md phd ufrj

Que tal tentar o

Você estuda medicina já imaginou ganhar para fazer ciência enquanto estuda, o programa de doutorado concomitante com a faculdade e exclusivo para alunos de medicina. e com bolsas de até r$ 2.875*., *valor referente à maior bolsa de doutorado do país. o valor usual é de r$ 2.200., o que é.

MD-PhD é um título internacional dado a médicos com formação científica equivalente a um Doutorado (Ph.D.) Pouquíssimos médicos no Brasil tem esse título. Lá fora também.  

Não se iluda, para entrar o processo é complexo e existe pouca informação por aí. Você vai precisar ter diferencial e  criatividade . Queremos que você entenda os passos necessários para entrar nesse programa!

Você vira um especialista na sua área de escolha

Título reconhecido internacionalmente

Você faz o Doutorado sem precisar ter Mestrado

O título pontua muito nas provas de residência

As atividades científicas necessárias pra chegar no MD-PhD também pontuam

Te permite fazer pós-doutorado e seguir área acadêmica (se você quiser!)

Quais as vantagens de ser MD-PhD?

E pra te ensinar tudo o que você precisa saber pra ser um md-phd, preparamos um pacote exclusivo para quem:.

Está fazendo graduação em uma faculdade que oferece MD-PhD

Estuda em uma instituição que não oferece o programa, mas está disposto a ter uma vida científica em outra (vamos te ensinar como fazer isso também!)

Pacote MD-PhD com tudo o que você vai precisar:

e leve de bônus:

Oficina do MD-PhD

Curso (R$ 449)

Curso (R$ 497)

De R$ 946  por  R$ 229

Comprar o pacote não garante que você será aprovado para um programa de MD-PhD ou que receberá uma bolsa. 

Curso que te explica como aplicar para o processo seletivo do MD-PhD com foco na documentação, na burocracia e em construir um currículo de peso pra passar!

O que está incluso?

5 Aulas explicando o processo seletivo do MD-PhD com exemplos da UFRJ, UFF e mais

Aula 1: Diagnóstico da sua situação acadêmica ​Aula 2: Iniciação Científica Aula 3: Orientação e Orientadores Aula 4: Documentação Aula 5: A banca de MD-PhD e a aprovação

Masterclass com 21 aulas pra entrar com o pé direito na ciência!

um eBook de   70 páginas contendo informações práticas e   24 exercícios para se tornar um cientista de excelência!

Quem serão seus instrutores?

Maria sampaio.

Medicina na UFRJ e Doutoranda (MD-PhD) do Instituto de Biofísica da UFRJ. Trabalho com genômica e cirurgia cardíaca e sou Coordenadora de redes sociais da Rede Nacional de Genômica Cardiovasucular.

Bruno Paranhos

Doutorado Direto no Instituto de Biofísica da UFRJ. Faço parte de um dos grupos que mais aprova MD-PhDs no país e já presenciei várias seleções. Trabalho com bioengenharia para transplante hepático.

Conheça a história de alguns alunos

Rafael Kader, médico pela UFRJ, CEO da BeSafe Saúde

Aluno de MD-PhD em Clínica Médica na UFRJ

O ingresso no programa MD-PhD, ainda enquanto graduando da Faculdade Nacional de Medicina da UFRJ, com 23 anos, me deu a oportunidade de trabalhar com COVID-19 em pacientes hospitalizados em centros de referência em assistência médica e de pesquisa no Rio de Janeiro - como o HUCFF e a FIOCRUZ. Além do propósito de deixar um legado científico e contribuir para o alívio de danos à saúde global causados pelo novo coronavírus, o MD-PhD permitiu que eu me qualificasse para um mercado de trabalho médico cada vez mais competitivo ainda tão jovem.

Julia Bispo, medicina UFRJ (12º período)

Aluna de MD-PhD em Fisiologia na UFRJ

Fiz iniciação científica durante minha graduação, mas isso não foi o suficiente para entender o passo-a-passo pra entrar no MD-PhD.  Entrar no MD-PhD completou a minha jornada na Medicina: ser um bom médico é obrigatório, mas ser um médico extraordinário é nossa própria escolha.

Pesquisador e médico não precisam ser duas profissões diferentes se a gente souber trilhar esse caminho: sempre um vai agregar ao outro. Como MD-PhD, temos uma visão diferenciada – desde a base molecular ao tratamento de uma doença – e com o treinamento necessário para ensinar diversas gerações de profissionais da saúde por vir. Acredito que a singularidade profissional e o leque de possibilidades só podem vir realmente para quem ousar trilhar um caminho que poucos têm a coragem. Como nós.

Clara Avelar, medicina Estácio de Sá (5º período)

Aluna de Iniciação Científica do LAPARC, estagiária no INC

Eu encontrei o MD-PhD pelo instagram de uma amiga. Na época, não tinha a menor ideia do que se tratava, assim como a maioria dos estudantes de medicina. Graças a ajuda da Maria, consegui fazer parte de uma pesquisa e aprendi como realmente me ver como cientista. Infelizmente, não é fácil encontrar informações sobre o MD-PhD e ninguém te ensina que você pode sim ser um cientista mesmo fazendo medicina. O curso me ensinou MUITAS coisas. Como pensar como cientista, criar minhas próprias obrigações, estimulou minha proatividade, senso crítico, criatividade e trabalho em equipe. É uma oportunidade única e incrível para todos aqueles que queiram desenvolver suas habilidades no mundo da ciência.

O pacote é oferecido pelo Coractium , uma startup feita de cientistas para cientistas. Queremos democratizar o acesso ao programa de MD-PhD e ampliá-lo para que se torne mais abrangente, mais concorrido, mais divulgado e com maior impacto nacional.  Todo acadêmico tem uma paixão dentro de si. Queremos despertar sua paixão pela ciência e te ajudar a fazer disso uma carreira médica mais focada em ciência. Afinal, você já deve ter percebido que o futuro é dos cientistas, certo? Se esse pensamento nunca tinha passado pela sua cabeça, tenta imaginar uma profissão que:   

Vá durar no tempo 

Gere riquezas e saúde para a população mundial 

Tenha metodologias estabelecidas há centenas de anos 

Infelizmente, muitos estudantes de medicina ainda não sabem as ferramentas necessárias para seu sucesso científico. 

Dúvidas frequentes.

Queremos que você se sinta à vontade, profissional do futuro.

Fomente a ciência por

R$ 99  , queremos tornar a ciência mais acessível., comprando este curso você ajuda uma empresa de jovens cientistas a desenvolver soluções para a comunidade.

Programa MD-PhD: como começar o doutorado cursando a faculdade

Você já ouviu falar sobre o programa MD- PhD? Já pensou sobre tentar se candidatar? À primeira vista, pode parecer impossível existir a possibilidade de fazer o doutorado cursando a faculdade de medicina. Como conciliar duas atividades que demandam muito tempo de dedicação e de estudo? Como conseguir se organizar para dar conta de todas as tarefas, já que os dias possuem apenas 24h? Será mesmo possível fazer isso?

À primeira vista, cursar a graduação e a pós-graduação de forma concomitante pode parecer loucura. No entanto, não é bem assim. Devemos ter em mente que esse é um programa diferenciado e adaptado para estudantes de medicina. Na realidade, mesmo com a carga horária extensa, cada universidade acaba adotando critérios e regras próprias, com o objetivo de tornar viável a realização do programa. Obviamente isso não quer dizer que a trajetória do aluno que opta pelo MD-PhD não seja cansativa. Pelo contrário, ela tende a ser mais cansativa do que a dos colegas que optam a dedicar- se exclusivamente à graduação.

Veja também: “Doutorado e faculdade de medicina ao mesmo tempo? Como assim?”

Dessa forma, o incentivo à produção de cientistas médicos pode não ser tão surreal assim quanto nos parecia no primeiro momento. Até porque, trata- se de uma oportunidade única de obter uma formação que propicie a realização de descobertas a partir de pesquisas desenvolvidas em laboratórios. Além disso, que possibilite a  utilização e a aplicação do conhecimento médico. Buscando traduzir suas conclusões em possíveis tratamentos eficazes para os pacientes. E você? Gostaria de encarar essa? Neste artigo, vamos entender um pouco mais sobre as motivações dos alunos, o dia- a- dia e as expectativas.

De onde surge a motivação dos alunos?

Todos os estudantes de medicina que pretendem cursar o programa MD- PhD precisam ter determinação para seguir em frente com projeto. Ao iniciar o doutorado antes de finalizar a graduação, ele precisa estar ciente de que precisará destinar. Além do tempo que reserva diariamente aos estudos e às aulas da graduação, uma quantidade de tempo também grande para a pós- graduação.

O aluno precisa estar disposto e decidido a realizar todas as atividades previstas nos dois programas de forma concomitante. Sempre conciliando os horários e se adaptando à cada situação. Portanto, esse aluno que pensa em se candidatar ao programa precisa realmente ter a certeza de seus objetivos e, adicionalmente, precisa ter a convicção de que o objetivo principal do programa está alinhado aos seus objetivos de vida.

Esse aluno precisa realmente ter vontade de trabalhar com pesquisa. Assim, o programa pode ser muito prazeroso e gratificante. Mais do que isso, a rotina nos laboratórios de pesquisa pode se tornar um gatilho para uma vida de muito sucesso acadêmico e de muita satisfação profissional e pessoal.

O que faz com que os alunos de medicina decidam seguir um programa de MD-PhD?

Em geral, o que move a maioria desses alunos é a curiosidade. Curiosidade essa que também é a chave responsável pela motivação de muitos pesquisadores, independentemente da formação de cada um. O que leva alunos a buscar um laboratório de pesquisa para participarem ativamente de projetos de pesquisa e para efetivamente participarem de diversos experimentos ainda como estudante de graduação é, sobretudo, o interesse em descobrir o novo. Em responder a perguntas que ainda não possuem respostas.

Nesse sentido, essas características e formas de pensar funcionam como combustíveis para esses alunos, os quais se sentem motivados a buscar entender de forma mais aprofundada os motivos e as formas. É isso que fomenta a busca pelo que está por trás de toda a conduta médica.

À medida que vão ganhando experiência, os alunos envolvidos em projetos de pesquisa ficam ainda mais entusiasmados com o mundo da investigação experimental. Além disso, a leitura frequente de artigos científicos permite que esses estudantes estejam cada vez mais atualizados e desenvolvam o senso crítico. Isso fomenta ainda mais a busca pelo saber.

E o que eles ganham com isso?

Enquanto na clínica é possível testemunhar a maneira com a qual as diferentes terapias propostas causam impacto na vida de cada paciente acompanhado. No laboratório são oferecidas inúmeras oportunidades de criar novas possibilidades terapêuticas. Entretanto, essas novas terapias desenvolvidas, se obtiverem sucesso, serão reproduzidas em grande escala. Com isso terão impacto imensurável no tratamento da doença para incontáveis pacientes.

De maneira geral, pode- se dizer que, na maioria dos casos, o principal ganho desses alunos é a satisfação na possibilidade de- além de receber o retorno e a recompensa imediatos ao cuidar de seus pacientes nos consultórios, hospitais e clínicas.

Bem, uma vez concluído o PhD. Que tipos de opções de carreira o programa MD-PhD oferece?

De maneira geral, a maioria dos graduados que completam o MD- PhD buscam uma carreira em medicina acadêmica. Esperando que ela seja pautada no trabalho em um hospital de ensino. Nesse contexto, é possível que o médico-cientista busque oportunidades incluindo ensinar, ver pacientes, investigar questões biomédicas importantes no laboratório. O duplo grau permite que um médico-cientista se mova de forma fluida entre os domínios clínicos e/ ou cirúrgicos e de pesquisa. São amplamente encontrados em hospitais universitários.

No entanto, médicos- cientistas não estão limitados e essas opções. Apesar de as trajetórias mencionadas acima serem mais comuns e tradicionais, não são as a únicas existentes. Médicos-cientistas também podem buscar cargos nas indústrias de biotecnologia, nas indústrias farmacêuticas, trabalhos em consultoria, administração, defesa de direitos, políticas públicas, saúde global, educação e muito mais.

E se eu me interessar pelo programa? Que tipo de experiência de pesquisa é ideal ter antes de me candidatar?

Isso pode variar de acordo com cada universidade em que o programa MD-PhD esteja vigente. Em geral, é valorizado que, como estudante de graduação, o aluno faça estágios em algum laboratório da própria universidade. Além disso, é interessante que o aluno participe de seminários, discussões de artigos e que esteja sempre em contato com outros pesquisadores, buscando sempre manter- se informado.

Como escolher um laboratório?

É muito importante manter a mente aberta sobre o tipo de pesquisa e laboratórios para participar do seu trabalho de doutorado. Muitos alunos entram pensando que sabem exatamente o que querem fazer durante o doutorado e acabam recusando grandes oportunidades

Além disso, não se limitar a uma ideia específica permite muitas vezes que alunos se surpreendam e acabem por optar por seguir linhas de pesquisa bastante diferentes das que planejaram originalmente. É frequente ver os alunos alegarem que estão muitos satisfeitos por terem “mudado de ideia”.

Por isso, se você pretende entrar nessa, tente conhecer vários tipos de laboratórios e de linhas de pesquisa, antes de selecionar um orientador de PhD e um laboratório. Esteja preparado para mergulhar fundo e para fazer um trabalho de qualidade.

E se você me perguntar: Bia, como você se sente em relação ao programa MD- PhD? O que você mais gosta nele?

Particularmente sou suspeita para falar. Gosto do programa e vejo nele a possibilidade de encurtar o tempo necessário para que eu atinja o meu sonho. Adoro o fato de que, quanto mais aprendo, mais sou motivada a buscar aprender mais, conhecer mais. Acho incrível a rapidez com que surgem novas possibilidades de criar, de produzir, de descobrir. Além disso, sinto- me privilegiada por estar cercada por colegas extremamente competentes, curiosos e, principalmente APAIXONADOS pelo que fazem.

Ver o brilho no olhar dos meus colegas é minha recompensa diária. Considero que ser médico-cientista não consiste em apenas um trabalho, mas sim em uma trajetória desafiadora e inigualável. Ao longo dos anos, você provavelmente experimentará alguns momentos de aflição, mas também muitos momentos de felicidade extrema. Permanecer flexível, paciente e resiliente é fundamental para aproveitar o processo.

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Metastatic pulmonary calcification: high-resolution computed tomography findings in 23 cases

Affiliations.

• 1 MD, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.
• 2 MD, PhD, Ottawa Hospital Research Institute, University of Ottawa, Canada.
• 3 MD, PhD, Faculdade de Medicina de São José do Rio Preto (Famerp) and Ultra X, São José do Rio Preto, SP, Brazil.
• 4 MD, PhD, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil.
• 5 MD, PhD, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.
• 6 MD, PhD, Hospital Universitário, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil.
• 7 MD, PhD, Universidade Federal do Rio de Janeiro (UFRJ) and Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro, RJ, Brazil.
• 8 MD, Hospital Beneficência Portuguesa and Med Imagem, São Paulo, SP, Brazil.
• 9 MD, MSc, Facultad de Medicina Clinica Alemana, Universidad del Desarrollo, Santiago, Chile.
• 10 MD, PhD, A.C.Camargo Cancer Center, São Paulo, SP, and Universidade Federal do Vale do São Francisco (Univasf), Petrolina, PE, Brazil.
• 11 MD, PhD, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.
• PMID: 28894330
• PMCID: PMC5586513
• DOI: 10.1590/0100-3984.2016-0123

Abstract in English, Portuguese

Objective: The aim of this study was to evaluate the high-resolution computed tomography (HRCT) findings in patients diagnosed with metastatic pulmonary calcification (MPC).

Materials and methods: We retrospectively reviewed the HRCT findings from 23 cases of MPC [14 men, 9 women; mean age, 54.3 (range, 26-89) years]. The patients were examined between 2000 and 2014 in nine tertiary hospitals in Brazil, Chile, and Canada. Diagnoses were established by histopathologic study in 18 patients and clinical-radiological correlation in 5 patients. Two chest radiologists analyzed the images and reached decisions by consensus.

Results: The predominant HRCT findings were centrilobular ground-glass nodules ( n = 14; 60.9%), consolidation with high attenuation ( n = 10; 43.5%), small dense nodules ( n = 9; 39.1%), peripheral reticular opacities associated with small calcified nodules ( n = 5; 21.7%), and ground-glass opacities without centrilobular ground-glass nodular opacity ( n = 5; 21.7%). Vascular calcification within the chest wall was found in four cases and pleural effusion was observed in five cases. The abnormalities were bilateral in 21 cases.

Conclusion: MPC manifested with three main patterns on HRCT, most commonly centrilobular ground-glass nodules, often containing calcifications, followed by dense consolidation and small solid nodules, most of which were calcified. We also described another pattern of peripheral reticular opacities associated with small calcified nodules. These findings should suggest the diagnosis of MPC in the setting of hypercalcemia.

Objetivo: O objetivo deste estudo foi avaliar os achados de tomografia computadorizada de alta resolução (TCAR) em pacientes com diagnóstico de calcificação pulmonar metastática (CPM).

Materiais e métodos: Revisamos, retrospectivamente, os achados na TCAR de 23 casos de CPM [14 homens e 9 mulheres; idade média, 54,3 (intervalo, 26-89) anos]. Os pacientes foram examinados entre 2000 e 2014 em nove hospitais terciários no Brasil, Chile e Canadá. O diagnóstico foi estabelecido por estudo histopatológico em 18 pacientes e correlação clinicorradiológica em 5 pacientes. Dois radiologistas de tórax analisaram as imagens e chegaram a decisões por consenso.

Resultados: Os achados predominantes na TCAR foram nódulos centrolobulares em vidro fosco ( n = 14; 60,9%), consolidação com alta atenuação ( n = 10; 43,5%), pequenos nódulos densos ( n = 9; 39,1%), opacidades reticulares periféricas associadas com pequenos nódulos calcificados ( n = 5; 21,7%) e opacidades em vidro fosco sem nódulos centrolobulares em vidro fosco ( n = 5; 21,7%). Calcificação vascular na parede torácica foi encontrada em quatro casos e derrame pleural foi observado em cinco casos. As anormalidades foram bilaterais em 21 casos.

Conclusão: CPM manifestou-se com três padrões principais na TCAR. O aspecto mais comum foram os nódulos centrolobulares em vidro fosco, frequentemente contendo calcificações, seguido de consolidação densa e de pequenos nódulos sólidos, a maioria deles calcificada. Também descrevemos o padrão de opacidades reticulares periféricas associadas a pequenos nódulos calcificados. Esses achados devem sugerir o diagnóstico de CPM no contexto de hipercalcemia.

Keywords: Computed tomography; Metabolic diseases; Metastatic pulmonary calcification; Pulmonary diseases.

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Minc Brazilian Jiu-Jitsu’s mission is to teach the entire family, regardless of knowledge, level, age and gender. In addition to experienced athletes, the MBJJ team consists of doctors, scientists and PHDs that help us further more in its mission.

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Applying to MD-PhD Programs

New section.

Are you considering a MD-PhD program? Here the basics about applying to MD-PhD programs to help you get started.

The MD-PhD dual degree training prepares you for a career that is busy, challenging, and rewarding, and offers opportunities to do good for many people by advancing medical science, developing new diagnostics and treatments for diseases, and pushing back the boundaries of the unknown.

How do I know if a combined program is right for me?

MD-PhD programs are specifically designed for those who want to become physician-researchers, also known as physician-scientists. Graduates of MD-PhD programs often go on to become faculty members at medical schools, universities, and research institutes such as the National Institutes of Health (NIH).

MD-PhD program students are being prepared for careers in which they will spend most of their time doing research in addition to caring for patients. It is critical that applicants have a passion for doing both — most MD-PhD graduates feel strongly that they would not be fulfilled by only pursuing medicine or science.

How do I apply?

Nearly all MD-PhD programs participate in the application process via the American Medical College Application Service® (AMCAS®) . On their AMCAS applications, students designate themselves as MD-PhD applicants and complete two additional essays: one related to why they are interested in MD-PhD training, and the other highlighting their significant research experiences.

What schools offer this type of program?

Nationwide, there are more than 90 MD-PhD programs affiliated with medical schools. The National Institute of General Medical Sciences (NIGMS) supports Medical Scientist Training Programs or MSTPs. They currently provide training grants that partially support MD-PhD programs at 49 degree-granting institutions. You can see which schools offer MD-PhD degrees in the  Medical School Admission Requirements™  profiles under “Combined Degrees and Special Programs.” You can also review  Individual MD-PhD Program Information for Prospective Applicants for easy access to individual MD-PhD program websites.

How long does it take?

Students enter an integrated curriculum that typically takes seven to eight years to complete, during which time, they satisfy the full requirements for both the MD and the PhD degrees.

What kind of work can I do? How much time is spent as an MD? As a researcher?

According to a  study of MD-PhD program outcomes , nearly 80 percent of graduates are following career paths consistent with the goals of their training, including working as full-time faculty in academic medical centers or for the NIH, research institutes, industry, and federal agencies. Those in academia spend between 50 and 80 percent of their time conducting research, though this can vary by specialty. Their research may be lab-based, translational, or clinical. The remaining time is often divided between clinical service, teaching, and administrative activities.

MD-PhD Application Timeline

AMCAS application opens:  May preceding the year of expected entry Applicants interviewed:  October-March Final decisions sent to applicants:  December-March Applicants revisit program(s) to decide where to matriculate:  March-April MD-PhD programs start:  June-August

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Sleep Apnea Is Underdiagnosed in Cardiovascular Disease

Teresa santos (in collaboration with ilana polistchuck, md).

June 02, 2022

Several scientific studies have indicated a connection between obstructive sleep apnea and cardiovascular disease. According to Elizabeth Muxfeldt, MD, PhD, cardiologist and professor at the Federal University of Rio de Janeiro (UFRJ) and Estácio de Sá University, Rio de Janeiro, Brazil, the prevalence of obstructive sleep apnea among individuals with drug-resistant hypertension is around 80%. Leonardo Siqueira, MD, electrophysiologist at the UFRJ Clementino Fraga Filho Hospital, estimates that approximately half of patients with atrial fibrillation (AF) have some degree of obstructive sleep apnea.

Despite the prominence of the condition, obstructive sleep apnea remains underdiagnosed in the general population as well as among patients with cardiovascular diseases. In light of this fact, an alert was sounded during a virtual session of the 39th Congress of the State of Rio de Janeiro Society of Cardiology (SOCERJ), which took place in May.

At-Risk Populations

Many doctors still do not routinely assess the sleep quality of their patients. João Manoel Pedroso, MD, PhD, physician and professor at the UFRJ and moderator of the scientific session, believes that healthcare professionals need to ask patients about the quality of their sleep and provide guidance on sleep hygiene measures.

According to Luiz Lazzarini, MD, PhD, pulmonologist at the Pro-Cardiac Hospital and professor at the UFRJ, it is up to physicians, cardiologists, and clinicians in other specialties to increase research into snoring and daytime sleepiness — two symptoms often related to obstructive sleep apnea. "This investigation can be conducted using simple questions such as, 'Do you snore and/or feel very sleepy during the day?' If the answer is yes to one or, especially, both of these questions, we must at least consider the presence of sleep apnea," Lazzarini emphasized during the debate.

It is essential to consider the diagnosis of obstructive sleep apnea, particularly for patients with risk factors for cardiovascular diseases. Although research into snoring and daytime sleepiness is relevant in the diagnosis of sleep apnea, some specific cases also call for investigation, regardless of the response to these questions. According to Muxfeldt, this applies, for example, to patients with drug-resistant hypertension, given the high prevalence of obstructive sleep apnea in this population.

Not only do most patients with drug-resistant hypertension have this sleep disorder as a comorbidity, but also more than half of these patients present with moderate to severe apnea, said Muxfeldt.

These days, it is well known that sleep apnea is the leading cause of secondary systemic hypertension, said Lazzarini. This means that, after genetic predisposition, obstructive sleep apnea is the main cause of hypertension.

Another group to which particular attention should be paid is patients with AF. According to Siqueira, it is crucial to study the occurrence of obstructive sleep apnea in this patient population, especially in cases of persistent AF or when other risk factors, such as hypertension and diabetes, are involved. Siqueira also noted that research is key for patients with bradyarrhythmia and sinus node dysfunction, particularly when pauses are noted on the Holter monitor throughout the night.

Moreover, Siqueira noted that the incidence of ventricular extrasystoles is significantly higher among patients with obstructive sleep apnea than among those without apnea. "We know that obstructive sleep apnea is related to increased risk of sudden death," he added.

In contrast, central apnea is more prevalent in patients with congestive heart failure (HF), especially in patients with systolic HF. However, it also occurs in patients with diastolic HF, said Fernando Pacheco, MD, pulmonologist and chair of the Brazilian Association of Sleep – Rio de Janeiro Region. "Central apnea is a poor prognosis marker for HF, associated with higher mortality," he pointed out.

Diagnosis and Treatment

The gold standard for diagnosing obstructive sleep apnea is polysomnography. Nevertheless, Lazzarini highlighted that improper practice is not uncommon. "Nowadays, we see patients with suspected apnea being referred for continuous positive airway pressure (CPAP) titration without even receiving the diagnosis," he said. He also pointed out that polysomnography cannot be dismissed, as it provides extensive data and can confirm the presence or absence of obstructive sleep apnea.

"We will identify the degree and type of apnea, its duration, whether it is predominantly apnea or hypopnea, the degree of arterial hypoxemia, and whether it is most prevalent in one body position. The polysomnography provides a series of data. If we simply skip this stage of diagnosis, the patient would not be receiving the best care," Lazzarini added.

Once the diagnosis is confirmed, the treatment will be based on symptom severity, which can be determined according to the apnea/hypopnea index.

The specialists stated that CPAP is currently considered the most effective therapy for obstructive sleep apnea, but it is not the only option. Options range from changing the body's position during sleep to pushing the mandible forward using an intraoral device or by means of surgical intervention. In addition, lifestyle changes are essential, as there is a significant relationship between body weight and the severity of the condition.

It is important that patients remain in extended follow-up in all cases. Even with CPAP, it is important to follow up with the patient and monitor the long-term efficacy of the therapy, said Lazzarini.

Moreover, Pacheco emphasized the importance of referring patients with severe obstructive sleep apnea to a sleep medicine specialist. "This makes a great difference. It means that there is a personalized approach, the best mask, the search for the best device, the demystification that CPAP is not just an encumbrance at the patient's bedside. It also reminds patients that there are other treatments if they are diagnosed with sleep apnea and struggle to adapt," he explained.

Improvement of Cardiovascular Health?

Healthcare professionals often question the benefits of treating obstructive sleep apnea. This is because some studies, such as the SAVE study ( Sleep Apnea Cardiovascular Endpoints ), have shown that obstructive sleep apnea treatment did not change cardiovascular prognosis. However, Pacheco advised that, in these studies, poor adherence to CPAP treatment (mean of 3.5 hours per night) and the lack of patients with daytime sleepiness ― which is one of the phenotypes with higher mortality rates ― are some of the specific aspects of these studies that may have led to these findings.

For these reasons, the pulmonologist thinks that there is good reason to believe that it may be beneficial for those with severe obstructive sleep apnea to undergo extended treatment. Moreover, the physician added that it is likely that positive results are evident as soon as treatment is started. However, "long-term studies confirming this hypothesis are still needed."

Muxfeldt mentioned that data from the HIPARCO study , which was published in 2021, revealed that treatment with CPAP for an average of approximately 5 years was associated with a significant drop in the number of cerebrovascular events. The approach "presented a threefold reduction in cerebrovascular events, but there was no change in the incidence of coronary events," she pointed out.

Regarding blood pressure control, Muxfeldt commented that among patients with drug-resistant hypertension, those whose conditions are refractory to treatment seem to have a better response to CPAP.

In terms of sudden death, Siqueira explained there are still only a few relevant studies, with few patients, and that the results are unclear: some studies show that CPAP is beneficial, while others do not. "This is a question to which randomized studies may hold the answer," he concluded.

This article was translated from the Medscape Portuguese edition.

Lead image: iStock/Getty Images

Medscape Medical News © 2022 

Cite this: Teresa Santos (in collaboration with Ilana Polistchuck. Sleep Apnea Is Underdiagnosed in Cardiovascular Disease -  Medscape  - Jun 02, 2022.

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• Perspective
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• Additional Resources

• Philips Shares Rise on Final US Deal on Sleep Apnea Machines
• Philips' US Sales Of Sleep Apnea Devices Face Years-long Halt After FDA Deal

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• 2001/viewarticle/obstructive-sleep-apnea-linked-higher-stroke-risk-2024a10004q0 news Obstructive Sleep Apnea Linked to Higher Stroke Risk
• 2001/viewarticle/couples-based-therapy-sleep-apnea-nurtures-happier-2024a1000aw1 news Couples-Based Therapy for Sleep Apnea Nurtures Happier Relationships
• Childhood Sleep Apnea
• Obstructive Sleep Apnea (OSA)
• Obstructive Sleep Apnea and Home Sleep Monitoring
• Physiologic Approach in Snoring and Obstructive Sleep Apnea
• Central Sleep Apnea Syndromes
• Surgical Approach to Snoring and Sleep Apnea

• Sleep Apnea Hard on the Brain
• FDA Authorizes Sleep Apnea App
• Obstructive Sleep Apnea Linked to Higher Stroke Risk
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• 2001 Smartphone-Recorded Sleep Breathing Sounds May Help Predict OSA

Nyall R. London Jr. , MD , PhD

Skull base surgery, rhinology, sinus, and skull base surgery, rhinology and sinus surgery, otolaryngology.

• Johns Hopkins School of Medicine Faculty

4.9 of 5 stars

14 insurances accepted, primary academic title.

Associate Professor of Otolaryngology-Head and Neck Surgery

Dr. Nyall London’s clinical practice focuses on inflammatory sinonasal disease, skull base disorders, and malignancies of the skull base, sinonasal cavity, and oral cavity. This includes chronic rhinosinusitis and rhinitis, skull base defects such as encephalocele or cerebrospinal fluid leak, as well as malignancies including squamous cell carcinoma, olfactory neuroblastoma (esthesioneuroblastoma), and nasopharyngeal carcinomaborn.

Dr. London has published over 100 peer-reviewed research articles, reviews, and book chapters. This includes co-first author publications in Nature, Nature Medicine, Science Translational Medicine , and Nature Cell Biology . He directs a laboratory at the National Cancer Institute/National Institutes of Health focused on therapeutic advances and mechanisms of sinonasal tumorigenesis.

He received his bachelor’s degree in Microbiology from Brigham Young University followed by his M.D. Ph.D. from The University of Utah. Dr. London then completed his residency in Otolaryngology-Head and Neck Surgery at Johns Hopkins. He then completed a fellowship at The Ohio State University in open and endoscopic skull base surgery under the direction of Dr. Ricardo Carrau.

Centers and Institutes

• Comprehensive Brain Tumor Center
• Sinus Center
• Nyall London, M.D., Ph.D. | Sinus and Skull Base Surgeon
• Immunotherapy for Head and Neck Cancer Treatment
• Case Presentation: Sinonasal Squamous Cell Carcinoma
• Esthesioneuroblastoma: Angie‚Äôs Story

Additional Academic Titles

Associate Professor of Neurological Surgery

Selected Publications

Expression of Programmed Cell Death Ligand 1 and Associated Lymphocyte Infiltration in Olfactory Neuroblastoma . London NR Jr, Rooper LM, Bishop JA, Xu H, Bernhardt LJ, Ishii M, Hann CL, Taube JM, Izumchenko E, Gaykalova DA, Gallia GL. World Neurosurg. 135: 187-e193, 2020.

The genomics and epigenetics of olfactory neuroblastoma: A systematic review . Kaur RP, Izumchenko E, Blakaj DM, Mladkova N, Lechner M, Beaumont TL, Floudas CS, Gallia GL, London NR Jr. Laryngoscope Investig Otolaryngol. 6(4): 721-728, 2021.

Clinical outcomes, Kadish-INSICA staging and therapeutic targeting of somatostatin receptor 2 in olfactory neuroblastoma . Lechner M, Takahashi Y, Turri-Zanoni M, Liu J, Counsell N, Hermsen M, Kaur RP, Zhao T, Ramanathan M Jr, Schartinger VH, Emanuel O, Helman S, Varghese J, Dudas J, Riechelmann H, Sprung S, Haybaeck J, Howard D, Engel NW, Stewart S, Brooks L, Pickles JC, Jacques TS, Fenton TR, Williams L, Vaz FM, O'Flynn P, Stimpson P, Wang S, Hannan SA, Unadkat S, Hughes J, Dwivedi R, Forde CT, Randhawa P, Gane S, Joseph J, Andrews PJ, Royle G, Franchi A, Maragliano R, Battocchio S, Bewicke-Copley H, Pipinikas C, Webster A, Thirlwell C, Ho D, Teschendorff A, Zhu T, Steele CD, Pillay N, Vanhaesebroeck B, Mohyeldin A, Fernandez-Miranda J, Park KW, Le QT, West RB, Saade R, Manes RP, Omay SB, Vining EM, Judson BL, Yarbrough WG, Sansovini M, Silvia N, Grassi I, Bongiovanni A, Capper D, Schüller U, Thavaraj S, Sandison A, Surda P, Hopkins C, Ferrari M, Mattavelli D, Rampinelli V, Facchetti F, Nicolai P, Bossi P, Henriquez OA, Magliocca K, Solares CA, Wise SK, Llorente JL, Patel ZM, Nayak JV, Hwang PH, Lacy PD, Woods R, O'Neill JP, Jay A, Carnell D, Forster MD, Ishii M, London NR Jr, Bell DM, Gallia GL, Castelnuovo P, Severi S, Lund VJ, Hanna EY. Eur J Cancer. 162: 221-236, 2022.

Combinatorial Natural Killer Cell-based Immunotherapy Approaches Selectively Target Chordoma Cancer Stem Cells. Hoke ATK, Padget MR, Fabian KP, Nandal A, Gallia GL, Bilusic M, Soon-Shiong P, Hodge JW, London NR Jr. Cancer Res Commun. 1(3): 127-139, 2021.

Evaluation of the Incidence of Human Papillomavirus-Associated Squamous Cell Carcinoma of the Sinonasal Tract Among US Adults. London NR Jr, Windon MJ, Amanian A, Zamuner FT, Bishop J, Fakhry C, Rooper LM.JAMA Netw Open. 2023 Feb 1;6(2):e2255971. doi: 10.1001/jamanetworkopen.2022.55971.PMID: 36787144

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The Patient Rating score is an average of all responses to physician related questions on the national CG-CAHPS Medical Practice patient experience survey through Press Ganey. Responses are measured on a scale of 1 to 5, with 5 being the best score. Comments are also gathered from our CG-CAHPS Medical Practice Survey through Press Ganey and displayed in their entirety. Patients are de-identified for confidentiality and patient privacy.

Great visit!

Excellent Dr. I would absolutely recommend this doctor to anyone in need. Top in his field.

Excellent doctor

Complex issue needed more thorough explanation.

Dr. London provided outstanding service.

Both he and his resident were very thorough in examining my history and current concerns and providing a regimen of care.

Always prepared, easy to talk to.

Dr London was great. I am confident he can help me.

Dr. Nyall London is always very thorough and attentive, and kind, and that is no surprise. He saved my life helping me getting rid of a nasal tumor and has always been available for help when I needed him. He's special being.

Dr London is very knowledgeable and professional. Very patiently explained the situation.

Dr. London has taken good care of my problem, effects of adenoid carcinoma, soon after surgery

Dr. London was very thorough with my exam and any questions I had. I trust his words and his care

Dr London is always kind and caring, as well as extremely competent in his practice.

Knowledge, attentive, friendly, easy to talk to

Very cognizant of my time.

Dr London is the best

Dr Nyall London was very good. Listened to me attentively

Dr. London is professional and a great provider.

Dr. London is the best provider helping me with my cancer treatment.

Extraordinary bedside manner and expertise

I think Dr London is a wonderful Doctor

Very knowledgeable and personable and able to help me think through options.

Resident doctor was very good.

Dr London is excellent, listen, explain and does a thorough exam of my tonsil and throat following my radiation treatment.

Dr London is very thorough and won't stop investigating until the cause of my symptoms has been determined. He's friendly and speaks to me in terms I understand and explains why he's doing what he's doing.

Took interest and was interested in my situation

Dr. London & Dr. Nellis are the best! Couldn't ask for better.

Dr London is awesome! I always feel confident leaving the visit.

Very kind, knowledgeable, great listener, and very caring.

Dr London is always professional, kind and understanding.

The doctor seemed very competent and experienced. I felt very well taken care of. My health problems were taken seriously and the treatment suggested seems effective and reasonable so far.

Patient and nice

Easy to talk to, knowledgeable, made you comfortable to talk to.

I saw colleague of provider who took good time and carefully listened to my issues and concerns and thoroughly discussed situation.Provider then came into room and reviewed our discussion.

I would highly recommend Dr. London for anyone having a sinus problem. He listens carefully and try to understand a patient's problem very sincerely. I am so happy that Dr. London did my surgery; excellent procedure and improved my condition right away. I am so fortunate that I met Dr. London as my ENT doctor. He is my hero.

Very kind and very caring

Dr. London is very professional and takes to listen to my questiions.

Dr. London is an expert in his field . He was so kind and answered all of my questions.

I'm so thankful to fin Dr London. My sinus problems are gone.

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Michelle Monje, MD, PhD

The Milan Gambhir Professor in Pediatric Neuro-Oncology has been awarded 11th annual Ross Prize in Molecular Medicine from the Feinstein Institutes for Medical Research. The prize, which includes a $50,000 award, is in recognition of Monje’s contributions to research relating to the neuroscience of cancer and its implications for therapy.

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Stanford Medicine is an integrated academic health system comprising the Stanford School of Medicine and adult and pediatric health care delivery systems. Together, they harness the full potential of biomedicine through collaborative research, education and clinical care for patients. For more information, please visit http://mednews.stanford.edu .

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New Faculty Spotlight: Peter Ricci Pellegrino, MD, PhD

• Written by UNMC Department of Anesthesiology
• Published Aug 5, 2024

Peter Ricci Pellegrino, MD, PhD

Peter Ricci Pellegrino, MD, PhD, is a new faculty member at UNMC.

• Name : Peter Ricci Pellegrino, MD, PhD 
• Title and department at UNMC : Assistant professor, UNMC Department of Anesthesiology
• Hometown : Minneapolis

What drew me to anesthesiology : Anesthesiology is an amazing discipline with diverse subspecialties that span the breadth of patient care with a particular emphasis on providing critical care and palliation to patients in their most vulnerable states, and I love pretty much everything about it.  

Education background:  

• MD, PhD in physiology, UNMC
• BSE in biomedical engineering, University of Iowa 

Professional Memberships:  

• American Society of Anesthesiologists 
• American College of Cardiology 
• American Heart Association 
• American Physiological Society 
• Early-Stage Anesthesiology Scholars 
• International Anesthesia Research Society 
• Society of Critical Care Anesthesiologists 
• Society of Critical Care Medicine 
• American Academy of Pain Medicine 
• American Society of Regional Anesthesia 
• North American Neuromodulation Society 
• International Neuromodulation Society 
• International Pain and Spine Intervention Society  
• Alpha Omega Alpha 

What are you most looking forward to as you join the department?  

I am most excited for my elevated role in patient care. We have the capacity and duty to make a profound impact on our patients’ lives, and I take that very seriously. 

Three things people may not know about me :

• I spent most of my time in combined medical and graduate school believing I would forego residency training and pursue a research-only career, but I realized how much I loved taking care of patients as a third-year medical student, and my last eight years of clinical training have been extremely rewarding.  
• I find something about washing dishes therapeutic. 
• I am a fan of the recently relegated Frosinone soccer club. We’ll be back. 

Dr. Ricci Pellegrino,

Welcome to UNMC the home of the best in medicine! Glad you are cheering for Frosinone soccer club! In the 2023/2024 Serie A season, Frosinone finished 18th on the table and were relegated back to Serie B. Yes, we will be back!!!! Forza Frosinone!!!! Best wishes!

Hooray!! Well deserved. Anesthesiology department made a great decision!

Welcome to the next stage in your career! Another success of our MD-PhD program, and now enriching our faculty, so glad you are here with us.

Congratulations Peter: Hope to get you back in the fold and get the K08 submitted.

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