Vascular contraction of umbilical arteries of pregnant women with preeclampsia.

Objective: Potassium channels have an important role in the vascular adaptation during pregnancy and a reduction in the expression of adenosine triphosphate-sensitive potassium channels (Katp) has been linked to preeclampsia. Activation of Katp induces vasodilation; however, no previous study has been conducted to evaluate the effects of the inhibition of these channels in the contractility of preeclamptic arteries. Glibenclamide is an oral antihyperglycemic agent that inhibits Katp and has been widely used in vascular studies. Methods: To investigate the effects of the inhibition of Katp, umbilical arteries of preeclamptic women and women with healthy pregnancies were assessed by vascular contractility experiments, in the presence or absence of glibenclamide. The umbilical arteries were challenged with cumulative concentrations of potassium chloride (KCl) and serotonin. Results: There were no differences between the groups concerning the maternal age and gestational age of the patients. The percentage of smokers, caucasians and primiparae per group was also similar. On the other hand, blood pressure parameters were elevated in the preeclamptic group. In addition, the preeclamptic group presented a significantly higher body mass index. The newborns of both groups presented similar APGAR scores and weights. Conclusion: In the presence of glibenclamide, there was an increase in the KCl-induced contractions only in vessels from the PE group, showing a possible involvement of these channels in the disorder.

Effectiveness of metformin to pregnant women with PCOS to reduce spontaneous abortion and gestational diabetes mellitus: a protocol for an overview of reviews.

INTRODUCTION: Polycystic ovary syndrome (PCOS) is a globally prevalent endocrinological disorder and has been associated with poor pregnancy outcomes, including a higher rate of gestational diabetes and miscarriage. Metformin is among the drugs investigated to improve the prognosis of pregnant women with PCOS. OBJECTIVE: To conduct an overview of systematic reviews examining the effects of metformin versus placebo or no intervention throughout pregnancy among pregnant women with a preconception PCOS diagnosis to reduce the incidence of miscarriage and gestational diabetes. METHODS AND ANALYSIS: We will perform an overview of systematic reviews by searching Embase, PubMed, Virtual Health Library, Cochrane Central Register of Controlled Trials, Trip Database, Scopus, Web of Science and Cumulative Index to Nursing and Allied Health Literature from inception to 17 August 2023. Language, publication status and year indexed or published filters will not be applied. Two reviewers will independently screen and select papers, assess their quality, evaluate their risk of bias and collect the data. The included reviews will be summarised narratively. The quality and risk of bias of the systematic review and meta-analysis studies included will be assessed using AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews, Second Version) and ROBIS (Risk of Bias in Systematic Reviews), respectively. ETHICS AND DISSEMINATION: This overview of reviews will analyse data from systematic reviews on the use of metformin for prepregnancy diagnosis of PCOS to reduce adverse outcomes. As there will be no primary data collection, a formal ethical analysis is unnecessary. The study outcomes will be submitted to a peer-reviewed journal and presented at conferences. PROSPERO REGISTRATION NUMBER: CRD42023441488.

Deficiencies in reporting inclusion/exclusion criteria and characteristics of patients in randomized controlled trials of therapeutic interventions in pressure injuries: a systematic methodological review.

Wound care is a complex procedure and the related research may include many variables. Deficiencies in the sample inclusion and exclusion criteria may limit the generalizability of randomized controlled trials (RCTs) for wound patients in the real world. This study aimed to evaluate deficiencies in reporting the inclusion and exclusion criteria and the characteristics of patients in RCTs of pressure injuries (PI) therapeutic interventions. We conducted a systematic methodological review in which 40 full text RCTs of PI treatment interventions published in English, from 2008 to 2020, were identified. Data on the general characteristics of the included RCTs and data about inclusion/exclusion criteria and characteristics of patients were collected. The inclusion/exclusion criteria were categorized into five domains (definition of disease, precision, safety, ethical/legal and administrative). Study duration (in weeks) was 8.0 (quartile 1: 2.0; quartile 3: 48.0); only 5.0% of the trials mentioned race, skin colour or ethnicity, and 37.5% reported the duration of the wound. Only 9 (22.5%) studies reported the drugs that the included patients were using and 10 (25.0%) RCTs reported adverse events. The presence of the five domains was observed only in 12.5% of RCTs and only 12 (30.0%) had the precision domain. Much more research is required in systematic assessments of the external validity of trials because there is substantial disparity between the information that is provided by RCTs and the information that is required by clinicians. We concluded that there are deficiencies in reporting of data related to inclusion/exclusion criteria and characteristics of patients of RCTs assessing PI therapeutic interventions.

Assessment of healthcare accessibility and travel distance on intrapartum fetal death: a retrospective cohort study / Relación de la accesibilidad de la atención de salud y la distancia de desplazamiento con la muerte fetal durante el parto: un estudio de cohorte retrospectivo / Avaliação do impacto do acesso ao sistema de saúde e da distância percorrida na morte fetal intraparto: estudo retrospectivo de coorte

[ABSTRACT]. Objective. To determine if there was an association between intrapartum stillbirths and both traveled distance for delivery and delivery care accessibility, assessing periods before and during the COVID-19 pandemic. Methods. This is a population-based cohort study. Patients had birth occurring after the onset of labor; the primary outcome was intrapartum stillbirth. City of residence was classified according to the ratio between deliveries performed and total births among its residents; values lower than 0.1 indicated low delivery care accessibility. Travel distance was calculated using the Haversine formula. Education level, maternal age, and birth sex were included. In each period, relative risk was assessed by generalized linear model with Poisson variance. Results. There were 2 267 534 deliveries with birth occurring after the onset of labor. Most patients were between age 20 and 35 years, had between 8 and 11 years of education, and resided in cities with high delivery care accessibility. Low delivery care accessibility increased risk of intrapartum stillbirth in the pre-pandemic (relative risk [RR] 2.02; 95% CI [1.64, 2.47]; p < 0.01) and the pandemic period (RR 1.69; 95% CI [1.09, 2.55]; p = 0.015). This was independent of other risk-increasing factors, such as travel distance and fewer years of education. Conclusions. Low delivery care accessibility is associated with the risk of intrapartum stillbirths, and accessibility reduced during the pandemic. Delivery of patients by family physicians and midwives, as well as official communication channels between primary care physicians and specialists, could improve patient health- care-seeking behavior.

[RESUMEN]. Objetivo. Determinar si hubo una asociación entre la mortinatalidad durante el parto y la distancia recorrida o la accesibilidad de la atención para el parto, mediante la evaluación de un período anterior y de otro coin- cidente con la pandemia de COVID-19. Métodos. Se realizó un estudio de cohorte de base poblacional. Se incluyó a las pacientes que dieron a luz tras el inicio de un trabajo de parto; el criterio de valoración principal fue la mortinatalidad durante el parto. Se clasificaron las ciudades de residencia conforme al cociente entre el número de partos atendidos y el total de partos habidos entre sus residentes; los valores inferiores a 0,1 indican que la accesibilidad de la atención del parto es baja. La distancia recorrida para el parto se calculó utilizando la fórmula de Haversine. Se utilizaron datos del nivel de estudios y la edad de la madre y del sexo biológico neonatal. Para cada período, se evaluó el riesgo relativo mediante un modelo lineal generalizado con varianza de Poisson. Resultados. Hubo 2 267 534 partos que se produjeron tras el inicio de un trabajo de parto. La mayoría de las pacientes tenían edades comprendidas entre 20 y 35 años, tenían entre 8 y 11 años de estudios y residían en ciudades donde la accesibilidad de la atención del parto era alta. Una accesibilidad baja de la atención del parto se asoció a un aumento del riesgo de mortinatalidad durante el parto en el período prepandémico (riesgo relativo [RR] = 2,02; IC del 95% = [1,64, 2,47]; p < 0,01) y también durante la pandemia (RR = 1,69; IC del 95% = [1.09, 2.55]; p = 0,015). Este resultado fuer independiente de otros factores que incrementan el riesgo, como la distancia recorrida para dar a luz y un menor nivel de estudios. Conclusiones. Una accesibilidad baja de la atención del parto se asocia a un mayor riesgo de mortinatalidad durante el parto; y se observó una reducción de la accesibilidad durante la pandemia. Los partos asistidos por personal de medicina de familia o de partería y los canales de comunicación oficiales entre el personal médico de atención primaria y el especializado podrían mejorar el comportamiento de las pacientes a la hora de buscar atención de salud.

[RESUMO]. Objetivo. Determinar se existe alguma relação entre a morte fetal intraparto e dois fatores: a distância percorrida para o parto e o acesso à assistência ao parto, avaliando o período antes e durante a pandemia de COVID-19. Métodos. Este é um estudo de coorte de base populacional. As pacientes tiveram parto após o início do trabalho de parto; o desfecho primário foi morte fetal intraparto. A cidade de residência foi classificada de acordo com a razão entre os partos realizados e o total de nascimentos entre os residentes; valores inferiores a 0,1 indicavam baixo acesso à assistência ao parto. A distância percorrida foi calculada usando a fórmula de Haversine. Foram incluídos o nível de escolaridade, a idade materna e o sexo de nascimento. Em cada período, o risco relativo foi avaliado usando um modelo linear generalizado com variância de Poisson. Resultados. Foram registrados 2 267 534 partos com nascimento após o início do trabalho de parto. A maioria das pacientes tinha entre 20 e 35 anos de idade, entre 8 e 11 anos de escolaridade e residia em cidades com alto nível de acesso à assistência ao parto. O baixo acesso à assistência ao parto aumentou o risco de morte fetal intraparto no período anterior à pandemia (risco relativo [RR]: 2,02; intervalo de confiança [IC] de 95%: 1,64–2,47; p < 0,01) e durante a pandemia (RR: 1,69; IC 95%: 1,09–2,55; p = 0,015). Isso ocorreu independentemente de outros fatores de aumento de risco, como a distância percorrida e menor escolaridade. Conclusões. O baixo acesso ao atendimento de parto está associado ao risco de morte fetal intraparto, e a acessibilidade diminuiu durante a pandemia. A realização do parto por médicos de família e obstetrizes, bem como a existência de canais oficiais de comunicação entre médicos de atenção primária e especialistas, poderiam melhorar o comportamento de busca de saúde por parte das pacientes.

Markers of Endothelial Dysfunction Are Attenuated by Resveratrol in Preeclampsia.

Preeclampsia (PE) is characterized by great endothelial dysfunction, decreased nitric oxide (NO) bioavailability, and higher levels of arginase activity. In the present study, we investigated the potential modulatory effects of trans-resveratrol (RSV) on arginase and endothelial dysfunction biomarkers in endothelial cells exposed to plasma from patients with PE and healthy pregnant (HP) women, and umbilical arteries from patients with PE. Human umbilical vein endothelial cells (HUVECs) were incubated with pooled plasma from 10 HP or 10 PE pregnant women and RSV; umbilical arteries from patients with PE were incubated with RSV; intracellular NO and total reactive oxygen species (ROS) levels were assessed using a probe that interacted with these radicals; total arginase activity was evaluated measuring the urea produced; total antioxidant capacity was measured using the ferric reduction ability power (FRAP) assay; and endothelial dysfunction biomarkers were assessed using qPCR in endothelial cells and umbilical arteries. RSV increased NO levels and decreased total arginase activity in endothelial cells incubated with plasma from patients with PE. In addition, RSV increased total antioxidant capacity and downregulated endothelial dysfunction biomarkers, such as intercellular adhesion molecule-1 (ICAM-1), von Willebrand factor (vWF), and Caspase-3, (CASP-3), in endothelial cells and umbilical arteries from PE patients. RSV treatment positively modulated the L-arginine-NO pathway, decreased arginase activity, and increased antioxidant capacity, in addition to downregulating endothelial dysfunction biomarkers.

Glibenclamide Increases Nitric Oxide Levels and Decreases Oxidative Stress in an In Vitro Model of Preeclampsia.

(1) Background: The bioavailability of nitric oxide (NO) and oxidative stress are important events related to the pathophysiology of preeclampsia (PE). In this present study, we aimed to evaluate the antioxidant effect of glibenclamide (GB) on the NO synthesis, oxidative stress, and antioxidant capacity in endothelial cells incubated with plasma from preeclamptic (PE) and normotensive pregnant women (NT). (2) Methods: Human umbilical vein endothelial cells (HUVECs) were incubated with a plasma pool from 10 NT and 10 PE pregnant women; NO/NOx quantification and ROS levels were assessed by a fluorescence compound; lipid peroxidation was evaluated employing thiobarbituric acid (TBA); and total antioxidant capacity was measured by ferric reduction ability power (FRAP) and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT). (3) Results: We found that endothelial cells incubated with plasma from PE showed lower NO and NOx levels compared with the NT group. However, GB treatment increased these levels, as well as the antioxidant capacity. Furthermore, a decrease was observed in ROS generation and lipid peroxidation (4) Conclusions: The GB treatment exerted a positive effect on the NO/NOx production by HUVEC incubated with plasma from NT and PE pregnant women, as well as in the reduction in oxidative stress and increase in the antioxidant capacity.

Consolidation chemotherapy in postmolar low-risk gestational trophoblastic neoplasia: a systematic review protocol.

INTRODUCTION: Current evidence remains insufficient to strongly demonstrate the benefits of consolidation chemotherapy to all women with low-risk gestational trophoblastic neoplasia (GTN). This protocol outlines a systematic review to investigate whether consolidation chemotherapy is necessary for all patients with postmolar low-risk GTN after human chorionic gonadotropin normalisation with first-line single-agent chemotherapy. METHODS AND ANALYSIS: A search string will be used to search the PubMed (MEDLINE), EMBASE, Web of Sciences, Scopus, LILACS and Cochrane Central Register of Controlled Trials databases. Articles will be screened at the title and abstract level, and then at the full article level by two independent reviewers using inclusion/exclusion criteria. Randomised and non-randomised study designs will be included, while case studies, commentaries, editorials, review articles, animal studies, basic science studies and cross-sectional studies, as well as studies not reporting relapse/recurrence rates and/or whether consolidation chemotherapy was delivered will be excluded. There will be no restrictions on date of publication, geographical location, study setting, or language of publication. The primary outcome is rate of recurrence/relapse. The assessments of randomised controlled trials will be performed using the risk of bias tool from the Cochrane Collaboration. Non-randomised studies will be assessed using the Newcastle-Ottawa scale. The quality of evidence will be assessed using the Grading quality of evidence and strength of recommendations (Grades of Recommendations, Assessment, Development and Evaluation) guidelines. ETHICS AND DISSEMINATION: No formal ethical approval is required as all data collected will be secondary data and analysed anonymously. Results will be disseminated through a peer-reviewed publication and at scientific events. PROSPERO REGISTRATION NUMBER: CRD42020164822.

Vitamin D decreases cell death and inflammation in human umbilical vein endothelial cells and placental explants from pregnant women with preeclampsia cultured with TNF-α.

This study evaluated the impact of vitamin D on Human Umbilical Vein Endothelial Cells (HUVEC) and inflammation in placental explants from women with preeclampsia (PE). HUVEC and explants from 10 late-onset PE (LOPE), 10 early-onset (EOPE), and 10 normotensive (NT) pregnant women were cultured with/without tumor necrosis factor (TNF-α) and VD. Interleukin-1ß (IL-1ß), 18 (IL-18), TNF-α, and TNF-related apoptosis-inducing ligand (TRAIL) were detected by ELISA. High mobility group box 1 (HMGB1) was determined by qPCR/Western blotting, and cell death by flow cytometry. Statistical significance was accepted at p < .05. Compared to the NT group, the endogenous levels of IL-1ß, TNF-α, and IL-18 were higher in the PE group. The stimulus with TNF-α increased cytokines in NT, TNF-α in EOPE/LOPE, IL-18 in LOPE, and all cytokines in HUVEC. TNF-α+VD treatment decreased cytokines in explant and HUVEC supernatants. TRAIL was higher in EOPE versus NT, while TNF-α increased this receptor in NT versus control. In HUVEC, TNF-α increased TRAIL versus control, and TNF-α+VD decreased levels compared to only TNF-α stimulus. Protein expression of HMGB1 was higher in explant cultures treated with TNF-α and decreased after TNF-α+VD treatment in all groups, and gene/protein expression in HUVEC. Gene expression was elevated in EOPE versus NT and LOPE, and TNF-α increased HMGB1 in NT versus control, while TNF-α+VD decreased mRNA levels in EOPE. TNF-α stimulus increased late apoptosis in HUVEC, while VD increased viability. These in vitro observations suggest that VD administration to women with preeclampsia may be beneficial in reducing placental inflammation and cell death.

Pro-angiogenic approach for skeletal muscle regeneration.

The angiogenesis process is a phenomenon in which numerous molecules participate in the stimulation of the new vessels' formation from pre-existing vessels. Angiogenesis is a crucial step in tissue regeneration and recovery of organ and tissue function. Muscle diseases affect millions of people worldwide overcome the ability of skeletal muscle to self-repair. Pro-angiogenic therapies are key in skeletal muscle regeneration where both myogenesis and angiogenesis occur. These therapies have been based on mesenchymal stem cells (MSCs), exosomes, microRNAs (miRs) and delivery of biological factors. The use of different calls of biomaterials is another approach, including ceramics, composites, and polymers. Natural polymers are use due its bioactivity and biocompatibility in addition to its use as scaffolds and in drug delivery systems. One of these polymers is the natural rubber latex (NRL) which is biocompatible, bioactive, versatile, low-costing, and capable of promoting tissue regeneration and angiogenesis. In this review, the advances in the field of pro-angiogenic therapies are discussed.

Systematic review and meta-analysis of the safety of chloroquine and hydroxychloroquine from randomized controlled trials on malarial and non-malarial conditions.

BACKGROUND: Despite the expectations regarding the effectiveness of chloroquine (CQ) and hydroxychloroquine (HCQ) for coronavirus disease (COVID-19) management, concerns about their adverse events have remained. OBJECTIVES: The objective of this systematic review was to evaluate the safety of CQ and HCQ from malarial and non-malarial randomized clinical trials (RCTs). METHODS: The primary outcomes were the frequencies of serious adverse events (SAEs), retinopathy, and cardiac complications. Search strategies were applied to MEDLINE, EMBASE, LILACS, CENTRAL, Scopus, and Trip databases. We used a random-effects model to pool results across studies and Peto's one-step odds ratio (OR) for event rates below 1%. Both-armed zero-event studies were excluded from the meta-analyses. We used the Grading of Recommendations Assessment, Development, and Evaluation system to evaluate the certainty of evidence. RESULTS: One hundred and six RCTs were included. We found no significant difference between CQ/HCQ and control (placebo or non-CQ/HCQ) in the frequency of SAEs (OR: 0.98, 95% confidence interval [CI]: 0.76-1.26, 33 trials, 15,942 participants, moderate certainty of evidence). However, there was a moderate certainty of evidence that CQ/HCQ increases the incidence of cardiac complications (RR: 1.62, 95% CI: 1.10-2.38, 16 trials, 9908 participants). No clear relationship was observed between CQ/HCQ and retinopathy (OR: 1.63, 95% CI: - 0.4-6.57, 5 trials, 344 participants, very low certainty of evidence). CONCLUSIONS: CQ and HCQ probably do not increase SAEs, with low frequency of these adverse events on malarial and non-malarial conditions. However, they may increase cardiac complications especially in patients with COVID-19. No clear effect of their use on the incidence of retinopathy was observed. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020177818.

Exploring pooled analysis of pretested items to monitor the performance of medical students exposed to different curriculum designs.

Several methods have been proposed for analyzing differences between test scores, such as using mean scores, cumulative deviation, and mixed-effect models. Here, we explore the pooled analysis of retested Progress Test items to monitor the performance of first-year medical students who were exposed to a new curriculum design. This was a cross-sectional study of students in their first year of a medical program who participated in the annual interinstitutional Progress Tests from 2013 to 2019. We analyzed the performance of first-year students in the 2019 test and compared it with that of first-year students taking the test from 2013 to 2018 and encountering the same items. For each item, we calculated odds ratios with 95% confidence intervals; we also performed meta-analyses with fixed effects for each content area in the pooled analysis and presented the odds ratio (OR) with a 95% confidence interval (CI). In all, we used 63 items, which were divided into basic sciences, internal medicine, pediatrics, surgery, obstetrics and gynecology, and public health. Significant differences were found between groups in basic sciences (OR = 1.172 [CI95% 1.005 CI 1.366], p = 0.043) and public health (OR = 1.54 [CI95% CI 1.25-1.897], p < 0.001), which may reflect the characteristics of the new curriculum. Thus, pooled analysis of pretested items may provide indicators of different performance. This method may complement analysis of score differences on benchmark assessments.

Quality of reporting of outcomes in trials of therapeutic interventions for pressure injuries in adults: a systematic methodological survey.

Randomised controlled trials of therapeutic interventions for pressure injuries should include a clear description of outcomes to increase transparency and replicability and improve the construction of scientific evidence. The objective of this study was to assess the completeness of the descriptions of the outcomes of therapeutic interventions in adults with pressure injury (PI) and factors associated with completeness. This was a systematic methodological survey. The completeness of the outcome was assessed according to five criteria: domain (title), specific measure (technique/instrument used), specific metric, or format of the outcome data of each participant that was used for analysis, aggregation (method data from each group were summarised), and time that was used for analysis. Sixty-eight studies were included for analysis. A total of 265 outcomes were reported, and 46 trials (67.6%) had 73 primary outcomes, which were mainly intermediates/substitutes (78.8%). The main outcome evaluated was the ulcer area reduction (36.6%). Approximately 37.2% of the outcomes were incompletely reported, and the least described element was the data aggregation method (72.8%). Only 48.4% of the outcomes with the specified technique had the same reference or validation. Poor quality of reporting outcomes was associated with studies with an older year of publication and a small sample size, single-center studies, and those sponsored by industry. PI studies use many outcomes, mostly surrogates or intermediates, and some of them are incompletely described.

Altered maternal metabolism during mild gestational hyperglycemia as a predictor of adverse perinatal outcomes: A comprehensive analysis.

Mild gestational hyperglycemia (MGH), as assessed using the normal oral glucose tolerance test (OGTT) and detection of an altered glycemic profile, is associated with adverse perinatal outcome. This study described the results of 40 years of research conducted at the Perinatal Diabetes Research Centre at São Paulo State University (UNESP), Brazil, on the maternal MGH environment and placental markers. This study also described the unidirectional relationship between MGH and excessive fetal growth, also supplying moderator analysis. In addition to hyperglycemia, MGH is associated with an increased incidence of hypertension, metabolic syndrome, persistent insulin resistance after pregnancy, and high risk of developing type 2 diabetes mellitus (T2DM) after pregnancy. Structural changes and functional abnormalities resulting from MGH were observed in placenta. The fully adjusted model concluded that the predictor variable (MGH), which creates a complex environment for the fetus, has a direct effect on excessive birth weight and produces a z-score for ratios of birth weight to gestational age of ≥2. Maternal age, pre-pregnancy BMI, number of previous pregnancies, numbers of prenatal visits, and 1 h OGTT are moderator variables that impact MGH and excessive fetal growth. These results show that maternal MGH has some characteristics associated with similar long-term T2DM development and similar adverse perinatal results to those of gestational diabetes mellitus (GDM) mothers, making it an intermediate maternal and placental marker between normoglycemic and GDM mothers.

Teste de Progresso em Consórcios para Todas as Escolas Médicas do Brasil / Consortia of Cross-Institutional Progress Testing for All Medical Schools in Brazil

RESUMO O Teste de Progresso é uma ferramenta de avaliação longitudinal do ganho de conhecimento de estudantes que tem sido aplicada no Brasil há mais de dez anos. O teste situa o estudante em seu processo evolutivo de ensino-aprendizagem e permite à instituição realizar o diagnóstico de suas deficiências ao longo da estrutura curricular. Ele pode ser utilizado pelos colegiados competentes para avaliação de alterações curriculares e avaliações específicas de disciplinas ou módulos de ensino. Com base na experiência de um consórcio de escolas, a Associação Brasileira de Educação Médica (Abem) propôs um projeto que tinha como um de seus objetivos incentivar escolas de todo o País a adotarem o Teste de Progresso como uma de suas ferramentas de avaliação. Reportamos a estratégia adotada para constituir núcleos interinstitucionais de avaliação com Teste de Progresso, bem como os resultados da primeira prova nacional do Teste de Progresso, que contou com a participação de 58 escolas e 23.065 estudantes. A implantação de núcleos interinstitucionais de Teste do Progresso com processos colaborativos de realização da prova representou um avanço para as escolas envolvidas. As escolas iniciaram um processo de colaboração não apenas para o Teste de Progresso, mas também para o intercâmbio de informações e experiências que trocam com base no conhecimento de cada uma. O projeto funcionou como o início de um movimento para que escolas médicas de todas as regiões do País adotem o Teste de Progresso como uma ferramenta de avaliação com potencial para reorientar a formação médica, ao fornecer um diagnóstico de formação em nível individual e institucional.

ABSTRACT Progress Testing has been applied in Brazil for more than ten years. It is a tool for longitudinal evaluation of students' knowledge across levels of training. The test situates the student in his evolutionary teaching-learning process and allows the institution to diagnose its deficiencies throughout the curricular structure. It can be used to evaluate curricular changes and specific assessments of disciplines or teaching modules. From the experience of a consortium of schools, the Brazilian Association of Medical Education (ABEM) proposed a project that aimed to encourage schools throughout the country to adopt Progress Testing as one of its evaluation tools. We report on the strategy adopted to establish interinstitutional evaluation nuclei with Progress Testing, as well as the results of the first national exam, administered by 58 schools to 23,065 students. The implantation of cross-institutional Progress Testing triggered collaborative processes among the schools involved. Schools have begun a collaborative process not only for the Progress Testing, but also for the exchange of information. The project served as the beginning of a movement for medical schools in all regions of the country to adopt Progress Testing as an assessment tool with the potential to reorient medical training by providing information regarding institutional and individual performances.

Quality of reporting of outcomes in trials of therapeutic interventions for pressure ulcers in adults: a protocol for a systematic survey.

Pressure ulcers (PUs) have a high incidence, especially in hospital units. Randomised clinical trials (RCTs) of therapeutic interventions for PU should include a clear description of the outcomes and results to enhance transparency and replicability. OBJECTIVES: The primary objective of this study is to assess the completeness of the descriptions of the outcomes of therapeutic interventions in RCTs in adult patients with PU. The secondary objectives are to evaluate the types of reported primary outcomes, measurement methods or tools used to evaluate the outcomes and the results of reported outcomes. METHODS: We will conduct a systematic survey of RCTs published from January 2006 to April 2018. The selection process of the studies will be done in two stages of screening: title and abstract, and full text revision, always by two researchers independently. The completeness of the outcome will be assessed according to five criteria: domain (outcome title), specific measurement or technique/instrument used, specific metric or format of the outcome data that will be used for analysis, method of aggregation (how data from each group will be summarised) and time-points that will be used for analysis. The quality of the results of the outcome will be classified as either complete, incomplete or unreported. We will conduct a descriptive analysis of the number, type and degrees of outcome specification in the included RCTs. The frequency of categories in each domain of the outcomes will also be reported. The median and IQR will be estimated for each element of the specified outcome (out of five). ETHICS AND DISSEMINATION: This will be the first systematic assessment of the outcomes of therapeutic interventions used for pressure ulcers. After completion, this review will be submitted to a peer-reviewed journals.

The Correlation Between Students' Progress Testing Scores and Their Performance in a Residency Selection Process.

Brazil is currently seeing an increased number of medical schools, leading to high competition for medical residency vacancies. Public managers have thus considered Progress Testing scores potentially useful as part of the final decision in the medical residency selection process. We analyzed whether there is a correlation between students' Progress Testing scores and their performances in medical residency selection. We examined four subsequent cohorts of students who attempted Progress Testing yearly and compared their accumulated scores with their medical residency selection scores from Botucatu Medical School, Universidade Estadual Paulista. We included 212 students who finished the 6-year medical course in 2013, 2014, 2015, and 2016. The comparison between the area under the Progress Testing curve and the medical residency selection score was performed using a Pearson correlation, with a p value set at < 0.05. We found a positive association between the two scores (p < 0.05 for the 4 years). Next, the students were grouped according to their performance in Progress Testing: above one, within one, and below one standard deviation. A chi-square test was used to compare the rates of approval with the second step of the medical residency selection process. Approval rates were 91.7%, 69.2%, and 42.1%, respectively (p < 0.05). We conclude that, in fact, there is a correlation between students' performance on these measures. This is partially explained by the fact that both instruments measure cognitive competencies and knowledge. These data may support national policy changes for medical residency selection.

Prevalence of metabolic syndrome in non-diabetic, pregnant Angolan women according to four diagnostic criteria and its effects on adverse perinatal outcomes.

BACKGROUND: Metabolic syndrome (MetS) is a cluster of risk factors for type 2 diabetes (Type2 DM) and cardiovascular diseases (CVD), and its prevalence varies based on region, population, and sex. Newborns of women with MetS have a greater risk of adverse perinatal outcomes. This study explores the prevalence of metabolic syndrome in non-diabetic, pregnant Angolan women and the adverse perinatal outcomes associated with it. METHODS: This cross-sectional study collected the demographic, anthropometric and clinical data of 675 pregnant women in the maternity ward of General Hospital in Huambo, Angola. Metabolic syndrome was defined using four criteria: the third report of the National Cholesterol Education Program Adult Treatment Panel (ATPIII), the Joint Interim Statement (JIS), and definitions by both Bartha et al. and Chatzi et al. RESULTS: The crude prevalence of metabolic syndrome was 36.6 % based on the JIS definition, 29.2 % based on NCEP ATPIII, 12.6 % based on Chatzi et al. and 1.8 % based on Bartha et al. In general, the prevalence of adverse perinatal outcomes was 14.1 %. CONCLUSIONS: There was a high prevalence of metabolic syndrome, depending on the criteria used, and thus a great need to harmonize the criteria and cutoff points. Perinatal adverse outcomes were higher in pregnant women with metabolic syndrome.

Produção científica sobre educação médica no Brasil: estudo a partir das publicações da Revista Brasileira de Educação Médica / Scientific production on pedical education in Brazil: a Study based on the Brazilian Journal of Medical Education

A pesquisa em educação médica é o estudo crítico e sistemático do ensino e aprendizagem em Medicina. É um campo em crescimento, em número tanto de pesquisadores envolvidos, como de produções geradas. No Brasil, a Revista Brasileira de Educação Médica (RBEM) é o principal meio de divulgação científica da pesquisa da área. Este estudo visa caracterizar a pesquisa em educação médica brasileira a partir das publicações da RBEM no período de 2006 a 2010. Neste período, houve um crescimento de 117,6%, com média de 60,4 artigos por ano, com crescente participação proporcional de pesquisas inéditas. A Região Sudeste e instituições públicas têm a maior participação nos artigos. Os descritores mais utilizados foram "educação médica", "estudantes de Medicina" e "currículo". O crescimento da RBEM espelha o desenvolvimento da pesquisa em educação médica brasileira, seguindo a lógica da produção científica nacional.

Research in medical education is the critical and systematic study of teaching and learning in medicine. It's a developing field with an increasing number of researchers and publications. In Brazil, the Brazilian Journal of Medical Education (RBEM) is the main journal in the area. The present study describes Brazilian scientific production in medical education by analyzing papers published by the RBEM from 2006 to 2010. In this period, the number of articles increased by 117.6%, averaging 60.4 articles per year. There was also an increase in the proportion of new research studies. The Southeast region and public institutions account for the greatest share of the articles. The most frequent keywords were "medical education", "medical students" and "curriculum". The growth of the RBEM reflects the development of research in medical education in Brazil and is in keeping with the logic of national scientific production.

[Anthropometric characteristics of HIV/AIDS: pregnants and birth weight of theirs newborns]. / Gestantes vivendo com HIV/AIDS: características antropométricas e peso ao nascer dos seus recém-nascidos.

PURPOSE: To describe the anthropometric and pregnancy characteristics of women with HIV/AIDS, assisted by the Brazilian National Health System and the birth weight of their newborns. METHODS: The participants were women assisted at public STD/AIDS clinics of the Municipal Health system of São Paulo. The anthropometric characteristics were evaluated by trained nutritionists and other information was obtained from the medical records. For comparison of the survey data to those of the general population, secondary maternal and pregnancy data were obtained from live birth certificates through the Live Birth Information System. Continuous variables were summarized as mean and standard deviation or as the 25th, 50th and 75th percentiles and minimum and maximum values. The other variables are presented as percentages. Means were compared by the Student's t-test or Kruskal-Wallis test depending on the fulfillment of assumptions, with the decision based on the p value. RESULTS: We found the presence of inadequate maternal nutrition according to triceps skinfold (60.9%). The BMI/gestational age showed the presence of underweight (18.5%) and overweight or obesity (40%). There was no association between disease status (HIV or AIDS) and weight, height, and lean or fat mass. Mean newborn birth weight was lower than the value for the general population without infection or disease. The results of this study indicate the need to develop adapted curves to allow a more accurate nutritional assessment of this population group.

Gestantes vivendo com HIV/AIDS: características antropométricas e peso ao nascer dos seus recém-nascidos / Anthropometric characteristics of HIV/AIDS: pregnants and birth weight of theirs newborns

OBJETIVO:Descrever características antropométricas e da gestação de mulheres com HIV/AIDS, usuárias do Sistema Único de Saúde (SUS) e o peso de seus recém-nascidos. MÉTODOS: Participaram do estudo gestantes atendidas nos serviços de assistência à DST/AIDS da Secretaria Municipal de Saúde do município de São Paulo. A avaliação antropométrica foi realizada por nutricionistas treinadas e as demais informações foram obtidas em prontuários. Para a comparação entre os dados do estudo e os da população geral, foram utilizados dados secundários da mãe e da gestação oriundos das Declarações de Nascidos Vivos, disponíveis no Sistema de Informações sobre Nascidos Vivos. As variáveis contínuas foram resumidas por meio da média e desvio padrão ou pelos percentis 25, 50 e 75, valores mínimo e máximo. As demais variáveis são apresentadas em porcentagens. As médias foram comparadas por meio dos testes t Student ou Kruskall-Wallis, a depender do cumprimento das pressuposições, com decisão baseada no valor de p. RESULTADOS: Observaram-se presença de inadequação nutricional materna se considerada a prega cutânea do tríceps (60,9%), baixo peso (18,5%) e sobrepeso ou obesidade (40%), segundo o índice de massa corporal (IMC) gestacional; ausência de associação entre diagnóstico (HIV ou AIS) e peso, estatura, massa magra e gorda. Para filhos de mães com HIV/AIDS, observou-se peso médio ao nascer menor ao da população sem esta condição. CONCLUSÕES: Os resultados do presente estudo indicam a necessidade de desenvolvimento de curvas adaptadas que permitam a avaliação nutricional mais acurada deste grupo populacional.

PURPOSE: To describe the anthropometric and pregnancy characteristics of women with HIV/AIDS, assisted by the Brazilian National Health System and the birth weight of their newborns. METHODS: The participants were women assisted at public STD/AIDS clinics of the Municipal Health system of São Paulo. The anthropometric characteristics were evaluated by trained nutritionists and other information was obtained from the medical records. For comparison of the survey data to those of the general population, secondary maternal and pregnancy data were obtained from live birth certificates through the Live Birth Information System. Continuous variables were summarized as mean and standard deviation or as the 25th, 50th and 75th percentiles and minimum and maximum values. The other variables are presented as percentages. Means were compared by the Student's t-test or Kruskal-Wallis test depending on the fulfillment of assumptions, with the decision based on the p value. RESULTS: We found the presence of inadequate maternal nutrition according to triceps skinfold (60.9%). The BMI/gestational age showed the presence of underweight (18.5%) and overweight or obesity (40%). There was no association between disease status (HIV or AIDS) and weight, height, and lean or fat mass. Mean newborn birth weight was lower than the value for the general population without infection or disease. The results of this study indicate the need to develop adapted curves to allow a more accurate nutritional assessment of this population group.