Background The significance of detection of Trypanosoma cruzi (T. cruzi) DNA in blood of antibody-positive patients for risk of development of Chagas heart disease is not well established. The objective of this study was to compare detection of T. cruzi DNA with known clinical and laboratory markers of Chagas cardiomyopathy (CC) severity. Methods This is a case-control study nested within a retrospective cohort developed in Brazil to understand the natural history of Chagas disease. The study enrolled 499 T. cruzi seropositive blood donors (SP-BD) and 488 frequency matched seronegative control donors (SN-BD) who had donated between 1996-2002, and 101 patients with clinically diagnosed CC. In 2008-2010 all enrolled subjects underwent a health questionnaire, medical examination, electro- and echocardiograms and PCR analyses. A blinded panel of three cardiologists adjudicated the outcome of CC. T. cruzi kinetoplast minicircle sequences were amplified by real-time PCR using an assay with a sensitivity of one parasites/20mL of blood. All testing was performed on coded samples. Results Rates of PCR detection of T. cruzi DNA were significantly (p=0.003) higher in CC patients and SP--BD diagnosed with CC (79/105 [75.2 %]) compared with SP-BD without CC (143/279 [51.3%]). Presence of parasitemia was significantly associated with known markers of disease progression such as QRS and QT interval duration, lower left ventricular ejection fraction, higher left ventricular index mass, and elevated troponin and NTpro-BNP levels. Conclusion T cruzi PCR positivity is associated with presence and severity of cardiomyopathy, suggesting a direct role of parasite persistence in disease pathogenesis.

MedicinaCopyright Rego et al. Este é um artigo publicado em acesso aberto (Open Access) sob a licença Creative Commons Attribution, que permite uso, distribuição e reprodução em qualquer meio, sem restrições desde que o trabalho original seja corretamente citado.Resumo Objetivo: Descrever o perfil do estudante de Medicina e a sua repercussão na trajetória acadêmica. Método: Foi realizado um estudo transversal e descritivo através da aplicação de questionário a estudantes do curso de Medicina do segundo ao quinto semestre do curso, com coleta de dados no período de outubro de 2017 a fevereiro de 2018. Resultados: Participaram 154 alunos, sendo 50,6% do sexo masculino e com média de idade de 21,5±3,0 anos, observando-se que 30% considera seu desempenho regular e 37,5% moram em casa alugada ou cedida por terceiros, ao passo que a grande maioria mora distante da Universidade (61%), utiliza transporte público coletivo (70,1%) e relatam queixas relacionadas à má qualidade do sono (74,7%), bem como dificuldade em frequentar as aulas (39%). Destaca-se que 30,9% possui renda familiar de 1 a 3 salários mínimos, sendo que a maioria não exerce trabalho remunerado (94,2%). Conclusão: Conclui-se que as condições socioeconômicas já não são, universalmente, aquelas das classes mais altas da sociedade, o que pode ajudar a compreender as dificuldades enfrentadas por vários estudantes.Descritores: educação médica; classe social; fatores socioeconômicos; desempenho acadêmico. Summary Purpose: To describe the medical student profile and its repercussion in the academic trajectory. Methods: A cross-sectional descriptive study was done, using a survey that medical students from the second to the fifth semester answered it. The data was collected from October 2017 to February 2018. Results: 154 students with the average age of 21.5±3.0 years old participated on the survey; 50.6% of them were men, 30% consider their achievement regular, 37.5% live in rented houses or lent by third parties, most of them live far from the university (61%) and use public transportation (74%), 39% report difficulties to attend the classes. We highlight that 30.9% are from families that their monthly revenue is 1 to 3 minimum salaries. Conclusion: We conclude that the socio-economic conditions today are not those of the highest classes of the society, what may help us to understand the difficulties faced by several students. IntroduçãoEm geral, os cursos de Medicina apresentaram por muitos anos um perfil predominante de estudantes: sexo masculino, de classes sociais mais elevadas, provenientes de grandes centros urbanos 1 . Entretanto, atualmente percebe-se uma mudança neste perfil, em especial nas instituições públicas, relacionadas a mudanças nos processos de admissão, como ações afirmativas e sistemas de cotas, visando ampliar o acesso às instituições públicas de ensino superior. Estas mudanças trazem consigo a necessidade de conhecimento sobre possíveis novas variáveis, a fim de moldar o ensino médico a novos modelos educacionais mais adequados à situação...

Objective: To identify the factors related to the medical students' overload and observe how these students deal with them. Methods: We made a cross-sectional and descriptive study, with students from the second and fifth semesters. The data collection was made from October 2017 to February 2018. About 300 students participated, and 170 of them filled out the questionnaire. From this number, 16 questionnaires were excluded because they were incorrectly filled, so the final number of forms were 154, corresponding to the analyzed sample. Results: We could observe that, in reference to the academic performance selfevaluation, almost 30% of the students considered having a regular performance. One of the main factors related to the academic overload was the fatigue during classes. Almost all interviewed students (91.4%) pointed out this factor, and they also consider that the Medical School has a negative interference in other aspects of their personal life. Most students consider that they can't study all subjects satisfactorily (71%). Concerning the sleep time, 65% of the students sleep in average up to 5 hours per day, and consider their sleep time unsatisfactorily. Fortunately, only 1.3% of the medical students use stimulating substances, such as Ritalina®, without medical prescription. Conclusions: We hereby conclude that, once they have an extensive course load, medical students need orientation about how to better manage their time and how to use strategies to reduce the stress, this way improving their personal satisfaction and performance.

Introduction: Program assessment is the process of data collection about a course or teaching program that takes into consideration the aspects of cost-effectiveness, checking the adequacy of the evaluation according to the course purpose and the program capacity to yield changes in real life. Such regular assessments provide feedback to the decision-making process that aim at better teaching and learning practices. The Mini Clinical Evaluation Exercise (MiniCex) is a performance rating scale designed to assess the skills that medical students and residents need in real-life situations with patients. Considering the importance of program assessment for an institution, the utilization of the MiniCex data might be of great value for the follow-up of students and the course, helping the planning process and generating improvements in the institution. Therefore, the objective of this study is to assess the program using MiniCex in the beginning of the medical internship, aiming to determine in what areas of the basic and pre-clinical course the students have more difficulties. Methods: A cross-sectional descriptive study was carried out, using the retrospective data obtained by the MiniCex forms that were applied to the 9th-semester medical students, which correspond to the first semester of medical internship in the Federal University of Pará. A total of 111 students was assessed, among the 154 students eligible for internship, from August 2017 to July 2018. Results: Among the performed evaluations, with 97% being requested by the teachers, most of them (72%) were about new cases, and 45% and 38% had low or moderate complexity, respectively. There was a predominance of musculoskeletal system disorders (27.7%), followed by the gastrointestinal/hepatology system (14.8%). Concerning the skills in each domain, the performance was satisfactory in all of them. We observed that 12% of the students had difficulties in at least one area, followed by 6.3% of students with difficulties in 2 areas and 4.5% with an unsatisfactory performance in 3 or more areas. Conclusion: the MiniCex, when applied to internship students, showed to be a source of important and useful information, as part of a program assessment concerning the areas preceding the internship. The analysis of the obtained data was sent to teachers of the pre-internship, internship and course management areas. To the first ones, with the objective of reviewing their programs, detecting where they can intervene and, thus, make changes that aim a better acquisition of basic knowledge by the students and, consequently, improve their performance. To the second ones, to provide an overview of where they will have to focus their programs according to the needs of the medical students who reach the internship. Finally, to the course management, as a guide of what should be supervised by the professionals teaching the semesters that precede the internship.

Fundamento: O acometimento do sistema nervoso autônomo é um dos mecanismos propostos para explicar a progressão da lesão miocárdica na doença de Chagas. Evidências indicam alterações do sistema nervoso simpático e parassimpático desde a fase aguda, e estudos são necessários para se entender os aspectos fisiopatológicos e o valor prognóstico dessas alterações. Objetivo: Analisar o comportamento da pressão arterial pela monitorização ambulatorial da pressão arterial (MAPA) em pacientes normotensos com doença de Chagas aguda (DCA) sem envolvimento cardíaco aparente, e a influência da infecção no descenso fisiológico do sono. Métodos: Foi realizado a MAPA em 54 pacientes com DCA e utilizado um grupo controle de 54 indivíduos normotensos, pareados para idade e sexo. O nível de significância adotado foi para um erro tipo I (alfa) de 5%. Resultados: Em um total de 54 pacientes com DCA ocorreu ausência de descenso sistólico do sono em 74,0%*, ausência de descenso diastólico do sono em 53,7%*, e ausência de descenso sistólico e diastólico do sono (51,8%)*, (*p<0,05). Em 12,9% ocorreu ascensão sistólica da pressão no sono e em 18,5% ascensão diastólica (p<0,05). Conclusão: Em pacientes com Doença de Chagas aguda, houve ausência significativa do descenso fisiológico da pressão arterial durante o sono, tanto da pressão arterial sistólica quanto a diastólica, e alguns pacientes apresentaram ascensão noturna desses parâmetros. Esses achados sugerem alterações autonômicas na doença de Chagas desde a fase aguda. (Arq Bras Cardiol. 2020; 114(4):711-715) Palavras-chave: Doença de Chagas/fisiopatologia; Pressão Arterial/fisiologia; Sistema Nervoso Autônomo/fisiologia; Monitoração Ambulatorial da Pressão Arterial/métodos; Hipertensão.