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PURPOSE: To evaluate the impact of simulators on the training of urology residents in retrograde intrarenal surgery (RIRS). METHODS: The study involved training eight urology residents, using two artificial simulators; one developed by the Universidade Estadual do Pará, using three-dimensional printing technology, and the other one patented by the medical equipment manufacturer Boston Scientific The qualification of residents took place through a training course, consisting of an adaptation phase (S0), followed by three training sessions, with weekly breaks between them (S1, S2 and S3). Study members should carry out a RIRS in a standardized way, with step-by-step supervision by the evaluator using a checklist. The participants' individual performance was verified through a theoretical assessment, before and after training (pre- and post-training), as well as by the score achieved in each session on a scale called global psychomotor skill score. In S3, residents performed an analysis of the performance and quality of the simulation, by completing the scale of student satisfaction and self confidence in learning (SSSCL). RESULTS: At the end of the course, everyone was able to perform the procedure in accordance with the standard. The training provided a learning gain and a considerable improvement in skills and competencies in RIRS, with p < 0.05. SSSCL demonstrated positive feedback, with an overall approval rating of 96%. CONCLUSIONS: Artificial simulators proved to be excellent auxiliary tools in the training of urology residents in RIRS.

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ABSTRACT Purpose: To evaluate the impact of simulators on the training of urology residents in retrograde intrarenal surgery (RIRS). Methods: The study involved training eight urology residents, using two artificial simulators; one developed by the Universidade Estadual do Pará, using three-dimensional printing technology, and the other one patented by the medical equipment manufacturer Boston Scientific The qualification of residents took place through a training course, consisting of an adaptation phase (S0), followed by three training sessions, with weekly breaks between them (S1, S2 and S3). Study members should carry out a RIRS in a standardized way, with step-by-step supervision by the evaluator using a checklist. The participants' individual performance was verified through a theoretical assessment, before and after training (pre- and post-training), as well as by the score achieved in each session on a scale called global psychomotor skill score. In S3, residents performed an analysis of the performance and quality of the simulation, by completing the scale of student satisfaction and self confidence in learning (SSSCL). Results: At the end of the course, everyone was able to perform the procedure in accordance with the standard. The training provided a learning gain and a considerable improvement in skills and competencies in RIRS, with p < 0.05. SSSCL demonstrated positive feedback, with an overall approval rating of 96%. Conclusions: Artificial simulators proved to be excellent auxiliary tools in the training of urology residents in RIRS.

RESUMO

PURPOSE: To evaluate the gain of microsurgical skills and competencies by urology residents, using low-fidelity experimental models. METHODS: The study involved the use of training boards, together with a low-fidelity microsurgery simulator, developed using a 3D printer. The model consists in two silicone tubes, coated with a resin, measuring 10 cm in length and with internal and external diameters of 0.5 and 1.5 mm. The support for the ducts is composed by a small box, developed with polylactic acid. The evaluation of the gain of skills and competencies in microsurgery occurred throughout a training course consisting of five training sessions. The first sessions (S1-S4) took place at weekly intervals and the last session (S5) was performed three months after S4. During sessions, were analyzed: the speed of performing microsurgical sutures in the pre and post-training and the performance of each resident through the Objective Structure Assessment of Technical Skill (OSATS) and Student Satisfaction Self-Confidence tools in Learning (SSSCL). RESULTS: There was a decrease in the time needed to perform the anastomosis (p=0.0019), as well as a progressive increase in the score in the OSATS over during sessions S1 to S4. At S5, there was a slightly decrease in performance (p<0.0001), however, remaining within the expected plateau for the gain of skills and competences. The SSSCL satisfaction scale showed an overall approval rating of 96.9%, with a Cronback alpha coefficient of 83%. CONCLUSIONS: The low-fidelity simulation was able to guarantee urology residents a solid gain in skills and competencies in microsurgery.

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ABSTRACT Introduction: Access represents one of the main challenges in performing posterior urethroplasty (1, 2). Several approaches and tactics have been previously described (3). This video demonstrates the Anterior Sagittal Transrectal Approach (ASTRA), which allows better visualization of the deep perineum (4). Materials and Methods: Our patient was a 65-year-old man with post radical prostatectomy vesicourethral anastomotic stenosis. He failed repeated endoscopic interventions, eventually developing urinary retention and requiring a cystostomy. We offered a vesicourethral anastomotic repair through ASTRA. The patient was placed in the jackknife position and methylene blue instilled through the cystostomy. To optimize access to the bladder neck, an incision of the anterior border of the rectum is performed. Anastomosis is carried out with six 4-0 PDS sutures. These are tied using a parachute technique, after insertion of a 16F Foley. Results: The patient was discharged after 72 hours, and the Foley catheter was removed after 4 weeks. There were no access-related complications. Retrograde urethrogram 3 months after surgery confirmed patency of the anastomosis. Upon review 5 months after surgery the patient had urinary incontinence requiring 5 pads/day and was considered for an artificial urinary sphincter. Discussion: In our series of 92 patients who have undergone reconstructive procedure through ASTRA there have been no cases of fecal incontinence. Two patients with prior history of radiotherapy developed rectourethral fistulas. Urinary incontinence was observed in those patients with stenosis after radical prostatectomy. Conclusion: This video presents a step-by-step description of ASTRA, an approach that provides excellent visualization to the posterior urethra, representing an alternative access for repair of complex posterior urethral stenosis.

RESUMO

INTRODUCTION: Access represents one of the main challenges in performing posterior urethroplasty (1, 2). Several approaches and tactics have been previously described (3). This video demonstrates the Anterior Sagittal Transrectal Approach (ASTRA), which allows better visualization of the deep perineum (4). MATERIALS AND METHODS: Our patient was a 65-year-old man with post radical prostatectomy vesicourethral anastomotic stenosis. He failed repeated endoscopic interventions, eventually developing urinary retention and requiring a cystostomy. We offered a vesicourethral anastomotic repair through ASTRA. The patient was placed in the jackknife position and methylene blue instilled through the cystostomy. To optimize access to the bladder neck, an incision of the anterior border of the rectum is performed. Anastomosis is carried out with six 4-0 PDS sutures. These are tied using a parachute technique, after insertion of a 16F Foley. RESULTS: The patient was discharged after 72 hours, and the Foley catheter was removed after 4 weeks. There were no access-related complications. Retrograde urethrogram 3 months after surgery confirmed patency of the anastomosis. Upon review 5 months after surgery the patient had urinary incontinence requiring 5 pads/day and was considered for an artificial urinary sphincter. DISCUSSION: In our series of 92 patients who have undergone reconstructive procedure through ASTRA there have been no cases of fecal incontinence. Two patients with prior history of radiotherapy developed rectourethral fistulas. Urinary incontinence was observed in those patients with stenosis after radical prostatectomy. CONCLUSION: This video presents a step-by-step description of ASTRA, an approach that provides excellent visualization to the posterior urethra, representing an alternative access for repair of complex posterior urethral stenosis.

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O teste Emissões Otoacústicas (EOA) é parte da avaliação Audiológica para detecção precoce da surdez na infância. Desse modo, o aprendizado das EOA na graduação do curso de Fonoaudiologia é fundamental conforme a Diretriz Curricular Nacional (DCN). As diretrizes educacionais sugerem a inclusão de tecnologias de informação no ensino da graduação para melhor desempenho dos futuros profissionais da saúde. Objetivo: Validar o protótipo simulador OTOBABY para o Teste de Emissões Otoacústicas como ferramenta de ensino em Fonoaudiologia. Metodologia: Trata-se de uma pesquisa metodológica, experimental, com a participação de dez fonoaudiólogos professores e/ou preceptores, denominados juízes e 20 alunos de graduação de Fonoaudiologia em Belém do Pará/Brasil. Os juízes responderam a um questionário de validação de Escala Likert sobre a usabilidade e efetividade do simulador OTOBABY como ferramenta de ensino. Os alunos participaram de um curso de capacitação com o uso do protótipo e foram avaliados com checklists antes e depois do curso para a verificação da eficácia do simulador como instrumento de ensino. Os dados foram analisados estatisticamente com o teste de Wilcoxon. Resultados: O simulador alcançou 98% de aprovação como ferramenta de ensino para as EOA pelos juízes. Quanto a habilidade dos alunos, observou-se que era de 60,3%, antes do curso, obtendo-se um desempenho de 97,7% após curso com o OTOBABY. Conclusão: Conclui-se que o protótipo simulador OTOBABY foi aprovado e validado como um instrumento facilitador do aprendizado das Emissões Otoacústicas no ensino da prática Audiológica.

The Otoacoustic Emissions (OAE) test is part of the Audiological evaluation for early detection of childhood deafness. Thus, the learning of OAE in the undergraduate course of Speech Therapy is fundamental according to the National Curriculum Guideline (NCD). The educational guidelines suggest the inclusion of information technologies in undergraduate education for better performance of future health professionals. Objective: Validate the prototype OTOBABY simulator for the Otoacoustic Emissions Test as a teaching tool in Speech Therapy. Methodology: This is a methodological, experimental research, with the participation of ten phonoaudiologists, professors and/or preceptors, called judges and 20 undergraduate students of Speech Therapy in Belém do Pará/Brazil. The judges responded to a Likert Scale validation questionnaire on the usability and effectiveness of the OTOBABY simulator as a teaching tool. Students took part in a training course using the prototype and were evaluated with checklists before and after the course to verify the simulator's effectiveness as a teaching instrument. The data were statistically analyzed with the Wilcoxon test. Results: The simulator achieved 98% approval as a teaching tool for OAE by the judges. As for the ability of the students, it was observed that it was 60.3%, before the course, obtaining a performance of 97.7% after course with OTOBABY. Conclusion: It is concluded that the prototype simulator OTOBABY was approved and validated as a facilitator instrument of the learning of Otoacoustic Emissions in the teaching of Audiological practice.

La prueba EOA es parte de la evaluación auditiva para la sordera temprana en la niñez. En consecuencia, el aprendizaje de las EOA en el curso de posgrado de fonoaudiología es fundamental de acuerdo con la Directriz Nacional de Planes de Estudio (NCN). Las directrices educativas sugieren la inclusión de las tecnologías de la información en la enseñanza de cursos de pregrado para mejorar el desempeño de futuros profesionales de la salud. Objetivo: Validar el prototipo de simulador OTOBABY para la Prueba de Emisiones Otoacústicas como herramienta docente en fonoaudiología. Metodología: Estamos tratando con la investigación metodológica, experimental, con la participación de diez audiólogos de idiomas, profesores y/o preceptores, llamados jueces y 20 estudiantes universitarios de fonoaudiología en Belém do Pará/Brasil. Los jueces respondieron a un cuestionario de validación de la Escala Likert sobre la utilidad y la eficacia del simulador OTOBABY como instrumento de enseñanza. Los estudiantes participaron en un curso de capacitación utilizando el prototipo y fueron evaluados con checklists de verificación antes y después del curso para verificar la efectividad del simulador como instrumento educativo. Los datos se analizaron estadísticamente con el test de Wilcoxon. Resultados: El simulador alcanzó el 98% de la aprobación como herramienta de enseñanza para la EOA por parte de los jueces. En cuanto a la capacidad de los estudiantes, se observó que era del 60,3% antes del curso, alcanzando un desempeño del 97,7% después del curso con OTOBABY. Conclusión: Se concluye que el prototipo de simulador OTOBABY ha sido aprobado y validado como instrumento que facilita el aprendizaje de emisiones ópticas en la enseñanza de la práctica audiológica.

RESUMO

Purpose: To evaluate the gain of microsurgical skills and competencies by urology residents, using low-fidelity experimental models. Methods: The study involved the use of training boards, together with a low-fidelity microsurgery simulator, developed using a 3D printer. The model consists in two silicone tubes, coated with a resin, measuring 10 cm in length and with internal and external diameters of 0.5 and 1.5 mm. The support for the ducts is composed by a small box, developed with polylactic acid. The evaluation of the gain of skills and competencies in microsurgery occurred throughout a training course consisting of five training sessions. The first sessions (S1-S4) took place at weekly intervals and the last session (S5) was performed three months after S4. During sessions, were analyzed: the speed of performing microsurgical sutures in the pre and post-training and the performance of each resident through the Objective Structure Assessment of Technical Skill (OSATS) and Student Satisfaction Self-Confidence tools in Learning (SSSCL). Results: There was a decrease in the time needed to perform the anastomosis (p=0.0019), as well as a progressive increase in the score in the OSATS over during sessions S1 to S4. At S5, there was a slightly decrease in performance (p<0.0001), however, remaining within the expected plateau for the gain of skills and competences. The SSSCL satisfaction scale showed an overall approval rating of 96.9%, with a Cronback alpha coefficient of 83%. Conclusions: The low-fidelity simulation was able to guarantee urology residents a solid gain in skills and competencies in microsurgery.

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The study on cadavers, although considered fundamental in the teaching of human anatomy, is limited in several universities, mainly due to the acquisition and manipulation of cadaveric material. Throughout history, several artificial anatomical models have been used to complement the real anatomical pieces. The present study offers a new alternative: the making of three-dimensional models from Computed Tomography (3D-CT) patient image acquisition. CT images from the USP University Hospital database were used. Patients underwent examinations for reasons other than the present study and were anonymized to maintain confidentiality. The CT slices obtained in thin cross-sections (approximately 1.0 mm thick) were converted into three-dimensional images by a technique named Volume Rendering for visualization of soft tissue and bone. The reconstructions were then converted to an STL (Standard Triangle Language) model and printed through two printers (LONGER LK4 Pro® and Sethi S3®), using PLA and ABS filaments. The 3D impressions of the thigh and leg muscles obtained better visual quality, being able to readily identify the local musculature. The images of the face, heart, and head bones, although easily identifiable, although seemed to present lower quality aesthetic results. This pilot study may be one of the first to perform 3D impressions of images from CT to visualize the musculature in Brazil and may become an additional tool for teaching.

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ABSTRACT Introduction: Diabetes mellitus is accompanied by increased formation of reactive oxygen species (ROS) and decreased antioxidant capacity, leading to oxidative damage to cellular components. There is evidence to suggest that regular physical training positively changes oxidative homeostasis in the cells and tissues by lowering basal levels of oxidative damage, increasing resistance to oxidative stress. Objective: To verify the possible effects of aerobic physical training and resistance on glycemia and oxidative metabolism, and to determine whether there is any difference in outcomes resulting from different types of training in sedentary people with Type 2 Diabetes Mellitus (T2DM). Methods: A systematic review of controlled and randomized trials based on PRISMA. The databases LILACS, IBECS, Pubmed/MEDLINE, Cochrane Library, SciELO, PEDro, ScienceDirect and BIREME were searched, combining the descriptors type 2 diabetes mellitus, resistance training, aerobic exercise and oxidative stress in Portuguese, English and Spanish. The methodological quality of the papers was assessed by the PEDro scale. The data were read, analyzed, extracted and summarized. Results: Of the 1386 papers retrieved, only five met the inclusion criteria. The five selected papers, consisting of controlled and randomized clinical trials, were summarized. Conclusion: There have been many published studies reporting on exercises and diabetes. However, there is limitation when it comes to comparing their results. The variability of research methods and measurement instruments used makes it difficult to draw conclusions as to which physical training modality is most effective in reducing glycemic levels and oxidative stress in sedentary individuals with T2DM, considering that in each study analyzed in this review, the response to these variables is different. In future research, it would be important to standardize exercise modality, intensity, training time and evaluation parameters. Level of evidence I; Systematic review of RCTs (Randomized controlled trials).

RESUMO Introdução: A diabetes mellitus é acompanhada por um aumento da formação de espécies reativas de oxigênio (EROs) e diminuição da capacidade antioxidante, levando a danos oxidativos dos componentes celulares. Há evidência sugerindo que o treinamento físico regular altera positivamente a homeostase oxidativa nas células e tecidos, ao diminuir os níveis basais de danos oxidativos, aumentando a resistência ao estresse oxidativo. Objetivo: Verificar possíveis efeitos do treinamento físico aeróbio e de resistência sobre a glicemia e o metabolismo oxidativo e determinar se há diferença nos desfechos dos diferentes tipos de treinamento em indivíduos sedentários com Diabetes Mellitus tipo 2 (DM2). Métodos: Revisão sistemática de estudos controlados e randomizados baseada no PRISMA. Foram utilizadas as bases de dados LILACS, IBECS, Pubmed/MEDLINE, Cochrane Library, SciELO, PEDro, ScienceDirect e BIREME combinando os descritores diabetes mellitus tipo 2, treinamento de resistência, exercício aeróbio e estresse oxidativo em português, inglês e espanhol. A qualidade metodológica dos artigos foi avaliada pela escala PEDro. Realizou-se a leitura, análise, extração e síntese dos dados. Resultados: De 1386 artigos consultados, apenas cinco atenderam aos critérios de inclusão. Foi realizada a síntese dos cinco artigos selecionados, os quais consistem em ensaios clínicos controlados e randomizados. Conclusão: Há muitos estudos publicados relacionando exercícios e diabetes, entretanto, há limitação quando se pretende comparar seus resultados. A variabilidade dos métodos de pesquisa e dos instrumentos de medição utilizados tornam difícil concluir sobre qual modalidade de treinamento físico é mais eficaz em relação à redução dos níveis glicêmicos e do estresse oxidativo em indivíduos sedentários com DM2, considerando que, em cada estudo analisado nessa revisão, a resposta para essas variáveis é diferente. Em futuras pesquisas seria importante padronizar a modalidade de exercício, intensidade, o tempo de treinamento e os parâmetros avaliativos. Nível de evidência I; Revisão sistemática de ECRC (Estudos clínicos randomizados e controlados).

RESUMEN Introducción: La diabetes mellitus es acompañada por un aumento de la formación de especies reactivas de oxígeno (ROS) y disminución de la capacidad antioxidante, llevando a daños oxidativos de los componentes celulares. Algunas evidencias sugieren que el entrenamiento físico regular altera positivamente la homeostasis oxidativa en las células y tejidos, al disminuir los niveles basales de daños oxidativos, aumentando la resistencia al estrés oxidativo. Objetivo: Verificar posibles efectos del entrenamiento físico aeróbico y de resistencia sobre la glucemia y el metabolismo oxidativo, y determinar si hay diferencia en los desenlaces de los diferentes tipos de entrenamiento en individuos sedentarios con Diabetes Mellitus tipo 2 (DM2). Métodos: Revisión sistemática de estudios controlados y aleatorizados, con base en el PRISMA. Se utilizaron las bases de datos LILACS, IBECS, Pubmed/MEDLINE, Cochrane Library, SciELO, PEDro, ScienceDirect y BIREME combinando los descriptores diabetes mellitus tipo 2, entrenamiento de resistencia, ejercicio aeróbico y estrés oxidativo en portugués, inglés y español. La calidad metodológica de los artículos fue evaluada por la escala PEDro. Se procedió a la lectura, análisis, extracción y síntesis de los datos. Resultados: De 1386 artículos consultados, sólo cinco cumplieron los criterios de inclusión. Se hizo la síntesis de los cinco artículos seleccionados, que consisten en ensayos clínicos controlados y aleatorizados. Conclusión: Hay muchos estudios publicados relacionando ejercicios y diabetes, entretanto, existe limitación cuando se pretende comparar sus resultados. La variabilidad de los métodos de investigación y de los instrumentos de medición utilizados hacen que sea difícil concluir sobre qué modalidad de entrenamiento físico es más eficaz con relación a la reducción de los niveles glucémicos y del estrés oxidativo en individuos sedentarios con DM2, considerando que, en cada estudio analizado en esta revisión, la respuesta a estas variables es diferente. En futuras investigaciones sería importante estandarizar la modalidad de ejercicio, intensidad, el tiempo de entrenamiento y los parámetros evaluativos. Nivel de evidencia I; Revisión sistemática de ECAC (Estudios clínicos aleatorizados y controlados).

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ABSTRACT Introduction: Nandrolone decanoate is a synthetic testosterone analogue considered one of the most widely used anabolic androgenic steroids (AAS) among adolescents and athletes. Chronic ingestion of AAS increases the incidence of cardiovascular abnormalities in athletes, but the mechanism that causes these changes remains unknown. Objectives: The purpose of this study is to verify the possible effects of the use of anabolic androgenic steroids (AAS) on the morphology and oxidative metabolism of the heart in exercised and sedentary rats. Methods: This is a comparative prospective level II study. Twenty-four Wistar rats were distributed in groups that performed voluntary (TG) and sedentary (SG) running exercises, and used AAS: the Anabolic Training Group (ATG), and the Anabolic Sedentary Group (ASG). During the three months of the running protocol, the animals received an intramuscular injection of 5 mg/kg b.p. of AAS. After the training period, the rats were euthanized and the hearts were removed for evaluation of lipid peroxidation and antioxidant capacity, and for morphometric analysis. Results: The anabolic groups, ASG (0.3072 ± 0.0531) and ATG (0.2732 ± 0.0413), presented higher lipid peroxidation when compared to the non-anabolic groups SG (0.1705 ± 0.0224) and TG (0.1785 ± 0.0340). Conclusion: There was no change in total antioxidant capacity or in the thickness of the interventricular septum and left ventricular wall. Thus, the use of anabolic androgenic steroids did not cause morphological changes in the myocardium. However it did alter the oxidative metabolism. It was also verified that aerobic exercise had no protective effect against lipid peroxidation in the myocardium caused by the use of AAS. Level of evidence II; Prospective comparative study.

RESUMO Introdução: O decanoato de nandrolona é um análogo sintético da testosterona, considerado um dos esteroides anabólicos androgênicos (EAA) mais utilizados entre adolescentes e atletas. Sua ingestão crônica aumenta a incidência de anormalidades cardiovasculares em atletas, porém o mecanismo que causa essas alterações ainda permanece desconhecido. Objetivos: O estudo teve como objetivo verificar os possíveis efeitos do uso de esteroides anabólicos androgênicos (EAA) na morfologia e no metabolismo oxidativo do coração de ratos treinados e sedentários. Métodos: Trata-se de um estudo prospectivo comparativo nível II. Vinte e quatro ratos Wistar foram distribuídos em grupos que realizaram exercícios de corrida voluntária (GT) e sedentários (GS) e faziam uso dos EAA, Grupo Treinado com Anabolizante (GTA) e Grupo Sedentário com Anabolizante (GSA). Durante os três meses do protocolo de corrida, os animais receberam injeção intramuscular de 5 mg/kg p.c. de EAA. Após o período de treinamento, houve a eutanásia e remoção do coração dos ratos para avaliação da peroxidação lipídica e capacidade antioxidante, além da análise morfométrica. Resultados: Verificaram-se que os grupos anabolizantes, GSA (0,3072 ± 0,0531) e GTA (0,2732 ± 0,0413), apresentaram maior peroxidação lipídica quando comparados aos grupos não anabolizantes GS (0,1705 ± 0,0224) e GT (0,1785 ± 0,0340). Conclusões: Não houve alteração na capacidade antioxidante total, assim como não houve alteração na espessura do septo interventricular e da parede ventricular esquerda. Portanto, o uso de esteroides anabólicos androgênicos não provocou alterações morfológicas no miocárdio, contudo alterou o metabolismo oxidativo. Verificou-se também que a prática de exercício aeróbico não teve efeito protetor contra a peroxidação lipídica no miocárdio provocada pelo uso dos EAA. Nível de evidência II; Estudo prospectivo comparativo.

RESUMEN Introducción: El decanoato de nandrolona es un análogo sintético de la testosterona considerado uno de los esteroides anabólicos androgénicos (EAA) más utilizados entre los adolescentes y atletas. Su ingestión crónica aumenta la incidencia de anomalías cardiovasculares en atletas, aunque el mecanismo que causa esas alteraciones sigue siendo desconocido. Objetivos: El estudio tuvo como objetivo verificar los posibles efectos del uso de esteroides anabólicos androgénicos (EAA) en la morfología y en el metabolismo oxidativo del corazón de ratones entrenados y sedentarios. Métodos: Se trata de un estudio prospectivo comparativo nivel II. Fueron distribuidos 24 ratones Wistar en grupos que realizaron ejercicios de carrera voluntaria (GE) y sedentarios (GS), y hacían uso de los EAA, Grupo Entrenado con Anabolizante (GEA) y Grupo Sedentario con Anabolizante (GSA). Durante los tres meses del protocolo de carrera, los animales recibieron inyección intramuscular de 5 mg/kg p.c. de EAA. Después del período de entrenamiento, hubo la eutanasia y remoción del corazón de los ratones, para evaluación de la peroxidación lipídica y capacidad antioxidante, además del análisis morfométrico. Resultados: Se verificó que los grupos anabolizantes, GSA (0,3072 ± 0,0531) y GEA (0,2732 ± 0,0413), presentaron mayor peroxidación lipídica cuando comparados a los grupos no anabolizantes GS (0,1705 ± 0,0224) y GE (0,1785 ± 0,0340). Conclusiones: No hubo alteración en la capacidad antioxidante total, así como no hubo alteración en el espesor del septo interventricular y de la pared ventricular izquierda. Por lo tanto, el uso de esteroides anabólicos androgénicos no provocó alteraciones morfológicas en el miocardio, aunque alteró el metabolismo oxidativo. Se verificó también que la práctica de ejercicio aeróbico no tuvo efecto protector contra la peroxidación lipídica en el miocardio provocada por el uso de EAA. Nivel de evidencia II; Estudio prospectivo comparativo.