Decreased retinal capillary density as a beneficial response to 24-week high-speed circuit resistant training in healthy older adults.

PURPOSE: To determine the changes in retinal microvascular density after a 24-week high-speed circuit resistance training program (HSCT) in healthy older adults. METHODS: Thirty healthy older adults were recruited and randomly assigned to either a training group (HSCT) or a non-training (CON) group. Fifteen subjects (age 73.3 ± 7.76 yrs) in the HSCT group exercised three times per week on non-consecutive days for 24 weeks. Fifteen subjects in the CON group (age 72.2 ± 6.04 yrs) did not have formal physical training. Both eyes of each subject were imaged using optical coherence tomography angiography (OCTA) at baseline and at the 24-week follow-up. The vessel densities of the retinal vascular network (RVN), superficial vascular plexus (SVP), and deep vascular plexus (DVP) were measured. RESULTS: There were no demographic differences between the study groups. There were significant decreases in the retinal vessel densities of RVN, SVP and DVP in the HSCT group (P < 0.05). However, there were no significant changes in all three vascular measurements in the CON group (P > 0.05), although the changes showed a decreasing trend. The decreased vessel densities were doubled in the HSCT group in comparison to the CON group. However, the differences between groups did not reach a significant level (P > 0.05). CONCLUSIONS: This is the first study to reveal the decreased retinal vessel densities as a possible imaging marker for the beneficial effects of the 24-week HSCT program in older adults.

Perception of newly graduated physicians toward ethical education in medical schools: a Brazilian cross-sectional nationwide study.

OBJECTIVE: The objective of this study was to evaluate fresh medical graduates' perceptions regarding the general aspects of ethics teaching in Brazilian medical schools. METHODS: A structured questionnaire was applied to 4,601 participants among the 16,323 physicians who registered in one of the 27 Regional Medical Councils of Brazil in 2015. Answers to four questions regarding general aspects of ethics education in medical school were analyzed. Sampling procedures involved two stratification variables: legal nature (public vs. private) of medical schools and monthly household income higher than 10 minimum wages. RESULTS: A large percentage of the participants had witnessed unethical behaviors during contact with patients (62.0%), toward coworkers (51.5%), and in relationships with patients' families (34.4%) over the course of their medical training. Even though most of the responders (72.0%) totally agreed that patient-physician relationship and humanities education were part of their medical school curriculum, important topics such as conflicts of interest and end-of-life education were not satisfactorily addressed in the participants' medical training. Statistically significant differences were found between the answers of public and private school graduates. CONCLUSION: Despite great efforts to improve medical ethics education, our findings suggest the persistence of deficits and inadequacies in the ethics training currently given in medical schools in Brazil. Further modifications in ethics training must be made to address the deficiencies shown in this study. This process should be accompanied by continuous evaluation.

Perception of newly graduated physicians toward ethical education in medical schools: a Brazilian cross-sectional nationwide study

SUMMARY OBJECTIVE: The objective of this study was to evaluate fresh medical graduates' perceptions regarding the general aspects of ethics teaching in Brazilian medical schools. METHODS: A structured questionnaire was applied to 4,601 participants among the 16,323 physicians who registered in one of the 27 Regional Medical Councils of Brazil in 2015. Answers to four questions regarding general aspects of ethics education in medical school were analyzed. Sampling procedures involved two stratification variables: legal nature (public vs. private) of medical schools and monthly household income higher than 10 minimum wages. RESULTS: A large percentage of the participants had witnessed unethical behaviors during contact with patients (62.0%), toward coworkers (51.5%), and in relationships with patients' families (34.4%) over the course of their medical training. Even though most of the responders (72.0%) totally agreed that patient-physician relationship and humanities education were part of their medical school curriculum, important topics such as conflicts of interest and end-of-life education were not satisfactorily addressed in the participants' medical training. Statistically significant differences were found between the answers of public and private school graduates. CONCLUSION: Despite great efforts to improve medical ethics education, our findings suggest the persistence of deficits and inadequacies in the ethics training currently given in medical schools in Brazil. Further modifications in ethics training must be made to address the deficiencies shown in this study. This process should be accompanied by continuous evaluation.

Is It Worth Using Botulinum Toxin Injections for the Management of Mild to Moderate Blepharoptosis?

BACKGROUND: Mild ptosis can be aesthetically displeasing for patients, especially in unilateral cases. However, some patients do not desire to undergo a surgical repair. Botulinum toxin injection might be an option in these cases. OBJECTIVES: The authors sought to objectively examine the effects of botulinum neurotoxin A (BoNT-A) injection into the orbicularis oculi muscle in the management of blepharoptosis. METHODS: In this prospective study, 8 patients with mild to moderate ptosis received application of BoNT-A in the pretarsal orbicularis oculi muscle. Standardized photographs were obtained at baseline and 2, 4, and 24 weeks. Digital image analysis software (Image J) was employed for objective analysis. Primary outcomes were the margin reflex distance-1 and qualitative changes on a 4-point scale. RESULTS: A significant increase in the margin reflex distance-1 on the treated side (baseline: 2.00 ±â€…1.13 mm; week 2: 2.52 ±â€…1.13 mm; P = 0.003) and a significant reduction (baseline: 3.23 ±â€…0.92 mm, week 2: 3.07 ±â€…0.96; P = 0.0268) on the contralateral eyelid were observed at week 2. After 24 weeks, the effect of BoNT-A diminished, and no significant difference from baseline was observed in either eyelid. Subjectively, 87.5% of patients reported improvement in their eyelid ptosis. CONCLUSIONS: Botulinum toxin injection in the pretarsal orbicularis oculi muscle can be an option to temporarily manage ptosis in patients who do not desire to undergo a surgical procedure. This alternative treatment can also be employed to manage temporary ptosis induced by botulinum toxin diffusion to the levator aponeurosis.

Medical students' participation in the Volunteering Program during the COVID-19 pandemic: a qualitative study about motivation and the development of new competencies.

BACKGROUND: Considering evidence on competency-based curricula and the benefits of volunteering, this study highlights innovative ideas to improve medical education during the COVID-19 pandemic. We investigated the motivations and perceptions of competencies developed as leadership and management skills in medical students who joined the COVID-19 Volunteering Program in a Brazilian medical school. METHODS: We performed a cross-sectional, qualitative study involving medical students from the University of São Paulo, Brazil. They were invited to participate in an institutional Volunteering Program during the pandemic and filled out online application forms, including sociodemographic fields and two open-ended questions about their motivation to volunteer and perceptions of their own competencies. At the end of the program, students who were involved in management-related activities were also invited to participate in focus group interviews to track their perceptions about volunteering in this area. Data were submitted to descriptive and content analysis methods. All participants provided informed consent with electronic signatures. RESULTS: A total of 286 medical students subscribed to the Volunteering Program: 171 (60%) were men, 152 (53%) were enrolled in their 5th year of medical school, and 158 (55%) were 23-25 years old. One hundred and twelve (44%) students reported that they were motivated by altruistic reasons, 95 (37%) reported duty and 47 (19%) prioritized academic interests. Concerning CanMEDS competencies, 91 (36%) students' responses matched the Scholar component, followed by 51 (20%) with Collaborator, 49 (20%) with Professional, 32 (13%) with Communicator, 17 (7%) with Leader and 11 (4%) with Health Advocate. In focus groups, students reported the importance of management and leadership skills as a curricular component, motivations to volunteer, and acquired skills from volunteering in management and leadership-related activities, thereby indicating the development of resilient attitudes. CONCLUSIONS: Students who participated in the School of Medicine of University of Sao Paulo (FMUSP) Volunteering Program reported being motivated to help others (altruistic reasons) and to serve society as future health professionals (duty). Knowledge and work-related competencies prevailed over leadership or soft skills, emphasizing the importance of including such activities in the curriculum. Participating in management-related activities could help develop a more resilient attitude toward medical training. Volunteering programs offer students opportunities to develop competencies essential for their roles as future health professionals. Thus, we should think about including such activities in the curricular structure.

Retinal microvascular density modifications during the water drinking test.

PURPOSE: The water drinking test (WDT) is a well-known stress test that increases intraocular pressure (IOP) momentarily and can indicate risk of glaucoma progression. This study focuses on correlating changes in the retinal microvascular plexus with the WDT in young healthy subjects. METHODS: A total of 20 eyes of 20 healthy young subjects (mean age 24.37 ± 2.17 years) were included in this study. In our protocol, WDT consisted of drinking 1 L of water within 5 min. Outcome measures in this prospective observational study were mean arterial pressure (MAP), heart rate (HR), IOP, and retinal vessel density of both superficial and deep macular retina using optical coherence tomography angiography (OCTA), which were assessed before water ingestion and four times after at 15-min intervals. OCTA images were later quantified by fractal analysis (box counting [Dbox]). One-way repeated measures analysis of variance (ANOVA) was used to assess the effects of WDT on each of the parameters. RESULTS: The WDT resulted in significant peak changes of the following parameters compared to baseline: IOP: 15.63 ± 3.37 versus 18.38 ± 4.53 mmHg at 30 min, p < 0.001; HR: 75.74 ± 12.23 versus 64.95 ± 11.37 bpm at 15 min, p < 0.001; deep retinal vessel density 1.758 ± 0.14 versus 1.749 ± 0.16 at 15 min, p = 0.040. CONCLUSIONS: Besides IOP elevation and systemic effects in HR, WDT is associated with temporary modifications of the deep vascular plexus in young healthy subjects.

SARS-CoV-2 pneumonia-receptor binding and lung immunopathology: a narrative review.

The current pandemic of COVID-19 caused thousands of deaths and healthcare professionals struggle to properly manage infected patients. This review summarizes information about SARS-CoV-2 receptor binding dynamics and intricacies, lung autopsy findings, immune response patterns, evidence-based explanations for the immune response, and COVID-19-associated hypercoagulability.

Perfil Multicêntrico do Acadêmico de Medicina e suas Perspectivas sobre o Ensino da Oftalmologia / Multicentric Medical Student Profile and Their Perspectives About Ophthalmology Education

Resumo Objetivo: Analisar qualitativa e quantitativamente o perfil do aluno de Medicina que cursou a disciplina de Oftalmologia, correlacionando aspectos do seu ensino em conhecimentos básicos e perspectivas discente sobre a sua formação. Métodos: Foi realizado um estudo transversal descritivo do tipo inquérito, em 242 alunos de 12 estados brasileiros. A execução do projeto foi feita com a participação das Ligas Acadêmicas de Oftalmologia de Instituições de Ensino Superior vinculadas a Associação Brasileira de Ligas Acadêmicas de Oftalmologia (ABLAO). A amostra foi composta por alunos da graduação do curso de Medicina, escolhidos aleatoriamente, que já cursaram uma disciplina referente a Oftalmologia. Foi utilizado um questionário individual com perguntas sobre o perfil do aluno, conhecimentos básicos da especialidade e perspectivas sobre o seu ensino. A análise estatística foi feita com o programa Statistical Package for the Social Sciences SPSS, de forma descritiva, com média, desvio padrão e intervalo de confiança de 95%. Resultados: A média de idade foi de 23,96 (3,36±) anos de idade, e o sexo feminino foi predominante em 63,6%. Participaram 42% dos estados de todas as regiões do Brasil nessa pesquisa. 71,9% dos alunos eram de instituições privadas de ensino e estavam cursando o 8 ° período (±1,97). 43 % faziam parte de Liga Acadêmica de Oftalmologia. Observou-se variação de acertos nas questões de conhecimentos básicos, e ao final 95,9% dos alunos responderam que consideram a Oftalmologia importante na sua formação como médico geral, entretanto apenas 31% se sentem seguros em atender e ou encaminhar pacientes para avaliação do especialista. Conclusão: Definimos nessa pesquisa um perfil para o aluno de graduação que cursou a Disciplina de Oftalmologia. Verificamos o quanto ele considera importante a saúde ocular, e que existe uma procura por mais conhecimento no seu preparo como médico generalista. Constatamos também que as Ligas Acadêmicas de Medicina compõem o principal apoio extracurricular ao seu aprendizado. Consideramos importante que diferentes estratégias de ensino sejam discutidas e implementadas para melhora na sua formação.

Abstract Purpose: To analyze quantitative and qualitative data about the profile of the Medical student who attended the Ophthalmology discipline, correlating aspects of the basic knowledge and the student perspectives on his training. Methods: An observational cross-sectional survey study was performed in 242 students over 12 brazilian states. The project was done by Associação Brasileira de Ligas Acadêmicas de Oftalmologia (ABLAO) with the participation of the associated Academic Leagues of Ophthalmology. The sample was composed by random undergraduate medical students, who have already had Ophthalmology as subject. An individual questionnaire was used with questions about the student profile, basic knowledge of the speciality and perspectives about their teaching. Descriptive statistical analysis was performed with the Statistical Package for Social Sciences SPSS program, measuring mean, standard deviation and 95% confidence intervals. Results: The mean age was 23.96 (3.36±) years and female students were predominant in 63.6%. 42% of the states from all regions of Brazil participated. 71.9% of the students were from private educational institutions and were in the 8th period (±1,97). 43% were a member of the Academic League of Ophthalmology in the origin institution. Basic knowledge questions had a variation of the correct answers. Despite of only 31% of the students feel safe to attend or refer patients for evaluation of the specialist, 95.9% of the students answered that they consider ophthalmology important in their training as general practitioner. Conclusion: We defined in this research a profile for the undergraduate student who attended the Ophthalmology Department. We verify how the student considers eye health important and how they search for more knowledge in his preparation in general. We also found that the Medical Academic Leagues make up the main extracurricular support for their learning. It is important to discuss and implement different teaching strategies to improve their training.

Why ophthalmology? Analysis of the motivating factors influencing the choice of ophthalmology as a career among different generations in Brazil.

OBJECTIVES: The increasing demand for medical specialties with flexible working hours has been associated with the important role of quality of life as a determining factor when choosing a career in medicine, which might change the motivations for pursuing a career in ophthalmology. We aim to identify the main determinants of ophthalmology as a career choice as well as the reasons that motivated previous generations to follow this path. METHODS: Responses to self-administered online questionnaires were analyzed. RESULTS: A total of 225 responses were analyzed, including those of baby boomers (21), generation X (48), generation Y (131) and generation Z (25). Although the main reasons for choosing ophthalmology as a career are the same for all the generations in this study (flexible working hours, self-satisfaction from helping people improve their vision and the possibility of performing surgical procedures), some reasons for this career choice are more important to the younger generations (short-term results and short procedures), and some are more important to the older generations (the influence of an ophthalmologist in the family). CONCLUSION: The main reasons for choosing ophthalmology as a career are essentially the same over time. The differences in secondary motivations could be explained by generational differences.

Who and Where are the University of São Paulo Medical School Graduates?

OBJECTIVE: To evaluate the impact of a complex-care-based medical school in the context of the Brazilian health care system on students' career choices. METHODS: This was a retrospective cross-sectional study based on medical regulatory organization records. It included records for 7,419 physicians who graduated from FMUSP. Geographic data were analyzed using Kernel maps, and the statistical analysis was performed with SPSS® version 24.0. A p-value less than 0.05 was considered significant. RESULTS: Of the 7,419 physicians, 68.6% (95% CI 67.5-69.7) were male, and 20.7% (95% CI 19.8%-21.7%) had no medical specialty, compared to 46.4% nationwide. Internal medicine and surgery-based specialties were more popular, accounting for 39.4% (95% CI 38.3%-40.5%) and 16.8% (95% CI 15.5%-17.6%) of our study group, compared to the Brazilian averages of 25.9% and 13.5%. Our graduates also had a higher probability of staying in São Paulo City, especially when born outside the city. CONCLUSION: We believe that FMUSP remains an interesting model for studying the impact of a highly specialized center on the education and career choices of medical students.

Evaluation of endothelial/Descemet membrane complex of eye bank donor corneas using enhanced depth imaging optical coherence tomography.

Objective: We present a novel method for screening eye bank donor corneas using high definition optical coherence tomography (HD-OCT). This technology allows for the quantification of endothelial/Descemet membrane (En/DM) complex thickness ex vivo. Design: Prospective interventional study. Participants: Fifty-two corneal grafts from 27 donors were included in this study. Twenty additional control eyes and 11 eyes with Fuchs' endothelial corneal dystrophy were also evaluated for comparison. Methods: A custom built, high speed HD-OCT device (Envisu R2210, Bioptigen, Buffalo Grove, IL, USA) was used to obtain images, and custom-made graph-based segmentation software was used to automatically deconstruct corneal images into micro-layers. HD-OCT imaging was used to scan through the sealed sterile case of donor corneas stored in McCarey-Kaufman medium to image their En/DM complex through the center of the cornea. Results: This technology allowed for quantification of En/DM complex thickness in all donor corneas through the sealed sterile container used to transport graft tissue. Mean En/DM complex thickness of donor corneas was 17±4 µm. The difference between donor cornea En/DM thickness and that of control subjects (16±2 µm) was not statistically significant (p=0.3), suggesting that the transport container and media do not affect measurements. There was a significant difference between En/DM thickness of Fuchs' endothelial corneal dystrophy eyes (25±5 µm) and both donor corneas (p<0.0001) and control subjects (p<0.0001). Conclusions: We have described a new technique to measure En/DM complex thickness in eye bank donor corneas stored in a sealed sterile case. This may represent a novel adjunctive approach to screen corneal grafts for early endothelial disease.

Who and Where are the University of São Paulo Medical School Graduates?

OBJECTIVE: To evaluate the impact of a complex-care-based medical school in the context of the Brazilian health care system on students' career choices. METHODS: This was a retrospective cross-sectional study based on medical regulatory organization records. It included records for 7,419 physicians who graduated from FMUSP. Geographic data were analyzed using Kernel maps, and the statistical analysis was performed with SPSS® version 24.0. A p-value less than 0.05 was considered significant. RESULTS: Of the 7,419 physicians, 68.6% (95% CI 67.5-69.7) were male, and 20.7% (95% CI 19.8%-21.7%) had no medical specialty, compared to 46.4% nationwide. Internal medicine and surgery-based specialties were more popular, accounting for 39.4% (95% CI 38.3%-40.5%) and 16.8% (95% CI 15.5%-17.6%) of our study group, compared to the Brazilian averages of 25.9% and 13.5%. Our graduates also had a higher probability of staying in São Paulo City, especially when born outside the city. CONCLUSION: We believe that FMUSP remains an interesting model for studying the impact of a highly specialized center on the education and career choices of medical students.

Why ophthalmology? Analysis of the motivating factors influencing the choice of ophthalmology as a career among different generations in Brazil

OBJECTIVES: The increasing demand for medical specialties with flexible working hours has been associated with the important role of quality of life as a determining factor when choosing a career in medicine, which might change the motivations for pursuing a career in ophthalmology. We aim to identify the main determinants of ophthalmology as a career choice as well as the reasons that motivated previous generations to follow this path. METHODS: Responses to self-administered online questionnaires were analyzed. RESULTS: A total of 225 responses were analyzed, including those of baby boomers (21), generation X (48), generation Y (131) and generation Z (25). Although the main reasons for choosing ophthalmology as a career are the same for all the generations in this study (flexible working hours, self-satisfaction from helping people improve their vision and the possibility of performing surgical procedures), some reasons for this career choice are more important to the younger generations (short-term results and short procedures), and some are more important to the older generations (the influence of an ophthalmologist in the family). CONCLUSION: The main reasons for choosing ophthalmology as a career are essentially the same over time. The differences in secondary motivations could be explained by generational differences.