Faculty of Medicine of São José do Rio Preto

Medical education is considered psychologically challenging, and medical students often report higher levels of psychological distress compared to non-medical students and the general population. This scoping review aims to identify and map the available scientific evidence on social skills and emotional regulation in medical students, characterize existing studies, identify knowledge gaps, and provide a synthesis of evidence to inform educational practice and curriculum development. This scoping review will follow the methodological frameworks proposed by the Joanna Briggs Institute (JBI) and the PRISMA-ScR checklist. Relevant studies will be searched in electronic databases (EMBASE, ERIC, PubMed, Science Direct, Scopus, and Web of Science) and gray literature sources. The search strategy will use descriptors in English, Portuguese, and Spanish, combined with Boolean operators. Two reviewers will independently screen titles, abstracts, and full-texts for inclusion. Data will be extracted using a standardized form and synthesized narratively. Qualitative and quantitative analyses, including thematic analysis and meta-analysis analysis (if appropriate), will be employed to provide a comprehensive overview of the evidence. The review will provide a comprehensive overview of the available scientific evidence on social skills and emotional regulation in medical students, identifying study characteristics, knowledge gaps, and areas for future research. The findings of this scoping review may inform educational practice and guide the development of strategies to promote the well-being and performance of medical students by addressing social skills and emotional regulation in medical curricula. The review protocol will be registered in the Open Science Framework (OSF).

Introduction: Trigeminal schwannomas (TSs) are the second most common type of intracranial schwannoma. Surgical approaches are chosen depending on the type of tumor extension. The middle fossa extradural approach, infratemporal extradural approach, transmaxillary approach, transmandibular approach, and transcervical approach have been used. However, these approaches are associated with a variety of complications including other cranial nerve dysfunction. Recently, with the wide application of endoscopic technology, the endoscopic endonasal approach (EEA) seems to be an alternative skull base surgical approach for skull base pathology. Objective: The objective of the present study is to evaluate the safety and efficacy EEA approach for TSs. Methods: We searched Medline, Embase, and Web of Science databases following PRISMA guidelines. We used single proportion analysis with 95% confidence intervals (CI) under a random-effects model, I2 to assess heterogeneity, and Baujat and sensitivity analysis to address high heterogeneity. Eligible studies included those with ≥4 patients treated with the endoscopic endonasal approach for trigeminal schwannomas. Results: Of the 2,550 initially identified studies, 9 were selected, involving 195 patients, with a median follow-up of 36 months. The combined analysis showed a 29% (CI: 11% - 49%) partial resection rate, while a pooled analysis for complete resection demonstrated an 84% rate (CI: 68% to 99%). Preservation of cranial nerves reached a 99% rate (CI: 96% to 100%) with a 100% preservation of facial function rate (CI: 97% to 100%) and a 5% complications rate (CI: 0% to 13%). Conclusion: Based on these findings, our meta-analysis identified that the endonasal endoscopic approach for the treatment of trigeminal schwannomas presents a low rate of complications, favorable results regarding the preservation of facial function and cranial nerves, and, a high rate of effectiveness, demonstrated by the results of complete resection.

Niemann-Pick type-C (NPC) disease is a rare genetic condition with a clinical spectrum ranging from a fatal prenatally-presenting and quickly lethal disorder to an adult-onset chronic neurodegenerative condition. Given the scarcity of information regarding NPC disease in Brazil, a group of experts decided to discuss some disease-related aspects at the national level. The present manuscript describes the results of a Brazilian consensus meeting conducted to propose recommendations for the diagnosis, management, and follow-up of NPC disease in Brazil, considering the clinical practice point of view. These recommendations include patient characteristics on clinical presentation, as systemic and neurological manifestations according to the age group and atypical manifestations; a flowchart for diagnostic confirmation, considering the Brazilian scenario; and treatment, encompassing disease-modifying therapy, supportive care, and patients' follow-up. The expert panel provided an objective basis of recommendations on NPC diagnosis and management in Brazil. The authors expect that this manuscript will help clinicians to identify, adequately treat and follow-up NPC patients in Brazil.

Introduction: Neurocritical patients may suffer functional limitations due to various factors, ranging from primary brain injury to cultural and structural barriers. Objective: To compare the functional mobility of adult neurocritical patients on invasive mechanical ventilation (IMV) undergoing an early mobilization protocol between intensive care unit (ICU) admission and discharge and to evaluate ventilatory and clinical outcomes. Methods: A retrospective study conducted in the neurological ICU of a teaching hospital from January to December 2022. Data were collected from electronic medical records, including sex, age, diagnosis, comorbidities, length of IMV and ICU stay, discharge or death outcomes, and functionality scores from the ICU Mobility Scale and the Johns Hopkins Scale. Results: Seventy-five patients were included in the study, with a mean age of 52.1 ± 19.5 years, predominantly female (52%). The most prevalent diagnosis and comorbidity were traumatic brain injury (24%) and hypertension (40%). The mean duration of IMV was 4.7 ± 3.3 days, with an average ICU stay of 11.9 ± 6.9 days. The study showed an 85% success rate in IMV weaning and 95% of ICU discharge rate. There was a significant improvement in functionality (p < 0.0001) from admission to discharge, with a notable reduction (p < 0.0001) in the total restriction score and a significant increase (p < 0.0001) in the moderate and mild reduction in mobility scores. Conclusion: The functional mobility of neurocritical patients improved from total complete bed restriction to the ability to perform orthostatic activities, transfer out of bed, and walk with assistance between ICU admission and discharge. Among the outcomes analyzed, there were high rates of ventilatory weaning and ICU discharges.

BACKGROUND The lack of a triage system for urgent surgical patients leads to non-standardized decision-making. Developing an instrument to objectively identify the complexity of care required for each case is challenging. The aim of this report is to develop and validate an urgent surgical patient classification instrument using the Delphi technique. MATERIALS AND METHODS The study was conducted in several stages: (1) definition of the construct; (2) item elaboration; (3) expert analysis; (4) item selection; (5) pretest. In the first study, scale items were designed and content validity was confirmed. In the second study, the factorial structure was analyzed. In the third study, alternative measurement models were tested. In the fourth study, criterion validity was analyzed. RESULTS Experts validated 14 items (31.81%) from Domain 1 with 75% agreement and specific items from Domain 2 with 100% agreement. Factor analysis indicated a two-factor solution explaining 58.4% of the variance. The bifactor model presented the best fit (χ2/df = 1.51; CFI = 0.95; TLI = 0.94; RMSEA = 0.051; SRMR = 0.043). Factors showed excellent internal consistency (α > 0.88; CR > 0.90; ω > 0.92). CONCLUSION This pioneering study developed and validated the content of the first specific instrument for classifying urgent surgical patients regarding their priority for care. The instrument was deemed valid in terms of content, based on expert consensus. Further studies are recommended to evaluate its practical application and perform additional psychometric measures. This instrument has the potential to enhance the organization of emergency services and operating theaters, promoting patient safety and efficient resource management in healthcare institutions. Its implementation should align with current health guidelines and policies to optimize the triage and prioritization process for urgent surgical patients.

The V-GOOD study evaluated the effectiveness of trimetazidine modified-release (MR) 80 mg once daily (OD) in patients with chronic coronary syndrome (CCS) who remained symptomatic despite antianginal therapies in routine clinical practice. This prospective, observational study involved 1026 adult outpatients with symptomatic CCS from 70 sites in Brazil who were prescribed trimetazidine MR 80 mg OD plus background antianginal treatment. Data on number of angina attacks, short-acting nitrate consumption, prevalence of angina-free patients, severity of angina, patient-reported daily physical activity impairment, treatment adherence, tolerability, and cardiologist and patient satisfaction were collected at baseline (V1), then at 1 month (V2) and 3 months (V3). Following the addition of trimetazidine MR 80 mg OD, the mean ± standard deviation number of angina attacks per week decreased from 3.1 ± 2.8 at V1 to 1.0 ± 2.1 at V2, and 0.7 ± 1.7 at V3, with concurrent reductions in short-acting nitrate consumption, patient-reported daily physical activity impairment and the proportion of patients with limiting angina (Canadian Cardiovascular Society class III or IV), and increases in the proportion of angina-free patients (all p < 0.001 vs. V1). Most cardiologists rated trimetazidine MR 80 mg OD as satisfactory/very satisfactory (90.7% for effectiveness and 94.8% for tolerability); most patients rated the treatment schedule as convenient/very convenient (97.2%) and satisfactory/very satisfactory (97.1%). Treatment was well tolerated. These data support the symptomatic benefits and good tolerability associated with adding trimetazidine MR 80 mg OD to other antianginal therapies in patients with persistent symptoms. Graphical abstract available for this article. NCT06464276.

Postharvest fungal diseases caused by Colletotrichum, Rhizopus, and Penicillium are major concerns, driving the search for sustainable antimicrobial alternatives to enhance food shelf life. This study examines the chemical composition of essential oils (EO) from Origanum vulgare, Syzygium aromaticum, Cymbopogon citratus, Cymbopogon martinii, Mentha piperita, and Mentha spicata, evaluating their in vitro effectiveness against Colletotrichum sp., Rhizopus stolonifer, and Penicillium expansum. Different EO concentrations were tested via volatile exposure and direct contact to determine the minimum inhibitory concentration (MIC) for each fungus. The results indicate that there is no universal strategy for prevention and control, as the effectiveness of EO depends directly on the fungal species. Colletotrichum sp. and R. stolonifer were more susceptible to volatiles from O. vulgare (200 μL/L_air) and M. piperita (180 μL/L_air), respectively, whereas P. expansum was more sensitive to direct contact with O. vulgare (250 μL/L_medium). Scanning electron microscopy (SEM) revealed that O. vulgare, rich in phenolic terpenes, and C. citratus, rich in aldehydic monoterpenes, induced hyphal breakage and twisting at varying intensities in these three common postharvest fungi. The results highlight the potential of EO via volatile exposure and direct contact as a promising alternative for postharvest fungal control.

Neurofibromatosis type 1 (NF1) is a syndrome triggered by mutations in the NF1 gene, which alter the neurofibromin protein, a negative regulator of the RAS oncogenic pathway. Due to underreporting, the scarcity of studies on NF1 in Brazil and its importance in public health. This study aimed to assess the clinical and epidemiological characterisation of NF1 in a Reference Hospital in the country and DataSUS. The study analysed the electronic medical records of patients with NF1 and the DataSUS databases. The medical records showed a greater number of female, white and adult patients. There was a high frequency of clinical features adopted by the NIH consensus for the clinical diagnosis of the disease, such as CALMs, dermal neurofibromas and axillary/inguinal ephelides, bone and ophthalmological changes, in addition malignant and benign neoplasms and neurodevelopmental disorders. On the other hand, the data provided by DataSUS shows a disproportionate concentration of NF1 consultations between the country’s regions, with a low level of diagnoses of newborn with NF1 and a NF1 mortality rate of 3.06% in the population. There is therefore a need for new public policies on access to diagnosis, treatment and information about the disease for the Brazilian population.

In 1923, H.R. Carter published a seminal treatise on the possibility of yellow fever virus spreading to the Asia Pacific region, where large numbers of susceptible people were at risk of infection. This paper marks the 100th anniversary of that publication, and posits that, despite many public health advances, global trends increase the likelihood of yellow fever virus geographic spread. Potential reasons for the failure of the virus to spread are discussed.