Impact of different etiologies of bronchiectasis on the pulmonary function tests.

BACKGROUND: Bronchiectasis develops along the natural course of several respiratory and systemic conditions and induces significant changes in the morphofunctional structure of airways. Our objective was to assess the impact of various causes of bronchiectasis on clinical data, pulmonary function tests, and high-resolution computed tomography (HRCT). METHODS: The present report was a cross-sectional study that was conducted with 112 consecutive patients with bronchiectasis, who were allocated to five groups, as follows: sequelae of tuberculosis, history of non-tuberculosis infection, cystic fibrosis (CF), primary ciliary dyskinesia (PCD), and rheumatoid arthritis. All of the participants underwent spirometry, whole-body plethysmography, measurement of the diffusing capacity for carbon monoxide (DLco), and HRCT. RESULTS: The highest HRCT score was exhibited in patients with CF (6.03 ± 1.03). The values of forced expiratory volume in 1 second (FEV1) (52.2 ± 17.7%) and DLco (74.1 ± 15.2%) were lower in patients with sequelae of tuberculosis. The increase in the residual volume was more accentuated in the patients with CF (193.5 ± 39.5%) and PCD (189 ± 36.4%). By the multivariate analysis, the cause of FEV1 and bronchiectasis, HRCT score, and degree of dyspnea behaved as independent predictors of DLco. CONCLUSION: In individuals with bronchiectasis, the pulmonary function abnormalities are associated with the etiology of the underlying disease.

A Practical Approach for Ischemic Preconditioning Intervention in Sports: A Pilot Study for Cuff Thigh Occlusion Pressure Estimation Based on Systolic Blood Pressure.

For the ischemic preconditioning (IPC) intervention, the accuracy of the protocol is paramount for mediating its possible ergogenic effects. However, the lack of standardization and widespread use of arbitrary cuff pressures (ranging from 130 to >300 mmHg) have been predominantly observed, potentially affecting the results and compromising the reproducibility of findings. Thus, the purpose of this study was to determine an appropriate cuff pressure during IPC. Seventeen healthy male participants were enrolled in the study. Anthropometric measurements were initially conducted, followed by systolic and diastolic blood pressure measurements. Subsequently, we determined the individual thigh occlusion pressure (TOP) for the right leg using a hand-held Doppler device. Based on these findings, we developed an estimation equation for TOP, considering the current brachial systolic blood pressure (SBP) values. We then conducted a retrospective analysis of its capacity to mediate occlusion. We observed the ability to estimate TOP using the equation (p = 0.01; ES: 0.86), presenting ~6% superiority in absolute values for occlusion compared to direct measurement (TOP equation: 169.9 ± 9.1; TOP direct measured: 161.2 ± 11.1). However, TOP estimation was insufficient to produce complete occlusion in two out of 17 subjects (11.8%). In conclusion, the estimation of TOP incorporating SBP values may offer a valid and practical means for cuff administration during IPC protocols with potential to minimize adverse effects and maximize its positive effects.

On the functional capacity and quality of life of patients with acromegaly: are they candidates for rehabilitation programs?

[Purpose] This study compared patients having active acromegaly with those having controlled acromegaly in terms of peripheral muscle strength, body composition, and functional capacity. We also examined the associations between these measures. [Methods] A total of 14 patients with active acromegaly, 12 patients with controlled acromegaly, and 12 healthy controls were subjected to isometric dynamometry, surface electromyography, electrical bioimpedance, and a six-minute walk test. [Results] The active acromegaly group exhibited significantly more fat-free mass than the control group. With respect to the peripheral muscle performance, the controlled acromegaly group presented a significantly lower electromyographic median frequency than the control group. The quadriceps maximum strength was significantly lower in the controlled acromegaly group than in the control group. The fat-free mass was significantly correlated with the quadriceps maximum strength. The global scores of the Acromegaly Quality of Life Questionnaire were significantly correlated with the six-minute walk distance. [Conclusion] Patients with acromegaly have more fat-free mass, less peripheral muscle strength, and greater fatigability than healthy control subjects. These findings depend on the degree of hormonal control. In acromegalic patients, peripheral muscle strength is related to body composition, and functional capacity is correlated with quality of life.

Effects of transcutaneous electrical diaphragmatic stimulation in critically ill elderly patients: a randomized controlled trial.

BACKGROUND: Elderly patients under invasive mechanical ventilation (IMV) are more susceptible to muscle weakness. In the out-of-hospital environment, there are benefits to transcutaneous electrical diaphragmatic stimulation (TEDS), which is an easy-to-apply and low-cost technique. OBJECTIVE: To evaluate the effect of TEDS on respiratory muscle strength, diaphragm thickness (DT), and IMV time in critically ill elderly patients. METHODS: This was a randomized controlled trial in which patients were divided into an experimental group (EG) and a control group (CG). TEDS started 24 h after orotracheal intubation and lasted until the end of weaning. Both groups underwent the following assessments during the spontaneous breathing test after weaning from mechanical ventilation (MV): measurement of respiratory muscle strength by pressure gauge, analysis of DT by lung ultrasound, and extubation failure prevention checklist. RESULTS: There were 23 participants in the EG and 21 in the CG. The median age was 66 (60-79) years. The mean values of the diaphragmatic thickening index in the EG and CG participants were 99.13 ± 26.75 and 66.88 ± 31.77, respectively (p = .001, Cohen's d = 1.094). The mean values of maximum inspiratory pressure in the EG and CG were 22.04 ± 3.41 and 19.34 ± 4.23 cmH2O, respectively (p = .005, Cohen's d = 0.698). The Tobin index and the integrative weaning index were similar between groups (p = .584 and p = .102, respectively). The duration of MV in the EG and CG was 6.28 ± 2.68 and 9.21 ± 2.76 days, respectively (p = .001, Cohen's d = -1.075). CONCLUSION: Critically ill elderly patients receiving TEDS had shorter MV time, greater inspiratory muscle strength, and greater diaphragmatic contraction capacity according to their thickness fraction.

Immediate Hemodynamic Responses to Transcutaneous Electrical Diaphragmatic Stimulation in Critically Ill Elderly Patients.

BACKGROUND: Critically ill patients admitted to intensive care units (ICUs) may develop diaphragmatic dysfunction, especially when artificial airways are used. Positive effects have been observed when using the transcutaneous electrical diaphragmatic stimulation (TEDS) technique in different clinical conditions. However, no study has evaluated the safety of TEDS in patients admitted to ICUs. This study is aimed at evaluating the influence of TEDS on the hemodynamic and vital parameters of critically ill elderly patients under invasive mechanical ventilation (IMV). METHODS: Forty-seven patients aged >60 years under IMV were evaluated for hemodynamic variables before and after TEDS. The procedure lasted 30 minutes and was performed once. RESULTS: The sample consisted of 33 men and 14 women with a mean age of 69.9 ± 7.64 years. The mean systolic blood pressures pre-TEDS and post-TEDS were 126.6 ± 23.7 and 122.9 ± 25.9, respectively (p = 0.467). The mean diastolic blood pressures pre-TEDS and post-TEDS were 71.1 ± 12.2 and 67.7 ± 14.2, respectively (p = 0.223). No significant differences in the mean arterial pressure or heart rate were found between the pre-TEDS and post-TEDS time points (p = 0.335 and p = 0.846, respectively). CONCLUSION: Our findings suggest that TEDS does not have clinically relevant impacts on hemodynamic or vital parameters in critically ill elderly patients. These findings point to the possible safety of TEDS application in this population.

Abdominal ultrasound augments the medical students' ability to identify free intraabdominal fluid.

OBJECTIVE: Free intra-abdominal fluid describes an accumulation of free fluid in the peritoneal cavity. It has different etiologies, but it frequently constitutes a meaningful clinical sign. In this study, the authors interrogate whether abdominal ultrasound augments the medical students' ability to identify free intra-abdominal fluid. METHODS: Thirty-one medical students without any previous formal ultrasound training were subjected to cognitive assessment before and after four and a half-hour of theoretical lecture and hands-on course about the diagnosis of free intra-abdominal fluid by physical examination and abdominal ultrasound. The hands-on sessions were done in healthy volunteers with a simulated peritoneal catheter and in patients treated with peritoneal dialysis with different amounts of dialysate in their cavity. RESULTS: The cognitive assessment before and after the course increased from 6.7±2.3 to 11.6±1.1 points (p<0.0001). The sensitivity, specificity, and accuracy in the diagnosis of free intra-abdominal fluid were higher when students used abdominal ultrasound. The students agree with the inclusion of abdominal ultrasound in the diagnose of free intra-abdominal fluid in the undergraduate curriculum. CONCLUSIONS: This study demonstrates that incorporating abdominal ultrasound is feasible and improves medical students' short-time competency in performing and interpreting the findings diagnostic of free intra-abdominal fluid.

Teaching point-of-care transfontanellar ultrasound for pediatricians and medical students.

OBJECTIVES: The authors aim to evaluate the "point-of-care" transfontanellar ultrasound (TU) as an extension to pediatric physical examination and suggest a TU teaching protocol. METHODS: The students were randomly divided into two groups, group A (12 participants) and group B (15 participants). The first group only received theoretical training, while the second group received theoretical and practical training. A third group, group C, included 15 pediatricians and interns who also received theoretical and practical training. All the participants underwent multiple-choice testing before and after a four-hour short course on TU. Six months later, another evaluation was performed to analyze the retained knowledge. Furthermore, a questionnaire based on the Likert scale was administered to evaluate satisfaction. RESULTS: The cognitive evaluation (maximum score=10 points) before and after training increased in group A from 4,0±1,04 to 7,5±1,2 (p<0.001) and, 6 months later, to 6,5±1,16 (p<0.003); in group B from 3,8±1,24 to 8,8±1,01 (p<0.001) and, 6 months later, to 8,46±0,91 (p<0.001); and in group C from 6,0±0,75 to 9,0±0,75 (p<0.001) and, 6 months later, to 8,8±0,77 (p<0.001). The average satisfaction estimated by the Likert scale was over 80% for all questions. CONCLUSION: Cognitive assessment before and after classes and training reveals progress in learning, with knowledge retention in 6 months. Theoretical-practical courses are well accepted.

Cerebellar infarction after sneezing.

Vertebral Artery Dissection (VAD) is a rare condition that can be caused by a wide amplitude of neck movement, which injures the vessel wall and can cause ischemia in the cerebellum. We present a 37-year-old man with herniated lumbar disc and allergic rhinosinusitis, which caused sneezing spells. After one of these bouts with a ricochet of the head, he presented C3 misalignment with local pain. Twenty-one days later, affected by a new crisis, he presented left temporal headache, nystagmus, and vertigo. After 3 days, Magnetic Resonance Imaging (MRI) identified 2 regions of cerebellar ischemia and filling failure of the right vertebral artery. After 2 days, Computed Angiotomography (CT Angiography) was performed and showed right VAD with a local thrombus, without aneurysmal signs. Transcranial Doppler did not indicate an increase in blood flow from this artery. The suggested treatment involved administration of anticoagulant Apixabana 5mg, 12/12h, for 3 months, until the condition was reevaluated with new Angio CT and MRI. It was recommended that the patient was released from work for 1 month and forbidden from doing intense physical exercises for 3 months; however, due to setbacks, these deadlines were extended until a new appointment, 4 months after the first visit. The new tests showed no changes, indicating that the condition was stable. This case aims to indicate the possible investigations of the diagnosis and therapeutic options of the rare association between VAD with cerebellar infarction in a well-documented case.

Predictors of surgical outcome and early criteria of remission in acromegaly.

BACKGROUND: Transsphenoidal surgery (TSS) is the cornerstone of acromegaly treatment, however there are no robust predictors of surgical outcome and remission can only be defined three months after surgery. PURPOSE: To analyze if biochemical, demographical, radiological, and immunohistochemical characteristics are predictors of surgical remission and investigate if immediate postoperative GH and IGF-I levels can help defining remission earlier. METHODS: Consecutive acromegaly patients submitted to TSS between 2013-2016 were evaluated. Remission criteria was defined as normal IGF-I and GH <1 mcg/L three months after surgery. Data of age, sex, GH and IGF-I levels, tumor volume, cavernous sinus invasion, T2-weighted signal, Ki-67, and granulation pattern were correlated with remission status. GH and IGF-I levels at 24, 48 h, and one week postoperative were evaluated as early criteria of remission. RESULTS: Sixty-nine patients were included (84% macroadenomas) and surgical remission was achieved in 45%. No difference between cured and not cured patients concerning age, gender, preoperative GH or IGF-I levels, tumor volume, T2-weighted signal, Ki-67 and tumor granularity was observed. Remission was obtained in 20 of 36 (56%) of the non-invasive tumors, and in 3 of 16 (19%) of the invasive tumors (p = 0.017). A GH <1.57 mcg/L 48 h after surgery was able to predict remission with 93% sensitivity and 86% specificity and an IGF-I < 231% ULNR one week after surgery predicted remission with 86% sensitivity and 93% specificity. CONCLUSION: Cavernous sinus invasion is the only preoperative predictor of surgical remission. GH at 48 h and IGF-I one week after surgery can define earlier not cured patients.

Computed tomography airway lumen volumetry in patients with acromegaly: Association with growth hormone levels and lung function.

INTRODUCTION: The segmentation and skeletonisation of images via computed tomography (CT) airway lumen volumetry provide a new perspective regarding the incorporation of this technique in medical practice. Our aim was to quantify morphological changes in the large airways of patients with acromegaly through CT and, secondarily, to correlate these findings with hormone levels and pulmonary function testing (PFT) parameters. METHODS: This was a cross-sectional study in which 28 non-smoker patients with acromegaly and 15 control subjects underwent CT analysis of airway lumen volumetry with subsequent image segmentation and skeletonisation. Moreover, all participants were subjected to PFT. RESULTS: Compared with the controls, patients with acromegaly presented higher diameters in the trachea, right main bronchus and left main bronchus. The patients with acromegaly also showed a higher tracheal sinuosity index (the deviation of a line from the shortest path, calculated by dividing total length by shortest possible path) than the controls [1.06 (1.02-1.09) vs. 1.03 (1.02-1.04), P = 0.04], and tracheal stenosis was observed in 25% of these individuals. The tracheal area was correlated with the levels of growth hormone (rs  = 0.45, P = 0.02) and insulin-like growth factor type I (rs  = 0.38, P = 0.04). The ratio between the forced expiratory flow and forced inspiratory flow at 50% of the forced vital capacity was correlated with the tracheal area (rs  = 0.36, P = 0.02) and Δ tracheal diameters (rs  = 0.58, P < 0.0001). CONCLUSION: Patients with acromegaly exhibit tracheobronchomegaly and tracheal sinuosity/stenosis. Moreover, there are associations between the results of CT airway lumen volumetry, hormone levels and functional parameters of large airway obstruction.

Functional changes are associated with tracheal structural abnormalities in patients with acromegaly.

INTRODUCTION: Although impaired pulmonary function and respiratory sleep disorders are described as responsible for increased mortality in acromegalic patients, little is known about the tracheal abnormalities in this group of patients. Thus, the objectives of this study were to describe the tracheal structural abnormalities and correlate these changes with the respiratory function and clinical data of acromegalic patients. MATERIAL AND METHODS: This is a cross-sectional study that was carried out at two university hospitals. Twenty acromegalic patients underwent spirometry, forced oscillation technique, and computed tomography (CT) assessments. Dyspnea and daytime sleepiness were assessed using the Modified Medical Research Council (MMRC) scale and the Epworth Sleepiness Scale (ESS), respectively. Forty matched subjects served as controls. RESULTS: The acromegalic patients exhibited larger median ratios between forced expiratory flow and forced inspiratory flow at 50% of the forced vital capacity (FEF50%/FIF50%) (2.05 vs. 1.06, p = 0.0001) compared with healthy volunteers. In the CT analysis, acromegalic patients exhibited larger median differences between their cervical and thoracic tracheal diameters (Δ tracheal diameters) (3 vs. 1 mm; p = 0.003). An association was found between FEF50%/FIF50% and the following variables: mean resistance (Rm), cervical tracheal diameter, and Δ tracheal diameters. Rm also exhibited a negative correlation with cervical tracheal diameter. Neither the MMRC scale nor the ESS exhibited any significant correlation with large airway obstruction (LAO) indices or with the measured tracheal diameters. CONCLUSIONS: Acromegalic patients have tracheal structural abnormalities which are associated with functional indicators of LAO but not with clinical data.

Teaching point-of-care transfontanellar ultrasound for pediatricians and medical students

Abstract Objectives: The authors aim to evaluate the ''point-of-care'' transfontanellar ultrasound (TU) as an extension to pediatric physical examination and suggest a TU teaching protocol. Methods: The students were randomly divided into two groups, group A (12 participants) and group B (15 participants). The first group only received theoretical training, while the second group received theoretical and practical training. A third group, group C, included 15 pediatricians and interns who also received theoretical and practical training. All the participants underwent multiple-choice testing before and after a four-hour short course on TU. Six months later, another evaluation was performed to analyze the retained knowledge. Furthermore, a questionnaire based on the Likert scale was administered to evaluate satisfaction. Results: The cognitive evaluation (maximum score = 10 points) before and after training increased in group A from 4,0 ± 1,04 to 7,5 ± 1,2 (p < 0.001) and, 6 months later, to 6,5 ± 1,16 (p < 0.003); in group B from 3,8 ± 1,24 to 8,8 ± 1,01 (p < 0.001) and, 6 months later, to 8,46 ± 0,91 (p < 0.001); and in group C from 6,0 ± 0,75 to 9,0 ± 0,75 (p < 0.001) and, 6 months later, to 8,8 ± 0,77 (p < 0.001). The average satisfaction estimated by the Likert scale was over 80% for all questions. Conclusion: Cognitive assessment before and after classes and training reveals progress in learning, with knowledge retention in 6 months. Theoretical-practical courses are well accepted.

Anatomia radiológica vascular e desenvolvimento de plataformas de ensino interativo / Vascular radiological anatomy and the development of interactive teaching platforms

Anatomia e Radiologia são disciplinas amplamente presentes nas grades curriculares de cursos da área da saúde. A interseção entre a Anatomia Radiológica e as tecnologias recentes, como plataformas de ensino interativo, caracteriza-se como uma tendência a ser seguida na esfera educacional, sendo as implicações desse processo ainda não muito debatidas. O Departamento de Anatomia da Universidade Federal de Juiz de Fora iniciou o desenvolvimento de um atlas de anatomia vascular radiológica, o qual apresenta versões impressa e interativa. Possui imagens de angiotomografias computadorizadas feitas em aparelhos multislice de 16 a 128 canais, sendo as imagens de arquivo pessoal dos organizadores. O atlas promove a identificação das estruturas vasculares em questão e propicia a integração do conhecimento adquirido em salas de aula com a visualização de exames de imagem complementares rotineiros. A indiscutível presença de exames de imagem adicionais na rotina dos profissionais da saúde atuais faz com que seja válida a estratégia de integração entre o método tradicional de ensino e as práticas ativas de aprendizagem, as quais vêm ganhando destaque recentemente, devido a sua efetividade na fixação de conhecimentos.

Anatomy and Radiology are subjects widely present in health courses at universities. The intersection between Radiological Anatomy and recent technologies, such as interactive teaching platforms, is characterized as a tendency to be followed in the educational sphere, and the implications of this process are not much debated. The Department of Anatomy of Juiz de Fora Federal University has begun the development of an atlas of radiological vascular anatomy, which features printed and interactived versions. It presents computed tomography images taken on multislice devices from 16 to 128 channels, and the images are from the personal authors' archives. The Radiologic Vascular Atlas provides the identification of vascular structures in study and makes easier the integration of knowledge acquired in classrooms with the visualization of routine complementary imaging exams. The indisputable presence of complementary imaging examinations in the routine of current health professionals makes valid the strategy of integration between the traditional teaching method and active learning practices, which have recently gained prominence, due to its effectiveness in setting knowledge.

Cerebellar infarction after sneezing

SUMMARY Vertebral Artery Dissection (VAD) is a rare condition that can be caused by a wide amplitude of neck movement, which injures the vessel wall and can cause ischemia in the cerebellum. We present a 37-year-old man with herniated lumbar disc and allergic rhinosinusitis, which caused sneezing spells. After one of these bouts with a ricochet of the head, he presented C3 misalignment with local pain. Twenty-one days later, affected by a new crisis, he presented left temporal headache, nystagmus, and vertigo. After 3 days, Magnetic Resonance Imaging (MRI) identified 2 regions of cerebellar ischemia and filling failure of the right vertebral artery. After 2 days, Computed Angiotomography (CT Angiography) was performed and showed right VAD with a local thrombus, without aneurysmal signs. Transcranial Doppler did not indicate an increase in blood flow from this artery. The suggested treatment involved administration of anticoagulant Apixabana 5mg, 12/12h, for 3 months, until the condition was reevaluated with new Angio CT and MRI. It was recommended that the patient was released from work for 1 month and forbidden from doing intense physical exercises for 3 months; however, due to setbacks, these deadlines were extended until a new appointment, 4 months after the first visit. The new tests showed no changes, indicating that the condition was stable. This case aims to indicate the possible investigations of the diagnosis and therapeutic options of the rare association between VAD with cerebellar infarction in a well-documented case.

RESUMO A Dissecção da Artéria Vertebral (DAV) é quadro raro que pode ser causado por movimentação de grande amplitude do pescoço, que lesiona a parede desse vaso, podendo provocar isquemia no cerebelo. Apresentamos um homem de 37 anos, com hérnia de disco e rinossinusite alérgica que lhe causava crises de espirros em salva (CE). Após uma dessas crises com ricocheteamento da cabeça, apresentou desalinhamento de C3 com dor local. Vinte e um dias depois, acometido por nova crise, apresentou cefaleia temporal esquerda, nistagmo e vertigem. Decorridos 3 dias, o paciente foi submetido a Ressoânncia Magnética (RM), que identificou 2 regiões de isquemia cerebelar e enchimento comprometido da artéria vertebral direita. Após 2 dias, foram feitos Angiotomografia Computadorizada (Angio TC), que constatou DAV direita com trombo local, sem sinais aneurismáticos, e Doppler Transcraniano, que não indicou aumento do fluxo sanguíneo dessa artéria. O tratamento sugerido envolvia administração de anticoagulante Apixabana 5mg, 12/12h, por 3 meses, até que o quadro fosse reavaliado com novas Angio TC e RM. Foi recomendado que o paciente ficasse afastado do trabalho por 1 mês e de exercícios físicos intensos por 3 meses, porém devido a contratempos, esses prazos foram prorrogados até nova consulta, 4 meses após a primeira. Os novos exames não apresentaram alterações, indicando que o quadro estava estável. Esse caso tem como objetivo indicar as possíveis investigações do diagnóstico e opções terapêuticas da rara associação entre DAV com infarto cerebelar em caso bem documentado.

Análise das ligas acadêmicas de medicina sob a perspectiva dos alunos / Analysis of academic medical leagues from the students' perspective

Objetivo: analisar as ligas acadêmicas de medicina (LAM) estruturadas e em funcionamento em instituição de ensino superior como estratégias de ensino e aprendizagem, considerando o perfil e verificar se as atividades promovidas pelas LAM estão alinhadas com a medicina baseada em evidências. Métodos: estudo descritivo, do tipo transversal, aprovado pelo Comitê de Ética da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora. Participaram como sujeitos da pesquisa estudantes do último ano de medicina e médicos recém-formados no ano de 2018. Essa amostragem não probabilística teve como finalidade a avaliação da influência das LAM na formação médica. Resultados: oito (5,9%) entrevistados não participaram de qualquer LAM. Observou-se que 31 (24,2%), 49 (38,3%) e 38 (29,7%) participaram de uma, duas ou três LAM, respectivamente. A maioria participou de LAM do terceiro ao oitavo período, porém em todos os períodos houve participação de algum aluno. Para 50 (39,1%) entrevistados, as LAM ajudaram de alguma forma para confirmar a escolha da área da residência, já para 53 (41,4%) deles, elas ajudaram na exclusão da área para a residência. Nota-se, ainda, que 117 (91,4%) dos que participaram de LAM acharam a experiência válida para a formação acadêmica. Conclusões: a maior parte dos alunos atualmente participam de ligas; há enorme interesse em participar de diretoria de LAM e estágios extracurriculares; as LAM contribuem para a escolha da futura especialidade; os estudantes veem neces-sidade na regulamentação das LAM; a avaliação global é de que a experiência é válida para a formação médica. O tema ligas acadêmicas é de enorme relevância atualmente em virtude da extensa participação dos estudantes nessas atividades. A educação em saúde visa compreender a importância dessas entidades para garantir o maior êxito possível no ensino, na pesquisa e na extensão.

Aims: the objective was to analyze the structured and functioning of academic medical leagues (AML) in higher education institution as teaching and learning strategies, considering the profile and to verify if the activities promoted by the AML are aligned with the evidence-based medicine. Methods: descriptive, cross-sectional study, approved by the Ethics Committee of the Faculty of Medical and Health Sciences of Juiz de Fora. Medical students and newly graduated physicians participated in the research in 2018. This non-probabilistic sampling aimed to evaluate the influence of AML on medical education. Results: eight respondents did not participate in AML (5.9% of the sample). 31 (24.2%), 49 (38.3%) and 38 (29.7%) participated in one, two or three AML, respectively. Most participated in AML from the third to the eighth period, but in all periods, there was participation. For 50 (39.1%) of respondents, the AML helped in some way to confirm the choice of area of residence, while for 53 (41.4%) of them, AML helped to exclude the area for residence. It is also noted that 117 (91.4%) of those who participated in AML found the experience valid for academic education. Conclusions: thus, most students currently participate in leagues; There is tremendous interest in attending AML board and extracurricular internships; AML contribute to the choice of future specialty; Students needs AML regulation; The overall assessment is that experience is valid for medical education. The academic leagues theme is of enormous relevance today because of the extensive participation of students in these activities. Health education aims to understand the importance of these entities to ensure the greatest possible success in teaching, research, and extension.

Posture and balance control in patients with acromegaly: results of a cross-sectional study.

Acromegaly is a chronic debilitating disease that presents with multiple systemic manifestations, including changes in body composition, joint abnormalities, muscular impairment and visual disturbances. This study aimed to assess posture and body balance in acromegalic patients and to establish the correlation between these measures. Twenty-eight acromegalic patients and a similar number of control subjects matched for sex, age, weight, height and body mass index underwent postural evaluation using the photogrammetry and measurement of balance using the stabilometry in two tasks: feet apart, eyes open and feet together, eyes closed. In comparison with the control group, the acromegalic group presented postural deviations in lateral views in the vertical alignment of the trunk (P=0.001 for the right side and P=0.021 for the left), the hip angle (P=0001 for the right side and P=0.016 for the left side) and horizontal alignment of the pelvis (P=0.017 for the right and P<0.001 for the left side). Compared with healthy subjects, the acromegalic patients presented displacement of the centre of pressure in both the anterior-posterior direction and the medial-lateral direction in both evaluated tasks. We observed significant correlations between balance measures and the following posture evaluation variables: distance between the lower limbs, horizontal alignment of the head and vertical alignment of the head. Our results suggest that posture and balance need to be evaluated for acromegalic patients in clinical practice, as there are significant postural imbalances and deviations in these patients.

Burkitt lymphoma with initial clinical presentation due to infiltration of the central nervous system and eye orbits.

BACKGROUND: Burkitt lymphoma rarely affects the central nervous system and ocular region. Under these conditions, computed tomography and (particularly) magnetic resonance imaging of the skull increase the diagnostic accuracy, as they objectively show the topography of lesions and the effect of neoplasia on structures. CASE REPORT: We report here the case of a 17-year-old male whose initial clinical manifestations were related to neurological impairment and to the ocular musculature and ocular innervation. The diagnosis of Burkitt lymphoma with leukemization and infiltration of the central nervous system was confirmed. CONCLUSIONS: In this case, it is important to recognize that the neuroimaging findings were fundamentally important in indicating the initial form of the disease and in directing the appropriate clinical management.

Differential diagnoses of overgrowth syndromes: the most important clinical and radiological disease manifestations.

Overgrowth syndromes comprise a heterogeneous group of diseases that are characterized by excessive tissue development. Some of these syndromes may be associated with dysfunction in the receptor tyrosine kinase (RTK)/PI3K/AKT pathway, which results in an increased expression of the insulin receptor. In the current review, four overgrowth syndromes were characterized (Proteus syndrome, Klippel-Trenaunay-Weber syndrome, Madelung's disease, and neurofibromatosis type I) and illustrated using cases from our institution. Because these syndromes have overlapping clinical manifestations and have no established genetic tests for their diagnosis, radiological methods are important contributors to the diagnosis of many of these syndromes. The correlation of genetic discoveries and molecular pathways that may contribute to the phenotypic expression is also of interest, as this may lead to potential therapeutic interventions.