Introduction: In the scenario of cardiovascular disease (CVD), the WHO reported in 2017 that there are about 21.7 million deaths, of which more than ten million are due to atherosclerotic coronary disease. In Brazil, CVD is responsible for about 384 thousand deaths per year. Arterial access for coronary angiography and percutaneous coronary interventions has addressed the change from the transfemoral to the transradial (TRA) pathway, as this presents fewer complications, especially the distal transradial pathway (dTRA) in the anatomical snuffbox. Objective: To carry out a systematic review of the main snuffbox approaches. Methods: Review papers, systematic reviews, prospective studies, retrospective studies, clinical trials, and case reports were selected. The MeSH Terms were the Radial artery. Catheterization. Percutaneous coronary intervention. Of the total of 105 articles found, 23 studies were selected, following the rules of PRISMA. Results: The studies analyzed showed that dTRA is a reliable, safe, effective and comfortable route. The position of the arm during the intervention is comfortable for the patient, who does not need to expose the palm side of the arm while flexing the arm towards the operator. The studies also reported that there is a low rate of obstruction of the distal radial artery. There is also early hemostasis, low risk of hematoma formation, low level of pain perceived by patients, reduced risk of compartment syndrome, saving the radial artery for possible future myocardial revascularization grafting, and the operator's ability to work at a safe distance of the radiation source. The average success rate in the studies analyzed was 97%. The average rate of occlusion of the distal radial artery was 0.5%. Other complications at the access site were hematoma (0.2%), pulsatile hematoma (<0.1%), infection (0.1%), dissection (0.1%), arteriovenous fistula (<0.1%) . Conclusion: Distal radial access is a reliable, safe, effective, and comfortable route for cardiovascular interventions. They have a less arterial obstruction and short hemostasis. The main disadvantage is the difficulty in cannulation. However, more randomized studies and meta-analysis are needed to establish a guideline. Keywords: Transradial artery. Distal transradial artery. Left distal transradial artery. Catheterization. Percutaneous coronary intervention.  
Objective: This study measured the cortisol levels of professional athletes during a CrossFit® championship. Then, it evaluated the physiological response caused by cortisol. Increased cortisol levels may interfere with the athletes’ performance and muscle recovery. Materials and Methods: A prospective observational cross-sectional study was performed with a sample of eight female professional athletes, aged between 20 and 34 years, enrolled in the 2017 Brazil CrossFit Championship (TCB), held in Valinhos, state of Sao Paulo, Brazil.  The salivary samples were obtained during the three days of the championship in two different moments: in the morning, before athletes’ warm-up, and 15 minutes after the last workout of each day. Results: Before warming up, the mean values of salivary cortisol were 15.9 ng/mL, 13.2 ng/mL, and 13.1 ng/mL, respectively. After the last workout, the mean values for cortisol were 6.4 ng/mL, 9.6 ng/mL, and 7.1 ng/mL, respectively. A statistically significant difference was found on the first day of competition.  The results presented the expected diurnal cycle of this hormone.  Conclusion: CrossFit® is a sport that alternates medium- to high-intensity exercises, including gymnastics, metabolic conditioning, and weight lifting. This competitive sport presents a variability of stressors, which may increase cortisol production and secretion according to different studies. This study found that the physiological stress of a CrossFit® championship affects the production of cortisol and increases the stimulation of the hypothalamic axis. However, the normal cortisol secretion response suggests a physiological adaptation or alteration in the cortisol receptor in the athletes studied.  Further studies carried out with a larger sample are necessary to assess these neuroendocrine changes.Keywords: CrossFit®. Cortisol. Physical activity. Women.
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Introduction: The number of disabilities due to age is expected to double by 2060. In this scenario, the development of sarcopenia is an important risk factor for the development of frailty, loss of independence and physical disability in the elderly and is associated with lower survival in critically ill patients. In this sense, the decline in fat-free mass correlates with the decline associated with the age of growth hormone (GH) secretion. Thus, GH secretagogue (MK-677) as the first orally active ghrelin mimetic may increase pulsatile GH secretion in the elderly. Objective: The main objectives were to determine whether oral MK-677 in healthy elderly would increase GH and IGF-I levels, prevent the decline of FFM and decrease abdominal visceral fat (AVF) with acceptable tolerability. Methods: A total of 18 articles were found involving MK-677, GH secretagogue, sarcopenia, insulin-like growth factor-1, safety, and efficacy. Initially, it was held the existing exclusion title and duplications following the interest described in this work. After this process, 5 articles were included and discussed in this study. The present study was elaborated according to the rules of systematic review- PRISMA (Transparent reporting of systematic reviews and meta-analysis- Results: In a clinical study, MK-677 neutralized three important factors contributing to the development of sarcopenia, which is reduced GH secretion, fat-free mass loss, and inadequate food intake. A recent study looked at the safety and efficacy of the oral GH secretagogue (MK-677) in humans, showing that MK-677 promotes pulsatile GH release that is subject to negative feedback and may prevent supra-therapeutic levels. of GH and its sequelae. Available studies indicate that MK-677 is well tolerated, however, there is a bias in decreased insulin sensitivity. There were no adverse effects attributable to MK-677. However, MK-677 had an unfavorable safety profile in individuals with congestive heart failure. Conclusion: The most confirmed sarcopenia treatment methods are nutritional overfeeding and resistance training, but studies have shown that supplementation with MK-677 can significantly reduce three important factors contributing to the development of sarcopenia, which is reduced secretion. GH loss, fat-free mass loss, and inadequate food intake, safely and effectively. However, it is imperative to increase randomized clinical trials to establish a consensus treatment. Keywords: MK-677. Ibutamoren. GH secretagogue. Sarcopenia. Elderly.
INTRODUCTION: Obesity is an important health condition that is related to high rates of morbidity and mortality. Bariatric surgery, although effective, has limited indications and may pose a risk of early and late postoperative complications, one of which is related to the gastric retaining ring, such as erosion, sliding of the device, and food intolerance. One of the modalities used in the endoscopic treatment of ring extraction is the use of stents, which represents a minimally invasive, safe, and effective alternative to the detriment of surgical treatment. OBJECTIVE: To characterize the modalities of endoscopic treatment using Stents for the treatment of complications associated with the retaining ring in the postoperative period of bariatric surgery and to determine the success rate of the different methods of endoscopic treatment. METHODS: The present study will follow an international model of systematic review and meta-analysis, following the rules of PRISMA. The search strategies for this systematic review will be based on the keywords (MeSH Terms) “Obesity. Endoscopy. Bariatric surgery. Gastric Bypass. Stents ”, with publications between 2010 and 2020, in order to analyze more recent scientific publications. Meta-analysis: A common descriptive statistical analysis will be carried out, obtaining the values of total N, mean, standard deviation, confidence interval (CI), and percentage (frequency) for all predictors. The One-Way test (ANOVA) will be applied, adopting the α level less than 0.05 with a statistically significant difference for the 95% CI. The value of R-sq (I2) will be analyzed to discover the inaccuracy or heterogeneity of the analyzes. The S factor will indicate the standard deviation between the data points and the adjusted values.  Keywords: Obesity. Endoscopy. Bariatric surgery. Gastric Bypass. Stent.
Background: Endoscopic methods, especially the intragastric balloon (IGB), have been shown to be effective for the treatment of excess weight. This study aimed to assess the tolerance, complications and efficacy of excess weight treatment with a non-adjustable IGB during 6 months. Methods: A total of 5,874 patients treated with a liquid filled IGB (600-700mL) and followed up by a multidisciplinary team were evaluated.  Participants presented an initial body mass index (BMI) ≥25 kg/m2 and were stratified according to sex and degree of overweight (pre-obesity and obesity grade I, II and III).  Results: The incidence of complications was 7.32% (n=430): 6.10% (n=357) early IGB removal, 0.20% (n=12) gas production inside the balloon, 0.54% (n=32) leakage, 0.32% (n=19) pregnancy, 0.07% (n=4) gastric perforation, 0.05% (n=3) upper digestive bleeding,  0.01% (n=1) Wernick Korsakoff syndrome due to excessive vomiting, 0.02% each (n=1) pancreatitis and esophagus perforation. The 5,444 remaining patients (4081 women, 38±38years) presented a weight loss of 19.13±8.86kg and a BMI decreased significantly (p<0.0001) (36.94±5.67 vs. 30.08±5.06 kg/m2). The % total weight loss (%TWL) was 18.42±7.25% and % excess weight loss (%EWL) 65.66±36.24%. The treatment success rate (%TWL≥10%) was 85%. The %EWL was higher in the pre-obese group (122.19%), followed by obesity grades I (76.67%), II (56.01%) and III (45.45%), with p<0.0001 for each group. %EWL was higher in women (69.71%) than in men (53.39), with p<0.0001 for each group. There was also a statistical difference between the TWL and EWL groups, with p<0.001 for all analyzes. Conclusion: Endoscopic IGB treatment for excess weight is an excellent therapeutic option for patients with different degrees of overweight. Keywords: Intragastric balloon. Orbera balloon. Bariatric endoscopy. Endoscopic. Obesity treatment.
Introduction: Coronaviruses (CoV) are a diverse group of viruses described in the literature since 1960. In particular SARS-CoV and MERS-CoV, and a deadly recent COVID-2019 infection [3], which is now causing a worldwide outbreak in the first half of 2020. SARS-CoV was discovered in China in 2002. This new virus was found in the city of Wuhan, in the province of Hubei, in central China, where 11 million inhabitants live. Objective: Due to the chaos of the coronavirus, worldwide, and because it is a new deadly virus, the present study aimed to carry out a systematic study on the global status of the new coronavirus COVID-2019 and aspects of previous SARS-CoV infections and MERS- CoV. Methods: The present study was followed by the Systematic Review in relation to the new coronavirus COVID-2019. The research was conducted from January to March 2020. A total of 89 clinical studies were compared and submitted to the eligibility analysis and, after that, 50 studies were selected, following the systematic review rules – PRISMA. The COCHRANE instrument was adopted to assess the quality of the included studies. Major findings and conclusion: The COVID-2019 pandemic is notorious. In some regions of the planet, it appears to be out of control. In case of suspicion in the region, tests are essential to identify it in the early stages of infection. These tests will guide quarantine decisions and other public health measures to limit the spread of contagion. However, it now seems likely that advanced support is needed to identify and isolate infected patients, as well as drugs that help control the virus, and, above all, to the promising solution for this circumstance, vaccines to control the epidemiological situation in each region. These measures are expected to reduce the proportion of infections, decrease the growth and spread of the coronavirus and, especially, in which countries are anxiously awaiting, the development of effective drugs and vaccines for COVID-2019. Keywords: COVID-2019. SARS-CoV. MERS-CoV. Pandemic. Contagion. Coronavirus.
Introduction: On March 11, 2020, the World Health Organization (WHO) declared the coronavirus outbreak (COVID-19) to be pandemic. By March 16, 2020, 139 countries were affected. In this situation, the Scientific Societies decided to prepare this Contingency Plan to guide the response of health services. 4,088,848 COVID-19 cases and 283,153 deaths were confirmed worldwide. Recent data presented by the Ministry of Health in Brazil show that 177,589 cases of coronavirus and 72,597 recovered people have already been registered. However, nursing homes usually are not counted in these statistical data, as people usually die in the Istitution. Thus, developing a monitoring program in medical services, such as in nursing homes for eldery people (NHE) with ideal care for possible patients infected with COVID-19, is essential to increase the protection of the most vulnerable, as well as professionals of health. Objective:  To present the monitoring program of the Nursing homes in the city of São José do Rio Preto/SP, by Faceres Medica School, as an important strategy to identify, control and allocate patients infected by COVID-19. Methods:. All the NHE registered in the city council were raised , with data such as head nurse name, number of beds available and number of inpatients . According to the program's action plan, telephone calls was made daily by trained medical students with a professor tuition to all institutions and information was provided by the head nurse. Thus, when a resident or employee has symptoms, he was removed and tested for SARS-CoV-2. Subsequently, epidemiological surveillance was communicated and the case was monitored. Final Considerations: According to the world literature, elderly patients with COVID- 19 are more likely to progress to severe disease. Therefore, extensive measures to reduce the transmission of COVID-19 from person to person are being implemented to control the current outbreak. The monitoring program at the NHE proposed in the present study aims to collaborate in this regard, especially to the most vulnerable.