Major changes and pedagogical challenges in the curriculum of physicians in the post-pandemic of COVID-19: a systematic review

Introduction: Respiratory disease (COVID-19) caused by the new coronavirus (SARSCoV-2) has spread around the world causing respiratory illnesses and deaths. The COVID-19 pandemic caused an unprecedented crisis in the field of education. It is essential to reflect on the role of educational systems in curricular training, especially for doctors. Objective: The present study prepared a systematic review to analyze the main curriculum changes in medical education institutions around the world. Methods: The present study followed a systematic review model (PRISMA). The search strategy was performed in the PubMed, Cochrane Library, Web of Science and Scopus, and Google Scholar database, using scientific articles from 2009 to 2021. Results: As a corollary of the literary search system, 155 studies were analyzed and submitted to eligibility analysis, and then 55 high to moderate quality studies were selected. Biases did not compromise the scientific basis of the studies. It was analyzed that it is crucial that the academic education community learn from experience and prioritize a forward-thinking academic approach as practical solutions are implemented. The pandemic has brought about a lasting transformation in medicine with the advancement of telehealth, adaptive research protocols, and clinical trials with flexible approaches to achieving solutions. The studies analyzed in general did not address criticisms about the weaknesses of remote education, limiting themselves to defending it as the only viable strategy. There was no consensus on the inclusion of students in the practical activities of curricular internships and medical internships. A part of the studies defends the inclusion in hospital spaces as a way to contribute to overcoming the health crisis imposed by the pandemic. The studies evidenced the inclusion of pandemic management disciplines with a focus on public health in the medical curricula. Conclusion: The medical activity and curriculum underwent and are undergoing significant changes and adaptations. Thus, the doctor will need to develop other skills, without losing the traditional ones. The highlight is telehealth and soft skills, as they will allow students to connect to the best in world medicine, highlighting the importance of scientific knowledge when establishing treatments in cases of pandemics with a focus on public health.

Analysis of the racial profile of women with COVID-19: a cross-sectional study about evolution to death of black women in the southeast region of Brazil

Introduction: The first coronavirus disease (COVID-19) case in Brazil was registered in December 2019. Since then, an important social situation has been highlighted. Black women correspond to the highest death rate, by group, in the Southeast even not occupying the highest percentage of diagnosis. This scenario was also experienced in other places around the world. Therefore, some questions must be highlighted, such as social and economic vulnerability of black population in brazilian territory, less access to health service and testing for Covid-19. Objective: This study analyzed the clinical picture and evolution - cure or death-of black women with COVID-19 in the Southeast region. In addition, consolidating knowledge about the factors that precede death in black women and comparing them with other race groups. Methods: Cross-sectional study with data from the Ministry of Health's Severe Acute Respiratory Syndrome (SARS) from March to November 23, 2020, with a total number of women classified as level 5, with SARS caused by the virus SARS-Cov-2, equal to 33,991, being 21,551 white and 12,063 black. Results and Conclusion: Therefore, black women present themselves as a vulnerable group in relation to COVID-19. This group was less present in the ICU, but both groups, white and black women, had dyspnea as an aggravating factor. Considering those facts, it's possible that black women had less access, this would explain a greater number of deaths among this group compared to white women, which could signify a failure in the health care of this population. When analyzing deaths by age group, it is evident that white women followed the literature pattern - severe forms occur in patients over 65 years of age with comorbidities, while there was a rejuvenation of deaths among black women. It is a limitation of our study not to include comorbidities in the analysis. This situation becomes relevant for directing public policies that aim to reverse the factors associated with this situation. More studies are needed to elucidate the socioeconomic issues that support this outcome, seeking to reduce the number of deaths from COVID-19 in black women.

Acute pulmonary edema as a complication of urinary infection in pregnant women: a case report

Introduction: Urinary infection (UI) is the third most common pathology during pregnancy, affecting 10-12% of pregnant women in the first trimester. Thus, the prenatal care is important to reduce indicators of maternal-fetal mortality, promoting quality of life during pregnancy and postpartum. Objective: The aim of this study is to report the case of a pregnant woman with pyelonephritis, who evolved with acute pulmonary edema. Case report: The present study was elaborated according to the rules of CARE case report. This study was analyzed and approved by the Research Ethics Committee (CEP) according to a substantiated opinion number 4,375,418 and obtaining the patient's consent. The present study therefore highlights pyelonephritis as the most severe form of UI in pregnant women, associated with septic shock, with evolution to respiratory failure, resulting from acute pulmonary edema, and may be related to worse maternal-fetal prognoses. This clinical study contributes to the literature, emphasizing that, currently, all forms of UI during pregnancy should be considered as great potential for complications, and should be treated even in its asymptomatic form. Conclusion: It is evident the need for early intervention to minimize maternal-fetal losses, unnecessary interventions and to reduce costs in relation to additional treatments. The importance of rapid diagnosis and early treatment is emphasized in order to minimize or extinguish the damage. As well as promoting actions to encourage pregnant women to perform prenatal care.

Scientific research with cancer patients during the COVID-19 pandemic: an experience report

Scientific research brings resolutions to several problems in society, supporting clinical performance in health. Work with cancer patients needs to be even more careful. During the COVID-19 pandemic, cancer patients enter the risk group for exposure to the virus, limiting the monitoring of the disease, impairing treatment. New health technologies and telemedicine have been on the rise in recent years, changing the course of medicine, research and health care. Its implementation and validation have been widely discussed in recent years, and it was greatly encouraged by the COVID-19 pandemic. To report the development, adaptations and the six-month longitudinal follow-up of 20 individuals who underwent thyroidectomy at a university hospital. The research flowchart initially persisted in evaluating symptoms and vocal fatigue in individuals undergoing thyroidectomy due to thyroid cancer at three times: pre-surgical (M1), immediate post-surgical (M2) and late post-surgical (M3) in three to six months. The individuals were submitted to videolaryngoscopy, voice recording, voice acoustic analysis and completion of self-assessment protocols along with the medical consultation. All assessments were performed on an outpatient basis at the three times described. The research began in October 2019, and was interrupted at the beginning of the pandemic. In February 2020 we obtained eight cases with the two initial assessments, and only two cases with M3. Due to the pandemic, the surgeries were suspended and the continuity of the study was impaired, requiring modifications. The initial goal was to last nine months with 30 individuals in the sample. New cases were followed up from October 2020 until May 2021 when there was a reduction in cases. At the end, all data from 20 individuals in this period of the research were collected. The completion time increased from nine months to 20 months. None of the patients were infected by COVID-19 during the research period. Therefore, the treatment of cancer patients encompasses several aspects that have been hampered by its continuity, delaying deadlines and making access difficult by COVID-19. As well as, scientific research in this population has undergone several adaptations to preserve the health of individuals, not unnecessarily exposing them to contamination with the virus. Monitoring by telemedicine proved to be effective for the initial objectives of this study, but it may limit it depending on the type of proposed intervention. Despite the existing pandemic, scientific production should not be stopped because it brings discoveries that aim to improve the health of the population.

Analysis of the acute neuroinflammatory response and endogenous markers in the amygdala of animals submitted to status epilepticus by intrahippocampal pilocarpine application

Introduction: Experimental evidence and clinical evidence indicate that the inflammatory process is a crucial mechanism in the pathophysiology of epileptic seizures and temporal lobe epilepsy. The amygdala when involved in an atypical processing is associated with multiple moods such as depression and anxiety disorder and psychiatric disorders such as schizophrenia. Objective: This study investigated the acute inflammatory process and modulation of the endogenous proteins’ galectins and AnxA1 in the amygdala of animals submitted to an experimental model of temporal lobe epilepsy. Methods: The experimental procedures were approved by the Ethics Committee on the Use of Animals at UNIFESP (CEUA nº2958050814). The experiments performed in this study used data and materials that were obtained from the project “Neuroprotective and anti-inflammatory role of the mimetic peptide ac2-26 of the annexin a1 protein in intrahippocampal pilocarpine-induced status epilepticus” conducted by the advisor. The experimental model used male Wistar rats that were divided into 3 experimental groups (NAIVE; SHAM, Status Epilepticus or SE - n = 5 animals/group). Once acclimated, the animals in the SHAM and SE groups underwent stereotaxic surgery for implantation of the intracerebral cannula in the right hippocampus. The SHAM animals received sterile saline in all procedures and the NAIVE group only manipulated. The animals were monitored throughout the period and after 24 hours of experiment all animals were euthanized by overdose of thiopental to remove the brain and performed histological and immunohistochemical analysis. Results and Conclusion: Initial results demonstrate that SE and the acute inflammatory process cause damage to the amygdala, and there is also modulation of inflammatory markers in this structure. However, further studies are needed to better understand the mechanism of action in neuroinflammation in status epilepticus.