Alessandro de Moura Almeida

Effects of light-to-moderate alcohol consumption on steatosis and steatohepatitis in severely obese patients.

Objectives The effect of light-to-moderate alcohol consumption (LMAC) in nonalcoholic fatty liver disease (NAFLD) remains a controversial subject. The aim of this study was to evaluate the relationship between LMAC and the severity of NAFLD in morbidly obese patients. Methods We studied 132 patients undergoing liver biopsy during bariatric surgery. The patients were divided into three groups: G1: alcohol intake greater than 20 g/day and less than 40 g/day; G2: alcohol intake less than 20 g/day; G3: no alcohol intake. Insulin resistance was defined by the Homeostasis Model Assessment (>3). NAFLD was classified according to the Matteoni types: type I: steatosis alone; type II: steatosis with inflammation; types III–IV: steatosis with ballooning and/or fibrosis. Results The mean age was 37.3±11 years. Sixty-three percent were females and body mass index was 43.9±5.6 kg/m2. G1, G2, and G3 included 19, 56, and 57 patients, respectively. Histological diagnoses classified by levels of alcohol were: G1: 10.5% normal liver, 89.5% type III or IV; G2: 10.7% normal liver, 1.8% type I or II, and 87.5% grade III or IV; G3: 10.5% normal liver, 3.5% type I or II, and 86% type III or IV (one had cirrhosis). The presence of IR was similar in moderate and no alcohol consumption (81.3 and 78.7%) but significantly less in the light consumption group (54%, P<0.05). Conclusion The results suggest that LMAC may have a protection effect against IR in severely obese patients. However, it had no impact on the severity of activity and stage of liver disease.

Preoperative upper gastrointestinal endoscopy in obese patients undergoing bariatric surgery: is it necessary?

BACKGROUND Obesity has been shown to be an important risk factor for several gastrointestinal diseases. However, the indication for preoperative upper gastrointestinal endoscopy (UGE) for all patients before bariatric surgery is controversial. The aim of the present study was to evaluate the spectrum of gastrointestinal diseases detected during preoperative UGE in patients undergoing bariatric surgery and the relevance of this procedure. METHODS A series of severely obese patients, who had undergone UGE before Roux-en-Y gastric bypass from October 2004 to May 2005 were consecutively enrolled in this study. The demographic and clinical data and endoscopic diagnoses were evaluated. Gastric biopsies were performed in elective patients according to the endoscopic findings. RESULTS The study included 162 patients, 69.8% of whom were women. The mean age was 36.7 +/- 10.8 years. Abnormal findings were observed in 77.2% of patients. Esophagitis was present in 38.9%, gastritis in 51.2% (erosive gastritis in 49.3% and nonerosive gastritis in 50.7%), gastric ulcers in 1.9%, hiatal hernia, in 8.6%, gastric polyp in .6%, and duodenitis in 6.8% of patients. No patient had esophageal or gastric varices. Helicobacter pylori infection was investigated in 96 patients and was detected in 37.5%. Gastric biopsies were performed in 36 patients, with chronic inflammation found in 72.2%, inflammatory activity in 30.6%, and intestinal metaplasia in 11.1%. Glandular atrophy was not found in any patient. CONCLUSION The results of our study have shown that the spectrum of gastrointestinal diseases observed in severely obese patients who underwent bariatric surgery is broad. Although this issue remains highly controversial, these findings suggest that systematic preoperative UGE and H. pylori testing should be performed in all patients scheduled to undergo bariatric surgery.

Trabalho e síndrome da estafa profissional (Síndrome de Burnout) em médicos intensivistas de Salvador

OBJETIVO: Descrever a prevalencia da Sindrome de Burnout em medicos intensivistas de Salvador, associando-a a dados demograficos e aspectos da situacao de trabalho (demanda) psicologica e controle sobre o trabalho. METODOS: Um estudo de corte transversal investigou a associacao entre aspectos psicossocias do trabalho e a sindrome da estafa profissional em uma populacao de 297 medicos intensivistas de Salvador, Bahia. Um questionario individual autoaplicavel avaliou aspectos psicossociais do trabalho, utilizando o modelo demanda-controle (Job Content Questionnaire) e a saude mental dos medicos, usando Inventario de Burnout de Maslach (MBI). RESULTADOS: Constatou-se elevada sobrecarga de trabalho e de trabalho em regime de plantao. A prevalencia da Sindrome da Estafa Profissional (Burnout) foi de 7,4% e estava mais fortemente associada com aspectos da demanda psicologica do trabalho do que com o controle deste por parte dos medicos intensivistas. CONCLUSAO: Medicos com trabalho de alta exigencia (alta demanda e baixo controle) apresentaram 10,2 vezes mais burnout que aqueles com trabalho de baixa exigencia (baixa demanda e alto controle).

Médicos plantonistas de unidade de terapia intensiva: perfil sócio-demográfico, condições de trabalho e fatores associados à síndrome de burnout

OBJECTIVES: Burnout syndrome is a response to prolonged occupational stress that involves three main dimensions: emotional exhaustion, depersonalization, and reduced personal accomplishment. The aim of this study was to describe socio-demographic characteristics of intensive care unit physicians and evaluate factors associated to the presence of Burnout syndrome in this population. METHODS: A cross-sectional study was performed to evaluate physicians who have worked in intensive care units from the city of Salvador (Bahia - Brazil) with a minimum weekly workload of 12-hour. An anonymous self-reported questionnaire was used and it was divided into two parts: socio-demographic characteristics and evaluation of Burnout syndrome through Maslach Burnout Inventory. RESULTS: We studied 297 physicians and most of them were male (70%). The mean age and time of graduation were, respectively, 34.2 and 9 years. High levels of emotional exhaustion, depersonalization, and reduced personal accomplishment were found in respectively, 47.5%, 24.6% and 28.3%. The prevalence of Burnout syndrome, considered as high level in at least one dimension, was of 63.3%. This prevalence was statistically lower in physicians specialized on intensive care, those with more than nine years of graduation and those who intend to continue working in intensive care units for more than 10 years. The prevalence was higher in the doctors with more than 24-hours of uninterrupted intensive care work per week. CONCLUSIONS: Burnout syndrome was common among intensive care physicians and it was more frequent in the youngest doctors, with higher workload and without specialization on intensive care.

Common mental disorders among medical students

OBJECTIVE: Common mental disorders (CMD) have a high impact on interpersonal relationships and quality of life and are potential underlying causes for the development of more serious disorders. Medical students have been indicated as a risk population for the development of CMD. The aim of this study was to determine the frequency of CMD in undergraduate medical students and to identify related factors. METHODS: A cross-sectional study was performed in a sample population of medical students. CMD was identified according to the 20-item Self-Report Questionnaire. RESULTS: Two hundred and twenty-three students completed the questionnaire. The overall prevalence of CMD was 29.6% and its presence was independently associated with sleep disorders, not owning a car, not working and sedentary lifestyle. CONCLUSIONS: These findings indicate a high prevalence of CMD in the sample studied and are important for supporting actions to prevent mental disorders in future doctors and for reflecting on the curricula currently in use in medical schools.

Avaliação do Programa de Triagem Neonatal na Bahia no ano de 2003

OBJECTIVES: describe and assess the Neonatal Screening Program of Bahia in 2003. METHODS: descriptive study based on the databank of the Neonatal Screening Reference Service of Bahia in all newborns previously screened in the data collecting network of 2003. RESULTS: the program was implemented in 94.5% of the municipalities. The monthly average of newborns assessed was of 13.991 (72.51% of the registered newborns). During data collection, 63.9% of the children were between eight days and one month old, 14.5% seven days old and 21.6% over one month old. The incidence determined was 1:22,000 for phenylketonuria, 1:4,000 for congenital hypothyroidism and 1:650 for sickle cell disease. CONCULSIONS: the Neonatal Screening Program of Bahia in 2003 fell short to the expected coverage of 100%, failed in selecting the ideal age group for blood sampling; there were difficulties as well related to the time elapsed between blood collection and samples arrival to the Neonatal Screening Reference Service; of test delivery to the family; and of positive cases recall. Therefore, improvements are needed to expedite procedures.

Conhecimento e interesse em ética médica e bioética na graduação médica

OBJECTIVES: To evaluate the interest and knowledge about Medical Ethics and Bioethics in medical graduation. METHODS: Transversal and descriptive study. Two different questionnaires were applied with questions about the interest in Medical Ethics and Bioethics and the knowledge about the Brazilian Code of Medical Ethics (CME), one to professors and the other to students. RESULTS: One hundred and one professors and 331 students answered the questionnaires. The Brazilian CME had been read by 86.2% of the teachers and by 100% of the students. The importance given to the discipline Medical Ethics, on a scale from 1 to 5, was similar among teachers and students (4.7 ± 0.7 vs. 4.5 ± 0.8; p = 0.086); however the self-evaluation on knowledge about this subject was higher in the first group (3.4 ± 0.9 vs. 3.2 ± 0.7; p = 0.017). In a block with 9 questions, the right answer was given by 5,0 ± 1.9 of teachers and 5.9 ± 1.5 of students (p < 0,001); the mean of correct answers were related to the reading of the CME. CONCLUSIONS: The present study presents unpublished data about the perception of medical teachers and students about medical ethics and bioethics and can be useful for improving the teaching of these disciplines in our medical schools.

Análise de estressores para o paciente em Unidade de Terapia Intensiva

JUSTIFICATIVA E OBJETIVOS: O ambiente hospitalar, especialmente o de uma Unidade de Terapia Intensiva (UTI), devido a complexidade do atendimento prestado, bem como a estrutura fisica, o barulho, os equipamentos e a movimentacao das pessoas, e tido como gerador de estresse para os pacientes. O objetivo deste estudo foi identificar e estratificar os estressores para pacientes internados em UTI, na perspectiva do proprio paciente, familiares e profissionais de saude. METODO: Estudo de corte transversal realizado entre junho e novembro de 2004, na UTI geral de hospital privado. A amostra foi composta por tres grupos: pacientes (G1), familiares (G2) e um membro da equipe da UTI responsavel pelo atendimento do paciente incluido (G3). Para identificacao e estratificacao dos fatores estressantes, utilizou-se a Escala de Estressores em UTI (Intensive Care Unit Environmental Stressor Scale - ICUESS). Para cada paciente e participante, foi calculado um escore total de estresse (ETE) pela soma de todas as respostas da escala. RESULTADOS: Foram incluidos 30 pacientes e participantes em cada grupo. A media de idade foi de: 57,30 ± 17,61 anos para o G1; 41,43 ± 12,19 anos para o G2; e 40,82 ± 20,20 anos para o G3. A media do ETS foi: 62,63 ± 14,01 para os pacientes; 91,10 ± 30,91 para os familiares; e 99,30 ± 21,60 para os profissionais. A media do ETS dos pacientes foi estatisticamente inferior a encontrada nos familiares e nos profissionais de saude (p < 0,01). Os principais estressores para os pacientes foram: ver a familia e amigos por apenas alguns minutos do dia; tubos no nariz e/ou boca; e nao ter controle de si mesmo. CONCLUSOES: A percepcao sobre os principais estressores foi diferente entre os tres grupos. A identificacao destes fatores e importante para a implementacao de medidas que possam facilitar a humanizacao do ambiente da UTI.

Efeito da injeção percutânea de etanol na redução de nódulos tireoideanos

Para verificar a eficacia da injecao percutânea de etanol (IPE) no tratamento de nodulos tireoideanos (NT) comparou-se o volume de 86 nodulos (77 pacientes), antes e apos uma ou duas sessoes de alcoolizacao. As medianas do volume inicial e final foram respectivamente: 3,5 mL (0,3 a 82,7) e 1,8 mL (0 a 29,4). Sete por cento dos nodulos desapareceram e a media de reducao volumetrica foi de 52,6% ± 31,1 (p< 0,0001). Os diferentes padroes ultra-sonograficos responderam distintamente ao tratamento, com as seguintes medianas de reducao: 37,3% (variando de -39,0 a 82,6) nos NT solidos; 53,5% (14,6 a 88,0) nos predominantemente solidos; 58,0% (21,0 a 64,5) nos mistos; 71,0% (18,8 a 100,0) nos predominantemente cisticos e 90,9% (45,9 a 100,0) nos cisticos. Adicionalmente, buscou-se comparar a variacao do maior diâmetro dos NT, inicialmente sem tratamento, e apos a alcoolizacao, cuja diferenca foi estatisticamente significante (p< 0,00001). A complicacao mais frequente foi dor moderada, em 27,6% dos casos. Concluimos que a IPE mostrou ser uma forma de tratamento segura e eficaz no tratamento de NT benignos.

Burnout syndrome and quality of life in intensivists

Burnout is a prolonged response to chronic emotional and interpersonal stressors on the job, and is defined by three dimensions: exhaustion, cynism (depersonalization), and inefficacy [1]. ICU physicians are exposed to several stress factors and are particularly predisposed to this syndrome [2].