Good Clinical Practices on Argon Plasma Coagulation Treatment for Weight Regain Associated with Dilated Gastrojejunostomy Following Roux-en-Y Gastric Bypass: a Brazilian-Modified Delphi Consensus.

INTRODUCTION: Argon plasma coagulation (APC) alone is effective and safe at treating weight regain following Roux-en-Y gastric bypass (RYGB). However, technical details of the treatment vary widely among studies. Therefore, we aimed to create good clinical practice guidelines through a modified Delphi consensus, including experts from the collaborative Bariatric Endoscopy Brazilian group. METHODS: Forty-one locally renowned experts were invited to the consensus by email. Experiences of > 150 APC-treated cases or authorship of relevant articles were the eligibility criteria. An initial questionnaire with short-answer questions was distributed to the experts. The organizing committee converted the responses into statements for an online 2-day voting webinar. Consensus was defined as more than 67% of positive answers. Three consecutive voting rounds were planned with discussion and statement refinements between rounds. RESULTS: Thirty-seven experts fulfilled eligibility criteria and attended the live webinar voting. The total number of patients treated by the panel was 12,349. By the third round, all 79 statements reached consensus. The recommendations include the definition of dilated gastrojejunal anastomosis as ≥ 15 mm, minimum regain of 20% of the lost weight to indicate the APC therapy, 6 to 8 weeks as the ideal interval between ablation sessions, and stopping treatment when the stoma reaches < 12 mm of breadth. CONCLUSIONS: This consensus provides several recommendations based on a highly experienced panel of endoscopists. Although it covers most aspects of the treatment, the level of evidence is low for the majority of the statements. Therefore, bariatric endoscopists should be constantly attentive to new evidence on APC treatment.

Beyond 'A Clinical Lesson at La Salpêtrière': a brief assessment of André Brouillet's other paintings on medical subjects, life, and times / Além de 'Une Leçon Clinique à La Salpêtrière': uma breve apreciação das outras pinturas sobre temas médicos, vida e época de André Brouillet

ABSTRACT André Brouillet's (1857-1914) famous group tableau 'A Clinical Lesson at La Salpêtrière' (French: Une leçon clinique à la Salpêtrière) is possibly the most celebrated painting in the history of neurology. His depiction of one of Jean-Martin Charcot's legendary "Tuesday Lessons" includes portraits of not only one of the master's most famous patients, but also of his pupils, the heirs to the founder of modern neurology. However, the painter himself has long been neglected, and even his other paintings on medical subjects are little acknowledged. The authors aim to bring attention to Brouillet's life and times, as well as the remainder of his notable works; and in giving a proper context to the famous painting, neurologists today may be able to appreciate better the early history of our field and its cultural impact.

RESUMO A famosa pintura 'Une leçon clinique à la Salpêtrière', de André Brouillet's (1857-1914), é possivelmente a representação mais célebre da história da Neurologia. Seu retrato de uma das lendárias "lições de terça-feira" dirigidas por Jean-Martin Charcot inclui ainda não apenas uma das pacientes mais famosas do mestre como também seus pupilos, os fundadores da Neurologia moderna. Entretanto, o pintor propriamente dito é ainda negligenciado, e mesmo outras pinturas suas sobre temas médicos são pouco reconhecidas. Os autores trazem à atenção a vida e época de Brouillet, bem como o restante de seus outros trabalhos notáveis; dando contexto apropriado à pintura, neurologistas atuais podem compreender melhor a própria história de nossa especialidade e seu impacto cultural.

Beyond 'A Clinical Lesson at La Salpêtrière': a brief assessment of André Brouillet's other paintings on medical subjects, life, and times.

André Brouillet's (1857-1914) famous group tableau 'A Clinical Lesson at La Salpêtrière' (French: Une leçon clinique à la Salpêtrière) is possibly the most celebrated painting in the history of neurology. His depiction of one of Jean-Martin Charcot's legendary "Tuesday Lessons" includes portraits of not only one of the master's most famous patients, but also of his pupils, the heirs to the founder of modern neurology. However, the painter himself has long been neglected, and even his other paintings on medical subjects are little acknowledged. The authors aim to bring attention to Brouillet's life and times, as well as the remainder of his notable works; and in giving a proper context to the famous painting, neurologists today may be able to appreciate better the early history of our field and its cultural impact.

The ratio between the whole-body and primary tumor burden, measured on 18F-FDG PET/CT studies, as a prognostic indicator in advanced non-small cell lung cancer.

OBJECTIVE: To determine whether the whole-body tumor burden, as quantified by 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT), is a prognostic indicator in advanced (stage III or IV) non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: This was a prospective study in which we evaluated 18F-FDG PET/CT staging parameters to quantify tumor burdens in patients with stage III or IV NSCLC. The following parameters were evaluated for the whole body (including the primary tumor) and for the primary tumor alone, respectively: maximum standardized uptake volume (wbSUVmax and tuSUVmax); metabolic tumor volume (wbMTV and tuMTV); and total lesion glycolysis (wbTLG and tuTLG). To determine whether the 18F-FDG PET/CT parameters were associated with overall survival (OS) and progression-free survival (PFS), we evaluated the wbSUVmax/tuSUVmax, wbMTV/tuMTV, and wbTLG/tuTLG ratios. RESULTS: 18F-FDG PET/CT was performed for staging in 52 patients who were followed for a median of 11.0 months (mean, 11.7 months). The estimated median PFS and OS were 9.6 months and 11.6 months, respectively. In the univariate analysis, OS was found to correlate significantly with wbTLG (hazard ratio [HR] = 1.001; 95% confidence interval [95 CI]: 1.000-1.001; p = 0.0361) and with the wbTLG/tuTLG ratio (HR = 1.705; 95% CI: 1.232-2.362; p = 0.0013). In the multivariate analysis, only the wbTLG/tuTLG ratio was independently associated with OS (HR = 1.660; 95% CI: 1.193-2.310; p = 0.0027). CONCLUSION: The wbTLG/tuTLG ratio is an independent prognostic indicator of OS in advanced-stage NSCLC.

OBJETIVO: Avaliar se a carga metabólica tumoral do corpo inteiro medida na tomografia por emissão de pósitrons/tomografia computadorizada com 18F-fluordesoxiglicose (18F-FDG PET/CT) é um indicador prognóstico em pacientes com câncer de pulmão de células não pequenas (CPCNP) em estágio avançado (estágio III ou IV). MATERIAIS E MÉTODOS: Avaliamos, prospectivamente, a carga tumoral na 18F-FDG-PET/CT de estadiamento em pacientes com CPCNP avançado. Os parâmetros avaliados do tumor primário (tu) e do corpo inteiro (wb) (incluindo o primário) foram: SUV máximo (wbSUVmax e tuSUVmax), volume metabólico tumoral (wbMTV e tuMTV), glicólise total da(s) lesão(ões) (wbTLG e tuTLG), além das seguintes razões: wbSUVmax/tuSUVmax, wbMTV/tuMTV e wbTLG/tuTLG. Os parâmetros medidos na 18F-FDG-PET/CT, variáveis clínicas e patológicas foram correlacionados com a sobrevida global (SG) e a sobrevida livre de progressão (SLP). RESULTADOS: 18F-FDG-PET/CT foi realizada em 52 pacientes (tempos mediano/médio de sobrevida = 11,0/11,7 meses). A SLP mediana foi de 9,6 meses e a SG foi de 11,6 meses. Houve correlação significativa da wbTLG (hazard ratio [HR] = 1,001; intervalo de confiança de 95% [IC 95%]: 1,000-1,001; p = 0,0361) e wbTLG/tuTLG (HR = 1,705; IC 95%: 1,232-2.362; p = 0,0013) com a SG. Na análise multivariada, a razão wbTLG/tuTLG associou-se independentemente com a SG (HR = 1,660; IC 95%: 1,193-2,310; p = 0,0027). CONCLUSÃO: A razão wbTLG/tuTLG é um indicador prognóstico independente de SG em CPCNP avançado.

The ratio between the whole-body and primary tumor burden, measured on 18F-FDG PET/CT studies, as a prognostic indicator in advanced non-small cell lung cancer / A relação entre a carga de doença de corpo inteiro e lesão primária medida em estudos de 18F-FDG PET/CT como um indicador prognóstico em câncer de pulmão não pequenas células avançado

Abstract Objective: To determine whether the whole-body tumor burden, as quantified by 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT), is a prognostic indicator in advanced (stage III or IV) non-small cell lung cancer (NSCLC). Materials and Methods: This was a prospective study in which we evaluated 18F-FDG PET/CT staging parameters to quantify tumor burdens in patients with stage III or IV NSCLC. The following parameters were evaluated for the whole body (including the primary tumor) and for the primary tumor alone, respectively: maximum standardized uptake volume (wbSUVmax and tuSUVmax); metabolic tumor volume (wbMTV and tuMTV); and total lesion glycolysis (wbTLG and tuTLG). To determine whether the 18F-FDG PET/CT parameters were associated with overall survival (OS) and progression-free survival (PFS), we evaluated the wbSUVmax/tuSUVmax, wbMTV/tuMTV, and wbTLG/tuTLG ratios. Results: 18F-FDG PET/CT was performed for staging in 52 patients who were followed for a median of 11.0 months (mean, 11.7 months). The estimated median PFS and OS were 9.6 months and 11.6 months, respectively. In the univariate analysis, OS was found to correlate significantly with wbTLG (hazard ratio [HR] = 1.001; 95% confidence interval [95 CI]: 1.000-1.001; p = 0.0361) and with the wbTLG/tuTLG ratio (HR = 1.705; 95% CI: 1.232-2.362; p = 0.0013). In the multivariate analysis, only the wbTLG/tuTLG ratio was independently associated with OS (HR = 1.660; 95% CI: 1.193-2.310; p = 0.0027). Conclusion: The wbTLG/tuTLG ratio is an independent prognostic indicator of OS in advanced-stage NSCLC.

Resumo Objetivo: Avaliar se a carga metabólica tumoral do corpo inteiro medida na tomografia por emissão de pósitrons/tomografia computadorizada com 18F-fluordesoxiglicose (18F-FDG PET/CT) é um indicador prognóstico em pacientes com câncer de pulmão de células não pequenas (CPCNP) em estágio avançado (estágio III ou IV). Materiais e Métodos: Avaliamos, prospectivamente, a carga tumoral na 18F-FDG-PET/CT de estadiamento em pacientes com CPCNP avançado. Os parâmetros avaliados do tumor primário (tu) e do corpo inteiro (wb) (incluindo o primário) foram: SUV máximo (wbSUVmax e tuSUVmax), volume metabólico tumoral (wbMTV e tuMTV), glicólise total da(s) lesão(ões) (wbTLG e tuTLG), além das seguintes razões: wbSUVmax/tuSUVmax, wbMTV/tuMTV e wbTLG/tuTLG. Os parâmetros medidos na 18F-FDG-PET/CT, variáveis clínicas e patológicas foram correlacionados com a sobrevida global (SG) e a sobrevida livre de progressão (SLP). Resultados: 18F-FDG-PET/CT foi realizada em 52 pacientes (tempos mediano/médio de sobrevida = 11,0/11,7 meses). A SLP mediana foi de 9,6 meses e a SG foi de 11,6 meses. Houve correlação significativa da wbTLG (hazard ratio [HR] = 1,001; intervalo de confiança de 95% [IC 95%]: 1,000-1,001; p = 0,0361) e wbTLG/tuTLG (HR = 1,705; IC 95%: 1,232-2.362; p = 0,0013) com a SG. Na análise multivariada, a razão wbTLG/tuTLG associou-se independentemente com a SG (HR = 1,660; IC 95%: 1,193-2,310; p = 0,0027). Conclusão: A razão wbTLG/tuTLG é um indicador prognóstico independente de SG em CPCNP avançado.

Effects of intragastric balloon placement in metabolic dysfunction-associated fatty liver disease: A systematic review and meta-analysis.

BACKGROUND: Metabolic dysfunction-associated fatty liver disease corresponds to a clinical entity that affects liver function triggered by the accumulation of fat in the liver and is linked with metabolic dysregulation. AIM: To evaluate the effects of the intragastric balloon (IGB) in patients with metabolic dysfunction-associated fatty liver disease through the assessment of liver enzymes, imaging and several metabolic markers. METHODS: A comprehensive search was done of multiple electronic databases (MEDLINE, EMBASE, LILACS, Cochrane and Google Scholar) and grey literature from their inception until February 2021. Inclusion criteria involved patients with a body mass index > 25 kg/m2 with evidence or previous diagnosis of hepatic steatosis. Outcomes analyzed before and after 6 mo of IGB removal were alanine aminotransferase (IU/L), gamma-glutamyltransferase (IU/L), glycated hemoglobin (%), triglycerides (mg/dL), systolic blood pressure (mmHg), homeostatic model assessment, abdominal circumference (cm), body mass index (kg/m2) and liver volume (cm3). RESULTS: Ten retrospective cohort studies evaluating a total of 508 patients were included. After 6 mo of IGB placement, this significantly reduced alanine aminotransferase [mean difference (MD): 10.2, 95% confidence interval (CI): 8.12-12.3], gamma-glutamyltransferase (MD: 9.41, 95%CI: 6.94-11.88), glycated hemoglobin (MD: 0.17%, 95%CI: 0.03-0.31), triglycerides (MD: 38.58, 95%CI: 26.65-50.51), systolic pressure (MD: 7.27, 95%CI: 4.79-9.76), homeostatic model assessment (MD: 2.23%, 95%CI: 1.41-3.04), abdominal circumference (MD: 12.12, 95%CI: 9.82-14.41) and body mass index (MD: 5.07, 95%CI: 4.21-5.94). CONCLUSION: IGB placement showed significant efficacy in improving alanine aminotransferase and gamma-glutamyltransferase levels in patients with metabolic dysfunction-associated fatty liver disease as well as improving metabolic markers related to disease progression.

Cardiac magnetic resonance assessment of right ventricular remodeling after anthracycline therapy.

There are limited data on the effects of anthracyclines on right ventricular (RV) structure, function, and tissue characteristics. The goal of this study was to investigate the effects of anthracyclines on the RV using cardiac magnetic resonance (CMR). This was a post-hoc analysis of a prospective study of 27 breast cancer (BC) patients (51.8 ± 8.9 years) using CMR prior, and up to 3-times after anthracyclines (240 mg/m2) to measure RV volumes and mass, RV extracellular volume (ECV) and cardiomyocyte mass (CM). Before anthracyclines, LVEF (69.4 ± 3.6%) and RVEF (55.6 ± 9%) were normal. The median follow-up after anthracyclines was 399 days (IQR 310-517). The RVEF reached its nadir (46.3 ± 6.8%) after 9-months (P < 0.001). RV mass-index and RV CM decreased to 13 ± 2.8 g/m2 and 8.13 ± 2 g/m2, respectively, at 16-months after anthracyclines. The RV ECV expanded from 0.26 ± 0.07 by 0.14 (53%) to 0.40 ± 0.1 (P < 0.001). The RV ECV expansion correlated with a decrease in RV mass-index (r = -0.46; P < 0.001) and the increase in CK-MB. An RV ESV index at baseline above its median predicted an increased risk of LV dysfunction post-anthracyclines. In BC patients treated with anthracyclines, RV atrophy, systolic dysfunction, and a parallel increase of diffuse interstitial fibrosis indicate a cardiotoxic response on a similar scale as previously seen in the systemic left ventricle.

Adverse Events and Complications with Intragastric Balloons: a Narrative Review (with Video).

Intragastric balloon (IGB) is a minimally invasive and reversible therapy for weight loss with a good efficacy and safety profile. Introduced in the 1980s, IGBs have significantly evolved in the last couple of decades. They mechanically act by decreasing the volume of the stomach and its reservoir capacity, delaying gastric emptying, and increasing satiety leading to a subsequent weight loss. Despite the low rates of complications and mortality associated with IGBs, adverse events and complications still occur and can range from mild to fatal. This review aims to provide an update on the current scientific evidence in regard to complications and adverse effects of the use of the IGB and its treatment. This is the first comprehensive narrative review in the literature dedicated to this subject.

Sobrepeso e obesidade em universitários: prevalências e fatores associados / Overweight and obesity in college students: prevalence and associated factors

O objetivo deste estudo foi estimar entre homens e mulheres universitários de Minas Gerais, as prevalências de sobrepeso e obesidade e suas associações com atividade física e tempo sentado. Este estudo transversal estimou por meio das medidas referidas da massa corporal e estatura, o índice de massa corporal (IMC) e analisou o sobrepeso (IMC: 25,0 a 29,9 kg/m2) e a obesidade (IMC: ≥30,0 kg/m2). As variáveis independentes foram a atividade física e o tempo sentado, e as variáveis de controle foram sociodemográficas, de vínculo com a universidade e comportamentais, analisadas em três modelos. As associações foram estimadas via Odds Ratio (OR) por meio da Regressão Logística Multinomial. O nível de significância foi de 5%. Participaram 1.105 universitários, sendo 61,6% de mulheres. A média etária foi de 21,25 (desvio padrão = 4,1) anos para as mulheres e para os homens foi de 21,83 (desvio padrão = 4,2) anos. As prevalências de sobrepeso e obesidade foram, respectiva-mente, 27,5% e 6,9% em homens e 15,5% e 8,0% em mulheres. O tempo sentado associou-se à obe-sidade em homens, independente apenas das características sociodemográficas (OR = 3,54; IC95%: 1,04 ­ 12,12) e dos atributos sociodemográficos mais as características de vínculo com a universidade (OR = 3,48; IC95%: 1,01 ­ 11,99). Com o ajuste para os comportamentos alimentares não houve associação (OR = 3,49; IC95%: 0,99 ­ 12,23). Para as mulheres não foram observadas associações significativas. Conclui-se que a prevalência de sobrepeso foi elevada em homens. Os homens univer-sitários com elevado tempo sentado apresentaram mais chances de serem obesos

The aim of this study was to estimate the prevalence of overweight and obesity and their associations with physical activity and sitting time among men and women university students in Minas Gerais, Brazil. This is a cross-sectional study that estimated the outcomes of overweight (BMI: 25.0 to 29.9 kg/m2) and obesity (BMI: ≥30.0 kg/m2) using the body mass index (BMI) by self-reported body mass and stature. The independent variables were physical activity and sitting time, and control variables were sociodemographic, link with the university and behavioral variables were included in three models. Association analyzes were performed via Odds Ratio (OR) using Multinomial Logistic Regression. The significance level was 5%. A total of 1,105 university students participated in the study, comprising 61.6% of women. The mean age was of 21.25 (SD = 4.1) and 21.83 (SD = 4.2) for women and men, respectively. The prevalence of overweight and obesity in men was 27.5% and 6.9% and in women 15.5% and 8.0%, respectively. Time sitting was associated with obesity in men, regardless of sociodemographic characteristics (OR = 3.54; 95%CI: 1.04 ­ 12.12) and university stage plus sociodemographic characteristics (OR = 3.48; 95%CI: 1.01 - 11.99). With the adjustment of health behaviors, the association was not observed (OR = 3.49; 95%CI: 0.99 ­ 12.23). For women, no significant associations were found. In conclusion, overweight prevalence was high in men. The university men with sitting time higher represented more chances of obesity

Validade das medidas do tempo sentado do questionário IPAQ-versão curta em universitários brasileiros / Validity of measure of sitting time of IPAQ Questionnaire short version in undergraduate from Brazil

Os objetivos deste estudo foram estimar o nível de reprodutibilidade das medidas do tempo sen-tado do questionário International Physical Activity Questionnaire (IPAQ-versão curta) e analisar a validade concorrente dessas medidas em relação ao tempo sedentário mensurado pelo acelerômetro em universitários. Realizou-se um estudo correlacional com amostra de 61 universitários de uma instituição do ensino superior de Minas Gerais, Brasil, que autopreencheram as medidas do tempo sentado do IPAQ, intercalados por dois momentos diferentes para fins da análise de reprodutibili-dade, e usaram o acelerômetro para estimativa do tempo sedentário e emprego como padrão ouro na análise de validade concorrente. Empregou-se as análises de correlação, via coeficiente de correlação intraclasse (CCI) e gráfico de dispersão de Bland-Altman, para analisar a concordância. O nível de significância adotado foi de 5%. A média de idade foi de 21,54 anos e 62,3% foram do sexo feminino. A reprodutibilidade do tempo sentado durante um dia de semana foi moderada (CCI = 0,51; p < 0,01), enquanto em um dia do final de semana foi baixa (CCI = 0,30; p = 0,01). As diferenças médias entre o tempo sentado pelo IPAQ e o tempo sedentário pelo acelerômetro, em um dia da semana foi de -51 minutos e em um dia do final de semana foi de -64,7 minutos. Conclui-se que houve correlações e concordâncias satisfatórias tanto na reprodutibilidade quanto na comparação com a medida critério (acelerômetro) das medidas do tempo sentado mensurado pelo IPAQ para aplicação em universitários

The objectives of this study were to estimate the level of reproducibility of the sitting time measurements of the International Physical Activity Questionnaire (IPAQ-short version), and to analyze the concurrent validity of these measurements in relation the sedentary time measured by the accelerometer, in university students. A correlational study was carried out with a sample of 61 university students of a higher educa-tion institution from Minas Gerais, Brazil, who self-completed the IPAQ sitting time measurements, with interval of seven days for the purposes of the reproducibility analysis and used the accelerometer to estimate sedentary time and employment as the gold standard in the analysis of concurrent validity. The correlation analyzes via intraclass correlation coefficient (ICC) and Bland-Altman scatter plot were used to analyze the agreement. The significance level adopted was 5%. The average age was 21.54 years and 62.3% were female. The reproducibility of sitting time on a weekday was moderate (ICC = 0.51; p < 0.01), while on a weekend day it was low (ICC = 0.30; p = 0.01). The mean differences between sitting time using the IPAQ and sedentary time using the accelerometer on a weekday was -51 minutes and on a weekend was -64.7 minutes. Concluded that there were satisfactory correlations and agreements both in reproducibility and in comparison, with the criterion measure (accelerometer) of the sitting time measures measured by the IPAQ for application in university students

Validade Preliminar da Escala Perfil do Estilo de Vida Individual para uso online em tempos de distanciamento social / Preliminary validity of Individual Lifestyle Profile Scale for online use in times of social distancing

Este estudo teve como objetivo estimar a validade de conteúdo e o nível de reprodutibilidade da escala "Perfil do Estilo de Vida Individual" em tempos de distanciamento social. Os itens da escala original proposta por Nahas, Barros e Francalacci, foram modificados para avaliar o estilo de vida de adultos, de forma online, durante o período distanciamento social, a exemplo, a pandemia da COVID-19. As 15 questões contemplaram comportamentos recomendados por especialistas em saúde durante a pandemia, mantendo-se os cinco domínios originais propostos na versão inicial: alimentação saudável, atividade física, controle do estresse, relacionamentos e comportamentos pre-ventivos. Foram avaliadas a adequação e pertinência por meio do julgamento de especialistas (n = 38) e, posteriormente, os profissionais e estudantes (n = 71) de Instituições de Ensino Superior (IES) avaliaram a clareza dos itens. A reprodutibilidade foi estimada via coeficiente Kappa. O nível de significância adotado foi de 5%. A validade de conteúdo mostrou valores médios de adequação, pertinência e clareza de 92,4%, 87,1% e 78,7%, respectivamente. Participaram na etapa de reprodu-tibilidade 83 estudantes e profissionais de IES e o nível de concordância variou de 0,358 referente ao item "G" (Procuro ocupar a maior parte do meu dia com atividades interessantes) a 0,626 relativo ao item "N" (Mantenho o distanciamento físico e uso máscara sempre que preciso sair). Conclui-se que a escala "Perfil do Estilo de Vida Individual" em tempos de distanciamento social apresentou satisfatória validade de conteúdo e os níveis de reprodutibilidade podem ser considerados aceitáveis para escalas desta natureza

This study aimed to estimate the content validation and the reproducibility level of the "Individual Lifestyle Profile" scale in times of social distancing. The items on the scale originally proposed by Nahas, Barros and Francalacci, were modified to assess the lifestyle of adults, of online form, during social distancing period, for example the COVID-19 pandemic. The 15 questions covered the behavior considered by health experts during a pandemic, maintaining the original five domains proposed in the initial version: healthy eating, physical activity, stress control, preventive behavior and relationships. Adequacy and pertinence were assessed through the judgment of specialists (n = 38) and, subsequently, professionals and students (n = 71) from Higher Education Institutions (HEIs) assess the clarity of the items. Reproducibility was estimated using the Kappa coefficient. The level of significance adopted was 5%. The average of the validity content of adequacy, relevance and clarity was 92.4%, 87.1% and 78.7%, respectively. 83 students and professionals of HEI participated in the reproducibility stage and the level of agreement ranged from 0.358 for item "G" (I try to occupy most of my day with interesting activities) to 0.626 for item "N " (I keep my physical distance and wear a mask whenever I need to leave). Concluded that "Individual Lifestyle Profile" scale in times of social distancing presented satisfactory content validity and reproducibility levels may be acceptable for scales of this nature

Brazilian Consensus on Endoscopic Sleeve Gastroplasty.

PURPOSE: Bariatric endoscopy is a less invasive approach for obesity management, with better efficacy than pharmacological treatment and low morbidity. Endoscopic sleeve gastroplasty (ESG) is the remodeling of the stomach using a suturing device showing technical feasibility, safety, and sustained weight loss. With growing numbers of procedures worldwide, there is a need to standardize the procedure. MATERIALS AND METHODS: A consensus meeting was held in São Caetano do Sul-SP, Brazil, in June 2019, bringing together 47 Brazilian endoscopists with experience in ESG from all regions of the country. Topics on indications and contraindications of the procedure, pre-procedure evaluation and multidisciplinary follow-up, technique and post-procedure follow-up, and training requirements were discussed. An electronic voting was carried, and a consensus was defined as ≥ 70% agreement. RESULTS: The panel's experience consisted of 1828 procedures, with a mean percentage total body weight loss (TBWL) of 18.2% in 1 year. Adverse events happened in 0.8% of the cases, the most common being hematemesis. The selected experts discussed and reached a consensus on several questions concerning patient selection, contraindications for the procedure, technical details such as patient preparation, procedure technique, and patient follow-up. CONCLUSIONS: This consensus establishes practical guidelines for performance of ESG. The experience of 1828 procedures shows the expertise of the selected specialists participating in this consensus statement. The group's experience has a satisfactory weight loss with low adverse events rate. The main points discussed in this paper may serve as a guide for endoscopists performing ESG. Practical recommendations and technique standardization are described.

"Stat Rosa Pristina Nomine, Nomina Nuda Tenemus": The Many Syndromes, Diseases, and Anatomic Structures Bearing Jean-Martin Charcot's Name.

The sheer magnitude of Jean-Martin Charcot's contributions to neurology, pathology, psychiatry, and internal medicine has allowed for the common usage of eponyms bearing the master's name in recognition of his work. However, these are so numerous that confusion has naturally arisen concerning the exact nature of each eponym, allowing for different specialists to refer to completely different ailments or symptoms, while using the very same expression. Previous compilations of his eponyms were often incomplete. Therefore, the authors aimed to bring some clarification into the nature and origin of each known eponym with Charcot's name.

" In the immortal forms of beauty": Frédéric Chopin seen through the eyes of the father of Brazilian neurological semiology.

Aloysio de Castro (1881-1959) is now remembered as one of Brazil's greatest physicians and is considered the father of Brazilian neurological semiology. However, his interests went far beyond the realm of Medicine, and he became one of the most illustrious intellectuals of his time. In 1927, he gave a speech at the São Paulo Society of Artistic Culture on Frédéric Chopin and embarked on a journey across the composer's life and times, discussing the medical issues involving his death, as well as his lovers, his compositions, and the spiritual aspects of musical interpretation. Thus, Castro reinforced the bonds of music and Medicine and provided lessons on Musicology that may very well be as suited to a hospital as they are to a concert hall.

"... In the immortal forms of beauty: Frédéric Chopin seen through the eyes of the father of Brazilian neurological semiology / "... nas imortais formas da beleza: Frédéric Chopin visto pelos olhos do pai da semiologia neurológica brasileira

ABSTRACT Aloysio de Castro (1881-1959) is now remembered as one of Brazil's greatest physicians and is considered the father of Brazilian neurological semiology. However, his interests went far beyond the realm of Medicine, and he became one of the most illustrious intellectuals of his time. In 1927, he gave a speech at the São Paulo Society of Artistic Culture on Frédéric Chopin and embarked on a journey across the composer's life and times, discussing the medical issues involving his death, as well as his lovers, his compositions, and the spiritual aspects of musical interpretation. Thus, Castro reinforced the bonds of music and Medicine and provided lessons on Musicology that may very well be as suited to a hospital as they are to a concert hall.

RESUMO Aloysio de Castro (1881-1959) é hoje lembrado como um dos maiores médicos do Brasil, bem como o pai da semiologia neurológica brasileira. Entretanto, seus interesses iam muito além dos domínios da Medicina, e ele se tornou um dos mais ilustres intelectuais de sua era. Em 1927, Castro deu uma palestra na Sociedade de Cultura Artística de São Paulo sobre Frédéric Chopin, e embarcou em uma jornada pela vida e época do compositor, discutindo o aspecto médico de sua morte, bem como suas amantes, composições e aspectos espirituais da interpretação musical. Assim, Castro reforçou os laços entre música e Medicina e ensinou lições de Musicologia que podem muito bem ser tão aplicadas à Medicina quanto a uma sala de concertos.

Ponto de vista dos profissionais de Educação Física sobre o uso da máscara facial durante o exercício físico na pandemia da COVID-19 / Point of view of Physical Education professionals on the use of the face mask during physical exercise in the COVID-19 pandemic

O objetivo do estudo foi analisar a opinião dos profissionais de Educação Física (PEF) sobre as recomendações do uso de máscara facial na prática de exercícios físicos (EF) ao ar livre durante a pandemia de COVID-19. Foi realizado um estudo transversal com 2.234 PEF do Brasil. Um formulário on-line foi enviado para os PEF com 12 perguntas sobre recomendações do uso de máscara facial na prática de EF ao ar livre. Foi realizado teste do c2 de Pearson e c2 para tendência linear para avaliar a associação entre as variáveis, adotando o nível de significância de 5%. Os resultados mostram que 73,4% dos PEF recomendam a prática de EF ao ar livre no cenário da pandemia da COVID-19. Sobre o uso de máscara facial durante o EF, a recomendação foi maior para o uso somente em locais com aglomerações de pessoas e impossibilidade de distanciamento social (48,2%). Uma proporção significativa de profissionais opinou que a utilização da máscara facial durante o EF ao ar livre pode ser prejudicial, tanto para o desempenho físico (50,6%), como à saúde dos praticantes (37,7%).Houve associação entre o maior grau de titulação acadêmica do PEF com a recomendação do uso de máscara facial em qualquer situação (p = 0,003). Concluímos que, apesar dos PEF recomendarem a prática de EF ao ar livre, a maioria recomenda a utilização da máscara facial apenas na impossibilidade de distanciamento social

The objective of the study was to analyze the opinion of Physical Education professionals (PEP) on the recommendations for the use of face masks during physical exercise (PE) outdoors during the COVID-19 pandemic. A cross-sectional study was carried out with 2,234 PEP from Brazil. An online form was sent to the PEP with 12 questions about the recommendations for using a face mask when practicing PE outdoors. Pearson'sc2 test and c2 test for linear trend were performed to assess the association among variables, adopting a 5% significance level. The results show that 73.4% of the PEP recommend the practice of outdoor PE in the pandemic scenario of COVID-19. Regarding the use of a face mask during PE, the recommendation was higher for use only in places with crowds of people and the impossibility of social distance (48.2%). A significant proportion of professionals expressed the opinion that the use of a face mask during outdoor PE can be detrimental both to physical performance (50.6%) and to the health of the people (37.7%). There was an association between the highest degree of academic qualification in the PEP and the recommendation to use a face mask in any situation (p = 0.003). We conclude that, although the PEP recommend the practice of PE outdoors, the majority of them recommend the use of the face mask only with the impossibility of social distance

Inatividade física no lazer durante a pandemia da COVID-19 em universitários de Minas Gerais / Leisure-time physical inactivity during COVID-19 pandemic in undergraduate from Minas Gerais

Os objetivos deste estudo foram estimar a prevalência de inatividade física no lazer e analisar a associação entre as práticas de atividades físicas (AF) pregressas na Educação Física (EF) escolar e fora do contexto escolar, sob a inatividade física no lazer durante o período da pandemia de COVID-19. Estudo transversal em que 1.679 estudantes dos cursos de graduação e pós-graduação da Universidade Federal de Uberlândia responderam um questionário online adaptado do Indicadores de Saúde e Qualidade de Vida em Acadêmicos (ISAQ-A). O período de coleta teve duração de 25 dias, em maio de 2020. A análise da associação empregada foram as Razões de Prevalências (RP), complementadas pelo intervalo de confiança a 95% (IC95%), nas análises brutas e ajustadas. A variável dependente foi relatar não praticar AF no lazer durante a pandemia de COVID-19. As variáveis independentes: prática de AF no período da infância e adolescência, fora da escola e participação nas aulas de Educação Física escolar (participação regular e irregular). As variáveis de controle foram estado de saúde, meios para a prática de AF antes da pandemia e renda. O nível de significância adotado foi de 5%. O não envolvimento em atividades físicas fora do contexto escolar está associado a maiores prevalências de inatividade física no lazer (RP = 1,245; IC95%: 1,087 ­ 1,426). Os achados deste estudo indicam que as AFs realizadas no âmbito do lazer no período da infância e adolescência podem influenciar na manutenção da prática mesmo em situações adversas, como o distanciamento social ocasionado pela pandemia de COVID-19

The objectives of the study were to estimate the prevalence of leisure-time physical inactivity and to analyze the association between past physical activity practices in childhood and adolescence, in the classes of Physical Education and outside the school context, under physical inactivity during leisure-time in COVID-19 pandemic. A cross-sectional study was carried out with college and postgraduate students (n = 1.679) of Federal University of Uberlândia, who answered an adapted online survey "Indicadores de Saúde e Qualidade de Vida em Acadêmicos (ISAQ-A)". The Prevalence Ratio was used, complemented by the 95% confidence interval (95% CI) to estimate association in crude and adjusted analysis. The significance value was 5%. The results revealed that non-involvement in physical activities outside the school context, during childhood and adolescence, is associated with higher prevalence of physical inactivity during leisure (RP: 1,245; IC95%: 1,087 ­ 1,426). The dependent variable was the reported absence of physical activities practice during the covid-19 pandemic. The independent variables were: practice of physical activities during childhood and teenage years during the physical education classes (even if not on a regular basis) and/also out of it. The control variables were health condition, personal income and resources available to enable the practice of physical activities.The findings of this research indicate that the PAs performed in leisure-time during childhood and adolescence can influence the maintenance of the practice even in adverse situations, such as the social distance caused by the pandemic of COVID-19

The Devil Is in the Details: Neurological Diseases Presenting as Religious Hallucinations in Two Literary Works.

Few authors in the Western literature have acquired such a monumental reputation as Thomas Mann and Fyodor Dostoyevsky; although with different backgrounds and aesthetic peculiarities, their writings converge thematically in their frequent relationship with disease. From Dostoyevsky's struggle with epilepsy to Mann's descriptions of tuberculosis and cholera, many are the examples found in their body of work describing medical afflictions. One noteworthy similarity in their works is the presence of hallucinations with Mephistopheles-like devilish entities, possibly caused by neurological diseases: in Mann's case, concerning the main character of Doctor Faustus, caused by neurosyphilis, while for Dostoyevsky, concerning one of the titular Brothers Karamazov, by delirium tremens. In both cases, the authors leave room for ambiguity, with the characters themselves casting doubts on whether their experiences were indeed caused by their disease or by an actual supernatural being. In this, we may find an interesting intersection between neurology and the literature.