica de 117 declaraciones de diagnóstico/resultado y 199 declaraciones de intervención de enfermería. Fue operacionalizado a través de los siguientes pasos: implementación del Proceso de Enfermería en un ambulatorio del Sudeste de Brasil; preparación de estudios de caso; Análisis de concordancia entre enfermeros especialistas. Se utilizaron los coeficientes de concordancia Kappa. Kruskal-Wallis y coeficiente de correlación intraclase (CCI). Resultados: La muestra estuvo compuesta por 50 personas con enfermedad renal crónica. Los diagnósticos/resultados e intervenciones se evaluaron con una concordancia casi perfecta/perfecta y un CCI excelente. La prueba de Kruskal-Wallis mostró que no había diferencias significativas entre las valoraciones. El estudio permitió validar clínicamente un subconjunto con 110 diagnósticos/resultados y 195 intervenciones de enfermería. Conclusión: La atención a personas con enfermedad renal crónica sometidas a tratamiento conservador basado en el subconjunto propuesto se ha vuelto aplicable a la práctica clínica.

RESUMO Objetivo: Validar clinicamente um subconjunto terminológico da Classificação Internacional para a Prática de Enfermagem (CIPE®) para o cuidado às pessoas com doença renal crônica em tratamento conservador. Método: Estudo prospectivo. de avaliação de validação clínica de 117 enunciados de diagnósticos/resultados e 199 enunciados intervenções de enfermagem. Foi operacionalizado pelas seguintes etapas: implementação do Processo de Enfermagem em um ambulatório no Sudeste do Brasil; elaboração dos estudos de casos; análise de concordância entre enfermeiros especialistas. Utilizou-se o coeficiente de concordância de Kappa. Kruskal-Wallis e coeficiente de correlação intraclasse (CCI). Resultados: A amostra foi constituída por 50 pessoas com doença renal crônica. Os diagnósticos/resultados e intervenções foram avaliadas com concordância quase perfeita/perfeita e CCI excelente. O teste de Kruskal-Wallis mostrou inexistir diferença significativa entre as avaliações. O estudo possibilitou validar clinicamente um subconjunto com 110 diagnósticos/resultados e 195 intervenções de enfermagem. Conclusão: O cuidado às pessoas com doença renal crônica em tratamento conservador pautado no subconjunto proposto se tornou aplicável à prática clínica.

External root resorption evaluated by CBCT 3D models superimposition.

INTRODUCTION: The literature reports the association of external root resorption (ERR) with orthodontic movement. In cases of premolars extractions, orthodontic movement of anterior teeth is usually quite expressive, which are precisely the most susceptible teeth to suffer from ERR. OBJECTIVE: The aim of this study was to assess the root morphology of maxillary canines and incisors in patients submitted to four premolar extraction and orthodontic retraction of the anterior teeth, by means of 3D surface models superimposition and mapping. METHODS: The sample consisted of six adult patients, five female and one male, with a mean age of 23.5 ± 6.5 years, who underwent orthodontic treatment. All patients presented bimaxillary dental protrusion, with indication of maxillary and mandibular first premolar extractions, followed by the retraction of anterior teeth and space closure. Cone beam CT scans were performed before the beginning of the treatment (T0) and right after space closure (T1). 3D models were built at both times and superimposed to identify the root changes for the given period. RESULTS: All average differences were close to zero and, even when evaluating the extreme values, the observed changes were always smaller than the accuracy of the CBCT. CONCLUSION: A mild resorption trend was observed, although it was not clinically significant, with values lower than the tomography accuracy.

Do low-cost 3-dimensional printers produce suitable dental models?

INTRODUCTION: When choosing a 3-dimensional printer for dental models, the cost-benefit ratio should be evaluated. The purpose of this study was to evaluate the accuracy, precision, cost, and time taken to prepare and print using different low-cost techniques (2 digital light processing [DLP] and 1 fused filament fabrication [FFF] printer) compared with the reference proven to be clinically accepted (PolyJet). METHODS: For this purpose, the upper and lower virtual models of 5 patients were printed using: (1) DLP printer Moonray, (2) DLP printer Anycubic, (3) DLP printer Moonray with Anycubic resin, (4) Filament printer UpMini 2 (FFF), and (5) Polyjet printer Objet Eden500V. One of the virtual models was also printed 4 consecutive times on each printer to allow consistency assessment. Afterward, the 14 printed resin models were scanned, and their accuracy was evaluated by model superimposition using Geomagic Qualify software (3D Systems, Rock Hill, SC). A digital caliper was also used to obtain linear measurements. All measurements were carried out by a calibrated examiner. RESULTS: The results showed that all printers produced similar results, although Moonray with Anycubic resin showed loss of accuracy and Anycubic showed inconsistent vertical dimensions. The printing cost and time consumed from each pair of models were calculated for the overall printing process, analyzing which would have the best cost-benefit ratio. CONCLUSIONS: Polyjet printing was considered the fastest method but with the highest cost. FFF printing was the lowest printing and input cost but was considerably more time-consuming. There was a balance in both DLP printers, and they were considered the best cost-benefit ratio for small independent dental offices.

Physical Exercise Affects Quality of Life and Cardiac Autonomic Modulation in Patients With Chronic Kidney Failure Submitted to Hemodialysis: A Randomized Clinical Trial.

Performing physical exercise during hemodialysis has been debated regarding safety and efficacy for improving life quality for patients with chronic kidney disease (CKD). Thus, we explored the influence of physical exercise during hemodialysis on both autonomic modulation of heart rate and quality of life for patients with CKF in a randomized clinical trial. We randomly allocated participants requiring hemodialysis to an experimental exercise group (EG) and a control no-exercise group (CG) and assessed their quality of life with the Kidney Disease Quality of Life Short Form-KDQOL-SF™ 1.3 and with Polar RS800CX to monitor their heart rate variability (HRV) before and three months after the end of the exercise intervention. EG participants reported a significant increase in their quality of life (p = .05, physical function, physical aspects, pain, emotional well-being, emotional function; p = .03, energy and fatigue) and showed HRV improvement (p = .05, RMSSD, SDNN, and SD2; p = .004, SD1) after three months of exercise. Thus, we recommend supervised physical exercise during hemodialysis for carefully selected patients.

External root resorption evaluated by CBCT 3D models superimposition

ABSTRACT Introduction: The literature reports the association of external root resorption (ERR) with orthodontic movement. In cases of premolars extractions, orthodontic movement of anterior teeth is usually quite expressive, which are precisely the most susceptible teeth to suffer from ERR. Objective: The aim of this study was to assess the root morphology of maxillary canines and incisors in patients submitted to four premolar extraction and orthodontic retraction of the anterior teeth, by means of 3D surface models superimposition and mapping. Methods: The sample consisted of six adult patients, five female and one male, with a mean age of 23.5 ± 6.5 years, who underwent orthodontic treatment. All patients presented bimaxillary dental protrusion, with indication of maxillary and mandibular first premolar extractions, followed by the retraction of anterior teeth and space closure. Cone beam CT scans were performed before the beginning of the treatment (T0) and right after space closure (T1). 3D models were built at both times and superimposed to identify the root changes for the given period. Results: All average differences were close to zero and, even when evaluating the extreme values, the observed changes were always smaller than the accuracy of the CBCT. Conclusion: A mild resorption trend was observed, although it was not clinically significant, with values lower than the tomography accuracy.

RESUMO Introdução: A literatura relata a associação de reabsorção radicular externa (RRE) com a movimentação ortodôntica. Nos casos de extrações de pré-molares, a movimentação ortodôntica costuma ser bastante expressiva nos dentes anteriores, que são justamente os dentes mais suscetíveis à RRE. Objetivo: O objetivo do presente estudo foi avaliar a morfologia radicular de caninos e incisivos superiores em pacientes submetidos à extração de quatro pré-molares e retração ortodôntica dos dentes anteriores, por meio da sobreposição e mapeamento de modelos 3D. Métodos: A amostra foi composta por seis pacientes adultos, cinco do sexo feminino e um do masculino, com média de idade de 23,5 ± 6,5 anos, submetidos a tratamento ortodôntico. Todos os pacientes apresentavam biprotrusão dentária, com indicação de extração dos primeiros pré-molares superior e inferior, seguida de retração dos dentes anteriores e fechamento do espaço. A tomografia computadorizada de feixe cônico (TCFC) foi realizada antes do início do tratamento (T0) e logo após o fechamento de espaços (T1). Modelos 3D foram construídos em ambos os momentos e sobrepostos para identificar as mudanças nas raízes dentárias no período determinado. Resultados: Todas as médias das diferenças foram próximas de zero e, mesmo avaliando os valores extremos, as mudanças observadas foram sempre menores que a sensibilidade da TCFC. Conclusão: Observou-se tendência de leve reabsorção, embora não clinicamente significativa, com valores inferiores à sensibilidade tomográfica.

Musculoskeletal Manifestations Observed in Patients Diagnosed With Chikungunya Virus in 2 Municipalities of the Brazilian Amazon Region.

BACKGROUND: Chikungunya virus fever is an emerging disease that is rapidly spreading and becoming a global public health issue because of its clinical manifestations that cause physical limitations and high rates of chronification. No studies have characterized musculoskeletal manifestations in Brazilian patients with chikungunya. OBJECTIVE: To describe the musculoskeletal manifestations of patients with chikungunya infection in municipalities of the Brazilian Amazon region. METHODS: This study was an observational, descriptive, and analytical study conducted from March to May 2018. The gender, age, time of infection, clinical manifestations reported during the acute phase, and results of a physical examination of the musculoskeletal system were collected. RESULTS: The medical records of 63 patients with a laboratory confirmation of chikungunya virus fever were analyzed. Eighty-three percent of these patients were women, with a mean age of 50.6 ± 14.5 years and 3.3 ± 3.1 months of infection. The main clinical manifestations reported during the acute phase were arthralgia (100%), fever (91%), and exanthema (65%). The physical examination revealed that the main joints affected by arthralgia resulted in a polyarticular (57%, 5-10 joints) and symmetrical pattern (62%) that mainly affected the ankles (53%) and knees (51%). Regarding arthritis, the most frequently affected area was the wrist (42%), with an oligoarticular pattern (42%, 2-4 joints). CONCLUSIONS: In general, the clinical manifestations described in the Brazilian Amazon population are similar to those reported in publications from other countries; however, the main arthritis pattern identified is oligoarticular, with a predominance of the wrist. Moreover, the chronicity rate is 48%.

Custo-benefício de diferentes impressoras 3D na Ortodontia / Cost-benefit of different 3d printers in orthodontics

Ao escolher uma impressora 3D para modelos odontológicos, a relação custo-benefício deve ser avaliada. Os modelos impressos devem ser acurados, precisos e eficientes quanto ao tempo, assim como financeiramente acessíveis. O objetivo deste estudo é comparar a acurácia, precisão, custo e tempo necessário para a preparação e impressão de modelos usando diferentes tecnologias: duas impressoras DLP (Digital Light Processing) e uma FFF (Fused Filament Fabrication) comparadas ao padrão-ouro (PolyJet). Para realização deste estudo, foram selecionados 10 escaneamentos de 5 pacientes, contendo a arcada superior e inferior. Todos os 10 modelos foram impressos usando a seguinte combinação de tecnologias: (1) DLP Moonray (MR), (2) DLP Anycubic (AC) (3) DLP Moonray com utilização de resina da Anycubic (MRA), (4) filamento UpMini 2 (FFF) e (5) PolyJet Eden 500 da Objet (PJ). Um dos modelos virtuais foi impresso adicionalmente quatro vezes consecutivas em cada impressora, de forma a permitir a avaliação da precisão destas. O arquivo .STL original de cada modelo foi superposto com o escaneamento do seu respectivo modelo impresso, gerando mapas de cores que permitiram o cálculo de RMS (média quadrática) para a comparação de ambos. Além deste método, foram realizadas medidas lineares através de um paquímetro digital em 8 variáveis diferentes: distância inter-caninos (DIC), distância inter-molares (DIM), plano ântero-posterior bilateralmente (PAP-D e PAP-E), plano vertical bilateralmente (PV-D e PV-E) e plano misto bilateralmente (PM-D e PM-E). O teste Shapiro-Wilk mostrou que os dados não eram normalmente distribuídos. O teste de Friedman com o post hoc de Bonferroni foi utilizado para verificar se havia diferenças entre os valores obtidos para as variáveis avaliadas. Uma diferença acima de 0,4 mm foi considerada clinicamente significante para as medidas lineares. Observou-se diferenças clínica e estatisticamente significantes (p < 0,05) para as seguintes comparações: PV-D e PV-E entre MR e MRA (p=0,00), PV-D entre FFF e MR (p=0,01), e PV-E entre FFF e MR (p=0,00). Já para o RMS, ocorreram diferenças estatisticamente significantes entre: AC e MR (p=0,00); AC e MRA (p=0,00); FFF e MR (p=0,01) e PJ e MR (p=0,01). Para as diferenças no RMS, nenhum valor esteve acima do considerado clinicamente significante (0,25 mm). Quando avaliada a precisão dos modelos pelas medidas lineares, observou-se diferença estatisticamente significativa apenas na variável PV-D entre FFF e AC (p=0,00). A mesma diferença foi vista para os valores de RMS em: AC e MR (p=0,02) e AC e MRA (p=0,04). As impressoras produziram resultados de qualidade similares, embora a Moonray com a resina da Anycubic tenha mostrado perda de acurácia e a Anycubic tenha problema de consistência no plano vertical. Dentre elas, a impressão em PolyJet foi considerada o método mais rápido, porém com o custo muito elevado. A impressão em FFF apresenta um custo baixo da impressora e dos insumos, no entanto com o tempo de impressão consideravelmente mais elevado. Em ambas as impressoras DLP houve um equilíbrio, resultando em um bom custo-benefício(AU)

When choosing a 3D printer for dental models, cost-benefit should be evaluated. Printed models should be accurate, precise and time efficient, as well as financially accessible. The aim of this study is to compare the accuracy, precision, cost and time required for preparation and printing using different technologies: two DLP (Digital Light Processing) printers, and one FFF (Fused Filament Fabrication) compared to the gold standard (PolyJet). For this study, it was selected 10 intraoral scans of 5 patients. All 10 models were printed as follows: (1) DLP printer Moonray (MR), (2) DLP printer Anycubic (AC) (3) DLP printer Moonray with Anycubic resin (MRA), (4) filament printer UpMini 2 (FFF) and (5) PolyJet printer Objet eden500 (PJ). One of the virtual models was additionally printed four consecutive times on each printer to allow consistency assessment. The original .STL file of each model was superimposed by scanning its respective printed model, generating color maps that allowed the RMS (root mean square) calculation for the comparison of both models. In addition, linear measurements were performed using a digital caliper on 8 different variables: inter-canine distance (ICD), inter-molar distance (IMD), bilateral anteroposterior plane (APP-R and APP-L), bilateral vertical plane (VP-R and VP-L) and bilateral mixed plan (MP-R and MP-L). The Shapiro-Wilk test showed that the data was not normally distributed. Friedman's test with Bonferroni's post hoc test was used to verify if there were differences between the evaluated variables. A difference above 0.4 mm was considered clinically significant for linear measurements. Clinically and statistically significant differences (p <0.05) were observed for the following comparisons: VP-R and VP-L between MR and MRA (p = 0.00), VP-R between FFF and MR (p = 0.01), VP-L between FFF and MR (p = 0.00). For RMS, there were statistically significant differences between: AC and MR (p = 0.00); AC and MRA (p = 0.00); FFF and MR (p = 0.01) and PJ and MR (p = 0.00). For the differences in RMS, no value was above the clinical significancy threshold (0.25mm). When the consistency of the models by the linear measurements was evaluated, a statistically significant difference was observed only in the VP-R variable between FFF and AC (p = 0.00). The same difference was seen for the RMS values in: AC and MR (p = 0.02) and AC and MRA (p = 0.04). The printers produced similar quality results, although Moonray with Anycubic resin showed loss of accuracy and Anycubic has a consistency problem in vertical plane. Among them, PolyJet printing was considered the fastest one, but with the highest cost. FFF printing has a low printer and filament cost, but with considerably longer printing times. In both DLP printers there was a balance, resulting in a good cost-benefit(AU)

A Expectativa Profissional do Futuro Médico: Análise do Quadriênio 2014-2017 / Professional Expectations of Future Doctors: Analysis of the Quadriennium 2014-2017

RESUMO O objetivo deste trabalho é descrever as expectativas dos estudantes de Medicina quanto à carreira profissional. Foi realizado um estudo transversal, descritivo e analítico, no período de janeiro de 2014 a dezembro de 2017, com 116 estudantes concluintes em 2014, 116 de 2015, 91 de 2016 e 110 de 2017, totalizando uma amostra de 431 sujeitos. Foi aplicado um questionário para obtenção de informações sobre idade, gênero, ano de formatura, desejos de atuação profissional para os dez anos seguintes, a especialidade que deseja seguir, o nível de atenção no qual deseja trabalhar, a renda a ser alcançada, o número de empregos que acha necessário para alcançá-la e o número de empregos que pretende ter. O estudo demonstrou predomínio de homens (58,7%), e a média de idade foi de 26,4 ± 3,91 anos. Entre as especialidades pretendidas pelos egressos, Clínica Médica foi a mais almejada em todos os anos estudados, exceto no ano de 2016, em que predominou Pediatria. Sobre os desejos profissionais para dez anos após a formação, a docência foi almejada por cerca da metade deles, variando entre 46% e 59%, enquanto a quase totalidade da amostra demonstrou o desejo de trabalhar com assistência (atendimento direto ao paciente). Não houve predomínio entre as atividades ambulatorial/consultório e hospitalar, assim como entre o setor público e o privado. Em relação ao desejo de atuar nos diferentes níveis de atenção à saúde, os formandos de 2014 e 2016 expressaram desejo de atuar predominantemente no nível terciário (40,5 ± 29,3% e 41,1 ± 29,7%, respectivamente) em relação aos demais níveis de atenção. Sobre a pretensão de renda salarial, predominou a faixa acima de dez salários mínimos, sendo que a maioria expressou achar necessários pelo menos três empregos para alcançá-la, embora o desejo da maior parte dos estudados tenha sido manter apenas dois empregos. Conclui-se que as chamadas áreas básicas, como Clínica Médica, Cirurgia Geral e Pediatria, ainda são bastante almejadas pelos formandos. Contudo, mais do que o desejo de segui-las, provavelmente isto representa a necessidade de pré-requisito para acesso a outras especialidades. No geral, os egressos pretendem trabalhar com assistência, têm uma expectativa salarial alta, admitem a necessidade de diversos vínculos empregatícios para atingir esta meta e têm pouco interesse em trabalhar no nível primário de atenção à saúde. Tal realidade poderia ser discutida no âmbito da academia, a fim de oferecer informações realistas aos estudantes sobre o mercado de trabalho e a carreira médica, minimizando frustrações futuras durante o exercício profissional.

ABSTRACT The objective of this work is to describe the expectations of medical students regarding their professional career. In order to do this, a cross-sectional descriptive and analytical study was conducted, from January 2014 to December 2017, with 116 senior students of the class of 2014, 116 of 2015, 91 of 2016 and 110 of 2017, with a total of 431 individuals. A survey was applied to obtain information about their age, gender, graduation year, professional expectations for the 10 years to follow, intended specialty, level of care at which they want to work, intended income, the number of jobs they think they will need to work in to reach that level of income and the number of jobs they expect to have. The study showed that there are more male students (58%) than female, and the average age is 26.4 ± 3.91 years old. General Medicine was the most sought specialty by the graduate students, except for those of the year 2016, when the predominant specialty was Pediatrics. Concerning the professional goals for the 10 years after graduation, teaching was an objective of approximately half of them, ranging between 46% and 59%, while almost all of them demonstrated a wish to perform assistance work (direct patient care). No predominance was found when comparing the expectation of working in a hospital or in private clinics, nor between the private and public sector. Concerning the wish to work at different health care levels, the senior students from the classes of 2014 and 2016 expressed their wish to work predominantly at care level 3 (40.5 ± 29.3% and 41.1 ± 29.7%, respectively). Concerning the intended income, the most popular range was above 10 minimum monthly salaries. Most students stated they believe that at least three jobs would be necessary to reach this salary level, but they also expressed the wish of having only two jobs. We conclude that the so-called basic areas, such as General Medicine, General Surgery and Pediatrics are the most coveted by the senior students. However, this is probably due not only to a desire to follow these specialties, but also because they represent a prerequisite to access other specialties. In general, the graduates intend to work with direct care and have high salary expectations, which is only achieved by having multiple jobs. They have little interest in working at care level one. This reality could be discussed in academic circles, in order to offer realistic information to students about the job market and medical career, minimizing future frustrations during their professional practice.

Doença ulcerosa péptica: realmente é possível identificá-la por meio das características da dor epigástrica? / Peptic ulcer disease: is it really possible to identify it through the characteristics of epigastric pain?

OBJETIVO: Determinar se características da dor epigástrica são capazes de identificar pacientes com doença ulcerosa péptica. MÉTODOS: Estudo caso-controle, com coleta de dados de setembro de 2014 a junho de 2016. Foram incluídos pacientes com mais de 18 anos com dispepsia que realizaram endoscopia digestiva alta ambulatorialmente. Os pacientes foram abordados antes de realizar a endoscopia digestiva alta, verificando, em suas guias, a presença de dispepsia, tendo sido convidados a responder um questionário, e, posteriormente, o prontuário de cada entrevistado foi avaliado para verificação do diagnóstico, sendo, então, divididos entre o Grupo Doença Ulcerosa Péptica (casos), com 32 pacientes, e o Grupo Controle, com 44 pacientes com dispepsia atribuída a outras causas. RESULTADOS: Dos pacientes com dispepsia não ulcerosa, 52,27% caracterizaram a dor como em queimação, sendo 47,72% moderada e que piorava com alimentação. Dentre os demais sintomas, 45,45% relataram náuseas e 25% desconforto pós-prandial, com 52,27% relatando histórico familiar negativo de doença ulcerosa péptica. Em contrapartida, dos pacientes com doença ulcerosa péptica, 53,12% referiram dor em queimação e de moderada intensidade, e 50% relataram piora com alimentação. Dentre os demais sintomas, prevaleceram também náuseas (53,12%) e desconforto pós-prandial (40,62%). A maioria (81,25%) relatou histórico familiar de doença ulcerosa péptica. Observou-se diferença estatística em dor noturna, predominando na doença ulcerosa péptica (p=0,0225) e dor em cólica na dispepsia não ulcerosa (p=0,0308), assim como na ausência de histórico familiar entre os pacientes com dispepsia não ulcerosa (p=0,0195). CONCLUSÃO: A dispepsia relacionada à doença ulcerosa péptica relaciona-se, principalmente, à piora noturna, sendo que a intensidade da dor, a relação com alimentação e os sintomas associados não auxiliaram na diferenciação da dispepsia não ulcerosa, diferentemente do que a literatura tradicionalmente informa. (AU)

To determine whether it is possible to identify Peptic Ulcer Disease through the characteristics of epigastric pain. METHODS: This is a case-control study with data collected between September 2014 and June 2016 including patients over 18 years of age with dyspepsia who underwent upper gastrointestinal endoscopy as outpatients. The patients were approached before the upper gastrointestinal endoscopy when their test requisition form indicated the presence of dyspepsia. The subjects were invited to answer a questionnaire and, afterwards, the records of all interviewees were evaluated to check for the diagnosis. Then, they were divided into a peptic ulcer disease group (cases), with 32 patients, and a control group, with 44 patients with dyspepsia from other causes. RESULTS: Among non-ulcer dyspepsia patients, 52.27% described the pain as a "burning pain", with 47.72% reporting it as moderate and aggravated by food intake. As for other symptoms, 45.45% of subjects reported nausea, and 25% reported postprandial discomfort; 52.27% had no family history of peptic ulcer disease. In contrast, 53.12% of peptic ulcer disease patients reported "burning" and moderate pain, and 50% said the pain was aggravated by eating. As for the other symptoms, nausea (53.12%) and postprandial discomfort (40.62%) prevailed; most of the patients (81.25%) had family history of peptic ulcer disease. There was a statistical difference in night pain, which was more prevalent in peptic ulcer disease (p=0.0225), and colicky pain, which was more frequent in nonulcer dyspepsia (p=0.0308), as well as absence of family history in non-ulcer dyspepsia patients (p=0.0195). CONCLUSION: Dyspepsia caused by peptic ulcer disease is mainly related to night worsening, and pain intensity, the relationship with food intake, and associated symptoms did not help differentiate nonulcer dyspepsia, differently from what the medical literature traditionally suggests. (AU)

Lower frequency of antibodies to MOG in Brazilian patients with demyelinating diseases: An ethnicity influence?

OBJECTIVE: Antibodies against Myelin Oligodendrocyte glycoprotein (MOG-Ab) have been investigated as potential biological marker for neuromyelitis optica (NMO) and high-risk syndromes (HR) negative for AQP4-Ab in populations with different ethnic background. We tested AQP4 and MOG antibodies in a Brazilian population with high African ethnic background. METHOD: The study population was composed of adult patients from Rio de Janeiro with inflammatory demyelinating diseases (new and old cases). Blood samples were sent blindly to test the AQP4 and MOG antibodies by CBA. The frequency of positive MOG-Ab was estimated in the NMOHR and the NMO spectrum disorders (NMOSD). A systematic review with meta-analysis assessed the frequency of MOG-Ab in Caucasians and non-Caucasians. RESULTS: 200 adult patients (52% Afro-Brazilian) 115 of them with NMOHR were tested. MOG antibodies were found in 5/68 negative cases of AQP4-Ab negative (7%). The criteria for NMOSD were fulfilled by 70 patients with NMOHR and none of them was positive for MOG-Ab. A low prevalence of MOG antibodies and a predominant phenotype of bilateral Optic Neuritis were found in most non-Caucasian patients. CONCLUSION: The low frequency of MOG Ab in patients from Rio de Janeiro and in other non-Caucasian populations suggests a racial/ancestral influence.

Prevalence of multiple sclerosis in Brazil: A systematic review.

Epidemiological studies of multiple sclerosis (MS) conducted in Latin America have revealed prevalence rates of this disease from low to medium. The aim of this study was to gather and analyze surveys on prevalence conducted in Brazil, noting its variability in different regions. Systematic review was held in electronic databases and manual search in abstracts concerning ECTRIMS, LACTRIMS and Brazilian Congress of Neurology. Nineteen studies made reference to prevalence rates that ranged from 1.36/100,000 to 27.2/100.000 inhabitants. More studies on the epidemiology of MS in Brazil will be needed for a better assessment of its prevalence and profile.

Central Nervous System Idiopathic Inflammatory Demyelinating Disorders in South Americans: A Descriptive, Multicenter, Cross-Sectional Study.

The idiopathic inflammatory demyelinating disease (IIDD) spectrum has been investigated among different populations, and the results have indicated a low relative frequency of neuromyelitis optica (NMO) among multiple sclerosis (MS) cases in whites (1.2%-1.5%), increasing in Mestizos (8%) and Africans (15.4%-27.5%) living in areas of low MS prevalence. South America (SA) was colonized by Europeans from the Iberian Peninsula, and their miscegenation with natives and Africans slaves resulted in significant racial mixing. The current study analyzed the IIDD spectrum in SA after accounting for the ethnic heterogeneity of its population. A cross-sectional multicenter study was performed. Only individuals followed in 2011 with a confirmed diagnosis of IIDD using new diagnostic criteria were considered eligible. Patients' demographic, clinical and laboratory data were collected. In all, 1,917 individuals from 22 MS centers were included (73.7% female, 63.0% white, 28.0% African, 7.0% Mestizo, and 0.2% Asian). The main disease categories and their associated frequencies were MS (76.9%), NMO (11.8%), other NMO syndromes (6.5%), CIS (3.5%), ADEM (1.0%), and acute encephalopathy (0.4%). Females predominated in all main categories. The white ethnicity also predominated, except in NMO. Except in ADEM, the disease onset occurred between 20 and 39 years old, early onset in 8.2% of all cases, and late onset occurred in 8.9%. The long-term morbidity after a mean disease time of 9.28±7.7 years was characterized by mild disability in all categories except in NMO, which was scored as moderate. Disease time among those with MS was positively correlated with the expanded disability status scale (EDSS) score (r=0.374; p=<0.001). This correlation was not observed in people with NMO or those with other NMO spectrum disorders (NMOSDs). Among patients with NMO, 83.2% showed a relapsing-remitting course, and 16.8% showed a monophasic course. The NMO-IgG antibody tested using indirect immunofluorescence (IIF) with a composite substrate of mouse tissues in 200 NMOSD cases was positive in people with NMO (95/162; 58.6%), longitudinally extensive transverse myelitis (10/30; 33.3%) and bilateral or recurrent optic neuritis (8/8; 100%). No association of NMO-IgG antibody positivity was found with gender, age at onset, ethnicity, early or late onset forms, disease course, or long-term severe disability. The relative frequency of NMO among relapsing-remitting MS (RRMS) + NMO cases in SA was 14.0%. Despite the high degree of miscegenation found in SA, MS affects three quarters of all patients with IIDD, mainly white young women who share similar clinical characteristics to those in Western populations in the northern hemisphere, with the exception of ethnicity; approximately one-third of all cases occur among non-white individuals. At the last assessment, the majority of RRMS patients showed mild disability, and the risk for secondary progression was significantly superior among those of African ethnicity. NMO comprises 11.8% of all IIDD cases in SA, affecting mostly young African-Brazilian women, evolving with a recurrent course and causing moderate or severe disability in both ethnic groups. The South-North gradient with increasing NMO and non-white individuals from Argentina, Paraguay, Brazil and Venezuela confirmed previous studies showing a higher frequency of NMO among non-white populations.

Prevalência dos fatores de risco cardiovascular em adultos admitidos naunidade de dor torácica em Vassouras, RJ / Prevalence of cardiovascular risk factors among adults admitted to the chest pain unit, Vassouras, Rio de Janeiro State

Fundamentos: As doenças cardiovasculares constituema principal causa de morte no Brasil e para a redução desse importante problema de saúde pública é fundamental o monitoramento dos fatores de risco. Objetivo: Estimar a prevalência dos principais fatoresde risco cardiovascular em adultos do Município de Vassouras, Rio de Janeiro. Métodos: Estudo observacional, descritivo e transversal, com amostra de 1060 adultos admitidos na Unidade de Dor Torácica do Hospital Universitário Sul Fluminense em Vassouras (RJ). Fundamenta-se em análise retrospectiva de questionários padronizados aplicados aos pacientes com dor torácica, sendo avaliados: sexo, faixa etária, hipertensão arterial sistêmica,diabetes,sobrepeso/obesidade,sedentarismo, história de infarto agudo do miocárdio prévio, antecedentes familiares, etilismo, tabagismo e dislipidemia. Os dados foram armazenados e analisados através do software Microsoft Excel. Utilizou-se intervalo de confiança de 95% e também o teste do qui-quadrado para a análise estatística, com significância de 1% e 5%. Resultados: A amostra foi composta por 51,4% de indivíduos do sexo feminino e 48,6%, do sexo masculino. As prevalências dos fatores de risco foram: 65% de hipertensão, 49,4% de antecedentes familiares, 42,8% de sedentarismo, 25,3% de sobrepeso/obesidade, 23% de tabagismo, 22,9% de dislipidemia, 19,7% de diabetes 18,5% de infarto prévio e 8,6% de etilismo.Conclusão: A magnitude das prevalências dos fatores de risco sugere que é preciso intensificar as estratégias de prevenção e promoção de saúde assim como aprimorar o atendimento emergencial ao paciente com risco de doença coronariana.

[Stroke prevalence among the elderly in Vassouras, Rio de Janeiro State, Brazil, according to data from the Family Health Program]. / Prevalência de acidente vascular cerebral em idosos no Município de Vassouras, Rio de Janeiro, Brasil, através do rastreamento de dados do Programa Saúde da Família.

This study estimated the prevalence of stroke among the elderly in Vassouras, Rio de Janeiro State, Brazil, based on data from the Family Health Program (FHP). The elderly population was chosen since it is growing as a proportion of the general population, and since stroke risk increases with age. Data were screened for all the elderly registered in the FHP in Vassouras, identifying those with a history of stroke and analyzing their socio-demographic profile. The study used data from the Information System on Primary Care, the population census conducted by the Brazilian Institute of Geography and Statistics (IBGE), and the Ministry of Health's standardized FHP patient form. Quality of stroke diagnoses in the FHP was analyzed. Data screening detected 122 elderly with a history of stroke diagnosis (prevalence = 2.9%; 3.2% in men, 2.7% in women) and a progressive increase with age. The prevalence rate was the same in the rural and urban area of the municipality (2.9%). Knowledge of stroke prevalence in the elderly population is essential to improve health planning.

Prevalência de acidente vascular cerebral em idosos no Município de Vassouras, Rio de Janeiro, Brasil, através do rastreamento de dados do Programa Saúde da Família / Stroke prevalence among the elderly in Vassouras, Rio de Janeiro State, Brazil, according to data from the Family Health Program

O estudo estimou a prevalência de acidente vascular cerebral (AVC) em idosos em Vassouras, Rio de Janeiro, Brasil, pelo rastreamento de dados do Programa Saúde da Família (PSF). A população idosa foi escolhida por seu aumento no Brasil e pelo risco do AVC aumentar com a idade. Foram rastreados todos os idosos de Vassouras cadastrados no PSF, identificando os acometidos por AVC e analisando o seu perfil sócio-demográfico. Foram utilizados os dados do Sistema de Informação e Atenção Básica, do censo populacional do Instituto Brasileiro de Geografia e Estatística e a ficha de atendimento padronizada pelo PSF, do Ministério da Saúde. Avaliou-se a qualidade dos diagnósticos de AVC do PSF. No rastreamento, foram encontrados 122 idosos com diagnóstico de AVC, com prevalência de 2,9 por cento, e aumento progressivo com o avançar da idade, sendo a prevalência nos homens (3,2 por cento) maior do que nas mulheres (2,7 por cento). A taxa de prevalência foi igual tanto na zona rural quanto na zona urbana (2,9 por cento). O conhecimento da magnitude da prevalência do AVC na população idosa é fundamental para melhor planejamento de saúde.

This study estimated the prevalence of stroke among the elderly in Vassouras, Rio de Janeiro State, Brazil, based on data from the Family Health Program (FHP). The elderly population was chosen since it is growing as a proportion of the general population, and since stroke risk increases with age. Data were screened for all the elderly registered in the FHP in Vassouras, identifying those with a history of stroke and analyzing their socio-demographic profile. The study used data from the Information System on Primary Care, the population census conducted by the Brazilian Institute of Geography and Statistics (IBGE), and the Ministry of Health's standardized FHP patient form. Quality of stroke diagnoses in the FHP was analyzed. Data screening detected 122 elderly with a history of stroke diagnosis (prevalence = 2.9 percent; 3.2 percent in men, 2.7 percent in women) and a progressive increase with age. The prevalence rate was the same in the rural and urban area of the municipality (2.9 percent). Knowledge of stroke prevalence in the elderly population is essential to improve health planning.