Objective: Medical students are especially vulnerable to situations of poor sleep quality due to academic demands. The COVID-19 pandemic brought significant changes and high psychological stress, causing a great impact on this population. Here we aim to analyze the influence of the pandemic on the sleep quality of medical students. Methods: Cross-sectional, observational, and descriptive study with a quantitative approach carried out with students from medical universities in Rio Grande do Norte state (Brazil) through the online application of two questionnaires: Pittsburgh sleep quality index (PSQI-BR) and sociodemographic questionnaire (SQ). Results: A total of 142 medical students participated in this study: 103 women and 39 men. We observed a prevalence of low sleep quality in 78.16% of the sample and that the pandemic significantly affected the sleep quality among medical students (p<0.05). We also found an alteration in the sleep pattern in 83% of the participants, mainly due to anxiety symptoms (38%). Finally, we observed no statistically significant difference in sleep quality or sleep patterns between genders or college period (p>0.05). Discussion: This rate of poor sleep quality is higher than the prevalence of periods before the pandemic (58%). Concerns about COVID-19's negative impact on medical education, delayed training, and impact on the generation of medical jobs can directly aggravate the sleep quality. Conclusion:The COVID-19 pandemic negatively influenced the sleep quality of medical students, increasing the prevalence of poor sleep quality and promoting changes in the sleep pattern.

Introduction: Cholecystectomy is the intervention of choice for treating acute cholecystitis; when conservative management does not work, it operates on the patient outside the critical condition. It can be performed together with or after endoscopic papillotomy through endoscopic retrograde cholangiopancreatography (ERCP) when it is concurrent with a situation of cholechodocolithiasis or when there is compression and consequent increase in pressure in the bile duct caused by a calculus jammed in the vesicular infundibulum (Mirizzi’s syndrome), with or without jaundice, fever, and pain in the right hypochondrium (Charcot’s Triad), which can progress to sepsis of biliary origin. This review aims to assess whether the timing of cholecystectomy (before or after ERCP) interferes with the postoperative period and clinical outcome in patients with acute cholecystitis. Methods and Analysis: By searching the MEDLINE/PubMed, Embase, Web of Science, ScienceDirect, ClinicalTrials.gov , CINAHAL, Latin American and Caribbean Literature in Health Sciences, Scopus and Cochrane Central databases, Controlled Trials Registry Randomized clinical trials will be searched to analyze whether ERCP performed before or after open or laparoscopic cholecystectomy (LC) in patients with acute cholecystitis is beneficial or not, through the analysis of postoperative complications. No language or publication period restrictions will be imposed. The primary outcome will be postoperative complications (postoperative morbidity and mortality). Four independent reviewers will select the studies and extract data from the original publications, with a fifth reviewer in case of disagreement regarding the inclusion or not of particular research in the present review. The risk of bias will be assessed using The Risk of Bias 2 (RoB 2.0) tool, and the certainty of evidence will be evaluated using the grading of recommendations assessment, development, and evaluation. Data synthesis will be performed using the Review Manager software (RevMan V.5.2.3). To assess heterogeneity, we will calculate the I 2 statistics. Additionally, a quantitative synthesis will be performed if the included studies are sufficiently homogeneous. Ethics and Disclosure: Since the present study will review secondary data, previously published and scientifically validated, it will not be necessary to obtain ethical approval. The results of this systematic review will be published in a peer-reviewed journal. Prospero registration number: International Prospective Registry of Systematic Reviews (PROSPERO) CRD42021290726.

Background: Parkinsonism secondary to the treatment of obstructive hydrocephalus due to stenosis of the cerebral aqueduct, with implantation of a ventricular peritoneal (VP) shunt is a rare complication, still poorly described and disseminated in the literature. Case Description: A 38-year-old male presented a history of moderate-intensity daily headache, which deteriorated 2 months before admission, with no changes in the neurological examination. Magnetic resonance imaging showed hypertensive hydrocephalus associated with cerebral aqueduct stenosis. A VP shunt was performed, an adjustable pressure valve was successfully inserted, and he was discharged asymptomatic. However, months later, he progressed with important symptoms of hypo- and hyper-drainage, which persisted after valve pressure adjustments and even its exchange, culminating into an endoscopic third ventriculostomy (ETV). But soon after, severe Parkinsonian syndrome appeared. Therapy with levodopa and bromocriptine was initiated, revealing a slow response initially but good evolution within 6 months. At present, he presents low-intensity residual tremor, which is well controlled with medications, and has regained independence for daily activities, with minimal motor limitation and no cognitive changes. Conclusion: There is still no mechanism that explains the occurrence of Parkinsonian syndrome in these cases. It is suggested that the rostral portion of the midbrain was injured due to abrupt changes in the transtentorial gradient pressure after the ventricular shunt, along with various adjustments in the valve pressure. ETV and early introduction of levodopa therapy in patients who developed postventriculoperitoneal shunt Parkinsonism seems to be the most effective combination, with satisfactory clinical response in the medium/long term.

Este estudo teve por objetivo relatar a experiência na implantação do telemonitoramento na Atenção Primária à Saúde (APS) na pandemia do Covid-19 e como as tecnologias leve, leve-dura e dura tiveram papel fundamental na garantia da atenção integral e longitudinal dos usuários do Sistema Único de Saúde. Esta experiência ocorreu entre maio de 2020 a fevereiro de 2021, no município de Camaçari, na Bahia, e assistiu cerca de 1.259 indivíduos adscritos no território coberto pela unidade de saúde. Observou-se que o uso das tecnologias visou ofertar não apenas a manutenção da assistência, mas também o fortalecimento do vínculo criado entre profissional e usuário, a organização da gestão do serviço e do cuidado, a minimização de agravos e o fortalecimento da comunicação entre usuário e equipe de saúde. Por esses motivos, esta ferramenta digital reflete um potencial para ser útil e explorada em outros cenários após o período da pandemia.

A violência obstétrica é o termo utilizado para descrever as diversas formas de violência ocorridas na assistência à gravidez, ao parto, ao pós-parto e ao abortamento. Pode ser manifestada por meio de maus-tratos físicos, psicológicos e verbais além de práticas intervencionistas desnecessárias, como a episiotomia. As mulheres em situação de vulnerabilidade social e discriminação, como as mulheres negras, são mais acometidas pela violência obstétrica. O presente estudo teve como objetivo analisar a repercussão da violência obstétrica nas mulheres negras brasileiras a partir de trabalhos presentes na literatura. Trata-se de uma revisão integrativa, na qual utilizou-se a estratégia PICO e um instrumento validado para direcionamento do estudo nas bases de dados da Biblioteca Virtual em Saúde, do PubMed e do Google Acadêmico, a partir de trabalhos publicados entre 2011 e 2021. Houve a seleção de 06 artigos após os critérios de inclusão e exclusão. Os estudos demonstraram que a violência obstétrica mostrou-se mais frequente em mulheres negras durante todo o ciclo gravídico puerperal, tendo como principais repercussões o atendimento desigual e as consequências negativas associadas à saúde mental. Percebeu-se a necessidade de políticas educativas para desnaturalizar o racismo institucional e ampliar o debate sobre as iniquidades raciais na saúde.