Reversible Pulmonary Hypertension Secondary to Scurvy in a Patient with a Psychiatric Disorder: a Case Report and Literature Review.

Pulmonary hypertension (PH) can be related to several diseases, such as connective tissue disorders and pulmonary embolism, or to drugs; it may also be idiopathic. Few cases have been reported demonstrating an association between ascorbic acid deficiency and reversible PH. We report the case of a patient who arrived at the emergency department with dyspnoea, tachycardia and lower limb perifollicular haemorrhage. Examinations, including a transthoracic echocardiogram, revealed enlarged right chambers and an estimated pulmonary artery systolic pressure of 61 mmHg. Further evaluation revealed poor food intake due to paranoid personality disorder, leading to ascorbic acid deficiency and manifestations of scurvy. LEARNING POINTS: Diagnosing ascorbic acid deficiency is important as associated pulmonary hypertension could be completely resolved with appropriate treatment.Ascorbic acid deficiency is a condition that can still be found in many countries, including developed ones.Patients suffering from psychiatric disorders are at high risk of scurvy.

Is doctor-patient relationship influenced by health online information?

SUMMARY OBJECTIVES To analyse the opinions and attitudes reported by medical specialists regarding online health information and their interference in the doctor-patient relationship. Methods A cross-sectional study developed between 2016 and 2017 in Recife-Pernambuco-Brazil, which used a questionnaire in person in a population of 183 specialists from the Instituto de Medicina Integral Prof. Fernando Figueira. The results were analysed through the Statistical Package for the Social Sciences. Obtained approval of the Ethics Committee under the voucher number 121004/2016. Results In the opinion of 85.2% of physicians, online health information has both positive and negative impacts on the physician-patient relationship. Faced with a questioning patient who claims to have researched information on the internet, 98.9% of the physicians said they would try to explain the reasons for their diagnosis and treatment. 59% already had a patient who modified the treatment recommended after seeing health information on the Internet. 73.8% agreed that online health information has positive effects for the general public, but 89.1% feel that most patients do not know which online health information is reliable CONCLUSION The physicians surveyed view online health information in a positive way, but realize that it is necessary to be cautious as to their repercussions on the treatment of patients. There is concern about the accuracy of online health information, and it is incumbent upon the physician and health institutions to instruct patients about the sources of quality and that they are able to understand, as its known the patients have an active voice through the guarantee of the ethical principle of autonomy.

RESUMO OBJETIVOS Analisar opiniões e atitudes relatadas por médicos especialistas diante das informações de saúde on-line e suas interferências na relação médico-paciente. Métodos Estudo transversal desenvolvido entre 2016 e 2017 em Recife, Pernambuco, Brasil, que utilizou um questionário presencialmente em uma população de 183 médicos especialistas do Instituto de Medicina Integral Prof. Fernando Figueira. Os resultados foram analisados por meio do Statistical Package for the Social Sciences. Obtida aprovação do Comitê de Ética sob o número de comprovante 121004/2016. Resultados Na opinião de 85,2% dos médicos, as informações on-line sobre saúde têm tanto impacto positivo quanto negativo na relação médico-paciente. Diante de um paciente questionador, que diz ter pesquisado informações na rede, 98,9% dos médicos fazem com que o usuário entenda as razões sobre seu diagnóstico e tratamento; 59% já tiveram paciente que modificou o tratamento recomendado por ter visto informações na internet; 73,8% concordam que as informações on-line sobre saúde têm efeitos positivos para o público em geral, mas 89,1% opinam que a maioria dos pacientes não sabe quais informações sobre saúde on-line são confiáveis. CONCLUSÃO Os médicos pesquisados veem as informações on-line sobre saúde de forma positiva, mas percebem que é necessário ter cautela quanto às repercussões destas sobre o tratamento dos pacientes. Há preocupação quanto à acurácia dessas informações, cabendo ao médico e às instituições de saúde instruir os pacientes quanto às fontes de qualidade e que estejam acessíveis ao entendimento de leigos, visto que os pacientes passaram a ter voz ativa por meio da garantia do princípio ético da autonomia.

Is doctor-patient relationship influenced by health online information?

OBJECTIVES: To analyse the opinions and attitudes reported by medical specialists regarding online health information and their interference in the doctor-patient relationship. METHODS: A cross-sectional study developed between 2016 and 2017 in Recife-Pernambuco-Brazil, which used a questionnaire in person in a population of 183 specialists from the Instituto de Medicina Integral Prof. Fernando Figueira. The results were analysed through the Statistical Package for the Social Sciences. Obtained approval of the Ethics Committee under the voucher number 121004/2016. RESULTS: In the opinion of 85.2% of physicians, online health information has both positive and negative impacts on the physician-patient relationship. Faced with a questioning patient who claims to have researched information on the internet, 98.9% of the physicians said they would try to explain the reasons for their diagnosis and treatment. 59% already had a patient who modified the treatment recommended after seeing health information on the Internet. 73.8% agreed that online health information has positive effects for the general public, but 89.1% feel that most patients do not know which online health information is reliable. CONCLUSION: The physicians surveyed view online health information in a positive way, but realize that it is necessary to be cautious as to their repercussions on the treatment of patients. There is concern about the accuracy of online health information, and it is incumbent upon the physician and health institutions to instruct patients about the sources of quality and that they are able to understand, as its known the patients have an active voice through the guarantee of the ethical principle of autonomy.

Ética e Profissionalismo nas Redes Sociais: Comportamentos On-Line de Estudantes de Medicina / Ethics and Professionalism in Social Media: The Online Behaviour of Medical Students

RESUMO Novo tipo de relação entre médicos e pacientes vem surgindo após a expansão e abrangência das redes sociais. Assim, é necessário rever aspectos da formação de estudantes de Medicina, além de avaliar os benefícios e riscos da utilização dessas redes, no intuito de preservar a confiança e cumplicidade na relação médico-paciente. Objetivos: Descrever o comportamento on-line de estudantes de Medicina, bem como suas opiniões sobre o uso de redes sociais, além de conhecer aspectos da formação médica sobre ética e profissionalismo. Métodos: Estudo transversal realizado em hospitais de ensino de três escolas médicas em Recife (PE) entre 2015 e 2016. Um questionário autoaplicável elaborado pelos pesquisadores foi respondido por 260 estudantes de Medicina dos dois últimos anos do curso (internato). Ao mesmo tempo, os planos de ensino de cada instituição foram analisados separadamente. Os dados obtidos foram analisados por meio dos testes estatísticos Qui-Quadrado de Pearson, teste Exato de Fisher, Kruskal-Wallis e McNemar. Para a parte do questionário do tipo escala Likert foi calculado o ranking médio das respostas dos participantes, assim como o Alpha de Cronbach. O projeto foi submetido à apreciação ética com posterior aprovação e todos os participantes concordaram com o Termo de Consentimento Livre e Esclarecido. Resultados: Entre os estudantes, 41,5% (108) afirmaram ter postado fotos ou vídeos mostrando consumo de bebidas alcoólicas ou cigarro e 32,3% (84) postaram fotos ou vídeos com pacientes em rede social. Foi observada diferença estatisticamente significativa (p<0,001) entre as instituições pesquisadas quanto à postagem de fotos ou vídeos com pacientes, uma vez que os estudantes da instituição III relataram menor postagem (14,3% ou 12 participantes). Na análise das respostas dos estudantes das três instituições, foi observada relação de tendência inversa entre "postagem de fotos ou vídeos com pacientes" e "abordagem de profissionalismo on-line na graduação". Na instituição III, onde menor quantidade de estudantes relatou postagens em rede social com pacientes, maior quantidade deles relatou abordagem de questões sobre profissionalismo on-line na graduação (26,2% ou 22 participantes). Entre os pesquisados, 79% (205) concordaram em que certos conteúdos do perfil pessoal do Facebook do médico podem difamar a reputação deste. Em relação à abordagem de questões sobre profissionalismo on-line na graduação médica, 80,8% (210) dos participantes disseram que não tiveram essa abordagem. Na análise dos planos de ensino, apenas a instituição III apresentou um eixo curricular de desenvolvimento profissional e abordagem teórica formal sobre conceitos de ética durante o internato. Conclusão: Um número expressivo de estudantes pesquisados teve comportamentos contrários ao preconizado pelo Código de Ética Médica, resoluções do Conselho Federal de Medicina e guidelines estrangeiras de comportamento em rede social. É possível que a abordagem do profissionalismo e da ética na formação acadêmica tenha repercussão nos comportamentos de estudantes de Medicina na rede social. Estudos que poderiam estabelecer relação de causa e efeito são necessários para confirmar se há relação entre comportamentos on-line de estudantes e abordagem de ética e profissionalismo na graduação. Por fim, observa-se, nas escolas médicas pesquisadas, escassez da abordagem do tema profissionalismo on-line.

ABSTRACT A new type of doctor-patient relationship is emerging due to the widespread use of social media. Therefore, a review of certain aspects of medical education is needed in order to preserve the trust and cooperation of the doctor-patient relationship. Objectives: To describe the online behaviour of medical students, their opinions the use of social media and to understand aspects of undergraduate medical training regarding ethics and professionalism. Methods: This was a cross-sectional study with a sample of 260 medical students enrolled in the fifth and sixth years at three medical schools in Recife, Pernambuco, Brazil. The data were collected between August 2015 and July 2016 at the teaching hospitals of each medical school. This paper reports the results from a structured questionnaire composed by the authors about online ethics and professionalism and answered by the students. The obtained data were analysed by means of the following statistical tests: Pearson's Chi-square, Fisher's exact test, Kruskal-Wallis and McNemar tests. For the Likert scale-type part of the questionnaire average ranking was calculated for student responses. Cronbach Alpha was also calculated. The study was approved by the Ethics on Research Committee. Informed consent was obtained from all participants. In order to ensure the confidentiality of the results, the medical schools had their names omitted. Results: A total of 84 students (32.3%) reported that they had posted pictures or videos with patients and 108 (41.5%) had posted pictures or videos with alcoholic drinks or cigarettes. A statistically significant difference (p<0.001) was found between the three medical schools relative to students posting pictures or videos with patients. The students from institution number III were the least likely to post photos or videos with patients or with alcoholic drinks or cigarettes, according to their answers to the questionnaire. Furthermore, institution number III also had the highest number of students that reported having addressed issues of online professionalism in medical training (26.2%/22). Analysing the three institutions separately an inverse relationship was found between "posting photos or videos with patients" and "online professionalism during undergraduate training". Among those surveyed, 79% (205) agreed that some content published by doctors on Facebook might harm the doctor's reputation. Students reported having had no discussions concerning online professionalism during their undergraduate course in 80.8% of the cases. Analysing the curriculum from the three medical schools, only institution number III was found to offer specific content regarding professional development and formally addressed theories regarding concepts of ethics during the medical residency. Conclusion: When we consider the recommendations found in the Code of Medical Ethics, resolutions published by the Brazilian Federal Medical Council (BFMC), and foreign guidelines, it was evident that a large number of students had posted inappropriate content online. A failure to adequately address ethics and professionalism as part of academic training may well play a part in issues related to the behaviour of medical students on social meda. More research into online behaviour and ethics/professionalism taught as part of undergraduate training is needed to infer causal relationships. Finally, it could be concluded that online professionalism was a topic that was scarcely addressed in the curricula of the surveyed medical schools

COMPARATIVE ANALYSIS OF PREOPERATIVE ULTRASONOGRAPHY REPORTS WITH INTRAOPERATIVE SURGICAL FINDINGS IN CHOLELITHIASIS.

BACKGROUND: Laparoscopic cholecystectomy is widely used for cholelithiasis. Abdominal ultrasonography often precedes this operation and can prove diagnosis, as well as helps in showing possible complications during the perioperative period. AIM: Evaluate the description of variables of gallbladder and bile ducts present in reports of preoperative abdominal ultrasonography in cholelithiasis comparing with surgical findings. METHODS: Were studied 91 patients who underwent elective laparoscopic cholecystectomy with previous abdominal ultrasonography. Variables such as identification and amount of gallstones involved were evaluated, both in preoperative ultrasonography and during surgery to evaluate sensitivity, specificity, concordance and positive and negative predictive values. RESULTS: The reports did not mention diameter of vesicular light (98.9%), organ distension (62.6%), gallstone sizes (58.2%), wall thickness (41.8%) and evaluation of the common bile duct (39.6%). Ultrasound had high values for sensitivity, consistency and positive predictive value for identifying the presence/absence of gallstones: 98.8%, 96.7% and 97.8% respectively. As for the amount of stones, ultrasonography showed agreement in 82.7%, negative predictive value in 89.1% and specificity in 87.7%, with lower values for sensitivity (68.2%) and positive predictive value (65.2%). CONCLUSIONS: The ultrasound reports were flawed in standardization. Significant percentage of them did not have variables that could predict perioperative complications and surgical conversion.

Comparative analysis of preoperative ultrasonography reports with intraoperative surgical findings in cholelithiasis / Análise comparada dos laudos ultrassonográficos pré-operatórios com achados cirúrgicos transoperatórios na colelitíase

Background : Laparoscopic cholecystectomy is widely used for cholelithiasis. Abdominal ultrasonography often precedes this operation and can prove diagnosis, as well as helps in showing possible complications during the perioperative period. Aim : Evaluate the description of variables of gallbladder and bile ducts present in reports of preoperative abdominal ultrasonography in cholelithiasis comparing with surgical findings. Methods : Were studied 91 patients who underwent elective laparoscopic cholecystectomy with previous abdominal ultrasonography. Variables such as identification and amount of gallstones involved were evaluated, both in preoperative ultrasonography and during surgery to evaluate sensitivity, specificity, concordance and positive and negative predictive values. Results : The reports did not mention diameter of vesicular light (98.9%), organ distension (62.6%), gallstone sizes (58.2%), wall thickness (41.8%) and evaluation of the common bile duct (39.6%). Ultrasound had high values for sensitivity, consistency and positive predictive value for identifying the presence/absence of gallstones: 98.8%, 96.7% and 97.8% respectively. As for the amount of stones, ultrasonography showed agreement in 82.7%, negative predictive value in 89.1% and specificity in 87.7%, with lower values for sensitivity (68.2%) and positive predictive value (65.2%). Conclusions : The ultrasound reports were flawed in standardization. Significant percentage of them did not have variables that could predict perioperative complications and surgical conversion.

Racional: Colecistectomia laparoscópica constitui tratamento padrão para colecistolitíase e ultrassonografia abdominal frequentemente a precede e pode prever possíveis complicações durante o período transoperatório. Objetivo : Avaliar a descrição das variáveis da vesícula biliar e vias biliares presentes nos laudos ultrassonográficos pré-operatórios na colelitíase, e compará-los aos achados cirúrgicos. Métodos : Foram incluídos 91 pacientes submetidos à colecistectomia laparoscópica eletiva com ultrassonografia abdominal prévia. Variáveis como identificação e quantidade de cálculos foram avaliadas, tanto na ultrassonografia pré-operatória quanto durante a operação para analisar a concordância entre eles. Resultados : Nos laudos não constavam diâmetro da luz vesicular (98.9%), distensão do órgão (62.6%), tamanho aproximado dos cálculos (58.2%), espessura da parede (41.8%) e avaliação do colédoco (39.6%). Ultrassonografia teve altos valores para sensibilidade, concordância e valor preditivo positivo para identificação da presença/ausência de cálculos; 98.8%, 96.7% e 97.8% respectivamente. Quanto à quantidade de cálculos, a ultrassonografia apresentou concordância, valor preditivo negativo e especificidade de 82.7%, 89.1% e 87.7%, respectivamente, com valores menores para sensibilidade (68.2%) e valor preditivo positivo (65.2%). Conclusões: Os laudos ultrassonográficos foram falhos no quesito padronização. Porcentagem significativa dos laudos não apresentava variáveis que pudessem prever intercorrências transoperatórias e conversão cirúrgica.