Safety and efficacy of catheter ablation for atrial fibrillation in cancer survivors: a systematic review and meta-analysis.

BACKGROUND: Cancer survivors are at increased risk for atrial fibrillation (AF). However, data on the efficacy and safety of catheter ablation (CA) in this population remain limited. Therefore, we aimed to perform a systematic review and meta-analysis comparing outcomes after CA for AF in patients with versus without prior or active cancer. METHODS: We systematically searched PubMed, Cochrane Library, and Embase from inception to April 2023 for studies comparing the safety and efficacy of CA for AF in cancer survivors. Outcomes of interest were bleeding events, late AF recurrence, and need for repeat ablation. Statistical analyses were performed using Review Manager 5.4.1. We pooled odds ratios (OR) with 95% confidence intervals (CI) for binary endpoints. RESULTS: We included 5 retrospective cohort studies comprising 998 patients, of whom 41.4% had a history of cancer. Cancer survivors were at significantly higher risk of clinically relevant bleeding (OR 2.17; 95% CI 1.17-4.0; p=0.01) as compared with those without cancer. The efficacy of CA for AF was similar between groups. Late AF recurrence at 12 months was not significantly different between patients with vs. without a history of cancer (OR 1.29; 95% CI 0.78-2.13; p=0.32). Similar findings were observed in the outcome of repeat ablations (OR 0.71; 95% CI 0.37-1.37; p=0.31). CONCLUSIONS: These findings suggest that cancer survivors have an increased risk of bleeding after CA for AF relative to patients without cancer, with no significant difference in the efficacy of CA for maintenance of sinus rhythm between groups. STUDY REGISTRATION: This systematic review is registered in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42023394538.

Torsemida em Comparação com Furosemida no Tratamento da Insuficiência Cardíaca: Uma Revisão Sistemática e Metanálise de Ensaios Clínicos Randomizados / Torsemide versus Furosemide in the Treatment of Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Resumo A furosemida é o diurético mais utilizado para o tratamento de sintomas de sobrecarga de volume em pacientes com insuficiência cardíaca. Dados recentes sugerem que a torsemida pode ser superior à furosemida neste contexto. No entanto, ainda não é claro se isso se traduz em melhores resultados clínicos nesta população. Avaliar se a torsemida é superior à furosemida no contexto da insuficiência cardíaca. Realizamos uma revisão sistemática e metanálise de estudos clínicos randomizados (ECRs) comparando a eficácia da torsemida em comparação com a furosemida em pacientes com insuficiência cardíaca. PubMed, Embase e Web of Science foram as bases de dados pesquisadas em busca de estudos elegíveis. Os desfechos de interesse foram internações por todas as causas, internações por insuficiência cardíaca (IIC), internações por todas as causas cardiovasculares, mortalidade por todas as causas, e melhoria de classe da NYHA. Parâmetros ecocardiográficos também foram avaliados. Foi aplicado um modelo de efeitos aleatórios para calcular as razões de risco (RR) e as diferenças médias (DM) com intervalos de confiança (IC) de 95% e nível de significância de 0,05. Foram incluídos 12 ECRs, envolvendo 4.115 pacientes. A torsemida reduziu significativamente a IIC (RR de 0,60; IC de 95%, 0,43-0,83; p=0,002; I2=0%), internação por causas cardiovasculares (RR de 0,72; IC de 95%, 0,60-0,88; p=0,0009; I2=0%), e melhora da fração de ejeção do ventrículo esquerdo (FEVE) (DM de 4,51%; IC de 95%, 2,94 a 6,07; p<0,0001; I2=0%) em comparação com a furosemida. Não houve diferença significativa no número de internações por todas as causas (RR de 0,93; IC de 95%, 0,86-1,00; p=0,04; I2=0%), mortalidade por todas as causas (RR de 0,98; IC de 95%, 0,87-1,10; p=0,73; I2=0%), melhora da classe NYHA (RR de 1,25; IC de 95%, 0,92-1,68; p=0,15; I2=0%), ou mudança de classe NYHA (DM de -0,04; IC de 95%, -0,24 a 0,16; p=0,70; I2=15%) entre os grupos. A torsemida reduziu significativamente as internações por insuficiência cardíaca e causas cardiovasculares, melhorando também a FEVE.

Abstract Furosemide is the most used diuretic for volume overload symptoms in patients with heart failure (HF). Recent data suggested that torsemide may be superior to furosemide in this setting. However, whether this translates into better clinical outcomes in this population remains unclear. To assess whether torsemide is superior to furosemide in the setting of HF. We performed a systematic review and meta-analysis of RCTs comparing the efficacy of torsemide versus furosemide in patients with HF. PubMed, Embase, and Web of Science were searched for eligible trials. Outcomes of interest were all-cause hospitalizations, hospitalizations for HF (HHF), hospitalizations for all cardiovascular causes, all-cause mortality, and NYHA class improvement. Echocardiographic parameters were also assessed. We applied a random-effects model to calculate risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) and a 0.05 level of significance. 12 RCTs were included, comprising 4,115 patients. Torsemide significantly reduced HHF (RR 0.60; 95% CI, 0.43-0.83; p=0.002; I2=0%), hospitalization for cardiovascular causes (RR 0.72; 95% CI, 0.60-0.88; p=0.0009; I2=0%), and improved LVEF (MD 4.51%; 95% CI, 2.94 to 6.07; p<0.0001; I2=0%) compared with furosemide. There was no significant difference in all-cause hospitalizations (RR 0.93; 95% CI, 0.86-1.00; p=0.04; I2=0%), all-cause mortality (RR 0.98; 95% CI, 0.87-1.10; p=0.73; I2=0%), NYHA class improvement (RR 1.25; 95% CI, 0.92-1.68; p=0.15; I2=0%), or NYHA class change (MD -0.04; 95% CI, -0.24 to 0.16; p=0.70; I2=15%) between groups. Torsemide significantly reduced hospitalizations for HF and cardiovascular causes, also improving LVEF.

Câncer que toma o corpo feminino: representações dialogadas / Cancer that takes the female body: dialogic representations / Cáncer que toma el cuerpo femenino: representaciones dialógicas

Objetivo: descrever os conteúdos representacionais de mulheres vivenciando o câncer feminino. Método: estudo descritivo, exploratório e qualitativo, realizado com 20 mulheres em um centro de oncologia. Os dados foram coletados por entrevistas semiestruturadas áudio-gravadas, transcritas na íntegra, analisadas de acordo com a análise de conteúdo de Bardin. Utilizou-se como referencial teórico a Teoria das Representações Sociais. Resultados: da análise, emergiram quatro categorias que traduziram os conteúdos representacionais das mulheres, permeados pelo sofrimento interno e ancorados em representações de morte e medo. As falas apontaram que a depressão se une à essas representações, refletindo nas tomadas de decisões. O apoio social e forma como a mulher recebe o diagnóstico tem influência decisiva nas representações construídas e tratamento. Conclusão: dentro das representações sociais que cada mulher apresenta existem significados que requerem um olhar minucioso para se prestar uma assistência individualizada e que compreenda os processos biopsicossociais vivenciados pela mulher enfrentando o câncer.

Objective: to describe the representational contents of women experiencing female cancer. Method: in this exploratory, qualitative, descriptive study of 20 women in an oncology center, data were collected through audio-recorded, semi-structured, fully transcribed interviews and analyzed using Bardin content analysis. Social Representations Theory was used as a theoretical framework. Results: from the analysis, four categories emerged that expressed the representational contents voiced by the women, which were permeated by inner suffering and anchored in representations of death and fear. Their words showed that depression is linked to these representations and reflects on decision-making. Social support and how women receive their diagnosis have decisive influence on the representations constructed and on treatment. Conclusion: within the social representations that each woman presented, were meanings that required thorough consideration in order to provide individualized care that contemplated the biopsychosocial processes experienced by women facing cancer.

Objetivo: describir los contenidos representativos de mujeres que padecen cáncer femenino. Método: estudio descriptivo, exploratorio y cualitativo, realizado junto a 20 mujeres en una unidad oncológica. Se recolectaron los datos fueron a través de entrevistas semiestructuradas grabadas en audio, transcritas en su totalidad, analizadas según el análisis de contenido de Bardin. Se utilizó la Teoría de las Representaciones Sociales como marco teórico. Resultados: del análisis surgieron cuatro categorías que tradujeron los contenidos representacionales de las mujeres, impregnados por el sufrimiento interno y anclados en representaciones de muerte y miedo. Las declaraciones mostraron que la depresión se une a estas representaciones, reflejándose en la toma de decisiones. El apoyo social y la forma cómo la mujer recibe el diagnóstico tiene influencia en las representaciones y el tratamiento. Conclusión: dentro de las representaciones que presenta cada mujer, existen significados que requieren una mirada profunda para brindar una atención individualizada que comprenda los procesos biopsicosociales que viven las mujeres frente al cáncer.

Treatment and Survival Outcomes of Waldenstrom Macroglobulinemia in Latin American Patients: A Multinational Retrospective Cohort Study.

PURPOSE: Waldenstrom Macroglobulinemia (WM) is a rare lymphoma with distinct clinical features, and data from Latin American patients are lacking. Therefore, we aim to investigate the clinical, therapy, and outcome patterns of WM in Latin America. METHODS: We retrospectively analyzed patients with WM diagnosed between 1991 and 2019 from 24 centers in seven Latin American countries. The study outcomes were overall survival (OS) and progression-free survival (PFS). RESULTS: We identified 159 cases (median age 67 years, male 62%). Most patients (95%) were symptomatic at diagnosis. The International Prognostic Scoring System for WM (IPSSWM) at diagnosis was available in 141 (89%) patients (high-risk 40%, intermediate-risk 37%, and low-risk 23%). Twenty-seven (17%) patients were tested for MYD88L265P, with 89% (n = 24 of 27) carrying the mutation. First-line and second-line therapies were administered to 142 (89%) and 53 (33%) patients, respectively. Chemoimmunotherapy was the most commonly used first-line (66%) and second-line (45%) approach; only 18 (11%) patients received ibrutinib. With a median follow-up of 69 months, the 5-year OS rate was 81%. In treated patients, the 5-year OS and PFS rates were 78% and 59%, respectively. High-risk IPSSWM at treatment initiation was an independent risk factor for OS (adjusted hazard ratio: 4.73, 95% CI, 1.67 to 13.41, P = .003) and PFS (adjusted hazard ratio: 2.43, 95% CI, 1.31 to 4.50, P = .005). CONCLUSION: In Latin America, the management of WM is heterogeneous, with limited access to molecular testing and novel agents. However, outcomes were similar to those reported internationally. We validated the IPSSWM score as a prognostic factor for OS and PFS. There is an unmet need to improve access to recommended diagnostic approaches and therapies in Latin America.

How to choose initial treatment in multiple sclerosis patients: a case-based approach / Como escolher o tratamento inicial na esclerose múltipla: uma abordagem baseada em casos

ABSTRACT Background: Immunotherapy dramatically changed the natural history of multiple sclerosis (MS), which was classically associated with severe disability. Treatment strategies advocate that early control of disease activity is crucial to avoid progressive disability, and the use of high efficacy drugs may be beneficial, but safety is a concern. Choosing the disease-modifying therapy is challenging in clinical practice and should be further discussed. Objective: To discuss the state of art of selecting the initial therapy for relapsing MS patients. Methods: We used a case-based approach followed by clinical discussion, exploring therapeutic options in different MS settings. Results: We presented clinical cases profile compatible with the use of MS therapies, classified into moderate and high efficacy. In the moderate efficacy group, we discussed interferons, glatiramer acetate, teriflunomide and dimethyl fumarate, while in the high efficacy group we discussed fingolimod, cladribine, natalizumab, ocrelizumab, alemtuzumab and ofatumumab. Conclusion: Advances in MS treatment are remarkable. Strong evidence supports the use of early high efficacy therapy. However, biomarkers, clinical and radiologic prognostic factors, as well as patients' individual issues, should be valued and considered for a personalized treatment decision.

RESUMO Antecedentes: A imunoterapia mudou drasticamente a história natural da esclerose múltipla (EM), doença esta que era classicamente associada a grandes incapacidades. Sabe-se hoje que o controle precoce da atividade de doença é crucial para evitar incapacidade progressiva, e o uso de terapias de alta eficácia pode ser benéfico. Apesar disso, a segurança ainda é uma preocupação dos pacientes e médicos. A escolha da terapia modificadora da doença é um desafio na prática clínica e suas particularidades devem ser mais discutidas. Objetivo Discutir o estado da arte da seleção da terapia inicial para pacientes com EM remitente recorrente. Métodos Utilizamos uma abordagem baseada em casos clínicos, com discussão das diversas opções terapêuticas em diferentes contextos de EM. Resultados: Foram apresentados casos clínicos compatíveis com o uso das principais terapias para EM, divididas em moderada e alta eficácia. No grupo de moderada eficácia discutimos sobre os interferons, acetato de glatirâmer, teriflunomida e fumarato de dimetila enquanto que no de alta eficácia falamos sobre fingolimode, cladribina, natalizumabe, ocrelizumabe, alentuzumabe e ofatumumabe. Conclusão Os avanços no tratamento da EM são notáveis. Fortes evidências suportam que o uso de terapia de alta eficácia de forma precoce possa ser benéfica. No entanto, biomarcadores, fatores prognósticos clínicos e radiológicos, bem como questões individuais dos pacientes, devem ser valorizados e considerados para uma decisão de tratamento personalizado.

Perfil clínico-epidemiológico da dengue no município de anápolis - goiás entre os anos de 2016 a 2020 / Clinical-epidemiological profile of dengue in the municipality of anápolis - goiás from 2016 to 2020 / Perfil clínico-epidemiológico del dengue en el municipio de anápolis - goiás de 2016 a 2020

RESUMO Objetivo: descrever o perfil clínico epidemiológico da dengue em Anápolis, Goiás - BR entre os anos 2016 a 2020. Métodos: estudo descritivo de natureza quantitativa. Foram utilizados dados da ficha de notificação de dengue cadastrada no Departamento de Vigilância Epidemiológica. Utilizado o teste qui-quadrado com nível de significância cinco (5%) (p<0,05). Resultados: foram notificados 27.544 casos com o pico em 2019, sendo 54,2% do sexo feminino, faixa etária de 25 a 44 anos 36,7% e cor parda 70,3%. Dos casos ocorridos, 97,7% não foram hospitalizados, predominaram a dengue clássica em 98% e obteve-se cura em 99,9% dos casos. Houve diferença significativa em relação à faixa etária e à classificação da dengue, hospitalização e evolução clínica (p= 0,001). Conclusão: evidencia-se que a dengue é prevalente em Anápolis, sendo necessárias estratégias de prevenção e controle do vetor, principalmente, nos períodos de sazonalidade.

ABSTRACT Objective: to describe the clinical epidemiological profile of dengue in Anápolis, Goiás - BR between the years 2016 to 2020. Methods: descriptive study of a quantitative nature. Data from the dengue notification form registered in the Epidemiological Surveillance Department were used. Chi-square test was used with significance level five (5%) (p<0.05). Results: 27,544 cases were notified with the peak in 2019, being 54.2% female, age group 25 to 44 years 36.7% and brown color 70.3%. Of the cases that occurred, 97.7% were not hospitalized, classic dengue predominated in 98% and cure was obtained in 99.9% of cases. There was a significant difference regarding age group and dengue classification, hospitalization, and clinical evolution (p= 0.001). Conclusion: It is evident that dengue is prevalent in Anápolis, and strategies of prevention and control of the vector are necessary, especially during seasonal periods.

RESUMEN Objetivo: describir el perfil clínico epidemiológico del dengue en Anápolis, Goiás - BR entre los años 2016 a 2020. Métodos: estudio descriptivo de carácter cuantitativo. Se utilizaron datos de la ficha de notificación de dengue registrada en el Departamento de Vigilancia Epidemiológica. Se utilizó la prueba de chi-cuadrado con un nivel de significación del cinco (5%) (p<0,05). Resultados: Se notificaron 27.544 casos con el pico en 2019, siendo el 54,2% mujeres, el grupo de edad de 25 a 44 años el 36,7% y el color marrón el 70,3%. De los casos ocurridos, el 97,7% no fueron hospitalizados, el dengue clásico predominó en el 98% y se obtuvo la curación en el 99,9% de los casos. Hubo una diferencia significativa con respecto al grupo de edad y la clasificación del dengue, la hospitalización y la evolución clínica (p= 0,001). Conclusión: se evidencia que el dengue es prevalente en Anápolis, siendo necesarias estrategias de prevención y control del vector, principalmente, en los periodos de sazonalidad.

Análise das complicações clínico-obstétricas em gestantes adolescentes segundo a Classificação de Robson / Analyzing clinical obstetric complications in pregnant adolescents by the Robson / Classification Análisis de las complicaciones clínico-obstétricas en adolescentes embarazadas según la Clasificación de Robson

Objetivo: analisar as complicações obstétricas de gestantes adolescentes por meio da Classificação de Robson. Método: trata-se de uma pesquisa quantitativa documental. Foram pesquisados 150 prontuários de gestantes adolescentes de alto risco. O estudo foi de setembro a novembro/2019 e iniciou após a aprovação do Comitê de ética em Pesquisa da Universidade Federal de Alagoas. Resultados: as taxas de cesáreas do grupo 1 foram o dobro do recomendado (18,92%), pela Classificação de Robson. No grupo 2, houve 100% de cesárea, enquanto recomendação é de 20 a 35%. No grupo 4 observou-se 100% de parto vaginal, enquanto os grupos 5, 8 e 10 excederam o número de cesáreas em cerca de 15,40 a 20%. Conclusão: evidenciou-se, por meio da Classificação de Robson, que o tipo de parto das gestantes adolescentes que foram afetadas por uma complicação clínico-obstétrica foi o parto cesáreo, com aumento nos grupos de gestante 1, 2, 5, 8 e 10.

Objective: to analyze obstetric complications in pregnant adolescents using the Robson Classification. Method: in this quantitative study, 150 medical records of high-risk adolescent pregnant women were searched between September and November 2019, after approval by the research ethics committee of Alagoas Federal University. Results: by the Robson Classification, cesarean section rates in group 1 were twice as high as recommended (18.92%). Group 2 returned 100% cesarean section, while the recommendation is 20 to 35%; group 4 showed 100% vaginal deliveries; and, in groups 5, 8 and 10, these exceeded the number of cesarean sections by about 15.40 to 20%. Conclusion: using the Robson Classification, it was shown that pregnant adolescents affected by a clinical obstetric complication were delivered by cesarean sections, which increased in groups 1, 2, 5, 8 and 10.

Objetivo: analizar las complicaciones obstétricas en adolescentes embarazadas mediante la Clasificación de Robson. Método: se trata de una investigación cuantitativa documental. Se investigaron 150 historias clínicas de adolescentes embarazadas de alto riesgo. El estudio fue de septiembre a noviembre/2019 y se inició después de la aprobación del Comité de Ética en Investigación de la Universidad Federal de Alagoas. Resultados: Las tasas de cesáreas en el grupo 1 fueron el doble de lo recomendado (18,92%) según la clasificación. En el grupo 2, hubo 100% de cesáreas, mientras que la recomendación es del 20 al 35%. En el grupo 4, el 100% tuvo parto vaginal, mientras que los grupos 5, 8 y 10 superaron el número de cesáreas en aproximadamente del 15,40 al 20%. Conclusión: queda claro, a través de la Clasificación de Robson, que el tipo de parto de las adolescentes embarazadas que se vio afectado por una complicación clínico-obstétrica fue el cesáreo, con incremento en los grupos de embarazadas 1, 2, 5, 8 y 10.

BCL-2 Inhibition as Treatment for Chronic Lymphocytic Leukemia.

OPINION STATEMENT: At the end of the 1990s, with the advent of imatinib for chronic myeloid leukemia and rituximab for B cell lymphoproliferative diseases with CD20 expression, there was a great conceptual evolution in the treatment of onco-hematological diseases. Researchers from around the world and the pharmaceutical industry began to focus their efforts on the so-called target therapy used alone or associated with classic chemotherapeutic drugs. In chronic lymphocytic leukemia, the development of second-generation anti-CD20 antibodies, biosimilars, PI3K (phosphatidylinositol 3-kinases) inhibitors, BTK (Bruton's tyrosine kinase) inhibitors, and anti-bcl 2 drugs represented mainly by venetoclax brought new, broader, and more effective opportunities in the treatment of this disease. This breakthrough occurred mainly regarding patients with alteration in 17p or mutation of the p53 gene for whom selecting the new drugs that act on B cell signaling (BTK and PI3K inhibitors) in the first line is mandatory. In fit patients with immunoglobulin heavy chain mutation, it is still acceptable to use the chemotherapy regimen with fludarabine, cyclophosphamide, and rituximab (FCR) and, in those who do not fit or are not IgVH-mutated, bendamustine-rituximab regimen. However, the first-line use of ibrutinib or venetoclax associated with immunotherapy within the concepts of infinite (ibrutinib) or finite (venetoclax) treatment has been increasingly used. In the second line, venetoclax, ibrutinib, and idelalisib have become the preferred treatments. I believe that a process of instruction and decision shared with patients considering the risks-benefits-cost and access to treatments should guide the choices within these concepts. Another fundamental aspect to discuss is the objective of the treatment for chronic lymphocytic leukemia (CLL) for a specific patient: the increase progression-free survival and overall survival and/or the achievement of minimal residual disease. CLL is the most common leukemia in adults with a median age at diagnosis of 72 years. The clinical course is heterogeneous, and outcomes are influenced by individual clinical presentation and disease biology. Molecular and genomic factors, including fluorescence in situ hybridization (FISH) testing, karyotype, and immunoglobulin heavy chain variable region gene (IGHV) mutational status, are important to treatment decisions and to predict the clinical course. However, despite disease biology, the presence of active disease is the most important criteria to initiate treatment. In the past decade, target therapies that inhibit B cell receptor signaling pathways and, more recently, BCL2 antagonists have emerged as a new treatment paradigm: chemo-free with fixed duration therapy. Bruton's tyrosine kinase inhibitors (BTK) are a class of oral medications approved for frontline and relapsed disease, effective for achieving lasting response and disease control with a good safety profile. BTK inhibitors are an attractive option for high-risk patients who are not candidates for an intensive regimen. However, it is a continuous therapy, and drug resistance or severe adverse events could lead to treatment suspension. BCL2 antagonists are an attractive alternative to BTK inhibitors. Anti-apoptotic BCL2 is associated with tumor genesis and chemotherapy resistance. The BCl2, an anti-apoptotic protein located in the mitochondrial membrane, is a major contributor to the pathogenesis of lymphoid malignancies and is overexpressed in CLL cells promoting clonal cell survival. Venetoclax is a potent and selective member of the BH3 mimetic drugs and a physiologic antagonist of BCL2. Venetoclax has demonstrated quick and durable responses in naïve and relapsed or refractory CLL (r/r CLL) patients, including high-risk patients. Furthermore, it has shown deeper responses, achieving a higher incidence of negative minimal residual disease (MRD) with a fixed duration therapy. In the past decade, there was a remarkable progress in CLL treatment. However, neither of the new target therapies is considered curative or free of toxicity. This article will focus on the treatment approach of CLL patients with BCl2 antagonists. Treatment strategy (combined versus monotherapy; continuous versus limited duration therapy), toxicity profile, and future directions will be exposed in this review.

Saúde mental dos estudantes de Medicina do Brasil durante a pandemia da coronavirus disease 2019 / Brazilian medical students mental health during coronavirus disease 2019 pandemic

RESUMO Objetivo: O objetivo desta pesquisa é verificar a prevalência de sintomas de sofrimento psíquico em estudantes do curso de Medicina durante a pandemia da COVID-19. Métodos: Trata-se de um estudo transversal e exploratório que avaliou 656 estudantes do curso de Medicina do Brasil. Os dados foram coletados, em maio e junho de 2020, por meio de dois instrumentos autoaplicáveis. O primeiro foi um questionário elaborado pelos próprios autores para avaliar o perfil social, demográfico e cultural da população. Para o rastreamento de indícios de sofrimento psíquico, utilizou-se o Self-Report Questionnaire, um questionário com 20 itens divididos em quatro domínios. Durante a análise de dados, as associações entre variáveis categóricas foram testadas por meio do teste qui-quadrado de Pearson. O nível de significância adotado foi de 5%. Resultados: A prevalência de indivíduos com indícios de sofrimento psíquico foi de 62,8%. São fatores de risco para o adoecimento mental durante a pandemia da COVID-19: ser do sexo feminino, estar nos dois primeiros anos do curso, relatar má adaptação ao ensino a distância, apresentar dificuldade de concentração, preocupar-se com o atraso da graduação, ter um diagnóstico prévio de transtorno mental, morar com alguém que precisa trabalhar fora de casa, ser incapaz de manter hábitos saudáveis e ter medo de ser infectado pelo vírus. Conclusão: Este estudo demonstrou que os indícios de sofrimento psíquico estão elevados entre estudantes de Medicina durante a pandemia da COVID-19. Além disso, também foi possível concluir que há fatores protetores para o adoecimento mental.

ABSTRACT Objective: The objective of the research is to verify the prevalence of psychological distress symptoms in medical students during the COVID-19 pandemic. Methods: This is a cross-sectional and exploratory study that evaluated 656 medical students in Brazil. Data were collected between May and June 2020, through two self-administered instruments. The first was a questionnaire prepared by the authors themselves to assess the social, demographic and cultural profile of the population. For the screening of signs of psychological distress, the Self-Report Questionnaire was used, a questionnaire with 20 items divided into four domains. During data analysis, associations between categorical variables were tested using Pearson's chi-square test. The significance level adopted was 5%. Results: The results show that the prevalence of individuals with signs of psychological distress was 62.8%. Risk factors for mental illness during the COVID-19 pandemic are being female, being in the first two years of the course, reporting poor adaptation to Distance Learning, having difficulty concentrating, worrying about the delay of graduation, have a previous diagnosis of mental disorder, live with someone who needs to work outside the home, inability to maintain healthy habits and fear being infected by the virus. Conclusion: We conclude that the signs of psychological distress are high among medical students during the COVID-19 pandemic. In addition, it was also possible to conclude that there are protective factors for mental illness.

How to manage lymphoid malignancies during novel 2019 coronavirus (CoVid-19) outbreak: a Brazilian task force recommendation

ABSTRACT: The novel Coronavirus (CoVid-19) outbreak is now consider a world pandemic, affecting more than 1,300,000 people worldwide. Cancer patients are in risk for severe disease, including a higher risk of intensive care unit (ICU) admission, need for invasive ventilation or death. Management of patients with lymphoid malignancies can be challenging during the outbreak, due to need of multiple hospital visits and admissions, immunosuppression and need for chemotherapy, radiotherapy and stem cell transplantation. In this article, we will focus on the practical management of patients with lymphoid malignancies during the COVID-19 pandemic, focusing on minimizing the risk for patients.

How to manage lymphoid malignancies during novel 2019 coronavirus (CoVid-19) outbreak: a Brazilian task force recommendation.

The novel Coronavirus (CoVid-19) outbreak is now consider a world pandemic, affecting more than 1,300,000 people worldwide. Cancer patients are in risk for severe disease, including a higher risk of intensive care unit (ICU) admission, need for invasive ventilation or death. Management of patients with lymphoid malignancies can be challenging during the outbreak, due to need of multiple hospital visits and admissions, immunosuppression and need for chemotherapy, radiotherapy and stem cell transplantation. In this article, we will focus on the practical management of patients with lymphoid malignancies during the COVID-19 pandemic, focusing on minimizing the risk for patients.

Risk factors and incidence of thrombosis in a Brazilian cohort of patients with Philadelphia-negative myeloproliferative neoplasms.

Few data are available regarding epidemiology and outcomes of Philadelphia-negative chronic myeloproliferative neoplasms (MPN) in Latin America. Therefore, current models for MPN treatment are based in large cohorts of patients from Europe and North America. In this paper, we conducted a retrospective study to evaluate thrombotic and bleeding events in a cohort of patients with MPN from a reference center in Brazil. A total of 334 patients were included, being essential thrombocythemia the most common diagnosis. Here, we found that 41% of the MPN patients had a thrombotic event prior to the diagnosis. Thrombosis was more frequent in patients under 60 years-old. In a multivariable model, only JAK2 V617F mutation (OR 2.57 95% CI 1.58-4.18, p < 0.001) and presence of two cardiovascular risk factors (OR 1.90 95% CI 1.21-2.98, p < 0.005) were significant for thrombosis. The risk of thrombosis was similar among all subtypes of MPN. Cumulative incidence of thromboembolic event at 5 years from diagnosis was 5.8% (95% CI 3.5-8.9), which is similar to previous studies. The high incidence of thromboembolic events in younger patients suggests that socioeconomic disparities might have a role in the outcomes of MPN.

Pandemia do COVID-19 e implementação de telefonoaudiologia para pacientes em domicílio: relato de experiência / The COVID-19 pandemic and the implementation of telehealth in speech-language and hearing therapy for patients at home: an experience report

RESUMO Apresentamos um relato de experiência de implementação de telefonoaudiologia em tempo real para pacientes que anteriormente eram atendidos em ambulatório em um serviço de atenção primária em saúde. No total, 25 usuários estavam sendo acompanhados pela equipe de fonoaudiologia quando da notificação dos primeiros casos de COVID-19 no sul do Brasil. Destes, julgou-se que 12 pacientes demandavam teleatendimento, pelo menos, quinzenalmente. A teleconsulta disponibilizada nesta primeira etapa, em caráter emergencial na implementação do projeto neste formato, a fim de garantir a manutenção dos atendimentos de pacientes que poderiam sofrer agravamento ou mesmo comorbidades associadas à suspensão da fonoterapia, foram realizadas por telefone, com vídeo, por estudantes de fonoaudiologia, extensionistas do projeto e supervisionadas por um fonoaudiólogo, de forma síncrona. Todas as conversas e orientações durante a teleconsulta são encaminhadas com a maior calma possível e, no caso de pacientes infantis, permeadas por algumas atividades lúdicas. A telessaúde tem se mostrado um recurso eficiente para atendimento de pacientes com demandas fonoaudiológicas, possibilitando o atendimento remoto com a mesma qualidade que o atendimento presencial. Além disso, tem potencial relevante, considerando que há um número significativo de pacientes que precisam de avaliação fonoaudiológica e residem em regiões nas quais há escassez de profissionais qualificados.

ABSTRACT We present an experience report on the implementation of real-time telehealth in speech-language and hearing therapy for patients who were previously seen on an outpatient basis in a primary health care service. The Speech-Language Therapy (SLT) team was monitoring twenty-five users when the first cases of COVID-19 were notified in southern Brazil. Of these, it was judged that twelve patients required at least a monitoring call every two weeks. Teleconsultations were available in this first stage, on an emergency basis, during the implementation of the project in this format. The idea was to guarantee, due to the suspension of the SLT sessions, the maintenance of the care service for patients who could suffer worsening of their cases or even comorbidities. The appointments were carried out by video calls by SLT students, therapists of the extension project, and supervised by a speech-language therapist, synchronously. All conversations and orientations during the teleconsultation were conducted as calmly as possible and, in the case of infant patients, permeated by some playful activities. Telehealth has shown to be an efficient resource for the care of patients with SLT demands, enabling remote care with the same quality as face-to-face care. Besides, it has relevant potential, once there is a significant number of patients, who need SLT assessment and live in regions where there is a shortage of qualified professionals.

The scenario of researches regarding life experiences with cochlear implants: an integrative literature review / O cenário das pesquisas sobre experiências de vida com o implante coclear: uma revisão integrativa da literatura

ABSTRACT Purpose: to identify the scientific production regarding life experiences associated with the cochlear implant for the last ten years, including the process of education and presence of the family in this context. Methods: this is an integrative review that researched articles published between 2008 and 2018, on the Brazilian portal: Coordination for the Improvement of Higher Education Personnel. Results: after selecting and organizing the studies, the final sample consisted of ten articles; 2017 was the year with the greatest number of publications (three). In general, they addressed issues related to school performance, quality of life of cochlear implant users and their families, development of vocabulary and oral communication, and the meaning of cochlear implant for users and their families. Conclusion: an increasing production of studies involving the cochlear implant, family and schooling was noticed, emphasizing the importance of new researches in this context to clarify further inquiries and their use as a tool to promote new strategies aiming to improve both the quality of life of cochlear implant users and the (re)habilitation process.

RESUMO Objetivo: identificar a produção científica sobre experiências de vida associadas ao Implante Coclear nos últimos dez anos, incluindo o processo de escolarização e a presença da família dentro deste contexto. Métodos: trata-se de uma revisão integrativa, onde foi realizada a busca de artigos entre os anos de 2008-2018, realizada por meio do portal da Coordenação de Aperfeiçoamento de pessoal de Nível Superior. Resultados: após a seleção e organização dos estudos, a amostra final foi composta por dez artigos, sendo o ano com maior número de publicações o de 2017 (três), no geral abordando questões referentes ao desempenho escolar, qualidade de vida dos usuários de implante e de seus familiares, desenvolvimento de vocabulário e da comunicação oral e a representatividade do Implante Coclear para o usuário e para a família. Conclusão: observou-se um crescente cenário dos estudos envolvendo o implante coclear, a família e a escolarização, enfatizando a importância da realização de novas pesquisas neste âmbito para o esclarecimento de outros questionamentos e seu uso como ferramenta promovedora de estratégias, visando a qualidade de vida destes e o aperfeiçoamento do processo de re(habilitação).