Postoperative Imaging of Endometriosis.

Endometriosis is a highly prevalent disease that affects 10%-15% of women of reproductive age worldwide and is mainly associated with chronic pelvic pain and infertility. With the widespread use of imaging for the diagnosis and monitoring of endometriosis, combined with the ability of surgery to eradicate the disease and address infertility, there has been a significant increase in recent years in imaging examinations for postoperative evaluation of endometriosis. US and MRI are used not only to help diagnose and map endometriosis but also to evaluate refractory symptoms, residual lesions, and complications at posttreatment assessment. Knowledge of surgical techniques and recognition of expected postoperative imaging findings are crucial to differentiate postoperative changes from residual disease and/or recurrence. The authors discuss imaging aspects of postoperative endometriosis, with an emphasis on the imaging approach, comprehension of surgical techniques, recognition of the expected findings, possible complications, and analysis of residual disease or recurrence. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by VanBuren in this issue. The slide presentation from the RSNA Annual Meeting is available for this article.

Nandrolone combined with strenuous resistance training impairs myocardial proteome profile of rats.

We aimed to investigate the effects of high doses of nandrolone decanoate and resistance training (RT) on the proteomic profile of the left ventricle (LV) of rats, using a label-free quantitative approach. Male rats were randomized into four groups: untrained vehicle (UTV), trained vehicle (TV), untrained nandrolone (UTN), and trained nandrolone (TN). Rats were familiarized with the exercise training protocol (jump exercise) for one week. Jump-exercise was performed five days a week for 6 weeks, with 30 s of inter-set rest intervals. Nandrolone was administrated for 6 weeks (5 mg/kg, twice a week, via intramuscular). Systolic and diastolic arterial pressure and heart rate were measured 48 h post-training. LV was isolated and collagen content was measured. The expression of cardiac proteins was analyzed by ultra-efficiency liquid chromatography with mass spectrometry high / low collision energy (UPLC/MSE). Nandrolone and RT led to cardiac hypertrophy, even though high doses of nandrolone counteracted the RT-induced arterial pressures lowering. Nandrolone also affected the proteome profile negatively in LV of rats, including critical proteins related to biological processes (metabolism, oxidative stress, inflammation), structural function and membrane transporters. Our findings show physiological relevance since high doses of nandrolone induced detrimental effects on the proteome profile of heart tissue and hemodynamic parameters of rats. Furthermore, as nandrolone abuse has become increasingly common among recreational athletes and casual fitness enthusiasts, we consider that our findings have clinical relevance as well.

Sleep quality in times of Covid-19 pandemic.

BACKGROUND: Due to the 2019 novel coronavirus (COVID-19) disease outbreak, social distancing measures were imposed to control the spread of the pandemic. However, isolation may affect negatively the psychological well-being and impair sleep quality. Our aim was to evaluate the sleep quality of respiratory patients during the COVID-19 pandemic lockdown. METHODS: All patients who underwent a telemedicine appointment from March 30 to April 30 of 2020 were asked to participate in the survey. Sleep difficulties were measured using Jenkins Sleep Scale. RESULTS: The study population consisted of 365 patients (mean age 63.9 years, 55.6% male, 50.1% with sleep-disordered breathing [SDB]). During the lockdown, 78.9% of participants were confined at home without working. Most patients (69.6%) reported at least one sleep difficulty and frequent awakenings was the most prevalent problem. Reporting at least one sleep difficulty was associated with home confinement without working, female gender and diagnosed or suspected SDB, after adjustment for cohabitation status and use of anxiolytics. Home confinement without working was associated with difficulties falling asleep and waking up too early in the morning. Older age was a protective factor for difficulties falling asleep, waking up too early and non-restorative sleep. Notably, SDB patients with good compliance to positive airway pressure therapy were less likely to report sleep difficulties. CONCLUSIONS: Home confinement without working, female gender and SDB may predict a higher risk of reporting sleep difficulties. Medical support during major disasters should be strengthened and potentially delivered through telemedicine, as this comprehensive approach could reduce psychological distress and improve sleep quality.

Does hormonal contraception during molar pregnancy follow-up influence the risk and clinical aggressiveness of gestational trophoblastic neoplasia after controlling for risk factors?

OBJECTIVE: To evaluate the influence of hormonal contraception (HC) on the development and clinical aggressiveness of gestational trophoblastic neoplasia (GTN) and the time for normalization of human chorionic gonadotropin (hCG) levels. METHODS: A retrospective cohort study was conducted with women diagnosed with molar pregnancy, followed at the Rio de Janeiro Trophoblastic Disease Center, between January 2005 and January 2015. The occurrence of postmolar GTN and the time for hCG normalization between users of HC or barrier methods (BM) during the postmolar follow-up or GTN treatment were evaluated. RESULTS: Among 2828 patients included in this study, 2680 (95%) used HC and 148 (5%) used BM. The use of HC did not significantly influence the occurrence of GTN (ORa: 0.66, 95% CI: 0.24-1.12, p=0.060), despite different formulations: progesterone-only (ORa: 0.54, 95% CI: 0.29-1.01, p=0.060) or combined oral contraception (COC) (ORa: 0.50, 95% CI: 0.27-1.01, p=0.60) or with different dosages of ethinyl estradiol: 15mcg (ORa, 1.33, 95% CI 0.79-2.24, p=0.288), 20mcg (ORa: 1.02, 95% CI: 0.64-1.65, p=0.901), 30mcg (ORa: 1.17, 95% CI: 0.78-1.75, p=0.437) or 35mcg (ORa: 0.77, 95% CI: 0.42-1.39, p=0.386). Time to hCG normalization ≥10weeks (ORa: 0.58, 95% CI: 0.43-1.08, p=0.071) or time to remission with chemotherapy≥14weeks (ORa: 0.60, 95% CI: 0.43-1.09, p=0.067) did not significantly differ among HC users when compared to patients using BM, when controlling for other risk factors using multivariate logistic regression. CONCLUSIONS: The use of HC during postmolar follow-up or GTN treatment does not seem to increase the risk of GTN or its severity and does not postpone the normalization of hCG levels.

Unraveling the role of high-intensity resistance training on left ventricle proteome: Is there a shift towards maladaptation?

High-intensity resistance training (RT) induces adaptations that improve physiological function. However, high intensity, volume and/or frequency may lead to injury and other health issues such as adverse cardiac effects. The aim of this study was to evaluate the effect of RT on left ventricle proteome, and to identify the pathways involved on the harmful adaptations induced by this protocol. Male Wistar rats were randomized into 2 groups: Trained (T) and Sedentary (S). Animals from T group were trained for 6weeks, and then all the animals were sacrificed and left ventricle was isolated for analysis. We identified 955 proteins, and 93 proteins were considered; 36 were expressed exclusively in T group, and 4 in S group. Based on quantitative analysis, 42 proteins were found overexpressed and 11 underexpressed in T group compared with S group. Using the Gene Ontology to relate the biological processes in which these proteins are involved, we conclude that RT protocol promotes changes similar to those found in the initial phase of heart failure, but we also observed a concomitant increased expression of protective proteins, suggesting the activation of pathways to avoid major damages on left ventricle and delay the onset of pathological hypertrophy. STATEMENT OF SIGNIFICANCE OF THE STUDY: Our study shows that high-intensity RT protocol changes left ventricle proteome, modifying metabolic profile of heart tissue and inducing the expression of proteins that acts against cardiac injury. We hypothesize that these adaptations occur to prevent the onset of cardiac dysfunction. Despite highly significant, it remains to be determined whether these adaptations are sufficient to further keep left ventricle function and exert cardioprotection, and whether this panel will be shifted towards maladaptation, and heart failure.

Diabetic Nephropathy Induced by Increased Ace Gene Dosage Is Associated with High Renal Levels of Angiotensin (1-7) and Bradykinin.

Population studies have shown an association between diabetic nephropathy (DN) and insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene (ACE in humans, Ace in mice). The aim was to evaluate the modulation of Ace copies number and diabetes mellitus (DM) on renal RAS and correlate it with indicators of kidney function. Increased number of copies of the Ace gene, associated with DM, induces renal dysfunction. The susceptibility to the development of DN in 3 copies of animals is associated with an imbalance in activity of RAS enzymes leading to increased synthesis of Ang II and Ang-(1-7). Increased concentration of renal Ang-(1-7) appears to potentiate the deleterious effects triggered by Ang II on kidney structure and function. Results also show increased bradykinin concentration in 3 copies diabetic group. Taken together, results indicate that the deleterious effects described in 3 copies diabetic group are, at least in part, due to a combination of factors not usually described in the literature. Thus, the data presented here show up innovative and contribute to understanding the complex mechanisms involved in the development of DN, in order to optimize the treatment of patients with this complication.

Adesao ao tratamento antirretroviral: assistencia integral baseada no modelo de atencao as condicoes cronicas / Adherencia al tratamiento antirretroviral: atención integral basada en el modelo de atención a las condiciones crónicas / Adherence to antiretroviral treatment: comprehensive care based on the care model for chronic conditions

OBJECTIVE: To evaluate the adherence to antiretroviral therapy (ART), identifying possible interventions based on the Care Model for Chronic Conditions. METHODS: Observational, quantitative, cross-sectional study, involving 215 people with HIV/aids using antiretroviral drugs, between March and June 2012, in Fortaleza, Ceará. From the specific adherence questionnaire, we used nine questions for discussion in the light of the Care Model for Chronic Conditions (MACC). RESULTS: 35.4% failed to adhere to medication at least once. In view of the MACC, gaps were identified, such as the need for more professional intervention, showing possibilities to apply new strategies, such as self-care actions, motivational interviews, operative group and others. CONCLUSION: A significant percentage of non-adherence to ART was found, whose interventions are still incipient. Actions based on the MACC can favor comprehensive care for patients with HIV/aids.

O objetivo deste estudo foi avaliar a adesão à terapia antirretroviral (TARV), identificando possibilidades de intervenções embasadas no modelo de atenção às condições crônicas. MÉTODOS: Estudo observacional, quantitativo, transversal, desenvolvido com 215 pessoas com HIV/ AIDS em uso de antirretrovirais, entre março e junho de 2012, em Fortaleza, Ceará. De um questionário específico para avaliar a adesão utilizaram-se nove quesitos para discussão à luz do Modelo de Atenção às Condições Crônicas (MACC). RESULTADOS: 35,4% das pessoas estudadas deixaram de aderir ao tratamento pelo menos alguma vez, por se sentirem melhor/pior, ou tristes/deprimidas. Sob a luz do MACC, foram identificadas lacunas, como necessidade de mais intervenção profissional, evidenciando possibilidades de aplicar novas estratégias, como ações para o autocuidado, entrevista motivacional, grupo operativo, e outras. CONCLUSÃO: Constatou-se que há um percentual significativo de não adesão à TARV, cujas intervenções ainda são incipientes, e que ações baseadas no MACC podem favorecer uma assistência totalitária aos pacientes com HIV/AIDS.

OBJETIVO: Evaluar la adherencia a la terapia antirretroviral (TARV), identificando las posibles intervenciones basadas en el modelo de atención de las condiciones crónicas. MÉTODOS: Estudio observacional, cuantitativo, transversal, desarrollado con 215 personas con VIH/SIDA con medicamentos antirretrovirales, entre marzo y junio de 2012, en Fortaleza, Ceará. De un cuestionario específico para valorar la adherencia, se utilizaron nueve preguntas para su discusión a la luz del Modelo de Atención a las Condiciones Crónicas (MACC). RESULTADOS: Se observó que 35,4% de los pacientes dejaron de adherir a la medicación por lo menos una vez. A la luz del MACC, fueron identificadas deficiencias, como la necesidad de más intervención profesional, mostrando las posibilidades de implementar nuevas estrategias, como las acciones de autocuidado, entrevista motivacional, grupo operativo y otros. CONCLUSIÓN: Se encontró un porcentaje significativo de no adherencia al tratamiento antirretroviral, cuyas intervenciones son aún incipientes y las acciones basadas en el MACC pueden.

Uso da fotografia no processo do cuidar: tendências das ações de enfermagem / Uso de la fotografía en el proceso del cuidar: tendencias de acciones de enfermería / Use of photographhy in the process of caring: trends in nursing actions

Objetivou-se analisar, com base em evidências científicas, as tendências das ações de enfermagem mediadas pelo uso da fotografia. Realizou-se uma revisão integrativa, nas bases de dados LILACS, PubMed e CINAHL, por meio dos descritores nursing care e photography. Foram selecionados sete artigos em inglês, português e espanhol; sem restrição quanto ao ano de publicação. Os estudos apontam para uma maior utilização da fotografia no cuidado com pacientes com doença mental, na evolução de feridas e como forma de aprimorar a comunicação entre equipe de saúde e clientes. Conclui-se que a fotografia é um recurso disponível para avaliar o cuidado de enfermagem, decorrente das inúmeras informações produzidas mediante os registros visuais, pos-sibilitando ao enfermeiro planejar sua assistência de forma mais precisa. Contudo, esta técnica ainda é pouco utilizada, especialmente no Brasil.

This study aimed to analyze, based on scientific evidence, trends of nursing actions through the use of photography. Was performed an integrative review, whose articles were selected in the databases LILACS, CINAHL and PubMed, using the keywords: "nursing care" and "photography". Were selected seven articles in english, portuguese and spanish, without restriction as to the year of publication. The studies point out to greater use of photography in the care of patients with mental, illness in the evolution of wounds and as a way to improve communication between health staff and customers. We conclude that the use of photography is of great value in nursing care and the amount of information that can be obtained through visual records are countless, allowing nurses to plan your assistance more accurately. However, this technique is not widely used, especially in Brazil.

Este estudio tuvo como objetivo analizar, con base en la evidencia científica, la evolución de las acciones de enfermería a través del uso de la fotografía. Se realizó una revisión integradora, cuyos artículos fueron seleccionados en las bases de datos LILACS, CINAHL y PubMed, utilizando las palabras clave: "cuidado de enfermería" y "fotografía". Fueron seleccionados siete artículos en inglés, portugués y español, sin restricción en cuanto al año de publicación. Los estudios apuntan a un mayor uso de la fotografía, en el cuidado de pacientes con enfermedades mentales, en la evolución de las heridas y como una forma de mejorar la comunicación entre el personal sanitario y los clientes. Concluímos que el uso de la fotografía es de gran valor en la atención de enfermería y la cantidad de información que se puede obtener a través de registros visuales son innumerables, lo que permite a los enfermeros planear su asistencia con mayor precisión. Sin embargo, esta técnica no se utiliza ampliamente, especialmente en Brasil.

Influence of hydatidiform mole follow-up setting on postmolar gestational trophoblastic neoplasia outcomes: a cohort study.

OBJECTIVE: To assess the influence of hydatidiform mole (HM) management setting (reference center versus other institutions) on gestational trophoblastic neoplasia (GTN) outcomes. METHODS: This cohort study included 270 HM patients attending Botucatu Trophoblastic Diseases Center (BTDC, São Paulo State University, Brazil) between January 1990 and December 2009 (204 undergoing evacuation and entire postmolar follow-up at BTDC and 66 from other institutions [OIs]). GTN characteristics and outcomes were analyzed and compared according to HM management setting. The confounding variables assessed included age, gravidity, parity, number of abortions and HM type (complete or partial). Postmolar GTN outcomes were compared using Mann-Whitney's test, chi2 test or Fisher's exact test. RESULTS: Postmolar GTN occurred in 34 (34/204 = 16.7%) BTDC patients and in 27 (27/66 = 40.9%) of those initially treated in other institutions. BTDC patients showed lower metastasis rate (5.8% vs. 48%, p = 0.003) and lower median FIGO (2002) score (2.00 [1.00, 3.00] vs. 4.00 [2.00, 7.00], p = 0.003]. Multiagent chemotherapy to treat postmolar GTN was required in 2 BTDC cases (5.9%) and in 8 OI cases (29.6%) (p = 0.017). Median time interval between molar evacuation and chemotherapy onset was shorter among BTDC patients (7.0 [6.0, 10.0] vs. 10.0 [7.0, 16.0], p = 0.040). CONCLUSION: BTDC patients showed GTN characteristics indicative of better prognosis. This underscores the importance of GTD specialist centers.

Perspectivas da Medicina Tradicional e das práticas contemplativas na faculdade de medicina de Botucatu, UNESP / Perspectives of Traditional Medicine and Contemplative Practices at the Faculty of Botucatu medicine, UNESP

Introdução: A designação de saúde como "ausência de doença" sofreu uma alteração desde a criação da OMS, definindo-a como "o estado do mais completo bem-estar físico, mental e social e não apenas a ausência de enfermidade". A partir da década de 70, houve a hipervalorização do atendimento terciário em saúde e do tecnocentrismo, evidente com o processo de hospitalização e da tecnologia de ponta. Apesar de todo o avanço alcançado, tem-se observado um movimento considerável em várias partes do mundo em relação ao ensino e utilização de terapêuticas relacionadas à Medicina Tradicional (MT) e às Práticas Contemplativas (PC). Objetivo:Descrever as perspectivas da MT e das PC na Faculdade de Medicina de Botucatu (FMB), a partir da análise das ações que iniciaram a discussão sobre o tema. Metodologia: Análise descritiva e reflexiva dos fatos acadêmicos relacionados à MT e às PC que ocorreram na FMB. Resultados: Apesar do Hospital das Clínicas de Botucatu oferecer gratuitamente, desde 2000, atendimento homeopático e acupuntura, tendo atendido mais de 7000 pacientes, os graduandos não tinham a oportunidade de acompanhar o serviço. As práticas existentes eram restritas aos ambulatórios e não havia disciplinas optativas ou matérias curriculares oferecidas aos estudantes.A partir da demanda foram formados grupos de estudo sobre Homeopatia, Medicina Antroposófica e Espiritualidade. A fim de prover uma acessibilidade maior ao tema, em 2011 foi criada a Liga da Medicina Integrativa e Complementar. No mesmo ano ocorreram ainda o "I Congresso Médico Acadêmico de Acupuntura e Homeopatia", além de uma noite dedicada ao tema da Medicina Integrativa no 20° Congresso Médico Acadêmico de Botucatu. Conclusões:Incentivar o acesso ao conhecimento das abordagens que compõem a MT e as PC, não é apenas seguir uma tendência mundial, mas sim disponibilizar aos estudantes a possibilidade de um aprendizado que pode contribuir com a promoção do bem estar e da saúde integral do ser humano.

Amiloidose lingual associada à hemodiálise de longa duração: relato de caso / Lingual amyloidosis associated to long-term hemodialysis: report of a case

A amiloidose representa uma situação clínica resultante do depósito de proteína amilóide nos espaços extracelulares de órgãos e tecidos, a qual pode coexistir sem causar nenhuma anormalidade ou produzir sérias conseqüências ao organismo. Geralmente, é classificada em uma variante limitada a órgãos e uma forma sistêmica. Embora apenas raramente possa envolver os tecidos orais, o cirurgião-dentista deve reconhecer as suas manifestações clínicas para ajudar no tratamento ou interromper a sua progressão. O propósito deste trabalho é relatar o caso de uma paciente que apresentava depósitos de amilóide na língua causados por uma hemodiálise de longa duração

A influência da comunicação no processo de trabalho da equipe de saúde da família

O tema proposto busca discutir a influência da comunicação no processo de trabalho da Equipe de Saúde da Família, com intuito de despertar nos profissionais inseridos nas Equipes, a consciência e o interesse em atuar, utilizando adequadamente e de forma rotineira, uma nova forma de comunicação que possibilite a interdisciplinaridade e a melhora na assistência integral aos usuários. Trata-se de um estudo de revisão bibliográfica narrativa, utilizando artigos nacionais sobre o tema no período de 2000 a 2010. As buscas foram realizadas em base de dados e bibliotecas virtuais da área da saúde. Pôde-se constatar como a presença de algumas situações vivenciadas pela equipe em seu cotidiano, traz prejuízos ao processo de comunicação, desfavorecendo a ações de saúde. A prática comunicativa, através do diálogo, possibilita o vínculo e a interação entre equipe/comunidade, melhorando consideravelmente as relações, e consequentemente as ações de saúde.