Medication and supplement pharmacokinetic changes following bariatric surgery: A systematic review and meta-analysis.

OBJECTIVES: To evaluate the impact of bariatric surgery on the pharmacokinetic (PK) parameters of orally administered medications and supplements. METHODS: Systematic searches of bibliographic databases were conducted to identify studies. Pooled effect estimates from different surgical procedures were calculated using a random-effects model. RESULTS: Quantitative data were synthesized from 58 studies including a total of 1985 participants. Whilst 40 medications and 6 supplements were evaluated across these studies, heterogeneity and missing information reduced the scope of the meta-analysis to the following medications and supplements: atorvastatin, paracetamol, omeprazole, midazolam, vitamin D, calcium, zinc, and iron supplements. There were no significant differences in PK parameters post-surgery for the drugs atorvastatin and omeprazole, and supplements calcium, ferritin, and zinc supplements. Paracetamol showed reduced clearance (mean difference [MD] = -15.56 L/hr, p = 0.0002, I2 = 67%), increased maximal concentration (MD = 6.90 µg/ml, p = 0.006, I2 = 92%) and increased terminal elimination half-life (MD = 0.49 hr, p < 0.0001, I2 = 3%) post-surgery. The remaining 36 medications and 2 supplements were included in a systematic review. Overall, 18 of the 53 drugs and supplements showed post-operative changes in PK parameters. CONCLUSION: This study demonstrates heterogeneity in practice and could not reach conclusive findings for most PK parameters. Prospective studies are needed to inform best practice and enhance patient healthcare and safety following bariatric surgery.

Characterization of a Coproduct from the Sea Cucumber Cucumaria frondosa and Its Effects on Visceral Adipocyte Size in Male Wistar Rats.

Sea cucumbers have been shown to have potential health benefits and are a rich source of several bioactive compounds, particularly triterpenoid saponins. However, most studies concentrate on the body wall, and little is known about the health effects of the coproducts. The objectives of this study were to determine the nutritional composition of a coproduct from the sea cucumber Cucumaria frondosa and the effects of the dietary consumption of this coproduct on cardiometabolic health in rats. Chemical, biochemical, and nutritional analyses were performed to characterize this coproduct. Forty (40) male Wistar rats were then equally divided into four groups and fed a purified control diet or a diet enriched with 0.5%, 1.5%, or 2.5% (by protein) of coproduct. After 28 days of feeding, the rats were sacrificed. Body and tissue weight, body composition, epididymal adipocyte diameter, plasma and hepatic lipids, glycemia, and insulinemia were measured at the end of the 28-day experiment. Analysis of the coproduct revealed high levels of protein, omega-3 fatty acids, minerals, and saponins. The 1.5% group had significantly smaller epididymal adipocytes vs. the control. We conclude that dietary administration of this sea cucumber coproduct at 1.5% doses decreases visceral adiposity, potentially decreasing the risk of cardiometabolic dysfunction. The coproduct's saponin content may contribute to the observed effects, but the impact of other components cannot be ruled out.

Incidence of urinary infection among kidney-transplant recipients / Incidência de casos de infecção urinária em receptores pós-transplante renal

Urinary tract infection is the most common bacterial complication in renal transplant. This study investigated the number of urinary infection in renal transplant patients at a transplant center aimed at improving nursing care in order to minimize the incidence of urinary infection. We analyzed 59 medical records of patients subjected to renal transplant from May to June 2015 at a transplant center in a hospital in northwestern state of Paraná. The prevailing age of the patients was between 50 and 60 years (29%), and the hemodialysis time was up to 24 months (30%). In patients diagnosed with urinary tract infection (36%), the prevalent microorganisms were: Enterobacter cloacae (25%), occurring more frequently in the first month after transplantation (67%). It was concluded the nursing team may to act in the control and prevention of urinary tract infection.

A infecção do trato urinário é a intercorrência bacteriana mais comum em transplante renal. O presente trabalho objetivou investigar o número de infecções urinárias em pacientes transplantados renais em um centro transplantador, visando à melhoria dos cuidados de enfermagem a fim de amenizar a incidência de infecção urinária. Analisou-se 59 prontuários de pacientes que foram submetidos ao transplante renal entre janeiro 2012 à janeiro 2015 em um centro transplantador situado em um hospital no Noroeste do estado do Paraná. A idade prevalente dos pacientes foi entre 50 e 60 anos (29%), e o tempo de hemodiálise foi de até 24 meses (30%). Entre os pacientes diagnosticados com infecção urinária (36%) o microorganismo prevalente foi: Enterobacter cloacae (25%), ocorrendo com maior frequência no primeiro mês após o transplante (67%). Conclui-se que a equipe de enfermagem pode atuar satisfatoriamente no controle e prevenção da infecção urinária.

Three-dimensional ultrasonographic assessment of fetal total lung volume as a prognostic factor in primary pleural effusion.

OBJECTIVES: The purpose of this study was to predict perinatal outcomes using fetal total lung volumes assessed by 3-dimensional ultrasonography (3DUS) in primary pleural effusion. METHODS: Between July 2005 and July 2010, total lung volumes were prospectively estimated in fetuses with primary pleural effusion by 3DUS using virtual organ computer-aided analysis software. The first and last US examinations were considered in the analysis. The observed/expected total lung volumes were calculated. Main outcomes were perinatal death (up to 28 days of life) and respiratory morbidity (orotracheal intubation with mechanical respiratory support >48 hours). RESULTS: Twelve of 19 fetuses (63.2%) survived. Among the survivors, 7 (58.3%) had severe respiratory morbidity. The observed/expected total lung volume at the last US examination before birth was significantly associated with perinatal death (P < .01) and respiratory morbidity (P < .01) as well as fetal hydrops (P < .01) and bilateral effusion (P = .01). CONCLUSIONS: Fetal total lung volumes may be useful for the prediction of perinatal outcomes in primary pleural effusion.

Ensino de anestesiologia durante a graduação por meio de uma liga acadêmica: qual o impacto no aprendizado dos alunos? / Anesthesiology teaching during undergraduation through an academic league: what is the impact in students' learning?

JUSTIFICATIVA E OBJETIVOS: As ligas acadêmicas vêm se firmando como instrumentos de ensino médico e inserção dos estudantes de medicina na prática das especialidades, inclusive na anestesiologia. Como o papel das ligas no processo de desenvolvimento de competências e aprendizado de seus alunos não é bem conhecido, avaliou-se o aprendizado dos integrantes de uma liga acadêmica de anestesiologia após um ano de participação nas suas atividades. MÉTODO: Os alunos de uma liga acadêmica de anestesiologia foram acompanhados de março a dezembro de 2010 e avaliados por meio de testes cognitivos objetivos de múltipla escolha aplicados antes do início das atividades e após sua conclusão. A frequência nas atividades e o perfil epidemiológico dos alunos foram correlacionados aos resultados dos testes. RESULTADOS: Foram analisados 20 acadêmicos do 3º ao 6º ano, com média de idade de 22,8 (21-26) anos. A frequência média nas atividades propostas foi 10,4/13 (80 por cento). A média de acertos no primeiro teste foi 8,1/17 (47,6 por cento), sendo que os alunos do 3º ano apresentam notas menores (p < 0,02) em relação aos demais. No teste pós-liga, a média de acertos foi 11,9/17 (70 por cento), mostrando melhora no desempenho dos alunos (p < 0,05), e não houve diferença entre as notas dos diferentes anos da graduação. Foi encontrada relação forte entre frequência nas atividades e melhora nas notas (r = 0,719; p < 0,001). CONCLUSÕES: Os alunos que participaram da liga apresentaram melhora nos testes de avaliação de conhecimento, sugerindo que a liga é útil instrumento de ensino e promove ganho de aprendizado em anestesiologia. As atividades desenvolvidas nas ligas podem ter papel positivo na formação acadêmica dos graduandos, destacando-se, neste artigo, a anestesiologia.

BACKGROUND AND OBJECTIVES: Academic leagues have been consolidated as instruments of medical teaching and for the introducing of medical students to practice of specialties, including anesthesiology. As the role of leagues in the development process of competencies and learning of their students is not well known, the learning of members of an anesthesiology academic league was evaluated after participating in its activities for one year. METHOD: Students of an anesthesiology academic league were followed up from March to December 2010 and evaluated through objective cognitive tests of multiple choice applied before the beginning of activities and after their conclusion. Attendance in activities and epidemiologic profile of students were correlated with the tests results. RESULTS: Twenty medical students from 3rd to 6th year were analyzed, with an average age of 22.8 (21-26) years. The average participation in the proposed activities was 10.4/13 (80 percent). The average of right answers on the first test was 8.1/17 (47.6 percent), and 3rd year students had lower grades (p < 0.02) compared with other students. In the post league test, the average of right answers was 11.9/17 (70 percent), showing an improvement in performance (p < 0.05), and there was no difference between grades of different years of the medical undergraduation. A strong relationship between participation in activities and improved grades was found (r = 0.719; p < 0.001). CONCLUSIONS: Students who participated in the league had improvement in knowledge evaluation tests, suggesting that the league is a useful teaching instrument that can provide improved learning of anesthesiology. Participation in activities was connected with improved performance. Activities developed in leagues may have a positive role in students' academic education, more specifically in this article, in anesthesiology.

JUSTIFICATIVA Y OBJETIVOS: Las ligas académicas han venido afianzándose como instrumentos de enseñanza médica e inserción de los estudiantes de medicina en la práctica de las especialidades, inclusive en la anestesiología. Como el papel de las ligas en el proceso de desarrollo de competencias y de aprendizaje de sus alumnos no es algo que se conoce muy bien, se evaluó el aprendizaje de los integrantes de una liga académica de anestesiología después de un año de participación en sus actividades. MÉTODO: Los alumnos de una liga académica de anestesiología tuvieron un seguimiento desde marzo a diciembre de 2010, y fueron evaluados por medio de test cognitivos objetivos de múltiple elección, aplicados antes del inicio de las actividades y después de su conclusión. La frecuencia en las actividades y el perfil epidemiológico de los alumnos fueron correlacionados con los resultados de los test. RESULTADOS: Se analizaron 20 académicos del 3º al 6º año, con un promedio de edad de 22,8 (21-26) años. La frecuencia promedio en las actividades propuestas fue 10,4/13 (80 por ciento). El promedio de aciertos en el primer test fue de 8,1/17 (47,6 por ciento), siendo que los alumnos del 3º año tenían notas más bajas (p < 0,02) con relación a los demás. En el test post-liga, el promedio de aciertos fue de 11,9/17 (70 por ciento), mostrando una mejoría en el desempeño de los alumnos (p < 0,05), sin diferencias entre las notas de los diferentes años del pregrado. Se encontró una fuerte relación entre la frecuencia en las actividades y la mejoría en las notas (r = 0,719; p < 0,001). CONCLUSIONES: Los alumnos que participaron en la liga obtuvieron una mejoría en los test de evaluación de conocimiento, lo que indica que la liga es un instrumento útil de enseñanza y que genera progresos en el aprendizaje en anestesiología. Las actividades desarrolladas en las ligas pueden tener un rol positivo en la formación académica de los graduandos, destacándose...

Anesthesiology teaching during undergraduation through an academic league: what is the impact in students' learning?

BACKGROUND AND OBJECTIVES: Academic leagues have been consolidated as instruments of medical teaching and for the introducing of medical students to practice of specialties, including anesthesiology. As the role of leagues in the development process of competencies and learning of their students is not well known, the learning of members of an anesthesiology academic league was evaluated after participating in its activities for one year. METHOD: Students of an anesthesiology academic league were followed up from March to December 2010 and evaluated through objective cognitive tests of multiple choice applied before the beginning of activities and after their conclusion. Attendance in activities and epidemiologic profile of students were correlated with the tests results. RESULTS: Twenty medical students from 3rd to 6th year were analyzed, with an average age of 22.8 (21-26) years. The average participation in the proposed activities was 10.4/13 (80%). The average of right answers on the first test was 8.1/17 (47.6%), and 3rd year students had lower grades (p<0.02) compared with other students. In the post league test, the average of right answers was 11.9/17 (70%), showing an improvement in performance (p<0.05), and there was no difference between grades of different years of the medical undergraduation. A strong relationship between participation in activities and improved grades was found (r=0.719; p<0.001). CONCLUSIONS: Students who participated in the league had improvement in knowledge evaluation tests, suggesting that the league is a useful teaching instrument that can provide improved learning of anesthesiology. Participation in activities was connected with improved performance. Activities developed in leagues may have a positive role in students' academic education, more specifically in this article, in anesthesiology.

Prenatal diagnosis and natural history of fetuses presenting with pleural effusion.

OBJECTIVE: To describe the natural history of fetuses presenting with pleural effusion. METHODS: Between January 2005 and December 2009 all fetuses diagnosed with pleural effusion were followed up. Fetuses were divided into three groups: I, isolated pleural effusion; II, associated structural anomalies but normal karyotype; and III, chromosomal anomalies. Univariate and multivariate analyses were performed to determine the association between prenatal ultrasound findings and perinatal death. RESULTS: Fifty-six fetuses were included in the study. Associated structural or chromosomal anomalies occurred in 75.0% (42/56) of cases. Bilateral pleural effusion and fetal hydrops were associated with each other (p < 0.01) and with perinatal death (p < 0.05). Multivariate analysis indicated that only the presence of associated abnormalities was a statistical determinant of perinatal death (OR, 3.56; 95% CI, 1.48-5.64; p < 0.01). CONCLUSION: Fetal pleural effusion is often associated with other abnormalities, and this association has poor perinatal outcome.

Molecular targets for therapeutic interventions in human papillomavirus-related cancers (review).

The infection by the human papillomavirus (HPV) is the origin of several cancers around the world. In some areas of Brazil, cervical carcinoma is still the cancer with the highest incidence among women. After epithelial cell transformation by HPV, several molecular events are observed, resulting in the malignant phenotype. In this review we discuss potential molecular targets for therapeutic interventions in human HPV-related carcinomas, with emphasis on cervical cancer, based on the alterations observed in the signaling transduction pathways caused by HPV infection. With a special attention to tyrosine kinase receptors, and other kinases involved in signal transduction and angiogenesis, these pathological alterations are evaluated as novel targets for anticancer therapies in HPV-related carcinomas.

Gestação em pacientes com síndrome de Klippel-Trenaunay: revisão da literatura / Pregnancy in Klippel-Trenaunay syndrome: review of literature

Klippel-Trenaunay syndrome is a rare congenital anomaly of unknown etiology, characterized by capillary and venous malformations, and hypertrophy of bone and soft tissue. Cases of pregnancy in women with Klippel-Trenaunay syndrome are rare and usually associated with adverse perinatal outcomes. Objective: To resume knowledge about pregnancy in the Klippel-Trenaunay syndrome as well as the syndrome so these patients be readily recognized and receive proper care to have a successful pregnancy outcome. Method: It was performed a review of the English literature, in the MEDLINE and Cochrane Library bases until October2009. Results: Only 17 case reports of pregnancy in women with Klippel-Trenaunay syndrome have been found. The evolutions of pregnant were variable and involve adverse events, with worsening of previous manifestations, bleeding, disseminated intravascular coagulation, thromboembolic events and pain. Conclusion: Pregnancy increases the risk of adverse events. Knowledge of the syndrome and multidisciplinary prenatal, intra and postpartum care areessential to successful outcome of pregnancy...

A síndrome de Klippel-Trenaunay é uma anomalia congênita de etiologiadesconhecida, caracterizada pela presença de malformações venosas e arteriais, hipertrofia de ossos e tecidos moles. São raros os relatos de gravidez em pacientes portadoras dessasíndrome, sendo associada com alto risco obstétrico. Objetivo: Resumir os conhecimentos acumulados sobre gestação em pacientes com síndrome de Klippel-Trenaunay, bem como sobre a própria síndrome, para permitir que essas pacientes sejam prontamente reconhecidas e recebam os cuidados necessários para um bom desfecho obstétrico. Método: Foi realizadapesquisa na literatura em língua inglesa, até outubro de 2009, na base de dados Medline e Cochrane Library. Resultados: Foram encontrados 17 casos relatados na literatura de gestaçõesem pacientes com síndrome de Klippel-Trenaunay. A evolução obstétrica das gestantes é variável e envolve eventos adversos, com piora das manifestações prévias, hemorragia, coagulação intravascular disseminada, eventos tromboembólicos e dor. Conclusão: A gestação agrava o risco de eventos adversos. O entendimento da síndrome e cuidado multidisciplinar pré-natal, intra e pós-parto são fundamentais para o bom desfecho da gestação...

A história do Congresso Médico Universitário da FMUSP: COMU / The history of Congresso Médico Universitário da FMUSP: COMU

Em 2008, o Congresso Médico Universitário da FMUSP - COMU, chega a sua vigésima sétima edição. O COMU é composto de cursos, palestras, mesas redondas, workshops, jantares e apresentação de trabalhos científicos de acadêmicos que visam contribuir para a formação profissional de estudantes de medicina...

In 2008, the Congresso Médico Universitário da FMUSP - COMU, comes to its 27th edition. The COMU consists of courses, seminars, workshops, dinners and presentation of academics scientific works which purpose is to contribute to the medical formation, stimulate of academics research e promote cultural integration...