Coronary Angiography, Intravascular Ultrasound, and Optical Coherence Tomography for Guiding of Percutaneous Coronary Intervention: A Systematic Review and Network Meta-Analysis.

BACKGROUND: Results from multiple randomized clinical trials comparing outcomes after intravascular ultrasound (IVUS)- and optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) with invasive coronary angiography (ICA)-guided PCI as well as a pivotal trial comparing the 2 intravascular imaging (IVI) techniques have provided mixed results. METHODS: Major electronic databases were searched to identify eligible trials evaluating at least 2 PCI guidance strategies among ICA, IVUS, and OCT. The 2 coprimary outcomes were target lesion revascularization and myocardial infarction. The secondary outcomes included ischemia-driven target lesion revascularization, target vessel myocardial infarction, death, cardiac death, target vessel revascularization, stent thrombosis, and major adverse cardiac events. Frequentist random-effects network meta-analyses were conducted. The results were replicated by Bayesian random-effects models. Pairwise meta-analyses of the direct components, multiple sensitivity analyses, and pairwise meta-analyses IVI versus ICA were supplemented. RESULTS: The results from 24 randomized trials (15 489 patients: IVUS versus ICA, 46.4%, 7189 patients; OCT versus ICA, 32.1%, 4976 patients; OCT versus IVUS, 21.4%, 3324 patients) were included in the network meta-analyses. IVUS was associated with reduced target lesion revascularization compared with ICA (odds ratio [OR], 0.69 [95% CI, 0.54-0.87]), whereas no significant differences were observed between OCT and ICA (OR, 0.83 [95% CI, 0.63-1.09]) and OCT and IVUS (OR, 1.21 [95% CI, 0.88-1.66]). Myocardial infarction did not significantly differ between guidance strategies (IVUS versus ICA: OR, 0.91 [95% CI, 0.70-1.19]; OCT versus ICA: OR, 0.87 [95% CI, 0.68-1.11]; OCT versus IVUS: OR, 0.96 [95% CI, 0.69-1.33]). These results were consistent with the secondary outcomes of ischemia-driven target lesion revascularization, target vessel myocardial infarction, and target vessel revascularization, and sensitivity analyses generally did not reveal inconsistency. OCT was associated with a significant reduction of stent thrombosis compared with ICA (OR, 0.49 [95% CI, 0.26-0.92]) but only in the frequentist analysis. Similarly, the results in terms of survival between IVUS or OCT and ICA were uncertain across analyses. A total of 25 randomized trials (17 128 patients) were included in the pairwise meta-analyses IVI versus ICA where IVI guidance was associated with reduced target lesion revascularization, cardiac death, and stent thrombosis. CONCLUSIONS: IVI-guided PCI was associated with a reduction in ischemia-driven target lesion revascularization compared with ICA-guided PCI, with the difference most evident for IVUS. In contrast, no significant differences in myocardial infarction were observed between guidance strategies.

DDS-SIRC Cooperative Conferences Feel the Burn: RFA for Chronic Radiation Proctitis.

Chronic radiation proctitis, although relatively rare, can be the source of severe comorbidity in patients who had undergone prior radiotherapy for pelvic malignancy. Although current treatments for radiation proctitis include argon plasma coagulation, heater probe, bipolar neodymium/yttrium aluminum garnet (Nd: YAG) lasers, these interventions are often burdened by the frequent occurrence of rectal ulcerations and stenosis. Since radiofrequency ablation (RFA) is frequently used to ablate esophageal malignancy and pre-malignancy, we report the efficacy of RFA using through the scope system in two patients with rectal bleeding due to radiation proctitis. In both cases, the procedure was well-tolerated with hemostasis achieved after 1 or 2 sessions of RFA. Mucosal re-epithelialization was observed in areas of previous bleeding with no stenosis or ulceration observed at follow-up.

Antithrombotic strategies for preventing graft failure in coronary artery bypass graft.

Coronary artery bypass graft (CABG) procedures face challenges related to graft failure, driven by factors such as acute thrombosis, neointimal hyperplasia, and atherosclerotic plaque formation. Despite extensive efforts over four decades, the optimal antithrombotic strategy to prevent graft occlusion while minimizing bleeding risks remains uncertain, relying heavily on expert opinions rather than definitive guidelines. To address this uncertainty, we conducted a review of randomized clinical trials and meta-analyses of antithrombotic therapy for patients with CABG. These studies examined various antithrombotic regimens in CABG such as single antiplatelet therapy (aspirin or P2Y12 inhibitors), dual antiplatelet therapy, and anticoagulation therapy. We evaluated outcomes including the patency of grafts, major adverse cardiovascular events, and bleeding complications and also explored future perspectives to enhance long-term outcomes for CABG patients. Early studies established aspirin as a key component of antithrombotic pharmacotherapy after CABG. Subsequent randomized controlled trials focused on adding a P2Y12 inhibitor (such as clopidogrel, ticagrelor, or prasugrel) to aspirin, yielding mixed results. This article aims to inform clinical decision-making and guide the selection of antithrombotic strategies after CABG.

Epidemiology and Clinical impact of single and multi-viral respiratory infections in post-pandemic era.

Acute respiratory tract infections (ARI) are common diseases in children and adults and could cause severe infections in high-risk patients, like the immunocompromised and elderly, and are the leading cause of morbidity, hospitalization and mortality. This study aimed to explore the prevalence of respiratory viruses and the clinical impact of single- and multi-infection among hospitalized patients in various age groups. 3578 nasopharyngeal swabs (NPS) were analyzed for pathogen detection of acute respiratory tract infections. 930 out of 3578 NPS were diagnosed positive for at least one respiratory virus. The distribution of viral infections, prevalence and pathogen, differed significantly among age groups. Most RTI are observed in the age group over 65 years (50.6%) with a high SARS-CoV2 prevalence, following by group <5 years (25.6%), where the most frequently detected viruses were RSV, Rhinovirus, FluA-H3, MPV, and AdV. The co-infection rate also varies according to age and, in some cases, especially in older adults, could have severe clinical impact. This study emphasizes that it is important to know and analyze, in all age groups of hospitalized patients, the epidemiology of respiratory viruses, the prevalence of coinfections, and the clinical impact of various pathogens. Furthermore, in a clinical setting, the rapid diagnosis of respiratory infections by means of molecular tests is crucial not only to avoid hospital outbreaks, but also to allow early and optimal treatment to reduce morbidity and mortality.

P2Y12 Inhibitor Monotherapy: Considerations for Acute and Long-Term Secondary Prevention Post-PCI.

Following percutaneous coronary intervention (PCI), an initial course of dual antiplatelet therapy (DAPT) with aspirin and a P2Y 12 inhibitor ( P2Y 12 -i) is recommended to minimize the risk of thrombotic complications. After the initial period of DAPT, antiplatelet monotherapy, usually consisting of aspirin, is administered for long-term secondary prevention. However, over the last few years there has been accruing evidence on P2Y 12 -i monotherapy, both in the acute (i.e., post-PCI; after a brief period of DAPT, transitioning to monotherapy before six or 12 months in patients with chronic or acute coronary syndrome, respectively) and chronic (i.e., long-term secondary prevention; after completion of six or 12 months of DAPT, in patients with chronic or acute coronary syndrome, respectively) settings. In aggregate, most studies of short DAPT with transition to P2Y 12 -i monotherapy showed a reduced risk of bleeding complications, without any significant increase in ischemic events as compared to standard DAPT. On the other hand, the evidence on long-term P2Y 12 -i monotherapy is scarce, but results from a randomized trial showed that clopidogrel monotherapy outperformed aspirin monotherapy in terms of net benefit, ischemic events and bleeding. Antiplatelet therapy is also recommended for patients undergoing PCI and with an established indication for long-term oral anticoagulation (OAC). In this scenario, a brief period of triple therapy (i.e., aspirin, P2Y 12 -i and OAC) is followed by a course of dual antithrombotic therapy (usually with P2Y 12 -i and OAC) and ultimately by lifelong OAC alone. European and American guidelines have been recently updated to provide new recommendations on antithrombotic therapy, including the endorsement of P2Y 12 -i monotherapy in different settings. However, some areas of uncertainty still remain and further randomized investigations are ongoing to fulfil current gaps in knowledge. In this review, we assess the current knowledge and evidence on P2Y 12 -i monotherapy for the early and long-term secondary prevention in patients undergoing PCI, and explore upcoming research and future directions in the field.

Spontaneous pneumomediastinum associated with subcutaneous emphysema, pneumopericardium and pneumothorax: a rare association complicating measles.

A unique case of severe measles complicated by multiple features of gas accumulation is described, on the ground of the available literature evidences. Complications from measles have been reported in every organ system and they may vary by age and underlying conditions. Pneumomediastinum is usually associated with subcutaneous emphysema and pneumopericardium, but rarely associated with pneumothorax. We report extremely rare simultaneous occurrence of self-limiting pneumomediastinum, pneumopericardium, subcutaneous neck and chest region emphysema, and pneumothorax, in a 19-year-old girl with measles. A review of the literature has documented only one previous report of spontaneous pneumomediastinum, subcutaneous emphysema and pneumothorax in the course of measles, and no previous cases reported the association of pneumomediastinum, subcutaneous emphysema, pneumopericardium and pneumothorax complicating measles.

Exploring the impact of cardiologists expertise on publication metrics.

BACKGROUND: In the field of academic cardiology, the assessment of an author's scholarly impact and professional progression heavily relies on publications and citations. This study investigates whether specific cardiology expertise correlates with accelerated professional growth. METHODS: Using data from the 2023 European Society of Cardiology congress, 948 faculty attendees with an h-index of 30 or higher were analyzed. Expertises were categorized into six groups, and their association with publications and citations peaks was explored. RESULTS: Interventional cardiologists exhibited the highest annual publication peak, followed by imaging and electrophysiology experts. However, no significant differences were observed in citation peaks among expertise groups. While imaging experts initially appeared to reach citation peaks faster, this effect diminished after statistical adjustments. Additionally, holding multiple expertise areas prolonged the time to reach publication and citation peaks by approximately six years. CONCLUSION: This study underscores the influence of expertise in interventional cardiology on publication peaks but suggests that citation peaks and career progression velocity remain unaffected by expertise type. Furthermore, it highlights that holding multiple areas of expertise slowers the attainment of career peak for scholarly authors.

Trueness and precision of an intraoral scanner on abutments with subgingival vertical margins: An in vitro study.

OBJECTIVES: This study aimed to evaluate the accuracy of an intraoral scanner (IOS - Medit i700) on tooth abutments with vertical preparations at 2 depths below the free gingival margin, and to determine if the IOS can reproduce the area beyond the finish surface of the tested preparation geometry. METHODS: Two abutments for a maxillary first molar were designed by means of CAD software, with vertical preparations set at 1 and 2 mm below the gingiva. These abutments were subsequently printed in resin and placed on a reference model. The reference files consisted of scans made using a metrological machine on these abutments. Ten scans were made with the tested IOS on each sample, resulting in two study groups. The scans from the experimental groups were labeled "V-1″ for vertical preparation at 1 mm below the gingival margin and "V-2″ for 2 mm below. The analysis of these scans was performed using Geomagic Control X (3D SYSTEMS) to assess their trueness and precision in µm. Descriptive statistics with a 95 % confidence interval were employed, alongside independent sample tests, to ascertain any differences between the groups (α=0.05). RESULTS: Statistically significant differences were not found both for trueness (p=.104) and precision (p=.409), between the tested geometries. The mean values for trueness were V-1 = 37.5[31.4-43.6]; V-2 = 32.6[30.6-34.6]. About the precision, the mean values were V-1 = 20.5[8.4-32.5]; V-2 = 18.4[8.2-28.5]. In both the study groups, it was possible to detect the surface beyond the finish area. CONCLUSIONS: Within the limitations of this study, vertical preparation design allows for registration of the tooth anatomy beyond the finish area with IOS. Moreover, the mean accuracy values were clinically acceptable at both 1 and 2 mm below the gingival margin.

Influence of different palatal morphologies on the accuracy of intraoral scanning of the edentulous maxilla: A three-dimensional analysis.

PURPOSE: This study investigated the influence of different palatal morphologies on the accuracy of intraoral scanning (TRIOS 4) of edentulous maxillae. METHODS: Six typodonts were fabricated for different palatal morphologies with flat (F), medium (M), and deep (D) palates, with palatal wrinkles (W), or smooth palates (S), resulting in six groups: WF, WM, WD and SF, SM, SD. Ten scans were performed for each group; standard tessellation language files obtained were imported into a software to measure trueness and precision in micrometer. Trueness was calculated as the mean of the standard deviation values obtained by superimposing each scan onto the reference scan. Precision was achieved by overlapping each scan with that with the best trueness in the group. Descriptive and post-hoc analyses were conducted. RESULTS: The mean values for trueness were as follows: WM=48.7±4.7, WD=161.7±18.4, WF=85.9±16, SM=48.1±2.4, SD=349.9±8.8, and SF=349.1±25.5. The precision values were as follows: WM=46.7±7.3, WD=46.9±9, WF=48.9±6.7, SM=46±2.7, SD=105.9±17.4, SF=72.6±10.8. Significant differences were observed for trueness between SM and SD (P < 0.001), SM and SF (P < 0.001), and WF and SF (P = 0.003); whereas for precision, significant differences were reported between WD and SD (P = 0.015). Regarding trueness and precision, no difference was found between WM and SM (P = 1.0). CONCLUSIONS: Medium palatal depth showed the best accuracy. The mean accuracy values were within the clinical acceptability thresholds for all palatal morphologies. The presence of rugae improved the precision of deeper palates and the trueness of flat palates. No differences were observed in the medium palates with or without rugae.

Assessment of Noninferiority Margins in Cardiovascular Medicine Trials.

Background: Noninferiority trials are increasingly common in cardiovascular medicine, but their reporting and interpretation are challenging, particularly when an absolute risk difference is used as noninferiority margin. Objectives: This study aimed to investigate the effect of using absolute rather than relative noninferiority margins in cardiovascular trials. Methods: We reviewed noninferiority trials presented at major cardiovascular conferences from 2015 to 2022 and published within the same period. Based on the actual versus anticipated event rates in the control group, we recalculated the absolute noninferiority margin and re-assessed the trial results. The primary outcome of interest was the proportion of trials with a different interpretation after recalculation. Additionally, we analyzed the conclusion statements of these trials to determine if cautionary notes for the interpretation of study results were included. Results: We analyzed a total of 768 trials, of which 88 had a noninferiority design and 66 used an absolute noninferiority margin. Of 48 comparisons from 45 trials qualifying for the analysis, 11 (22.9%) had divergent results after recalculation of the absolute noninferiority margin based on the observed rather than anticipated event rate. Ten trials originally claiming noninferiority, did not meet it after the margin recalculation. All of them did not include statements suggesting cautionary interpretation of the study results in the conclusion section. Compared with the other trials, these displayed a larger median difference between anticipated and recalculated noninferiority margins (44.7% [IQR: 38.6%-56.7%] vs 15.3% [IQR: -1.5% to 28.9%]; P < 0.001). Conclusions: Recalculating noninferiority margins based on actual event rates, rather than anticipated ones, led to different outcomes in approximately 1 out of 4 cardiovascular trials, with most divergent trials lacking cautionary interpretation. These findings emphasize the importance of using or supplementing the relative noninferiority margin, particularly in studies with significant deviations between observed and expected event rates. This underscores the critical need for enhanced methodological and reporting standards in noninferiority trials, especially those employing absolute margins.

Percutaneous interventions for pulmonary embolism.

Pulmonary embolism (PE) ranks as a leading cause of in-hospital mortality and the third most common cause of cardiovascular death. The spectrum of PE manifestations varies widely, making it difficult to determine the best treatment approach for specific patients. Conventional treatment options include anticoagulation, thrombolysis, or surgery, but emerging percutaneous interventional procedures are being investigated for their potential benefits in heterogeneous PE populations. These novel interventional techniques encompass catheter-directed thrombolysis, mechanical thrombectomy, and hybrid approaches combining different mechanisms. Furthermore, inferior vena cava filters are also available as an option for PE prevention. Such interventions may offer faster improvements in right ventricular function, as well as in pulmonary and systemic haemodynamics, in individual patients. Moreover, percutaneous treatment may be a valid alternative to traditional therapies in high bleeding risk patients and could potentially reduce the burden of mortality related to major bleeds, such as that of haemorrhagic strokes. Nevertheless, the safety and efficacy of these techniques compared to conservative therapies have not been conclusively established. This review offers a comprehensive evaluation of the current evidence for percutaneous interventions in PE and provides guidance for selecting appropriate patients and treatments. It serves as a valuable resource for future researchers and clinicians seeking to advance this field. Additionally, we explore future perspectives, proposing "percutaneous primary pulmonary intervention" as a potential paradigm shift in the field.

Pharmacological and clinical appraisal of factor XI inhibitor drugs.

The evolution of anticoagulation therapy, from vitamin K antagonists to the advent of direct oral anticoagulants (DOACs) almost two decades ago, marks significant progress. Despite improved safety demonstrated in pivotal trials and post-marketing observations, persistent concerns exist, particularly regarding bleeding risk and the absence of therapeutic indications in specific subgroups or clinical contexts. Factor XI (FXI) has recently emerged as a pivotal contributor to intraluminal thrombus formation and growth, playing a limited role in sealing vessel wall injuries. Inhibiting FXI presents an opportunity to decouple thrombosis from haemostasis, addressing concerns related to bleeding events while safeguarding against thromboembolic events. Notably, FXI inhibition holds promise for patients with end-stage renal disease or cancer, where clear indications for DOACs are currently lacking. Various compounds have undergone design, testing, and progression to phase 2 clinical trials, demonstrating a generally favourable safety and tolerability profile. However, validation through large-scale phase 3 trials with sufficient power to assess both safety and efficacy outcomes is needed. This review comprehensively examines FXI inhibitors, delving into individual classes, exploring their pharmacological properties, evaluating the latest evidence from randomized trials, and offering insights into future perspectives.

One hundred thirty years of Dom Pedro II's death: "the emperor of the tropics" and the beginning of Brazilian Psychiatry / Cento e trinta anos da morte de Dom Pedro II: "o imperador dos trópicos" e o começo da psiquiatria brasileira

OBJETIVO: Associar a trajetória de vida de Dom Pedro II com o começo da história da psiquiatria brasileira por meio do Hospício Pedro II. MÉTODOS: Realizamos uma revisão narrativa da literatura com a pesquisa de três bases de dados: Google Scholar, PubMed e Web of Science (SciELO). RESULTADOS: A primeira instituição psiquiátrica brasileira, o Hospício Pedro II (1841-1889), foi criado por meio do Decreto nº 82, publicado no dia 18 de julho de 1841. Essa publicação ocorreu durante a cerimônia de coroação de Dom Pedro II. O objetivo dessa cerimônia de coroação era fortalecer o poder da monarquia brasileira e legitimizar a antecipação da maioridade do imperador com 14 anos. Ao longo dos 48 anos do império de Dom Pedro II, seus interesses culturais e científicos influenciaram o surgimento de uma incipiente pesquisa científica brasileira. Nesse sentido, o Hospício Pedro II não era apenas representativo de uma instituição de saúde, mas uma resposta às mudanças sociais e culturais que ocorreram após a chegada da família real portuguesa em 1808. Também era um representativo da influência da psiquiatria francesa baseada no tratamento moral de Phillipe Pinel (1745-1826). CONCLUSÃO: De forma concisa, o Hospício Pedro II era uma representação da personalidade de Dom Pedro II como um patrono da ciência, a emergência de uma psiquiatria brasileira e da hierarquia da sociedade imperial.

OBJECTIVE: Associate Dom Pedro II's life trajectory and the beginning of Brazilian psychiatry through the Pedro II Asylum. METHODS: We conducted a narrative review of the literature on three search databases: Google Scholar, PubMed, and Web of Science (SciELO). RESULTS: The first Brazilian psychiatry institution, the Pedro II Asylum (1841-1889), was created by the number 82 decree on 18 July 1841. The launching occurred at Dom Pedro II's coronation ceremony. It was a celebration that aimed at enhancing the Brazilian monarch's power and at legitimizing the emperor's adulthood at the age of fourteen. Throughout the 48 years of the Dom Pedro II empire, his cultural and science interests influenced the emergence of incipient Brazilian scientific research. In this regard, the Pedro II Asylum was portrayed not only as a health care institution but also undertook an effort to attend the social and cultural modifications promoted at the Brazilian imperial court after the Portuguese Crown family arrived in 1808. It also represented the influence of French psychiatry based on Phillipe Pinel's (1745- 1826) principles of moral treatment. CONCLUSIONS: Concisely, the Pedro II Asylum was a representation of Dom Pedro II's personality as a patron of science, the emergence of Brazilian psychiatry, and the imperial society hierarchy.

Blanching of papaya: effect on osmotic dehydration and characterization of the fruit invertase / Branqueamento de mamão: efeito na desidratação osmótica e caracterização da invertase da fruta

ABSTRACT: This research evaluated the influence of blanching on osmotic dehydration in sucrose solutions of papaya of Formosa cultivar. The characterization of invertase present in the fruits was also done. Blanching possibly caused damages to the cellular structure resulting in higher water loss, sugar gain and, thus, effective diffusion coefficients than fresh papayas during osmotic dehydration. The invertase extracted from papaya pulp presented optimum temperature of 45 °C and optimum pH of 4.8. Considering the low production cost of papaya and the invertase characteristics, the fruit shows to be a potential source for the referred enzyme extraction.

RESUMO: O objetivo desse trabalho foi avaliar a influência do branqueamento na desidratação osmótica de mamão Formosa em soluções de sacarose. A caracterização da invertase presente nos frutos também foi realizada. O branqueamento possivelmente danificou a estrutura celular do vegetal resultando em maior perda de água, ganho de açúcar e, consequentemente, maior coeficiente de difusão do que os mamões frescos após a desidratação osmótica. A invertase extraída da polpa do mamão apresentou temperatura ótima de 45 °C e pH ótimo de 4.8. Considerando o baixo custo de produção do mamão e as características da invertase, essa fruta apresenta-se como potencial fonte de extração da enzima.

Covid-19 e burnout em enfermeiros residentes de um hospital universitário / Covid-19 and burnout in resident nurses at a university hospital / Covid-19 y burnout en enfermeros residentes de un hospital universitario

Objetivo: analisar a ocorrência de burnout em enfermeiros residentes de unidades Covid-19 de um hospital universitário. Método: quantitativo, descritivo do tipo transversal com uma amostra de 40 enfermeiros residentes de um hospital universitário público situado no município do Rio de Janeiro. A coleta de dados foi realizada de outubro a dezembro de 2020, via Google Forms, mediante instrumento de caracterização da amostra e o Maslach Burnout Inventory - Human Services Survey. Resultados: prevaleceram residentes do sexo feminino, casados e maiores de 25 anos. Verificou-se que 12,5% da amostra preencheram os critérios para burnout com risco de desenvolvimento da síndrome devido a altos escores em exaustão emocional (55%), médios em despersonalização (47,5%) e baixa realização profissional (20%). Conclusão: a pandemia aumentou os riscos de burnout na amostra, tornando-se necessário investimentos em suporte social e técnico por parte das instituições formadoras de modo a minimizar o adoecimento.

Objective: to analyze the occurrence of burnout among resident nurses at Covid-19 units of a university hospital. Method: in this quantitative, descriptive, cross-sectional study of a sample of 40 nurses residing in a public university hospital in Rio de Janeiro city, data were collected from October to December 2020 on Google Forms, using an instrument to characterize the sample and the Maslach Burnout Inventory - Human Services Survey. Results: the residents were predominantly female, married and over 25 years old. Scores for emotional exhaustion were high (55%), for depersonalization, average (47.5%) and for professional achievement, low (20%), and 12.5% of the sample met the criteria for burnout with risk of developing the syndrome. Conclusion: the pandemic increased burnout risks in the sample, requiring educational institutions to invest more in social and technical support to minimize illness.

Objetivo: analizar la ocurrencia de burnout en enfermeras residentes en unidades Covid-19 de un hospital universitario. Método: cuantitativo, descriptivo del tipo transversal con una muestra de 40 enfermeros residentes de un hospital universitario público ubicado en la ciudad de Río de Janeiro. La recolección de datos se realizó de octubre a diciembre de 2020, vía Google Forms, utilizando un instrumento para caracterizar la muestra y el Maslach Burnout Inventory - Human Services Survey. Resultados: predominaron residentes del sexo femenino, casadas y mayores de 25 años. Se encontró que el 12,5% de la muestra cumplía con los criterios de burnout con riesgo de desarrollar el síndrome debido a puntuaciones altas en agotamiento emocional (55%), medianas en despersonalización (47,5%) y bajas en realización profesional (20%). Conclusión: la pandemia aumentó los riesgos de burnout en la muestra, volviendo necesario realizar inversiones en apoyo social y técnico por parte de las instituciones educativas para minimizar la enfermedad.

Covid-19 e burnout em enfermeiros residentes de um hospital universitário / Covid-19 y burnout en enfermeros residentes de un hospital universitario / Covid-19 and burnout in resident nurses at a university hospital

RESUMO Objetivo analisar a ocorrência de burnout em enfermeiros residentes de unidades Covid-19 de um hospital universitário. Método quantitativo, descritivo do tipo transversal com uma amostra de 40 enfermeiros residentes de um hospital universitário público situado no município do Rio de Janeiro. A coleta de dados foi realizada de outubro a dezembro de 2020, via Google Forms, mediante instrumento de caracterização da amostra e o Maslach Burnout Inventory - Human Services Survey. Resultados prevaleceram residentes do sexo feminino, casados e maiores de 25 anos. Verificou-se que 12,5% da amostra preencheram os critérios para burnout com risco de desenvolvimento da síndrome devido a altos escores em exaustão emocional (55%), médios em despersonalização (47,5%) e baixa realização profissional (20%). Conclusão a pandemia aumentou os riscos de burnout na amostra, tornando-se necessário investimentos em suporte social e técnico por parte das instituições formadoras de modo a minimizar o adoecimento.

RESUMEN Objetivo analizar la ocurrencia de burnout en enfermeras residentes en unidades Covid-19 de un hospital universitario. Método cuantitativo, descriptivo del tipo transversal con una muestra de 40 enfermeros residentes de un hospital universitario público ubicado en la ciudad de Río de Janeiro. La recolección de datos se realizó de octubre a diciembre de 2020, vía Google Forms, utilizando un instrumento para caracterizar la muestra y el Maslach Burnout Inventory - Human Services Survey. Resultados predominaron residentes del sexo femenino, casadas y mayores de 25 años. Se encontró que el 12,5% de la muestra cumplía con los criterios de burnout con riesgo de desarrollar el síndrome debido a puntuaciones altas en agotamiento emocional (55%), medianas en despersonalización (47,5%) y bajas en realización profesional (20%). Conclusión la pandemia aumentó los riesgos de burnout en la muestra, volviendo necesario realizar inversiones en apoyo social y técnico por parte de las instituciones educativas para minimizar la enfermedad

ABSTRACT Objective to analyze the occurrence of burnout among resident nurses at Covid-19 units of a university hospital. Method in this quantitative, descriptive, cross-sectional study of a sample of 40 nurses residing in a public university hospital in Rio de Janeiro city, data were collected from October to December 2020 on Google Forms, using an instrument to characterize the sample and the Maslach Burnout Inventory - Human Services Survey. Results the residents were predominantly female, married and over 25 years old. Scores for emotional exhaustion were high (55%), for depersonalization, average (47.5%) and for professional achievement, low (20%), and 12.5% of the sample met the criteria for burnout with risk of developing the syndrome. Conclusion the pandemic increased burnout risks in the sample, requiring educational institutions to invest more in social and technical support to minimize illness.

Trabalho noturno e alterações de peso corporal autopercebidas pelos profissionais de enfermagem / Night work and self-perceived body weight changes among nursing professionals / Trabajo nocturno y alteraciones en el peso corporal según los trabajadores de enfermería

Objetivo: avaliar as alterações de peso corporal em trabalhadores de enfermagem do turno noturno. Metodologia: estudo quantitativo, exploratório, descritivo, realizado em um hospital federal de grande porte do Rio de Janeiro. Foram estudadas variáveis sóciodemográficas; influências do turno noturno sobre o organismo e índice de massa corporal, após aprovação do Comitê de Ética em Pesquisa da instituição. Resultados: os 89 trabalhadores de enfermagem apresentaram ganho de peso médio de aproximadamente 20Kg a partir da admissão no turno noturno, sendo que os enfermeiros referiram maior influência da ausência de sono sobre o organismo, e maior exaustão quando comparados aos dados das demais categorias. Conclusão: considerando as desordens hormonais e os impactos sociais do serviço noturno, é imprescindível a implementação de mudanças para uma cultura prevencionista, seja por programas institucionais ou pesquisas intervencionistas, capazes de desenvolver medidas que conduzam ao autorreconhecimento e à promoção do bem-estar físico, mental e social dos trabalhadores de enfermagem.

Objective: to evaluate body weight changes in nursing workers on the night shift. Methodology: this quantitative, exploratory, descriptive study, conducted at a large federal hospital in Rio de Janeiro, after approval of the institution's research ethics committee, considered socio-demographic variables, influence of the night work on the organism, and body mass index. Results: average weight gain among the 89 nursing workers was approximately 20kg since admission to night work, and nurses reported greater influence of lack of sleep on the body, and greater exhaustion as compared with data on the other categories. Conclusion: considering the hormonal disorders and social impacts of night work, it is essential to implement changes towards a culture of prevention, through either institutional programs or interventionist research able to develop measures that lead to self-recognition and promotion of nursing workers' physical, mental and social wellbeing.

Objetivo: evaluar las alteraciones de peso corporal en trabajadores de enfermería del turno nocturno. Metodología: estudio cuantitativo, exploratorio, descriptivo, realizado en un gran hospital federal en Río de Janeiro. Se estudiaron las variables sociodemográficas, la influencia reportada de la guardia nocturna en el organismo y el índice de masa corporal, tras la aprobación del Comité de Ética de Investigación de la Institución. Resultados: Los 89 trabajadores de enfermería tuvieron un aumento de peso promedio de aproximadamente 20 kg desde el ingreso en el turno nocturno, y los enfermeros informaron una mayor influencia de la falta de horas dormidas sobre el cuerpo y un mayor agotamiento en comparación con los datos de las otras categorías. Conclusión: Teniendo en cuenta los trastornos hormonales y los impactos sociales del servicio nocturno, es esencial implementar cambios hacia una cultura de prevención, ya sea a través de programas institucionales o de investigación intervencionista, capaces de desarrollar medidas que conduzcan al auto reconocimiento y a la promoción del bienestar físico, mentales y social de los trabajadores de enfermería.

Os agentes comunitários de saúde nas práticas educativas: potencialidades e fragilidades / Community health workers in educational activities: potentials and weaknesses / Los agentes comunitarios de salud en las prácticas educativas: potencialidades y fragilidades

Objetivo: analisar a autoavaliação dos agentes comunitários de saúde (ACS) frente a sua atuação nas práticas e ações de educação em saúde, nas quais eles foram os facilitadores/moderadores. Método: estudo qualitativo, desenvolvido em 2013, com 36 ACS, em duas unidades de saúde da família do município do Rio de Janeiro. A pesquisa foi aprovada por Comitê de Ética e Pesquisa. Aplicou-se roteiro de entrevista semiestruturado para a obtenção dos dados. Os depoimentos foram submetidos à análise de conteúdos. Resultados: obtiveram-se duas categorias: potencialidades ­ destacando-se a maior segurança decorrente das capacitações e satisfação; e fragilidades ­ como sobrecarga de trabalho e falta de tempo para planejar as atividades educativas. Conclusão: os ACS sentem-se realizados, porém, ainda, inseguros, para assumir e se apropriar das atividades de educação em saúde na comunidade, sendo, por isso, necessários maiores investimentos na formação e na educação permanentes dos ACS.

Objective: to examine community health workers' (CHWs) self-assessment of their facilitation / moderation of health education practices and actions. Method: this qualitative study of 36 CHWs in two family health units in Rio de Janeiro City was conducted in 2013. The study was approved by the research and ethics committee. Data were obtained by scripted, semi-structured interview and analyzed using content analysis. Results: two categories were obtained, one highlighting the greater security resulting from training and satisfaction, and the other, the weaknesses, such as work overload and lack of time to plan educational activities. Conclusion: CHWs feel fulfilled, although still insecure, in taking on and appropriating health education activities in the community. Accordingly, there is a need for greater investment in continued professional development and education for CHWs.

Objetivo: analizar la autoevaluación de los agentes comunitarios de salud (ACS) ante su actuación en las prácticas y acciones de educación en salud, en las que fueron los facilitadores / moderadores. Método: estudio cualitativo, desarrollado en 2013, junto a 36 ACS, en dos unidades de salud de la familia del municipio de Río de Janeiro. La investigación fue aprobada por el Comité de Ética e Investigación. Se aplicó un guion de entrevistas semiestructuradas para la obtención de los datos. Las declaraciones se han sometido al análisis de contenidos. Resultados: se obtuvieron dos categorías: potencialidades - destacándose la mayor seguridad derivada de las capacitaciones y la satisfacción; y fragilidades - como sobrecarga de trabajo y falta de tiempo para planificar las actividades educativas. Conclusión: los ACS se sienten realizados, sin embargo, inseguros, para asumir y apropiarse de las actividades de educación en salud en la comunidad, por lo que son necesarias mayores inversiones en la formación y la educación permanentes de los ACS.

Invasive lobular carcinomas treated at Hospital de Clínicas of UFPR: incidence, characteristics and clinical outcome / Carcinomas lobulares invasores de mama tratados no Hospital de Clínicas da UFPR: incidência, características e evolução clínica

Objective: The aim of this study is to depict the clinical and epidemiological profile of patients treated for invasive lobular carcinoma (ILC) at Hospital das Clínicas of Universidade Federal do Paraná (HC-UFPR) over the course of ten years and to evaluate the variation of ILC dimensions on imaging exams by comparing them to real-size lesions identified in surgical specimens. Methods: Patients undergoing breast surgical procedures at HC-UFPR from 2005 to 2014 were selected. Out of these, 36 were diagnosed with ILC and had their medical files sought after clinical, epidemiological, therapeutic and prognosis characteristics. The variance of tumor sizes in imaging methods and anatomopathological descriptions were also studied. Results: Patients' mean age at diagnosis was 59.6 years. Most of them were classified as clinical stages II (40%) and III (26.7%) by the time they were diagnosed. The majority of tumors were HER2 negative (77.2%) and estrogen-receptor positive (90%). The surgical treatment was radical in 74.2% of the cases. 31.4% of the patients underwent both mammography and ultrasonography screening and 45.7% underwent only one of them. None of the patients were submitted to magnetic resonance imaging (MRI). Conclusion: Data found about patients with invasive lobular carcinoma at HC-UFPR is in accordance with the medical literature, including incidence rates and tumor characteristics. The variance of tumor sizes in imaging exams and surgical specimen was not statistically significant

Objetivo: O estudo busca caracterizar o perfil clínico epidemiológico referente às pacientes tratadas por carcinoma lobular invasor de mama (CLI) no Hospital de Clínicas da Universidade Federal do Paraná (HC-UFPR) em um período de dez anos e avaliar as variações das dimensões dos CLI nos exames de imagem quando comparadas ao real tamanho das lesões identificadas nas peças de anatomia patológica. Métodos: Foram selecionadas pacientes submetidas a procedimentos cirúrgicos de mama no HC-UFPR entre os anos de 2005 e 2014, dentre as quais 36 apresentaram diagnóstico de CLI. Seus prontuários foram analisados para avaliação de características clínicas, epidemiológicas, terapêuticas e prognósticas. Também foi avaliada a discrepância dos valores de tamanho do tumor em métodos de imagem em relação ao descrito nos laudos anatomopatológicos. Resultados: A s p acientes c om d iagnóstico d e C LI tinham média de idade no diagnóstico de 59,6 anos. O diagnóstico foi feito, em sua maioria, nos estádios clínicos II (40%) e III (26,7%). Houve maior negatividade (77,2%) para HER2 e positividade (90%) para receptor de estrógeno. O tratamento cirúrgico foi radical em 74,2% das pacientes. Em exames de imagem, 31,4% das pacientes realizaram mamografia e ultrassonografia em conjunto, 45,7% fizeram apenas um dos exames e nenhuma realizou ressonância magnética. Conclusão: Observou-se que a casuística de patologias mamárias do HC-UFPR está de acordo com a literatura em relação à incidência e às características próprias dos CLI. A análise da discrepância dos tamanhos dos tumores em exames de imagem em relação às peças cirúrgicas não obteve resultados significativos estatisticamente

Desempenho dos serviços de saúde na atenção à tuberculose na estratégia de saúde da família / Health service performance in tuberculosis care in the Family Health Strategy / Rendimiento de los servicios de salud en la atención a la tuberculosis en la estrategia de salud de la familia

Objetivo: avaliar o desempenho dos serviços de saúde na atenção à tuberculose, na percepção das equipes da estratégia saúde da família. Método: estudo transversal de abordagem quantitativa, realizado com 210 profissionais das equipes da estratégia de saúde da família de uma área de planejamento do Rio de Janeiro. Foi aplicado o questionário PCATool ­ tuberculose, no período de agosto a novembro de 2015. Os dados foram tratados e analisados, no programa epi info versão 7.1.5. Projeto aprovado no comitê de ética em pesquisa da Escola de Enfermagem Anna Nery e da Secretaria Municipal de Saúde. Resultados: observou-se que para o diagnóstico de tuberculose o desempenho das unidades foi razoável e para o tratamento o resultado foi satisfatório. Conclusão: o desempenho dos serviços de saúde apresenta fragilidades e atende parcialmente a clientela.

Objective: to evaluate health service performance in tuberculosis care as perceived by family health strategy teams. Methods: in this quantitative, cross-sectional study, the PCATool-tuberculosis was applied between August and November 2015, to 210 professionals from family health strategy teams in a planning area in Rio de Janeiro. Data were processed and analyzed using Epi Info software, version 7.1.5. The project was approved by the research ethics committees of the Anna Nery School of Nursing and Municipal Health Secretariat. Results: the units' performance was observed to be reasonable in tuberculosis diagnosis, and satisfactory in treatment. Conclusion: health service performance displays weaknesses and meets client needs partially.

Objetivo: evaluar el rendimiento de los servicios de salud en la atención a la tuberculosis, bajo la percepción de los equipos de la estrategia de salud de la familia. Método: estudio transversal de abordaje cuantitativo, realizado junto a 210 profesionales de los equipos de la estrategia de salud de la familia de un área de planificación de Río de Janeiro. Fue aplicado el cuestionario PCATool ­tuberculosis, en el periodo de agosto a noviembre de 2015. Los dados fueron tratados y analizados en el programa epi info versión 7.1.5. Proyecto aprobado en el comité de ética en investigación de la Escuela de Enfermaría Anna Nery y de la Secretaría Municipal de Salud. Resultados: se verificó que, para el diagnóstico de tuberculosis, el rendimiento de las unidades fue adecuado y, para el tratamiento de los resultados, fue satisfactorio. Conclusión: el rendimiento de los servicios de salud presenta fragilidades y atiende parcialmente la clientela.