Anatomy is an essential subject of the medical curriculum. Despite its relevance, the curricular time and logistical resources devoted to teaching anatomy are in decline, favoring the introduction of new pedagogical approaches based on computer‐assisted learning (CAL). This new pedagogical approach provides an insight into students' learning profiles and features, which are correlated with knowledge acquisition. The aim of this study was to understand how training with CAL platforms can influence medical students' anatomy performance. A total of 611 medical students attending Musculoskeletal Anatomy (MA) and Cardiovascular Anatomy (CA) courses were allocated to one of three groups (MA Group, CA Group, and MA + CA Group). An association between the performance in these anatomy courses and the number of CAL training sessions was detected. In the MA Group (r = 0.761, P < 0.001) and the MA + CA Group (r = 0.786, P < 0.001), a large positive correlation was observed between musculoskeletal anatomy performance and the number of CAL training sessions. Similarly, in the CA Group (r = 0.670, P < 0.001) and the MA + CA Group (r = 0.772, P < 0.001), a large positive correlation was observed between cardiovascular anatomy performance and the number of CAL training sessions. Multiple linear regression models were performed, considering either musculoskeletal or cardiovascular anatomy performance as the dependent variable. The results suggest that using CAL platforms to study has a positive dose‐dependent effect on anatomy performance. Understanding students' individual features and academic background may contribute to the optimization of the learning process.

The coronavirus disease 2019 (COVID-19) has led to an increasing number of patients in the intensive care units (ICU). The size of this post-ICU cohort will be unprecedented, with many patients vulnerable to post-intensive care syndrome. We analysed the respiratory and functional effects of a multidisciplinary rehabilitation program on functional performance, in patients hospitalized in ICU due to COVID-19.We conducted a randomized controlled clinical trial. Ninety-six patients, who fulfilled the eligible criteria, were randomized into control or intervention group. The control group received standard of care in the ICU, and the intervention group received a functional and respiratory rehabilitation protocol, that included medical, nursing, physiotherapy, and occupational therapy interventions.At discharge, the intervention group showed significantly better muscular strength and respiratory capacity, and significantly less days of hospitalization (12.90±5.8versus15.60±6.7 days, p=0.037). At the 4- and 12-week follow-up we applied our main outcome measure – 6-minute walking test. The intervention group had significantly better results than the control group on the 6-minute walking test at the 4-week follow-up (604±67versus571±57 m, p=0.018) and at the 12-week follow-up (639±53 37versus611±67, p=0.025).These results support the role of a multidisciplinary rehabilitation program in COVID-19 patients hospitalized in ICU and adds evidence that the implementation of rehabilitation programs in ICU could result in beneficial outcomes for the critical ill patients.

Objectives The primary objective of the presented study is to analyze the respiratory and functional effects of a rehabilitation program in patients affected by hospitalization in Intensive Care Unit (ICU) due to COVID-19, in comparison with the group treated with standard of care, at discharge endpoint. The secondary objectives of the presented study are to evaluate different outcomes of the rehabilitation program in comparison to standard of care regarding: functional performance at 4-week and 12-week post- discharge mark; health-related quality of life, the impact on the health services (namely days of hospitalization), the cost-effectiveness of the intervention proposed. Trial design This is a randomized, controlled, double-blind, double-arm clinical trial of treatment, with an allocation ratio 1:1 and framework of superiority. Participants The study will be conducted at Centro Hospitalar Entre Douro e Vouga, Santa Maria da Feira, Portugal. Potential participants will be adult patients (≥18 years old) hospitalized in ICU with respiratory insufficiency due to COVID-19, who are referred to respiratory and functional rehabilitation. Only patients approved by physical rehabilitation doctors to perform respiratory and functional rehabilitation will be considered potential participants. To be eligible for inclusion participants must have been independent in their activities of daily living before the onset of critical illness (verbal statement by their proxy) and have to meet the safety criteria defined by the Portuguese Society of Physical Rehabilitation Medicine. Intervention and comparator Both groups will receive usual medical and nursing care in the ICU, which involves assessment and treatment of the respiratory system and may include positioning, hyperinflation techniques and suctioning. The physical function of the patient is assessed, and active bed exercises and mobility are encouraged as soon as possible and may include sitting out of bed. The intervention group will receive a functional and respiratory multidisciplinary rehabilitation protocol (that includes medical, nursing, physiotherapy and occupational therapy interventions) during their entire hospital stay. After reassurance that the patients fulfil the safety criteria, they will initiate the rehabilitation protocol, individualized to each patient based on the clinical status. The rehabilitation interventions and exercises implemented will be consistent with recommendations from the Portuguese Society of Physical Rehabilitation Medicine. The intervention will occur 6 days per week (Monday to Saturday), fifteen minutes, twice per day for each participant. Throughout all activities, progression will be increased successively, depending on the individual’s tolerance and stability. After discharge, the intervention group will continue with rehabilitation exercises, prescribed by physical rehabilitation doctors. These exercises are designed for the patient to do at home, and then report their execution to rehabilitation nurses through teleconsultation, until 12 weeks after ICU discharge. Main outcomes Baseline descriptive data collection will include age, sex, comorbidities and date of admission to ICU. The need of mechanical ventilation and length of use, as well as the need for oxygen therapy, length of ICU stay (days/hours), incidence of ICU readmission, discharge destination and survival will also be recorded. Prior to intervention, every two days and at discharge, participants will be evaluated using the following scales: Glasgow Coma Scale, Richmond Agitation Sedation Scale, Chelsea Critical Care Physical Assessment, 5 standardized questions for cooperation, Medical Research Council Sum-Score, Handgrip strength test and Medical Research Council dyspnea scale. At discharge, Borg Rating of Perceived Exertion will be evaluated. The primary outcome measure will be functional capacity using the 6-Minute Walk Test, and it will be measured at discharge and at the 4-week and 12-week mark. Medical Research Council Sum-Score, Handgrip strength test, Medical Research Council dyspnea scale and Borg Rating of Perceived Exertion will also be re-evaluated at the 4-week and 12-week mark. The health related quality of life will also be used as an outcome measure, using the 12-Item Short Form Survey, at 12 weeks of follow-up. Randomisation Participants will be divided into two groups, standard care and intervention, by means of balanced randomization at a 1:1 ratio using blocks of 10 participants. The randomization sequence is going to be created using a free software (http://www.randomized.org/). In order to ensure the confidentiality of the randomisation sequence, this process will be conducted by an assessor external to the study. Blinding (masking) The evaluators in the study will be blinded during the entire process. The evaluators will be unaware of the study objectives and the randomized distribution of patients to study groups and will not have access to the randomization sequence. Although blinding for patients will not be possible to achieve completely, subjects will be unaware of other treatment modalities, and they will not know if they belong to the intervention or standard group. As for the treating physiotherapists and ICU staff, blinding will not be possible to achieve, but they will not be responsible for assessing outcomes. Numbers to be randomised (sample size) We plan to randomise 40 participants to each group. 80 participants in total. Trial Status This is the second and definitive protocol version, dated from 26th February 2021. Recruitment started on 8th March 2021. Participants will be recruited between March 8, 2021, and June 8, 2021. Study completion is expected to be October 2021. Trial registration ReBEC RBR-7rvhpq9. Registry name: The effect of rehabilitation in hospitalized COVID-19 patients. Registered on 17 March 2021.Retrospectively registered. Full protocol “The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol”.

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A colecistite aguda alitiásica é uma doença inflamatória aguda da vesícula biliar, sem evidência de cálculos e com patogénese multifatorial. Observa-se sobretudo em pacientes com múltiplas comorbilidades ou estados de imunossupressão, encontrando-se associada a maior morbilidade e mortalidade, comparativamente com a entidade litiásica.Doente, género feminino, 50 anos de idade, com infeção recente por SARS-CoV-2 recorreu a teleconsulta por epigastralgia com irradiação dorsal, com quatro dias de evolução, associado a náuseas, com melhoria sintomática naquele dia. Solicitados estudo analítico, ecografia abdominal e endoscopia digestiva alta urgentes.A ecografia demonstrou “colecistite aguda alitiásica”. Referenciada ao serviço de urgência com consequente colecistectomia por laparotomia, após conversão de laparoscopia, revelando perfuração pilórica por espinha de peixe com inflamação vesicular por contiguidade.A colecistite aguda alitiásica representa 2% a 15% dos casos de colecistite aguda, ocorrendo sobretudo acima dos 60 anos e no género masculino. A doente em causa não apresentava o biótipo, as comorbilidades e a apresentação clínica típicos desta patologia. A infeção recente por SARS-CoV-2 levantou a suspeita de um papel etiológico, contraposto após a cirurgia. A ingestão de corpos estranhos é considerada comum, mas apresenta maioritariamente um curso benigno, com complicações em menos de 1% dos casos. A doente apresentava escassos fatores predisponentes à ingestão de corpos estranhos. Uma tomografia computorizada no período pré-cirúrgico poderia ter esclarecido a etiologia e contribuído para a orientação do procedimento.Eis um caso clínico de uma patologia invulgar, de etiologia rara, numa doente atípica, com um desfecho bem-sucedido, em plena pandemia COVID-19.