Abstract Background Vitamin K antagonists (VKAs) are the recommended first-line treatment for left ventricular thrombus (LVT); however, direct oral anticoagulants (DOACs) have been considered an alternative therapy. Objectives To evaluate the efficacy and safety of DOACs compared with VKAs therapy in patients with LVT. Methods PubMed, Embase, and Cochrane were systematically searched for randomized clinical trials or cohort studies that compared DOACs versus VKAs for LVT. Risk ratios (RRs) were computed for binary endpoints, with 95% confidence intervals (95% CIs). Statistical significance was defined as p value < 0.05. Results A total of 4 randomized clinical trials and 29 cohort studies were included, with 4,450 patients assigned to either DOACs or VKAs. There was no significant difference between groups for stroke or systemic embolic (SSE) events (RR 0.84; 95% CI 0.65 to 1.07; p = 0.157), stroke (RR 0.73; 95% CI 0.48 to 1.11; p = 0.140), systemic embolic (SE) events (RR 0.69; 95% CI 0.40 to 1.17; p = 0.166), thrombus resolution (RR 1.05; 95% CI 0.99 to 1.11; p = 0.077), any bleeding (RR 0.78; 95% CI 0.60 to 1.00; p = 0.054), clinically relevant bleeding (RR 0.69; 95% CI 0.46 to 1.03; p = 0.066), minor bleeding (RR 0.73; 95% CI 0.43 to 1.23; p = 0.234), major bleeding (RR 0.87; 95% CI 0.42 to 1.80; p = 0.705), and all-cause mortality (RR 1.05; 95% CI 0.79 to 1.39; p = 0.752). Compared with VKAs, rivaroxaban significantly reduced SSE events (RR 0.35; 95% CI 0.16 to 0.91; p = 0.029) and SE events (RR 0.39; 95% CI 0.16 to 0.95; p = 0.037). Conclusions DOACs had a similar rate of thromboembolic and hemorrhagic events, as well as thrombus resolution, compared to VKAs in the treatment of LVTs. Rivaroxaban therapy had a significant reduction in thromboembolic events, compared to VKAs. (VKAs firstline first line LVT (LVT) however (DOACs PubMed Embase RRs (RRs endpoints 95 (95 CIs. CIs . CIs) 005 0 05 0.05 2 included 4450 450 4,45 (SSE RR 0.84 084 84 065 65 0.6 1.07 107 1 07 0.157, 0157 0.157 , 157 0.157) 0.73 073 73 048 48 0.4 1.11 111 11 0.140, 0140 0.140 140 0.140) (SE 0.69 069 69 040 40 1.17 117 17 0.166, 0166 0.166 166 0.166) 1.05 105 099 99 0.9 0.077, 0077 0.077 077 0.077) 0.78 078 78 060 60 1.00 100 00 0.054, 0054 0.054 054 0.054) 046 46 1.03 103 03 0.066, 0066 0.066 066 0.066) 043 43 1.23 123 23 0.234, 0234 0.234 234 0.234) 0.87 087 87 042 42 1.80 180 80 0.705, 0705 0.705 705 0.705) allcause all cause 079 79 0.7 1.39 139 39 0.752. 0752 0.752 752 0.752) 0.35 035 35 016 16 0.1 0.91 091 91 0.029 0029 029 0.39 039 0.95 095 0.037. 0037 0.037 037 0.037) LVTs (LVT 9 (9 0.0 445 45 4,4 0.8 08 8 06 6 0. 1.0 10 015 0.15 15 7 04 1.1 014 0.14 14 09 007 0.07 006 0.06 1.2 12 023 0.23 1.8 18 070 0.70 70 1.3 13 3 075 0.75 75 0.3 01 0.02 002 02 003 0.03 ( 44 4, 1. 0.2

Resumo Fundamento Os antagonistas da vitamina K (AVKs) são o tratamento de primeira linha recomendado para trombo ventricular esquerdo (TVE); entretanto, os anticoagulantes orais diretos (AODs) têm sido considerados uma terapia alternativa. Objetivos Avaliar a eficácia e a segurança dos AODs em comparação com a terapia com AVKs em pacientes com TVE. Métodos PubMed, Embase e Cochrane foram sistematicamente pesquisados em busca de ensaios clínicos randomizados ou estudos de coorte que comparassem AODs versus AVKs para TVE. As razões de risco (RR) foram calculadas para desfechos binários, com intervalos de confiança (IC) de 95%. A significância estatística foi definida como valor de p < 0,05. Resultados Foram incluídos um total de 4 ensaios clínicos randomizados e 29 estudos de coorte, com 4.450 pacientes designados para AODs ou AVKs. Não houve diferença significativa entre os grupos para acidente vascular cerebral ou eventos embólicos sistêmicos (AVC/EES) (RR 0,84; IC 95% 0,65 a 1,07; p = 0,157), acidente vascular cerebral (RR 0,73; IC 95% 0,48 a 1,11; p = 0,140), eventos embólicos sistêmicos (EES) (RR 0,69; IC 95% 0,40 a 1,17; p = 0,166), resolução do trombo (RR 1,05; IC 95% 0,99 a 1,11; p = 0,077), qualquer sangramento (RR 0,78; IC 95% 0,60 a 1,00; p = 0,054), sangramento clinicamente relevante (RR 0,69; IC 95% 0,46 a 1,03; p = 0,066), sangramento menor (RR 0,73; IC 95% 0,43 a 1,23; p = 0,234), sangramento maior (RR 0,87; IC 95% 0,42 a 1,80; p = 0,705) e mortalidade por todas as causas (RR 1,05; IC 95% 0,79 a 1,39; p = 0,752). Em comparação com AVKs, a rivaroxabana reduziu significativamente AVC/EES (RR 0,35; IC 95% 0,16 a 0,91; p = 0,029) e EES (RR 0,39; IC 95% 0,16 a 0,95; p = 0,037). Conclusões Os AODs tiveram uma taxa semelhante de eventos tromboembólicos e hemorrágicos, bem como de resolução do trombo, em comparação com os AVKs no tratamento de TVE. A terapia com rivaroxabana teve uma redução significativa nos eventos tromboembólicos, em comparação com os AVKs. (AVKs TVE (TVE) entretanto (AODs alternativa PubMed RR binários (IC 95 005 0 05 0,05 2 4450 450 4.45 AVCEES AVC (AVC/EES 0,84 084 84 065 65 0,6 1,07 107 1 07 0,157, 0157 0,157 , 157 0,157) 0,73 073 73 048 48 0,4 1,11 111 11 0,140, 0140 0,140 140 0,140) (EES 0,69 069 69 040 40 1,17 117 17 0,166, 0166 0,166 166 0,166) 1,05 105 099 99 0,9 0,077, 0077 0,077 077 0,077) 0,78 078 78 060 60 1,00 100 00 0,054, 0054 0,054 054 0,054) 046 46 1,03 103 03 0,066, 0066 0,066 066 0,066) 043 43 1,23 123 23 0,234, 0234 0,234 234 0,234) 0,87 087 87 042 42 1,80 180 80 0,705 0705 705 079 79 0,7 1,39 139 39 0,752. 0752 0,752 . 752 0,752) 0,35 035 35 016 16 0,1 0,91 091 91 0,029 0029 029 0,39 039 0,95 095 0,037. 0037 0,037 037 0,037) hemorrágicos (TVE 9 0,0 445 45 4.4 0,8 08 8 06 6 0, 1,0 10 015 0,15 15 7 04 1,1 014 0,14 14 09 007 0,07 006 0,06 1,2 12 023 0,23 1,8 18 0,70 070 70 1,3 13 3 075 0,75 75 0,3 01 0,02 002 02 003 0,03 44 4. 1, 0,2

ABSTRACT Purpose: To explore artificial intelligence’s impact on surgical education, highlighting its advantages and challenges. Methods: A comprehensive search across databases such as PubMed, Scopus, Scientific Electronic Library Online (SciELO), Embase, Web of Science, and Google Scholar was conducted to compile relevant studies. Results: Artificial intelligence offers several advantages in surgical training. It enables highly realistic simulation environments for the safe practice of complex procedures. Artificial intelligence provides personalized real-time feedback, improving trainees’ skills. It efficiently processes clinical data, enhancing diagnostics and surgical planning. Artificial intelligence-assisted surgeries promise precision and minimally invasive procedures. Challenges include data security, resistance to artificial intelligence adoption, and ethical considerations. Conclusions: Stricter policies and regulatory compliance are needed for data privacy. Addressing surgeons’ and educators’ reluctance to embrace artificial intelligence is crucial. Integrating artificial intelligence into curricula and providing ongoing training are vital. Ethical, bioethical, and legal aspects surrounding artificial intelligence demand attention. Establishing clear ethical guidelines, ensuring transparency, and implementing supervision and accountability are essential. As artificial intelligence evolves in surgical training, research and development remain crucial. Future studies should explore artificial intelligence-driven personalized training and monitor ethical and legal regulations. In summary, artificial intelligence is shaping the future of general surgeons, offering advanced simulations, personalized feedback, and improved patient care. However, addressing data security, adoption resistance, and ethical concerns is vital. Adapting curricula and providing continuous training are essential to maximize artificial intelligence’s potential, promoting ethical and safe surgery. Purpose intelligences s education challenges Methods PubMed Scopus SciELO, SciELO , (SciELO) Embase Science Results procedures realtime real time feedback trainees skills planning intelligenceassisted assisted security considerations Conclusions privacy surgeons educators crucial vital Ethical bioethical attention guidelines transparency intelligencedriven driven regulations summary simulations care However potential surgery (SciELO

Introduction: COVID-19 broke out in Wuhan in China in December 2019, soon reached pandemic level causing thousands of deaths worldwide. It presents mostly mild flu cases; however, it can evolve into a severe respiratory syndrome that is responsible for hospitalizations and deaths. Objective: To describe the epidemiological and spatial profile of confirmed cases of influenza-like syndrome (GB) by COVID-19 in the state of Pará. Method: Descriptive and ecological study, referring to cases of COVID-19 reported in the E-SUS VE. From the variables of the epidemiological profile, spatial distribution and temporal trend of the disease. Results: The spatial distribution showed that the concentration of cases is located in the southern municipalities of the state. In the profile variables: female gender (53.16%), age group (61.14%) 30 and 59 years, chronic heart disease represented (41.99%), diabetes (31.22%) and (16.30%) chronic respiratory diseases Health professionals infected (8%). Clinical features: fever (71.99%), cough (64.57%), and sore throat (46.78%). Confirmation criteria: rapid antibody test (84.39%), rapid antigen test (7.61%), and RT-PCR (7.48%). The temporal trend of the disease showed the peak of cases in the 20th epidemiological week. Conclusion: Mostly women, most frequent heart diseases and diabetes, confirmed by rapid test and classical symptoms of GS. A flattening of the curve was observed after the 21st week, possibly due to the lockdown intervention. However, it was shown the high number of cases on 07/07/2020 in several regions, specifically in municipalities of the southern region of the state.

Introdução: A COVID-19 surgiu em Wuhan na China em dezembro de 2019, logo alcançou o nível de pandemia causando milhares de mortes no mundo. Se apresenta em sua maioria casos gripais leves, entretanto pode evoluir para uma síndrome respiratória grave que é responsável pelas hospitalizações e óbitos. Objetivo: Descrever o perfil epidemiológico e espacial dos casos confirmados de Síndrome Gripal (SG) por COVID-19 no estado do Pará. Método: Estudo descritivo e ecológico, referente aos casos de COVID-19 notificados no E-SUS VE. A partir das variáveis do perfil epidemiológico, distribuição espacial e tendência temporal da doença. Resultados: A distribuição espacial mostrou que a concentração dos casos localiza-se nos municípios do Sul do estado. Nas viariáveis do perfil: sexo feminino (53,16%), faixa etária (61,14%) 30 e 59 anos, doenças cardíacas crônicas representou (41,99%), diabetes (31,22%) e (16,30%) doenças respiratórias crônicas Profissionais da saúde infectados (8%). Características clínicas: febre (71,99%),tosse (64,57%) e dor de garganta (46,78%). Critério de confirmação: teste rápido- anticorpo (84.39%), teste rápido antígeno (7.61%) e RT-PCR (7.48%). Na tendência temporal da doença evidenciou-se o pico de casos na 20º semana epidemiológica. Conclusão: A maioria mulheres, doenças cardíacas e diabetes mais evidentes, confirmados a maioria por teste rápido e sintomatologia clássica da SG. Observou-se o achatamento da curva após a 21º semana, possivelmente, por conta da intervenção lockdown. Entretanto mostrou-se a alta de casos na data de 07/07/2020 em diversas regiões, especificamente em municípios da região sul do estado.

ABSTRACT In Fortaleza, the capital of Ceara State, Brazil, the detection rate of tuberculosis (TB) in 2018 was 65.5/100,000 inhabitants with a cure rate of 59.1%, which is higher than the country average. This study investigated the risk factors associated with drug-resistant tuberculosis (DR-TB) and identified the drug-resistance phenotype and resistance-conferring mutations. The geographic distribution of DR-TB in Fortaleza, Brazil, was also determined. From March 2017 to February 2018, 41 DR-TB isolates and 69 drug-susceptible pulmonary TB isolates were obtained from patients seen at a referral hospital in Fortaleza, Brazil. Samples were subjected to phenotypic and genetic analysis of resistance; the spatial distribution of the participants was also analyzed. Primary resistance was high (50.9%) among participants. The following risk factors for DR were identified: being female ( p = 0.03), having diabetes ( p < 0.01), history of previous TB disease ( p < 0.01), and the number of intra-domiciliary contacts ( p < 0.01). Analysis by multiplex allele-specific polymerase chain reaction detected mutations in the genes katG (65.8%) , rpoB (43.9%), inhA promoter (14.6%), and gyrA (9.8%). Sequencing identified mutations in the the genes katG (75.6%), inhA promoter (19.5%), rpoB (85.4%), and gyrA (100%). There was no mutation in the rrs gene. Spatial analysis showed DR-TB isolates distributed in areas of low socioeconomic status in the city of Fortaleza. Our results emphasized the importance of detecting resistance to TB drugs. The resistance found in the gene gyrA is of concern due to the high number of pre-extensive DR-TB cases in Fortaleza.

OBJECTIVE: The aim of this study is to investigate the presence of human papillomavirus DNA and genotypes in breast cancer and normal breast tissue samples obtained from women from the northeast region of Brazil. METHOD: One hundred three breast cancer samples and 95 normal breast samples, as the non-malignant controls, were studied. DNA extraction was verified by human beta-globin gene amplification, and polymerase chain reaction was conducted based on HPV L1-specific consensus primers MY09/MY11 and GP5+/GP6+, followed by nested multiplex polymerase chain reaction with type-specific primers for the E6/E7 consensus region. RESULTS: Human papillomavirus DNA was detected in 51 (49.5%) breast carcinoma samples and 15 (15.8%) normal breast samples (p<0.0001). Human papillomavirus genotypes 6 and 11 were identified in 15.2% of all samples. CONCLUSIONS: The high frequency of human papillomavirus infection in breast cancer samples indicates a potential role of this virus in breast carcinogenesis in the studied participants.