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Abstract Objectives Medical training negatively impacts the quality of life of students. Assessing the well-being of medical students could guide academic policies and future research for improving the mental and physical health status of the population at risk. This study aimed to identify the influence of medical training on the quality of life of Brazilian medical students. Methods A systematic review and meta-analysis was conducted according to the Cochrane criteria and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol (PRISMA). The search was performed by two independent investigators using a predefined protocol registered on the PROSPERO database (CRD42021237926). Data were extracted from PubMed, Embase, and Biblioteca Virtual de Saúde (BVS). For quantitative synthesis, a meta-analysis was conducted to assess the mean difference in the quality of life between medical students at different stages in the academic cycle, stratified by sex. All data were analyzed using the random-effects model, with a confidence interval of 95% (95%CI). Results After evaluating the eligibility criteria, five studies were included in the meta-analysis. The data revealed that students in the pre-clinical cycle of the course exhibited higher quality of life scores in the physical (3.05 [1.48-4.62], p < 0.0001) and psychological (3.05 [0.80-5.30], p < 0.0001) domains than students in the clerkship cycle. No statistically significant differences were observed in the environmental (0.78 [-2.92-4.49], p = 0.68) or social domains (1.41 [-0.52-3.34], p = 0.15). Conclusion Our analysis revealed that the medical course is associated with decreased quality of life of medical students in the physical and psychological domains. This finding was observed in both men and women. However, these findings should be interpreted with caution given the study limitations. Registration number PROSPERO, CRD42021237926.
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The aim of this study was to investigate the risk factors age, gender, and 11 comorbidities for mortality attributed to COVID-19 among Brazilians. An observational, retrospective cohort study with 1,804,151 individuals was performed using the São Paulo State Statistics Portal database for COVID-19 monitoring. Multivariate binary logistic regression was conducted to estimate the influence of odds ratio (OR) for asthma, diabetes, obesity, Down's syndrome, puerperal, hematological, hepatic, neurological, pulmonary, immunological, kidney, and other diseases contributing to mortality attributed to COVID-19. An additional analysis was undertaken using age-stratified data including children, adults, and seniors. Our findings demonstrated that cardiac diseases (9.37%) and diabetes (6.26%) were the most prevalent disorders in therapeutically managed and deceased patients. Multivariate regression model found that male individuals (OR = 1.819, CI 1.783 to 1.856, p < 0.001), older age (OR per year = 1.081, CI 1.081 to 1.082, p < 0.001) and presenting comorbidities (OR varying from 1.84-5.47) were at a higher risk of death. The age-stratified analysis also indicates disparities in the impact of the comorbidities between children, adults, and seniors. Our comprehensive findings indicate the primary risk factors for mortality attributed to COVID-19 in the entire population examined, provide a broader perspective than investigations focused solely on hospitalized patients. This study may be utilized as a valuable tool for decision-making during the COVID-19 outbreak.
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COVID-19 , Diabetes Mellitus , Adulto , Criança , Humanos , Masculino , Fatores Etários , Brasil/epidemiologia , Diabetes Mellitus/epidemiologia , Hospitalização , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2 , Feminino , IdosoRESUMO
Background: Chronic Chagas heart disease (CCHD) and systemic arterial hypertension (SAH) frequently coexists in areas where Chagas disease is endemic. The effects of the association of both conditions (CCHD-SAH) on the extracellular matrix (ECM) remodeling are unknown. Matrix metalloproteinases (MMP) 2 and 9 are involved in ECM remodeling. The aim of this study was to evaluate MMP 2 and MMP9 in CCHD-SAH patients and to correlate their levels with those of the profibrogenic cytokine TGF-beta. Methods: We included 19 patients with CCHD-SAH, 14 patients with CCHD alone, and 19 controls matched by sex and age. MMP-2 and MMP-9 plasma levels were studied by gel zymography and showed as optical densities (OD). TGF-beta plasma levels were measured by double-ligand ELISA and expressed as pg/mL. Results: Median (5th, 95th) MMP-2 plasma levels were 1224.7 OD (1160, 1433.5) in patients with CCHD alone, 1424.1 OD (1267.5, 1561) in patients with CCHD-SAH, and 940 OD (898.1, 1000.8) in controls (p=0.001). MMP-9 plasma levels were 1870 OD (1740, 1904.1) in patients with CCHD alone, 1754.6 OD (1650, 2049) in those with CCHD-SAH and 89.7 OD (80, 96) in controls (p=0.0003). MMP-9 plasma levels were higher than those of MMP 2 in patients with CCHD-SAH (p=0.01). No correlation was found between TGF-beta plasma levels with MMP-2 serum levels (r = 0.12; p=0.7), but a moderate negative correlation (r = -0.46; p=0.048) was observed between TGF-beta and MMP-9 plasma levels. Conclusions: MMP-2 and especially MMP-9 may play a role in the ECM remodeling process in patients with CCHD-SAH. TGF-Beta may counteract the MMP effect on the ECM remodeling process in patients with CCHD-SAH.
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INTRODUCTION: Medical training negatively impacts the quality of life of students. Assessing the well-being of medical students might guide academic policies and future research for improving mental and physical health status of the population at risk. OBJECTIVES: This study aimed to identify the influence of medical training on the quality of life of Brazilian medical students. METHOD: A systematic review and meta-analysis was conducted according to the Cochrane criteria and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. The search was performed by two independent investigators using a predefined protocol registered in PROSPERO (CRD42021237926). Data were extracted from PubMed, EMBASE, and Biblioteca Virtual de Saúde. For quantitative synthesis, a meta-analysis was conducted to assess the mean difference in the quality of life between medical students of different academic cycles stratified by sex. All data were analyzed using the random-effects model, with a confidence interval of 95%. RESULTS: After evaluating the eligibility criteria, five studies were included in the meta-analysis. The data revealed that students in the pre-clinical cyclee of the course exhibited higher quality of life scores in the physical (3.05 [1.48, 4.62], p< 0.0001) and psychological (3.05 [0.80, 5.30], p< 0.0001) domains than students in the clerkship cycle. No statistically significant difference was observed in the environmental (0.78 [-2.92, 4.49], p= 0.68]) and social domains (1.41 [-0.52, 3.34], p= 0.15). CONCLUSION: Our analysis revealed that the medical course is associated with a decreased quality of life in the physical and psychological domains of medical students. This finding was observed in both men and women. However, these findings should be interpreted with caution given the limitations of this study.
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BACKGROUND: Chronic Chagas disease (CCHD) associated with Systemic Arterial Hypertension (SAH) is frequently found in areas where the disease is endemic. The pathogenesis of patients with both pathologies (CCHD-SAH) is unsettled. Nitric Oxide (NO) and Kinins are important players in the myocardial inflammation process in experimental CCHD. No previous study has addressed this question in patients with CCHD, particularly in those with CCHD-SAH. Accordingly, this study was undertaken in an attempt to contribute to the understanding of the pathogenesis of patients with CCHD-SAH. METHODS: Thirty-seven patients with a positive serology for Chagas disease were enrolled; 15 had CCHD alone, 22 had CCHD-SAH (abnormal ECG/Doppler echocardiogram plus a systolic blood pressure > 140 mmHg or diastolic blood pressure > 90 mmHg on admission), and 11 had SAH alone. Thirty healthy individuals matched by age and sex served as controls. Plasma High-molecular (Hkg) and low-molecular weight (LKg) kininogens, plasma kallikrein levels (Pkal and Tcal), Kininase II, and plasma NO were measured. RESULTS: HKg and LKg were lower in CCHD-SAH patients in comparison with other groups (P < .0001). Pkal and Tcal were higher in CCHD-SAH patients in comparison with the other groups (P< .0001). Kininase II levels were similar in SAH, CCHD, and CCHD-SAH patients, but lower in comparison with controls (P< .0001). NO levels were similar in CCHD and CCHD-SAH patients, but higher in comparison with SAH patients and controls (P > .0001). CONCLUSION: Such findings suggest increased Kinin and NO activity in patients with CCHD-SAH, thus contributing to the understanding of the pathogenesis of this condition.
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Pressão Arterial , Doença de Chagas/sangue , Hipertensão/sangue , Cininas/sangue , Óxido Nítrico/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Brasil/epidemiologia , Estudos de Casos e Controles , Doença de Chagas/diagnóstico , Doença de Chagas/epidemiologia , Doença de Chagas/fisiopatologia , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Regulação para CimaRESUMO
OBJECTIVE: The purpose of this study was to investigate the clinical evolution of patients treated with carbon-coated stent, as well as its patency and the inflammatory response triggered by this process through the quantification of serum elements of the kallikrein-kinin system (KKS). METHODS: This was a single-center prospective study with 27 patients with peripheral artery disease (PAD) who required percutaneous transluminal angioplasty and stenting of the iliacofemoropopliteal segment using carbon-coated stent grafts (carbostents). The blood concentrations of the total and kininogen fractions were evaluated using immunoenzymatic methods. Plasma kallikrein levels were assessed by the colorimetric method and tissue kallikrein levels were evaluated by the spectrophotometric method. The activity of kininase II was measured by -fluorometric analysis. RESULTS: Of the 27 patients who completed the 6 months of the study (11 iliac territory, 16 femoropopliteal territory), only one experienced restenosis (3.7%) (femoropopliteal segment) and no patient had occlusion (96.3% of patency). In 1 year, four patients were lost to follow-up and all 23 patients evaluated maintained stent patency, except for the patient who had restenosis throughout the first 6 months. We report complete (100%) member salvage in 12 months of follow-up. The activity levels of high- and low-molecular-weight kininogens decreased significantly over time (before vs. 24 h, p < 0.01; before vs. 6 months, p < 0.001, and before vs. 24 h, p < 0.01; before vs. 6 months, p < 0.001; 24 h vs. 6 months, p < 0.001, respectively). Patients also had signiï¬cantly lower levels of plasma and tissue kallikrein (before vs. 24 h, p < 0.001; before vs. 6 months, p < 0.001, and before vs. 24 h, p < 0.01; before vs. 6 months, p < 0.05, respectively). There was a significant increase in the enzymatic activity of kininase II at 24 h and after 6 months compared to the pre-treatment control (p < 0.001). CONCLUSION: Our early experience shows that the use of carbon-coated stents in PAD appears to be safe, with low rates of early restenosis (3.7% in the first 6 months and 5% in the 12 months of follow-up). We concluded that KKS was involved in the inflammatory response caused by the placement of carbon-coated stents.
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Angioplastia/métodos , Sistema Calicreína-Cinina/fisiologia , Doença Arterial Periférica/terapia , Stents/efeitos adversos , Idoso , Carbono , Feminino , Humanos , Calicreínas/sangue , Cininogênio de Alto Peso Molecular/sangue , Masculino , Pessoa de Meia-Idade , Peptidil Dipeptidase A/metabolismo , Estudos ProspectivosRESUMO
Chronic Chagas heart disease (CCHD affects about 30% of patients with chronic Chagas disease (CCD). Systemic arterial hypertension (SAH) afflicts about 25% of patients with CCD. The association of CCHD with SAH (CCHD-SAH) predisposes patients to develop chronic heart failure. The role of cytokines in disease progression in patients with CCHD-SAH is unknown. Accordingly, the aim of this study was to evaluate the plasma levels of cytokines expressing the Th1, Th2, Th17 pattern, as well as Treg cytokines, TNF-alpha, IL-1ß, IL-8, IL-7 in patients with SAH-CCHD to get insight into the immunomodulation process in patients with this condition. Fifteen patients with CCHD, 22 patients with CCHD-SAH, and 28 controls were studied. All patients underwent history-taking, physical examination, 12-lead resting ECG, chest X-ray, and Doppler-echocardiogram. Ten of 15 (66%) patients with CCHD, and 16 of 22 (73%) patients with CCHD-SAH had decreased left ventricular ejection fraction (p > 0.05). Cytokines levels were performed on plasma samples using the ELISA method. Overall, proinflammatory, anti-inflammatory, and regulatory cytokine levels were increased in patients with CCHD-SAH in comparison to patients with CCHD and controls. However, such a difference was higher regarding IL-2, IL-5, IL-17, IL-12, and TNF-alpha cytokine levels, respectively. Cytokine levels were higher in CCHD patients in comparison to controls. Patients with CCHD-SAH have increased plasma levels of pro-inflammatory, anti-inflammatory, and regulatory cytokines in comparison with CCHD patients, thus suggesting a higher level of immunomodulation in patients with CCHD-SAH.
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Cardiomiopatia Chagásica/imunologia , Citocinas/metabolismo , Hipertensão/imunologia , Linfócitos T Reguladores/metabolismo , Células Th1/metabolismo , Células Th17/metabolismo , Células Th2/metabolismo , Biomarcadores/metabolismo , Cardiomiopatia Chagásica/metabolismo , Doença Crônica , Progressão da Doença , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Hipertensão/metabolismo , Masculino , Pessoa de Meia-Idade , Linfócitos T Reguladores/imunologia , Células Th1/imunologia , Células Th17/imunologia , Células Th2/imunologiaRESUMO
BACKGROUND: Inflammatory activity may influence results of percutaneous transluminal angioplasty (PTA). The purpose of this study was to evaluate the relationship between (1) proinflammatory markers (interleukin [IL]-6, IL-8, tumor necrosis factor α (TNF-α), and highly sensitive C-reactive protein [CRP]); (2) type 1 T helper cell marker (IL-12); and (3) Type 2 T helper cell marker (transforming growth factor-ß [TGF-ß]) and in-stent restenosis, 6 months after femoral PTA with stent implantation. METHODS: We performed a single-center prospective study with 26 patients with peripheral artery disease requiring PTA and stenting. As control, we studied 26 patients who were submitted to diagnostic angiography. Serum samples were collected before stent implantation, 24 hr and 6 months after the procedure. To detect restenosis, a new angiography was obtained at 6 months. RESULTS: Restenosis was observed in 10 (38.5%) patients who underwent PTA and stenting. There was a trend to increased levels of IL-6, TNF-α, TGF-ß, and IL-12 24 hr after PTA and stenting compared with pretreatment. IL-8 levels showed a statistically significant reduction 24 hours after versus pretreatment (P < 0.05), 6 months vs. pretreatment, and 6 months vs. 24 hr (P < 0.01). There was no statistical difference between cytokine levels when comparing restenosis and no restenosis groups. CRP levels were already high at pretreatment. CONCLUSIONS: No inflammatory marker was independently identified as risk factor for in-stent restenosis, 6 months after femoral PTA with stent implantation. The question that remains is whether acute phase reactants will be clinically useful to predict the individual risk for in-stent restenosis.