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Colorectal cancer is the third most common neoplasm and the second most lethal worldwide. The most common histological type is adenocarcinoma, characterized by its glandular pattern. Medullary colon carcinoma is a rare histological variant of colorectal cancer, characterized by a predominantly solid architecture, poorly di?erentiated or undifferentiated morphology, often associated with an anomalous immunophenotype and microsatellite instability. The present study reports a case in an academic service of general surgery of a 74-year-old patient who presented with a tumor of the ascending colon, histologically with an exuberant lymphocytic in?ltrate, suggestive of large cell lymphoma, but which was revealed by subsequent immunohistochemistry to be medullary carcinoma of the colon with microsatellite instability.

O câncer colorretal é a terceira neoplasia mais comum e a segunda mais letal no mundo. O adenocarcinoma é o tipo histológico mais comum, caracterizado pelo seu padrão glandular. O carcinoma medular do cólon é uma variante histológica rara do câncer colorretal, caracterizada por uma arquitetura predominantemente sólida, morfologia pouco diferenciada ou indiferenciada, frequentemente associada a um imunofenótipo anômalo e instabilidade de microssatélites. O presente estudo relata um caso em um serviço acadêmico de cirurgia geral de um paciente de 74 anos que apresentou tumor de cólon ascendente, histologicamente com infiltrado linfocitário exuberante, sugestivo de linfoma de grandes células, mas que foi revelado através de exame subsequente imunohistoquímico como carcinoma medular do cólon com instabilidade de microssatélites.

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BACKGROUND: The COVID-19 pandemic put healthcare professionals, including residents (postgraduate trainees of health professions), under intense physical and psychological stress, hence at risk for mental disorders. We evaluated the prevalence of mental disorders among healthcare residents during the pandemic. METHODS: From July to September 2020, residents in medicine and other healthcare specialties in Brazil were recruited. The participants completed electronic forms with validated questionnaires (DASS-21, PHQ-9, BRCS) to screen for depression, anxiety, and stress, and to evaluate resilience. Data on potential predisposing factors for mental disorders were also collected. Descriptive statistics, chi-squared, students t, correlation and logistic regression models were applied. The study received ethical approval, and all participants provided informed consent. RESULTS: We included 1313 participants (51.3% medical; 48.7% nonmedical) from 135 Brazilian hospitals; mean (SD) age: 27.8 (4.4) years; 78.2% females; 59.3% white race. Of all participants, 51.3%, 53.4% and 52.6% presented symptoms consistent with depression, anxiety, and stress, respectively; 61.9% showed low resilience. Nonmedical residents exhibited higher anxiety compared to medical residents (DASS-21 anxiety score, mean difference: 2.26; 95% CI: 1.15-3.37; p < 0.001). In multivariate analyses, having any pre-existent, nonpsychiatric chronic disease was associated with higher prevalence of symptoms indicative of depression (odds ratio, OR: 2.05; 95% CI: 1.47-2.85, on DASS-21 | OR: 2.26; 95% CI: 1.59-3.20, on PHQ-9), anxiety (OR: 2.07; 95% CI: 1.51-2.83, on DASS-21), and stress (OR: 1.53; 95% CI: 1.12-2.09, on DASS-21); other predisposing factors were identified; by contrast, high resilience (BRCS score) was protective against symptoms of depression (OR 0.82; 95% CI: 0.79-0.85, on DASS-21 | OR 0.85; 95% CI: 0.82-0.88, on PHQ-9), anxiety (OR 0.90; 95% CI: 0.87-0.93, on DASS-21), and stress (OR 0.88; 95% CI: 0.85-0.91, on DASS-21); p < 0.05 for all outcomes. CONCLUSIONS: We found a high prevalence of mental disorder symptoms among healthcare residents during COVID-19 pandemic in Brazil. Nonmedical residents exhibited higher levels of anxiety than medical ones. Some predisposing factors for depression, anxiety and stress among residents were identified.

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Beans hold significant food and socioeconomic value for the global population. However, bean production often faces reductions due to diseases instigated by soil pathogens. The extensive use of chemicals to control these diseases presents numerous disadvantages, such as environmental pollution, harm to human health, and imbalances in disease and pest dynamics. Certain commercial products, registered as biofertilizers or compost additives, can control plant pathogens. This study aimed to evaluate the performance of biofertilizers and compost additives, along with their mixtures, in controlling dry root rot (caused by Fusarium solani f. sp. phaseoli) and Fusarium wilt (caused by Fusarium oxysporum f. sp. phaseoli) in bean plants in a greenhouse setting. Additionally, the study examined the effect of these products and their mixtures on bean growth. A completely randomized design, with six replicates, was used. The treatments included Soil-Plex Trust®, Soil-Plex Ready®, Soil-Plex Active®, and Nem-Out®, along with their mixtures, a chemical fungicide Captan® (positive control), water (negative control), and a control group of plants without pathogen inoculation. Soil-Plex Trust® effectively reduced the severity of dry root rot. Soil-Plex Trust®, Soil-Plex Active®, and a Soil-Plex Ready + Soil-Plex Active® mixture promoted dry root weight equivalent to that of plants without Fusarium solani f. sp. phaseoli inoculation. Considering both inoculation methods, the application of Soil-Plex Trust® alone via in-furrow application reduced the severity of Fusarium wilt in common bean plants. Plants treated with Soil-Plex Trust® + SoilPlex Active®, and Soil-Plex Ready® + Soil-Plex Active® and inoculated with F. oxysporum f. sp. phaseoli by mycelial disk method, also exhibited lower severity of Fusarium wilt. The blends of Soil-Plex Trust® and Soil-Plex Active®, Soil-Plex Ready® and Soil-Plex Active®, and Nem-Out® and Soil-Plex Active® resulted in a root length equivalent to that of plants without Fusarium oxysporum f. sp. phaseoli inoculation. The results suggest that biofertilizers and compost additives based on Bacillus and Trichoderma can serve as a strategy to control diseases caused by Fusarium spp., and to mitigate the reductions in bean plants growth caused by these fungi.(AU)

O feijão tem uma grande importância alimentar e socioeconômica para a população mundial. No entanto, a produção de feijão sofre reduções por causa de doenças causadas por patógenos de solo. O uso intensivo de produtos químicos para o controle destes tem várias desvantagens, incluindo danos à saúde humana e ao meio ambiente além de provocar desequilíbrios na dinâmica de doenças e pragas da cultura. Alguns produtos comerciais, registrados como biofertilizantes ou aditivos de compostagem têmapresentado controle de fitopatógenos. Este trabalho teve como objetivo a avaliação do desempenho de biofertilizantes e aditivo de compostagem e suas misturas no controle da podridão radicular seca (causada por Fusarium solani f. sp. phaseoli) e da murcha de Fusarium (causada por Fusarium oxysporum f. sp. phaseoli) em plantas de feijoeiro em casa-de-vegetação. Adicionalmente, este estudo investigou o efeito desses produtos e suas misturas no desenvolvimento do feijoeiro. O delineamento experimental foi inteiramente casualizado com seis repetições. Foram testados os produtos Soil-Plex Trust®, Soil-Plex Ready®, Soil-Plex Active® e Nem-Out® e suas misturas, fungicida químico Captan® (controle positivo), água (controle negativo) e um controle constituído por plantas não inoculadas com o patógeno. O produto Soil-Plex Trust® reduziu a severidade da podridão radicular seca. Os produtos Soil-Plex Trust®, Soil-Plex Active® e a mistura (Soil-Plex Ready® + Soil-Plex Active®) promoveram um peso seco da raiz igual ao de plantas sem inocular. Considerando ambos os métodos de inoculação, a aplicação de Soil-Plex Trust® sozinho no sulco de plantio reduziu a severidade da murcha de Fusarium em feijoeiro. Plantas tratadas com Soil-Plex Trust® + Soil-Plex Active® e Soil-Plex Ready® + Soil-Plex Active® e inoculadas com F. oxysporum f. sp. phaseoli pelo método do disco micelial, também apresentaram menor severidade de murcha de Fusarium. As misturas Soil-Plex Trust® + Soil-Plex Active®, Soil-Plex Ready® + Soil-Plex Active®e Nem-Out® Soil-Plex Active®, determinaram um comprimento de raiz igual ao de plantas sem inóculo. Os resultados indicam que biofertilizantes e aditivos de compostagem à base de Bacillus eTrichoderma podem ser utilizados na estratégia de controle de doenças causadas por Fusarium spp. e ainda contrarrestar as reduções de crescimento do feijoeiro ocasionadas por esses fungos.(AU)

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BACKGROUND: Since the beginning of the COVID-19 pandemic, health professionals have been working under extreme conditions, increasing the risk of physical and mental illness. We evaluated the prevalence of burnout and its associated factors among postgraduate student residents in health professions during the global health crisis. METHODS: Healthcare residents were recruited from all across Brazil between July and September 2020 through digital forms containing instruments for assessing burnout (Oldenburg Burnout Inventory (OLBI)), resilience (brief resilient coping scale (BRCS)) and anxiety, stress and depression (depression, anxiety and stress scale (DASS-21) and Patient Health Questionnaire (PHQ-9)). Additionally, the relationships between burnout and chronic diseases, autonomy and educational adequacy in the residency programme, personal protective equipment (PPE), workload and care for patients with COVID-19 were evaluated. The chi-square test, Student's t test, Pearson's correlation test and logistic regression were performed. RESULTS: A total of 1,313 participants were included: mean (standard deviation) age, 27.8 (4.4) years; female gender, 78.1%; white race, 59.3%; and physicians, 51.3%. The overall prevalence of burnout was 33.4%. The odds (odds ratio [95% confidence interval]) of burnout were higher in the presence of pre-existing diseases (1.76 [1.26-2.47]) and weekly work > 60 h (1.36 [1.03-1.79]) and were lower in the presence of high resilience (0.84 [0.81-0.88]), autonomy (0.87 [0.81-0.93]), and educational structure (0.77 [0.73-0.82]), adequate availability of PPE (0.72 [0.63-0.83]) and non-white race (0.63 [0.47-0.83]). Burnout was correlated with anxiety (r = 0.47; p < 0.05), stress (r: 0.58; p < 0.05) and depression (r: 0.65; p < 0.05). CONCLUSIONS: We observed a high prevalence of burnout among residents during the COVID-19 pandemic. Individual characteristics and conditions related to the work environment were associated with a higher or lower occurrence of the syndrome.

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BACKGROUND: The COVID-19 pandemic has led to high levels of physical, psychological, and social stress among health care professionals, including postgraduate students in medical and multidisciplinary residencies. This stress is associated with the intense fear of occupational exposure to SARS-CoV-2, the virus known to cause COVID-19. These professionals are at risk of developing physical and mental illnesses not only due to the infection but also due to prolonged exposure to multidimensional stress and continued work overload. OBJECTIVE: This study aims to evaluate the prevalence of symptoms suggestive of mental disorders and burnout syndrome and determine the risk factors for burnout among postgraduate students in medical and multidisciplinary residencies in Brazil during the COVID-19 pandemic. METHODS: For this prospective cohort study with parallel groups, participants were recruited between July and September 2020 to achieve a sample size of at least 1144 participants. Research instruments such as Depression, Anxiety, and Stress Scale; Patient Health Questionnaire; Brief Resilient Coping Scale; and Oldenburg Burnout Inventory will be used to collect data. Data will be collected in 2 waves: the first wave will include data related to sample characterization and psychosocial evaluation, and the second wave will be launched 12 weeks later and will include an evaluation of the incidence of burnout as well as correlations with the potential predictive factors collected in the first wave. Additionally, we will collect data regarding participants' withdrawal from work. RESULTS: The recruitment took place from July 29 to September 5, 2020. Data analyses for this phase is already in progress. The second phase of the study is also in progress. The final data collection began on December 1, 2020, and it will be completed by December 31, 2020. CONCLUSIONS: We believe the findings of this study will help evaluate the impact of the COVID-19 pandemic on the mental health conditions of health professionals in Brazil as well as contribute to the planning and implementation of appropriate measures that can alleviate these mental health challenges. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/24298.

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Liver and biliary tract diseases are common causes of morbidity and mortality worldwide. Invasive procedures are usually performed in those patients with hepatobiliary diseases for both diagnostic and therapeutic purposes. Defining proper indications and restraints of commonly used techniques is crucial for proper patient selection, maximizing positive results and limiting complications. In 2018, the Brazilian Society of Hepato-logy (SBH) in cooperation with the Brazilian Society of Interventional Radiology and Endovascular surgery (SOBRICE) and the Brazilian Society of Digestive Endoscopy (SOBED) sponsored a joint single-topic meeting on invasive procedures in patients with hepatobiliary diseases. This paper summarizes the proceedings of the aforementioned meeting. It is intended to guide clinicians, gastroenterologists, hepatologists, radiologists, and endoscopists for the proper use of invasive procedures for management of patients with hepatobiliary diseases.

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OBJECTIVE: Lead arthropathy is a well-known complication of gunshot injuries with retained intra-articular bullets. Although several previous reports have discussed the radiological findings of this entity, computed tomography (CT) and magnetic resonance imaging (MRI) findings have never been described before in this setting. MATERIALS AND METHODS: In this paper the authors review the imaging findings of 11 patients with lead arthropathy (1 of whom had clinical signs of lead poisoning as well), all of them studied by means of radiographs. In addition, non-enhanced CT scans were obtained in 3 patients and gadolinium-enhanced MRI in 1. RESULTS: Classic findings of intra-articular speckled lead deposits (occasionally with a "lead arthrogram" appearance), joint space narrowing and preserved bone density were found at radiographs in the great majority of cases. Furthermore, extension of intra-articular lead to adjacent tendon sheaths was observed in almost half of the patients, an observation rarely reported in the literature. CT scans and MRI, in their turn, were superior with regard to soft tissue abnormalities, accurately depicting joint effusion and the thickened synovium with lead particles embedded in it. CONCLUSION: Post-gadolinium MRI had the advantage of showing the enhancement pattern of the inflamed synovium and associated bone marrow edema pattern. Although it is not possible to establish the role of axial imaging in lead arthropathy from the small number of cases studied, this initial experience shows that both methods hold promise in this setting and may be useful, at least in selected cases.

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