Severe carotid atherosclerotic disease is responsible for 14% of all strokes,
which result in a high rate of morbidity and mortality. In recent years,
advances in clinical treatment of cardiovascular diseases have resulted in a
significant decrease in mortality due to these causes.To review the main studies on carotid revascularization, evaluating the
relationship between risks and benefits of this procedure.The data reviewed show that, for a net benefit, carotid intervention should only
be performed in cases of a periprocedural risk of less than 6% in symptomatic
patients. The medical therapy significantly reduced the revascularization net
benefit ratio for stroke prevention in asymptomatic patients. Real life
registries indicate that carotid stenting is associated with a greater
periprocedural risk. The operator annual procedure volume and patient age has an
important influence in the rate of stroke and death after carotid stenting.
Symptomatic patients have a higher incidence of death and stroke after the
procedure. Revascularization has the greatest benefit in the first weeks of the
event.There is a discrepancy in the scientific literature about carotid
revascularization and/or clinical treatment, both in primary and secondary
prevention of patients with carotid artery injury. The identification of
patients who will really benefit is a dynamic process subject to constant
review.
Background: The relationship between exercise and atrial fibrillation (AF) is controversial. Objectives: To analyze the effects of physical activity on the incidence of atrial fibrillation using systematic review and meta-analysis. Methods: Systematic review and meta-analysis of studies that relate physical exercise and atrial fibrillation. The following databases were searched: PubMed, BVS Saúde and Cochrane. The following descriptors were used: "atrial fibrillation", "exercise", "physical activity" and "exercise therapy". All prospective, retrospective, cross-sectional and cohort studies were investigated. All statistical analyzes were provided using Review Manager 5.3 to provide the mean difference (MD) and relative risk (RR) ratio with 95% confidence intervals (95% CI). The statistical method of heterogeneity index was used to assess heterogeneity. Level of significance was 5%. Results: Combined analysis of 11 studies totaling 276,323 participants aged between 12 and 90 years did not suggest a significant increase in AF in individuals submitted to physical exercise (RR = 0.914, 95% CI = 0.833-1.003, heterogeneity: p < 0.001). Conclusions: Physical exercise, lato sensu, without stratification by intensity, sex or age does not seem to be associated with an increase of atrial fibrillation.
At the time, Dr. William Healstead realized that seriously ill patients treated by recently certified clinicians had higher mortality rates. In response to this, and in the hopes of increasing the quality and success rates of patient care, Healstead created a new type of training program, in which emerging clinicians would receive their final training in the hospital environment itself. This model, replicated globally, is currently known as medical residency. 1 In Brazil, the Orthopedic Department at Hospital of Clínicas, associated with the University of São Paulo (USP), pioneered the first Brazilian medical residency program in 1945. However, this training model was not officially adopted in the country until September 5, 1977, through decree No. 80281, which instituted residency training as a formal component of medical graduate training. 2-4 Since then, physicians worldwide have been able to train in specialized medical residency programs that not only deepen their theoretical understanding, but also provide a supervised environment for development of the practical skills required by their desired area of expertise. After being identified on December 1, 2019 in Wuhan, China, with the first cases reported on December 31, a novel infectious disease-coronavirus disease 2019, or COVID-19-a quickly emerged as a global concern. 5 The World Health Organization (WHO) subsequently declared the COVID-19 outbreak a pandemic, and the highly transmissible virus was named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). 5
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