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einstein (São Paulo), Volume: 20, Published: 2022
  • Public Policies in the informational era: a compared perspective in the context of pandemic in two Lusophone countries Editorial

    Martins, Thiago Gonçalves dos Santos; Rangel, Flavia de Souza; Mendes, Luís Guilherme Arneiro; Silva, Rufino
  • Data warehouse and medical research Editorial

    Martins, Thiago Gonçalves dos Santos; Rangel, Flavia de Souza
  • Cross-cultural translation and adaptation of Functional Assessment of Cancer Therapy – Multiple Myeloma tool – MM1 and LEU3 – for Portuguese Original Article

    Todaro, Juliana; Souza, Polianna Mara Rodrigues de; Pietrocola, Marci; Vieira, Fernanda da Cunha; Amaro, Nazaré Solange da Silva; Bigonha, Jandey da Gloria; Oliveira Neto, José Belém de; del Giglio, Auro

    Abstract in English:

    ABSTRACT Objective To describe of the translation from English to Portuguese and adaption process of subitems of the Functional Assessment of Cancer Therapy – Multiple Myeloma. Methods In the first phase, translations from English into Portuguese of two subitems of Functional Assessment of Cancer Therapy – Multiple Myeloma were performed. Subsequently, a consensus and back translation were conducted, and, finally, translation and back translations were reviewed by four independent bilingual experts. In the second phase, the translated subitems were applied, along with a questionnaire, to 10 native Portuguese speakers patients with multiple myeloma. Results There was a recognition of the translation process in its first version applied to 10 patients with multiple myeloma, whose reported no difficult to understand the translated and validated instrument. Patients also did not find the content irrelevant or offensive, and they did not suggested changes. Conclusion The subitems of the Functional Assessment of Cancer Therapy – Multiple Myeloma were translated from English into Portuguese following the proposed methodology and there was not need of readjustments. This process allowed this instrument of quality of life, which is widely known to be beneficial in the management of patients with multiple myeloma, to be used among our population.
  • Clustering of behavioral risk factors for chronic noncommunicable diseases in climacteric women Original Article

    Leite, Roberto Rodrigues; Caldeira, Antônio Prates; Rocha, Josiane Santos Brant; Rossi-Barbosa, Luiza Augusta Rosa

    Abstract in English:

    ABSTRACT Objective To estimate the prevalence of clustering of behavioral risk factors for chronic non-communicable diseases, as well as the associated factors in climacteric women. Methods This is a cross-sectional, analytical study, with random selection of climacteric women, aged between 40 and 65 years, and registered in Family Health Strategy units. The dependent variable was clustering of three or more behavioral risk factors for chronic non-communicable diseases. The definition of associated variables was made after Poisson multiple regression analysis with robust variance. Results We evaluated 810 women, and 259 (32.0%) had a clustering of risk factors. The main risk behaviors were physical inactivity and low fruit consumption. The variables associated with clustering of behavioral factors were age group 52-65-years, marital status without a partner, overweight/obesity, moderate to severe anxiety and depression symptoms. Conclusion There was a considerable prevalence of women with three or more behavioral risk factors for chronic non-communicable diseases. Demographic variables and those related to health conditions were shown to be associated. Considering the results recorded, health services must provide differentiated care policies to climacteric women, seeking to alleviate high morbidity and mortality of chronic non-communicable diseases.
  • Minimally invasive swine spine surgery training: technical aspects, benefits, and anatomical limitations Original Article

    Gotfryd, Alberto Ofenhejm; Paula, Fábio Chaud de; Sauma, Marcel Lobato; Iutaka, Alexandre Sadao; Rodrigues, Luciano Miller Reis; Meyer, Guilherme Pereira Correa; Teivelis, Marcelo Passos; Poetscher, Arthur Werner; Del Curto, David; Kang, Davi Wen Wei; Cintra, Luciana; Gregores, Guilherme Buzon; Lenza, Mario; Ferretti, Mario

    Abstract in English:

    ABSTRACT Objective To describe the technical specificities and feasibility of simulation of minimally invasive spine surgery in live pigs, as well as similarities and differences in comparison to surgery in humans. Methods A total of 22 Large White class swine models, weighing between 60 and 80kg, were submitted to surgical simulations, performed during theoretical-practical courses for training surgical techniques (microsurgical and endoscopic lumbar decompression; percutaneous pedicular instrumentation; lateral access to the thoracic spine, and anterior and retroperitoneal to the lumbar spine, and management of complications) by 86 spine surgeons. For each surgical technique, porcine anatomy (similarities and differences in relation to human anatomy), access route, and dimensions of the instruments and implants used were evaluated. Thus, the authors describe the feasibility of each operative simulation, as well as suggestions to optimize training. Study results are descriptive, with figures and drawings. Results Neural decompression surgeries (microsurgeries and endoscopic) and pedicular instrumentation presented higher similarities to surgery on humans. On the other hand, intradiscal procedures had limitations due to the narrow disc space in swines. We were able to simulate situations of surgical trauma in surgical complication scenarios, such as cerebrospinal fluid fistulas and excessive bleeding, with comparable realism to surgery on humans. Conclusion A porcine model for simulation of minimally invasive spinal surgical techniques had similarities with surgery on humans, and is therefore feasible for surgeon training.
  • Validity and reliability of the Smoking-related Health Literacy Assessment Scale Original Article

    Fonseca, Adélia Dayane Guimarães; Silva Junior, Rene Ferreira da; Bauman, Claudiana Donato; Silva, Liliane Lacerda; Silva, Carla Silvana de Oliveira e; Martins, Andrea Maria Eleutério de Barros Lima

    Abstract in English:

    ABSTRACT Objective To create an instrument to assess smoking-related health literacy among smokers, and to estimate validity of its content and reliability. Methods A methodological, quantitative study. The creation of the instrument included the following steps: establishing a conceptual structure; defining objectives and target population; preparation of items or response scales; selecting and organizing items; instrument structuring; content validation and pre-test. The instrument was named Smoking-related Health Literacy Assessment Scale. Results The Smoking-related Health Literacy Scale had statistically significant measures of validity and reliability. Test-retest revealed substantial to almost perfect levels of reliability (reproducibility). Conclusion The Smoking-related Health Literacy Scale can provide researchers with a valid and statistically significant instrument, regarding content validity and reliability.
  • In loco provision of physical therapy services to military firefighters involved in Brumadinho dam disaster Original Article

    Souza, Marcelo von Sperling de; Souza, Anna Florence Alves Paulino de; Gomes, Pollyanna Figueiredo; Borges, Bárbara Brito de Carvalho e; Ribeiro, Roseane Marques; Moraes, Maria Rosália de Faria

    Abstract in English:

    ABSTRACT Objective To investigate the impact of in loco physical therapy interventions on military firefighters involved in search and rescue operations following the collapse of the Brumadinho dam, in Minas Gerais. To describe the clinical and demographic profile of military firefighters receiving physical therapy care. Methods Physical therapy assessment and care protocols were designed. Protocols were based on manual physical therapy approaches, and aimed primarily to alleviate musculoskeletal pain. Physical therapists involved were duly trained prior to interventions to level technical skills. Physical therapy was provided upon request (i.e., military workers sought the service after work shift completion). Results A total of 318 military firefighters, most of whom were males (92.5%) mean age 32.9 years, received physical therapy care (575 sessions spread out over 48 days). In this sample, 43.4% of military workers had a history of musculoskeletal complaints. Military workers seeking physical therapy after completion of their work shifts reported mean pain intensity of 5.4 in a numerical scale. Spinal pain was reported in 61.7% of cases, followed by generalized muscle and myofascial pain (16.7%), lower and upper limb pain (14.4% and 6.8%, respectively). At the end of sessions, mean pain intensity reported dropped down to 1.3. Differences were statistically significant (non-parametric Wilcoxon test; p=0.001). Conclusion The unprecedented physical therapy intervention described had a positive impact on relief of musculoskeletal pain among military firefighters involved in search and rescue operations during the Brumadinho dam disaster, and seen at the end of their work shifts.
  • Epidemiological profile and follow-up of patients with pulmonary disease by non-tuberculous mycobacteria in Baixada Santista area, São Paulo Original Article

    Coelho, Andréa Gobetti Vieira; Chiou, Ana Carolina; Pedro, Heloisa da Silveira Paro; Nardi, Susilene Maria Tonelli; Chimara, Erica

    Abstract in English:

    ABSTRACT Objective To present the frequency and species diversity of non-tuberculous mycobacteria, estimate the prevalence of non-tuberculous mycobacterial pulmonary disease, describe the epidemiological profile, and determine the follow-up of patients with non-tuberculous mycobacterial pulmonary disease living in a region with a high burden of tuberculosis. Methods This a retrospective cohort observational study using data records obtained from the Instituto Adolfo Lutz - Santos and from the São Paulo Sistema de Vigilância de Tuberculose do Estado de São Paulo in the period between 2000 and 2009. The studied variables were: socio-demographic characteristics, current and past history of tuberculosis, aspects related to diagnosis, and treatment and associated diseases. Results We included 319 non-tuberculous mycobacteria isolates in the study, corresponding to 257 patients. The species Mycobacterium kansasii (28.5%) and Mycobacterium fortuitum (16.6%) presented the higher occurrence. In 10.9% (24) of the patients, there was a criterion for confirming a case of pulmonary disease due to non-tuberculous mycobacteria. In relation to gender and age, male and individuals over 50 years old were the most frequent. Considering the confirmed cases, 47.8% had a past history of tuberculosis. Conclusion The lack of information about the cases is evident, since pulmonary disease due to non-tuberculous mycobacteria is not mandatory. The therapeutic regimen according to the identified species is fundamental for success in combating the infections caused by non-tuberculous mycobacteria. Besides that, information about the regional epidemiology of pulmonary disease caused by non-tuberculous mycobacteria and the search for associations with other comorbidities are important to establish the correct treatment. In order to improve surveillance of pulmonary diseases by non-tuberculous mycobacteria, we suggest the implantation of a sentinel surveillance and of population-based studies.
  • Maternal and early childhood factors associated with asthma and obesity in children aged 6 to 7 years: a case control study Original Article

    Silva, Bruna Becker da; Silva, Jane da; Traebert, Jefferson Luiz; Schlindwein, Aline Daiane

    Abstract in English:

    ABSTRACT Objective To determine the maternal and early childhood factors associated with asthma and obesity in children aged 6 to 7 years. Methods A case-control study conducted with children aged 6 to 7 years. Applications with questions about asthma symptoms in the last 12 months, maternal and childhood data in the first 2 years of life, and anthropometric data were collected. Children who presented asthma symptoms were considered as cases and those without asthma symptoms were considered as controls, later divided into two subgroups that were eutrophic or overweight/obesity. Logistic regression was performed to estimate the association between asthma symptoms (adequate weight and overweight/obesity) and gestational and personal factors, calculating odds ratio and 95% confidence interval (95%CI). Values of p<0.05 were considered significant. Results Two hundred and one children were evaluated, 25.4% had asthma symptoms, 37.2% of them were overweight/obesity. Waist circumference, triceps skinfold, and body mass index were higher in the group with overweight/obesity asthma symptoms compared to no asthma symptoms (p<0.05). Factors significantly associated with asthma and overweight/obesity symptoms included: the maternal history of asthma (odds ratio of 3.73; 95%CI: 1.10-12.6) and hypertension during pregnancy (odds ratio of 3.29; 95%CI: 1.08-9.94). Conclusion Maternal history of asthma and hypertension during pregnancy increased the chances of children, at 6 and 7 years of age, having symptoms of asthma and obesity.
  • Epidemiology and treatment of sepsis at a public pediatric emergency department Original Article

    Medeiros, Daniela Nasu Monteiro; Mafra, Ana Carolina Cintra Nunes; Souza, Daniela Carla de; Troster, Eduardo Juan

    Abstract in English:

    ABSTRACT Objective To describe the clinical characteristics and treatment of children with sepsis, severe sepsis, and septic shock at a pediatric emergency department of a public hospital. Methods A retrospective, observational study. The medical records of patients included in the hospital Pediatric Sepsis Protocol and patients with discharge ICD-10 A41.9 (sepsis, unspecified), R57 (shock) and A39 (meningococcal meningitis) were evaluated. Results A total of 399 patients were included. The prevalence of sepsis, severe sepsis, and septic shock at the emergency room were 0.41%, 0.14% and 0.014%, respectively. The median age was 21.5 months for sepsis, 12 months for severe sepsis, and 20.5 months for septic shock. Sepsis, severe sepsis, and septic shock were more often associated with respiratory diseases. The Respiratory Syncytial Virus was the most common agent. The median time to antibiotic and fluid administration was 3 hours in patients with sepsis and severe sepsis. In patients with septic shock, the median times to administer antibiotics, fluid and vasoactive drugs were 2 hours, 2.5 hours and 6 hours, respectively. The median length of hospital stay for patients with sepsis, severe sepsis and septic shock were 3 days, 4 days and 1 day, respectively. The overall mortality was 2%. Conclusion Sepsis had a low prevalence. Early diagnosis and recognition are a challenge for the emergency care pediatrician, the first place of admission.
  • Identification of Seniors at Risk: transcultural adaptation for Brazilian Portuguese Original Article

    Barros, Thabata Cruz de; Silva, Henrique Salmazo da; Gutierrez, Beatriz Aparecida Ozello

    Abstract in English:

    ABSTRACT Objective To perform cross-cultural adaptation of the Identification of Seniors at Risk tool. Methods This methodological study was based on the guidelines process proposed by Beaton, attending the stages of translation, back-translation, judgment by judges and content validation of the Identification of Seniors at Risk tool. The goal of this tool is to allow the identification of the elderly at risk for hospitalization, composed of six dichotomous questions (yes or no) related to functional decline, comorbidities, previous hospitalization (last 6 months), visual impairment, significant changes in memory and polypharmacy. Two bilingual translators and 16 health professionals with hospital and academic performance in the fields of geriatrics and gerontology participated in the study. Results Differences were observed between the initial translations and the final version. Changes were made to questions 1, 3, 4 and 6. In the last question, an item was modified to meet the Brazilian polypharmacy criterion. After the cross-cultural adaptation, the tool showed 100% agreement between the judges. Conclusion Brazilian Identification of Seniors at Risk has indexes of verbal comprehension and high content validity.
  • COVID-19 among workers assisting homeless and socially vulnerable people Original Article

    Horie, Nídia Celeste; Schmid, Karin; Silva, Brayan Filipe Farias da

    Abstract in English:

    ABSTRACT Objective To describe the profile of professionals assisting homeless and socially vulnerable populations tested for COVID-19, and to determine potential associations with exposure at the workplace, on the way to work, or at home, among infected professionals. To describe disease symptoms and progression and to investigate potential associations with age, sex and exposure at the workplace, on the way to work, or at home. Methods A retrospective analysis of data of 173 workers employed by Serviço Franciscano de Solidariedade tested for SARS-CoV-2. Between May 20 and June 2, 2020, professionals and volunteers were tested for anti-SARS-CoV-2 IgG and IgM antibodies, by means of qualitative rapid chromatographic immunoassay in whole blood. A questionnaire was used to collect data on demographic characteristics and working conditions, history and date of onset of symptoms and risk factors. Quantitative variables were expressed as mean and standard deviation, or median, maximum, and minimum values. Data normality was investigated using the Kolmogorov-Smirnov test. Results A total of 46 (26.6%) participants had positive serologic tests. Of participants with negative serologic test results, 109 (85.8%) were asymptomatic. History of symptoms was the most significant independent factor associated with positive serology. Serologic test results and symptoms differed significantly according to housing (p=0.045) and working (p<0.001) conditions. More than half of participants (52.4%) living in shared households tested positive, compared to 23% of participants living in family households. Participants working remotely from home did not test positive. In seropositive participants, onset of symptoms was associated with workplace exposure and shared housing conditions. Conclusion History of symptoms was associated with positive serology for COVID-19. Shared housing conditions tended to be associated with higher risk of infection. Onset of symptoms was associated with higher levels of workplace exposure and shared housing conditions in seropositive participants.
  • COVID-19 in healthcare workers in the state of Espírito Santo, Brazil: clinical and sociodemographic characteristics associated with death and hospitalization Original Article

    Corona, Rodolfo Antonio; Cunha, Arthur Arantes da

    Abstract in English:

    ABSTRACT Objective To analyze clinical and sociodemographic characteristics associated with death and hospitalization of healthcare workers due to COVID-19, in addition to calculating the incidence rates per profession. Methods A cross-sectional observational study using secondary open data from the State Health Department of Espírito Santo (ES), Brazil. The cases of COVID-19 in healthcare workers were recorded between February 27 and August 17, 2020, in Espírito Santo, excluding cases with missing information. Results Of the confirmed cases, 75.6% (n=9,191) were female. The overall case fatality rate was 0.27% and the general hospitalization rate was 0.99%. The clinical outcome of death and the occurrence of hospitalization were associated with male sex, age ≥50 years, higher education, fever, difficulty breathing, cough, cardiac comorbidity, diabetes and obesity (p<0.05). Only the occurrence of hospitalization was associated with case reported in the metropolitan region of Vitória, runny nose, sore throat, headache and renal comorbidity (p<0.05). The profession with the highest incidence rate was nurse (16,053.2 cases/100,000 nurses). Conclusion The study demonstrated high frequency of cases among women, low overall case fatality rate, and high incidence in nurses.
  • Hyoid displacement patterns in healthy swallowing Original Article

    Alves, Maria Regina Macedo; Oliveira Neto, Isabella Christina; Zica, Guilherme Maia; Lederman, Henrique; Gonçalves, Maria Inês Rebelo

    Abstract in English:

    ABSTRACT Objective To describe the patterns of displacement of the hyoid bone in healthy individuals, considering their displacements during swallowing of different consistencies. Methods Two hundred one swallowing videofluoroscopy exams of 67 adult and elderly individuals without swallowing disorders were analyzed. Descriptive analysis was performed to identify and describe the patterns of displacement of the hyoid bone. Results Seven types of displacement of the hyoid bone were found: H1 (horizontal), H2 (short vertical and long horizontal), H3 (vertical and diagonal to upper), H4 (long vertical and short horizontal), H5 (vertical), H6 (diagonal), and H7 (brief). The standards were maintained in different consistencies. The most frequent pattern of displacement was type H2. The distribution of the types of displacement of the hyoid was different among men and women. Conclusion Seven patterns of displacement of the hyoid bone during swallowing of normal adults and older people have been described. The most frequent pattern of displacement was horizontal, with variations in distribution between men and women. The displacement pattern was maintained during the swallowing of the three different consistencies (thin, pasty and solid liquid).
  • COVID-19 containment management strategies in a nursing home Original Article

    Barretto Filho, Antonio Carlos Pereira; Salotto, Danute Bareisys; Schoueri, João Francisco Lindenberg; Tsutsui, Jeane Mike; Granato, Celso Francisco Hernandes; Yamaguchi, Marianna Barbosa; Carvalho, Riciane de; Zacarias, Nadir; Marcelino, Antônio Sérgio Zafred; Rabelo, Rogerio; Jacob Filho, Wilson

    Abstract in English:

    ABSTRACT Objective: To describe the first COVID-19 pandemic at Casa Ondina Lobo, a philanthropic nursing home in São Paulo city, and the containment measures against the pandemic that proved to be effective. Methods: Several preventive measures were taken before and during the pandemic, with emphasis on universal testing by reverse transcription polymerase chain reaction for COVID-19. All residents and employees were tested twice in a D9 period. Results: Among the 62 residents and 55 employees, in both testing, eight residents and nine employees tested positive for COVID-19. Of 22% of employees and 75% of residents evolved asymptomatic, emphasizing the importance of universal testing for the detection and isolation of these cases. A quarter of residents evolved without any symptoms, however, with COVID-19 signs, reinforcing the importance of monitoring vital signs. The second testing did not detect any new cases among residents, demonstrating the effectiveness of the containment measures, however, it found four new cases among employees. This emphasized their role in COVID-19 outbreaks in nursing homes. Only one patient died, a 12.5% lethality among those known to be infected and a 1.6% mortality in the total population of residents were seen. Conclusion: The adoption of appropriate containment measures enabled to contain an COVID-19 pandemic in studied nursing home. Universal reverse transcription polymerase chain reaction testing for COVID-19 has proved to be particularly important and effective.
  • Needs of family members of patients in a coronary care unit Original Article

    Coelho, Alue Constantino; Lopes, Camila Takáo; Lopes, Juliana de Lima; Santos, Vinicius Batista; Barros, Alba Lucia Bottura Leite de

    Abstract in English:

    ABSTRACT Objective: To identify the need of family members of patients hospitalized in a coronary intensive care unit and their degree of satisfaction with the care provided. Methods: An observational and cross-sectional study including family members of patients hospitalized in the coronary intensive care unit for acute coronary syndrome in Killip I or II. After the second visit of the same family member to the patient in the unit, a 43-item inventory of needs and stressors of family members was applied. Family members assessed each need for its importance and satisfaction using a four-point Likert scale. The scores in each dimension of importance and satisfaction were compared using the Wilcoxon test, considering a value of p<0.05 as significant. Results: One hundred family members were interviewed. The most important needs were related to assurance and information. Family members had satisfaction scores corresponding to be very satisfied or totally satisfied, but with lower scores when compared to the needs scores (p<0.01). Conclusion: The most important needs of family members of patients hospitalized in the coronary intensive care unit were related to assurance and information. Multiprofessional interventions involving better communication of patient information to family members should be incorporated into the coronary intensive care unit.
  • Residue localization and risk for aspiration in partial laryngectomy: the relevance of assertive therapeutic strategies and resources Original Article

    Freitas, Andressa Silva de; Zica, Guilherme Maia; Freitas, Emilson Queiroz; Silva, Ana Catarina Alves e; Dias, Fernando Luiz; Santos, Izabella Costa

    Abstract in English:

    ABSTRACT Objective: To describe the correlation between the residues, their anatomical location and the presence of laryngotracheal penetration and aspiration in patients after supracricoid laryngectomy undergoing cricohyoidoepiglotopexy reconstruction. Methods: This study included 70 patients treated by supracricoid laryngectomy with cricohyoidoepiglotopexy reconstruction in a referral national cancer hospital. The patients were submitted to swallowing videofluoroscopy, and the findings were classified by the penetration and aspiration scale. The images were described observing the presence or absence of residues and their anatomical location. Results: The prevalence of penetration in this study was 68.6% and aspiration was 34.3%. An association was found between the presence of residue on the tongue (p=0.005), posterior pharyngeal wall (p=0.013), pyriform recesses (p=0.002), valecula (p=0.061), and laryngeal penetration. The residue in the upper esophageal sphincter (p=0.039) was associated with the occurrence of laryngotracheal aspiration. Conclusion: Patients undergoing supracricoid laryngectomy with cricohioidoepiglotopexy reconstruction have food residues in different anatomical regions after swallowing. Penetration was associated with the presence of residues on the base of the tongue and posterior pharyngeal wall. Aspiration was associated with the presence of residues in the upper esophageal sphincter.
  • Valuing tonsillitis manifestations in schoolchildren in Rio de Janeiro Original Article

    Goldenzon, Rafaela Valentim; Lucas, Tiago Oliveira; Roiseman, Maria de Marilacc Lima; Rodrigues, Marta Cristine Félix; Fonseca, Adriana Rodrigues; Oliveira, Sheila Knupp Feitosa de; Goldenzon, Andréa Valentim

    Abstract in English:

    ABSTRACT Objective: To evaluate the importance attributed to tonsillitis by guardians and their level of knowledge about the disease, correlating their management with their schooling and socioeconomic profiles. Methods: A quantitative, descriptive and observational cross-sectional study involving students aged 5 to 17 years from state-owned and private schools. A questionnaire was applied on management of tonsillitis and knowledge about rheumatic fever, addressing demographic and socioeconomic data. Results: A total of 323 students were included, predominantly females (61.3%), from state-owned schools (77.1%), with a mean age of 9.7±0.3 years. Among the guardians, 48.6% completed high school. Among the students 75.2% had at least one episode of odynophagia in the previous 12 months. Considering the previous 2 years, 89.8% reported this symptom. There was no collection of bacteriological specimens in 67.8%, and in 83% if taking into account only the last episode, despite the search for medical care in most cases (92.6%). The use of anti-inflammatory drugs was very frequent (43.0% “always” and 42.4% “sometimes”). Among the guardians, 81.7% denied being aware of the relation between rheumatic fever and inappropriate treatment of odynophagia; 85.8% said they wished they had received more information. Conclusion: Although it is quite common in schoolchildren, tonsillitis is neglected by many guardians and health professionals, and the ignorance of its relation with rheumatic fever is practically universal, which may contribute to its high prevalence.
  • Social isolation: main dermatosis and the impact of stress during the COVID-19 pandemic Original Article

    Mangini, Carolina Soutto Mayor; Vasconcelos, Rossana Cantanhede Farias de; Rodriguez, Eduarda Villela Rosa; Oliveira, Isabela Romeu Lorenzon de

    Abstract in English:

    ABSTRACT Objective To analyze the pattern of triggering and exacerbation of dermatological diseases between March and July 2020 and to compare this pattern to the corresponding period of 2019. Methods This was a quantitative, descriptive, comparative and documentary study that was carried out through the retrospective analysis of medical records (March to July 2019 and 2020) of individuals assisted at a private dermatology practice service located in the southern area of the city of São Paulo (SP). Results We evaluated 992 medical consultations in 2019 and 1,176 in 2020. In 2020, we observed a significant increase in cases of telogen effluvium (276%), psoriasis (1,400%), atopic dermatitis (178%), seborrheic dermatitis (200%), herpes zoster (1,200%) and vitiligo (433%). All diseases had stress as a possible initial trigger. In addition, fragile nail syndrome and contact dermatitis, pathologies associated with behavioral measures, also had an important increase in the prevalence (6,400% and 5,500%, respectively). However, the number of aesthetic procedures decreased by approximately 54% during the pandemic period. Conclusion During the pandemic period, the pattern of incidence of dermatoses had changed compared with the previous year. An emphasis was observed on diseases triggered by a psychological component, as well as those pathologies that have behavioral measures as the main cause. For this reason, the impacts of COVID-19 is greater than only among those infected.
  • Association between beta-2 adrenergic receptor variants and clinical outcomes in children and adolescents with acute asthma Original Article

    Muchão, Fábio Pereira; Souza, Andréa Vieira de; Souza, Juliana Miguita e; Silva Filho, Luiz Vicente Ribeiro Ferreira da

    Abstract in English:

    ABSTRACT Objective To investigate whether different genotypes of p.Arg16Gly, p.Gln27Glu, p.Arg19Cys and p.Thr164Ile variants interfere in response to treatment in children and adolescents with moderate to severe acute asthma. Methods This sample comprised patients aged 2 to 17 years with a history of at least two wheezing episodes and current moderate to severe asthma exacerbation. All patients received multiple doses of albuterol and ipratropium bromide delivered via pressurized metered-dose inhaler with holding chamber and systemic corticosteroids. Hospital admission was defined as the primary outcome. Secondary outcomes were changes in forced expiratory volume in the first second after 1 hour of treatment, and for outpatients, length of stay in the emergency room. Variants were genotyped by sequencing. Results A total of 60 patients were evaluated. Hospital admission rates were significantly higher in carriers of the genotype AA relative to those with genotype AG or GG, within the p.Arg16Gly variant (p=0.03, test χ2, alpha=0.05). Secondary outcomes did not differ between genotypes. Conclusion Hospital admission rates were significantly higher among carriers of the genotype AA within the p.Arg16Gly variant. Trial registration: ClinicalTrials.gov: NCT01323010
  • Epidemiological characteristics and adherence of a cohort of elderly people with HIV/AIDS in the Public Health System Original Article

    Ferreira, Cristiane Marcos Soares Dias; Leite, Isabel Cristina Gonçalves

    Abstract in English:

    ABSTRACT Objective To characterize the epidemiological profile of patients aged 50 years or older diagnosed as HIV/AIDS, in a Specialized Service of the Public Health System. Methods A retrospective cohort study using secondary data from medical records in the period 2014 to 2018. Sociodemographic and clinical characteristics, and features related to treatment adherence were organized in a database. Quantitative variables were expressed as mean (or median) ± standard deviation (or interquartile range), and categorical variables expressed as number and percentage of patients. The Kaplan-Meier method was applied to assess the probability of overall specific survival. Results Of the 241 initially eligible patients, 149 patients were evaluated, registering 19 deaths in the studied period. There was a predominance of males aged 50-59 years, with severe immunodeficiency upon admission (29.7%), and with a CD4+ T lymphocyte count below 200 cells in 62 (46.3%) of patients. Elderly people aged 61 or over were more adherent. There was an increase in the CD4+ T lymphocyte count by an average of 139.63 in the first 6 months, and 50.51 from the first 6 months to 12 months of follow-up, with an average increase in the first 12 months of 157.63 cells. Specific overall survival in the period was 85%. Conclusion Patients older than 50 years had an immune response and no viral load detection in the 12-month period, deserving further studies to improve survival.
  • Epidemiological analysis of 556 procedures of open thoracoabdominal aortic aneurysm repair in the Public Health System in the largest Brazilian city Original Article

    Anacleto, Alexandre Maierá; Morales, Marcia Maria; Teivelis, Marcelo Passos; Silva, Marcelo Fiorelli Alexandrino da; Portugal, Maria Fernanda Cassino; Stabellini, Nickolas; Szlejf, Claudia; Amaro Junior, Edson; Wolosker, Nelson

    Abstract in English:

    ABSTRACT Objective Despite the development of endovascular procedures, open repair remains the gold standard for the treatment of aortic thoracoabdominal aneurysms and some type B dissections, with well-established good outcomes and long-term durability at high-volume centers. The present study described and analyzed public data from patients treated in the public system in a 12-year interval, in a city where more than 5 million inhabitants depend on the Public Health System. Methods Public data from procedures performed between 2008 and 2019 were extracted using web scraping techniques. The variables available in the database include sex, age, elective or emergency hospital admission, number of surgeries, in-hospital mortality, length of stay, and information on reimbursement values. Results A total of 556 procedures were analyzed. Of these, 60.79% patients were men, and 41.18% were 65 years of age or older. Approximately 60% had a residential address registered in the municipality. Of all surgeries, 65.83% were elective cases. There were 178 in-hospital deaths (mortality of 32%). In the elective context, there were 98 deaths 26.78% versus 80 deaths (42.10%) in the emergency context (p=0.174). Mortality was lower in the hospitals that performed more surgeries. A total of USD 3,038,753.92 was paid, an average of USD 5,406.95 for elective surgery and USD 5,074.76 for emergency surgery (p=0.536). Conclusion Mortality was no different between groups, and hospitals with higher volume presented more favorable outcomes. Specialized referral centers should be considered by health policy makers.
  • Clinical outcome analysis in surgical patients enrolled in a Second Opinion Program in spine surgery Original Article

    Oliveira, Rebeca Barqueiro de; Oliveira, Isadora Orlando de; Antonioli, Eliane; Lenza, Mario; Ferretti, Mario

    Abstract in English:

    ABSTRACT Objective To analyze pain, functional capacity, quality of life, anxiety and depression outcomes in patients undergoing lumbar spine surgery following use of the Second Opinion Program, and to present disagreements regarding diagnoses and therapeutic indications between the first and second opinions. Methods A prospective, observational cohort study with 100 patients enrolled in the Second Opinion Program who underwent lumbar spine surgery. Questionnaires addressing pain intensity, level of disability, quality of life, anxiety and depression were applied prior to and within 1, 3, 6 and 12 months of surgery. Descriptive and comparative statistical analyses were performed. The following clinical outcomes were analyzed: pain intensity, level of disability, quality of life, anxiety, and depression. Results In this sample, 88% and 12% out of 100 patients were submitted to lumbar decompression and arthrodesis, respectively. Patients reported improvements in function, pain intensity, and quality of life factors following surgery and were able to attain the minimal clinically important difference relative to the preoperative period. Agreement between the first and second opinions was observed in 44% of diagnoses, and in 27% of therapeutic indications. Conclusion Patients had favorable postoperative outcomes regarding pain, disability, and quality of life. These findings and the high rates of diagnostic and therapeutic indication disagreements corroborate the need of a second opinion in cases of spine disease with surgical indications.
  • Fibroblast growth factor receptor 3 gene (FGFR3) mutations in high-grade muscle-invasive urothelial bladder cancer in a Brazilian population: evaluation and prevalence Original Article

    Monteiro, Camila Ribeiro de Arruda; Korkes, Fernando; Krutman-Zveibil, Deborah; Glina, Sidney

    Abstract in English:

    ABSTRACT Objective To understand the feasibility of FGFR3 tests in the Brazilian public health context, and to sample the mutational burden of this receptor in high-grade muscle invasive bladder cancer. Methods A total of 31 patients with high-grade muscle-invasive bladder cancer were included in the present study. Either transurethral resection of bladder tumor or radical cystectomy specimens were analyzed. Formalin-fixed paraffin-embedded tissue blocks were sectioned, hematoxylin and eosin stained, and histologic sections were reviewed. Total RNA was extracted using the RNeasy DSP formalin-fixed paraffin-embedded kit. Qualitative results were displayed in Rotor-Gene AssayManager software. Results Six patients were excluded. From the samples analyzed, four (16.7%) were considered inadequate and could not have their RNA extracted. Two patients presented FGFR3 mutations, accounting for 9.5% of material available for adequate analysis. The two mutations detected included a Y373C mutation in a male patient and a S249C mutation in a female patient. Conclusion FGFR3 mutations could be analyzed in 84% of our cohort and occurred in 9.5% of patients with high-grade muscle invasive bladder cancer in this Brazilian population. FGFR3 gene mutations are targets for therapeutic drugs in muscle-invasive bladder cancer. For this reason, know the frequency of these mutations can have a significant impact on public health policies and costs provisioning.
  • Functionality assessment in patients with rheumatic diseases undergoing treatment in the Public Health System Original Article

    Souza, Elisa Neide Barbosa de; Silva, Michael Ruberson Ribeiro da; Santos, Jéssica Barreto Ribeiro Dos; Reis, Edna Afonso; Alvares-Teodoro, Juliana; Acurcio, Francisco de Assis; Almeida, Alessandra Maciel

    Abstract in English:

    ABSTRACT Objective To evaluate the therapeutic response (functionality) and its associated factors in patients on biological drugs on the Public Health System for treatment of rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. Methods An open prospective cohort was carried out from 2011 to 2019, in Belo Horizonte (MG). Functionality was assessed using the Health Assessment Questionnaire Disability-Index at baseline, and after 6 and 12 months of follow-up. Factors associated with poor functionality were identified through logistic regression. Results The median Health Assessment Questionnaire Disability-Index at baseline was 1.5 (interquartile range of 0.8-1.9), with poor functionality observed in patients with rheumatoid arthritis. Improved functionality was seen at 6 months of treatment for the three diseases. The predictors of poor functionality at 6 months for psoriatic arthritis and ankylosing spondylitis were female sex, low education levels, and high disease activity; and for rheumatoid arthritis and psoriatic arthritis were female sex, advanced age, and high disease activity. In 12 months, the three diseases had predictors of worse functionality: female sex, low education, and high disease activity. Conclusion There was a significant improvement in functionality during the follow-up, with better response at 6 months of treatment. Poor functionality was observed in older, female patients, with low education and high disease activity.
  • Inadequate positioning of central venous catheters inserted at intensive care units Original Article

    Santos, Álisson Vinicius dos; Barbosa Neto, Edson Dias; Nunes Neto, Geraldo Vicente; Cavalcante, Raquel da Silva; Diniz, Ayanne Karla Ferreira; Freitas, Gustavo Rocha Costa; Araújo, Jaqueline Figueirôa Santos Barbosa de

    Abstract in English:

    ABSTRACT Objective To evaluate the positioning of the distal tip of central venous catheters and the factors that contributed to inadequate positioning in patients admitted to intensive care. Methods This is a cross-sectional study, with a sample of 246 medical records of patients admitted to intensive care units. A catheter position analysis form was used as an instrument for data collection. Results It was seen that 86.2% of catheters used in intensive care were centrally inserted in the internal jugular veins, 74.4% were double-lumen catheter, and ultrasound was employed for puncture technique in 84.6% of cases. Of the distal ends of the catheters, 53.7% were at the cavoatrial junction (correct position). According to statistical tests, there was a positive correlation between the inadequate positioning of the distal extremity with the central insertion catheter (p=0.012). Patients with presumptive diagnosis associated with COVID-19 showed a positive correlation with inappropriate positioning of the catheter distal tip (p=0.017). Conclusion There are extrinsic factors related to improper positioning of the distal tip of catheters, such as the type of catheter used, the patients’ diagnosis and the puncture with insertion in the left jugular vein.
  • Factors associated with the identification of drug therapy problems among older patients in Primary Health Care Original Article

    Dias, Bianca Menezes; Ramalho-de-Oliveira, Djenane; Santos, Bruna Damazio; Neves, Carina de Morais; Oliveira, Grazielli Cristina Batista de; Silva, Daniela Álvares Machado; Nascimento, Yone de Almeida; Cid, Annaline Stiegert; Buzelin, Gabriela Oliveira; Ferreira, Sabrina Gonçalves; Detoni, Kirla Barbosa; Nascimento, Mariana Martins Gonzaga do

    Abstract in English:

    ABSTRACT Objective To determine the frequency of drug therapy problems among older adults in Primary Health Care, and to analyze the factors associated with their identification in the initial patient assessment, carried out by pharmacists offering medication therapy management services. Methods A cross-sectional study conducted with data from 758 older adults followed up in medication therapy management services in Primary Health Care in the cities of Belo Horizonte, Betim, and Lagoa Santa (MG, Brazil). Univariate and multivariate analyses were performed to evaluate the factors associated with identification of four or more drug therapy problems in the initial clinical assessment. Results A total of 1,683 drug therapy problems were identified, 73.6% of older patients had at least one problem. The most frequent problems were nonadherence (23.0%) and the need for additional drug therapy (18.0%). Polypharmacy, chronic obstructive pulmonary disease, hypertension, diabetes mellitus, heart failure, and aged 75 years or older remained positively and statistically associated with identification of four or more drug therapy problems (p<0.05). Conclusion There is a high frequency of problems related to medication use among older users of Primary Health Care, and the medication therapy management services should be prioritized to the older patients, who present with polypharmacy, chronic obstructive pulmonary disease, hypertension, diabetes mellitus, heart failure, and age ≥ 75 years, since they are more likely to have more drug therapy problems.
  • Neurovascular manifestations in patients with COVID-19: a case series Original Article

    Reinaux, Juliana Cavalcanti de Freitas; Bezerra, Karenn Barros; Bezerra, Alexandre Sérgio de Araujo; Santana, Vanessa Garcia; Souza, Daniel Lima; Cardoso, Sarah Alcântara; Dias, Bruna Arrais

    Abstract in English:

    ABSTRACT Objective To describe cerebrovascular manifestations in patients hospitalized for treatment of severe COVID-19, highlighting the comorbidities observed, and those that may play a relevant role as risk factors for severe outcomes. Methods This case series retrospective analyzed, from June to November, 2020, ten patients admitted to the emergency department, with positive nasopharyngeal swab polymerase chain reaction assay for SARS-CoV-2, presenting with neurological symptoms and positive findings at brain imaging studies. Results In this sample, the clinical severity of the symptoms varied from mild to critical. Ischemic stroke was observed in four patients, hemorrhagic events occurred in five cases. Three patients evolved with large parenchymal hemorrhage, and one presented petechial bleeding foci. In one case, we observed subarachnoid hemorrhage associated with bilateral hypodensity in both globus pallidus. Typical posterior reversible encephalopathy syndrome findings were observed in one patient on brain computed tomography. Conclusion Patients with neurovascular complications related to COVID-19 had positive findings in brain imaging and neurological symptoms. The pathological entities observed drew attention to the neurological risk of patients with SARS-CoV-2 infection, including worse outcomes in individuals whose medical history includes clinical comorbidities, especially hypertension and obesity.
  • Degenerative injuries of the metatarsophalangeal plantar plate on magnetic resonance imaging: a new perspective Original Article

    Mann, Tania Szejnfeld; Nery, Caio Augusto de Souza; Baumfeld, Daniel; Fernandes, Eloy de Ávila

    Abstract in English:

    ABSTRACT Objective The magnetic resonance imaging diagnostic criteria for a complete tear of metatarsophalangeal plantar plate are well-established. However, more subtle abnormalities can also occur and be a source of pain. The objective of this study is to determine the prevalence of degenerative plantar plate injuries in patients with metatarsalgia who underwent forefoot magnetic resonance imaging and describe the main abnormalities found. The hypothesis is that mild capsular fibrosis will have high sensitivity but low specificity for plantar plate degenerative injuries. Methods A retrospective cross-sectional study was conducted with 85 patients (105 feet) with metatarsalgia who underwent forefoot magnetic resonance imaging using a specific protocol to study metatarsophalangeal plantar plate. The experiment observer classified second toe plantar plate as normal, complete rupture or degenerative lesion and described the main magnetic resonance imaging findings. Results A normal plantar plate was observed in 75 (71.4%) of the 105 feet assessed, in 25 (24%) feet there were degenerative plantar lesions, and in 5 (4.6%) feet there were complete ruptures. Degenerative injury of the plantar plate was best identified in coronal short axis intermediate-weighted images, with high sensitivity (92%). Pericapsular fibrosis below the intermetatarsal ligament was identified in 96% of cases, with high sensitivity (96%) for diagnosis of degenerative plantar plate injury. Conclusion Degenerative lesions of the metatarsophalangeal plantar plate were more prevalent than complete ruptures and were best viewed in coronal short axis intermediate-weighted sequences. Pericapsular fibrosis below the intermetatarsal ligament was the indirect finding most strongly associated with degenerative plantar plate injury.
  • Quality assessment of systematic reviews of surgical treatment of cervical spine degenerative diseases: an overview Original Article

    Astur, Nelson; Martins, Delio Eulalio; Kanas, Michel; Mendonça, Rodrigo Góes Medéa de; Creek, Aaron T.; Lenza, Mario; Wajchenberg, Marcelo

    Abstract in English:

    ABSTRACT Objective To gather all systematic reviews of surgical treatment of degenerative cervical diseases and assess their quality, conclusions and outcomes. Methods A literature search for systematic reviews of surgical treatment of degenerative cervical diseases was conducted. Studies should have at least one surgical procedure as an intervention. Included studies were assessed for quality through Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) and Assessment of Multiple Systematic Reviews (AMSTAR) questionnaires. Quality of studies was rated accordingly to their final score as very poor (<30%), poor (30%-50%), fair (50%-70%), good (70%-90%), and excellent (>90%). If an article reported a conclusion addressing its primary objective with supportive statistical evidence for it, they were deemed to have an evidence-based conclusion. Results A total of 65 systematic reviews were included. According to AMSTAR and PRISMA, 1.5% to 6.2% of studies were rated as excellent, while good studies counted for 21.5% to 47.7%. According to AMSTAR, most studies were of fair quality (46.2%), and 6.2% of very poor quality. Mean PRISMA score was 70.2%, meaning studies of good quality. For both tools, performing a meta-analysis significantly increased studies scores and quality. Cervical spondylosis studies reached highest scores among diseases analyzed. Authors stated conclusions for interventions compared in 70.7% of studies, and only two of them were not supported by statistical evidence. Conclusion Systematic reviews of surgical treatment of cervical degenerative diseases present “fair” to “good” quality in their majority, and most of the reported conclusions are supported by statistical evidence. Including a meta-analysis significantly increases the quality of a systematic review.
  • Testicular volume and Tanner stage: determinant factors for testicular torsion Original Article

    Dias Filho, Aderivaldo Cabral; Cruz, Pedro Rincon Cintra da; Ribeiro, Paulo Roberto Faria; Riccetto, Cassio Luis Zanettini

    Abstract in English:

    ABSTRACT Objective To assess testicular volumes and sexual maturation in patients with testicular torsion. Methods A retrospective analysis of consecutively treated patients with testicular torsion between 2016 and 2018. Age, pubic hair staging (Tanner), and by ultrasonography, volume of the unaffected testis (in cubic centimeters) were evaluated either immediately before surgery or at the first postoperative visit. Patients with previous testicular disease, such as cryptorchidism, or with no records of testicular volume were excluded. The analysis included descriptive statistics and Bayesian regression. Results We treated 149 patients during the study period, and 141 (94.6%, median age 17.3 years) met the inclusion criteria. Median testicular volume was 13.0cm3 (interquartile range of 10.5-15.2), with similar right and left volumes (12.9cm3versus 13.3cm3; p=0.94). Sixty-five (46.1%) patients were Tanner stage IV, 17 (12.1%) stage III, and 59 (41.8%) stage V. Conclusion In this study, we were able to estimate volumes of testicular torsion, which aggregated around late puberty values (13.0cm3 for the whole dataset, 12.2cm3 for patients <25 years), suggesting that testicular hypermobility, due to congenital anatomical abnormalities, remains quiescent until the organ reaches a critical volume, after which torsion becomes possible. These findings provide a tentative explanation for the disease’s age distribution.
  • Seroprevalence of hepatitis B, C and D markers in indigenous patients seen at the Native American Outpatient Clinic of Universidade Federal de São Paulo Original Article

    Lafer, Manuel Mindlin; Sitnik, Roberta; Santos Júnior, Marcos Schaper dos; Rodrigues, Douglas Antônio; Pinho, João Renato Rebello

    Abstract in English:

    ABSTRACT Objective To detect and treat cases of viral hepatitis B, C and D in patients seen at the Native American Outpatient Clinic of Universidade Federal de São Paulo. Methods This sample comprised 81 indigenous recruited between 2018 and 2020. Volunteers were aged 7 months to 70 years (mean age of 28±20 years), belonged to 26 ethnic groups spanning the Brazilian territory and answered a questionnaire, which was attached to their medical records. Peripheral blood samples (20mL) were collected, transported to the Clinical Laboratory of Hospital Israelita Albert Einstein, processed, and tested for markers of viral hepatitis B, C and D. Results In this study, 39 (48.1%) individuals were anti-HBs (+) only, 13 (16.0%) individuals were anti-HBs (+) and anti-HBc (+), and 28 (34.6%) individuals were negative for all markers. No anti-HBc IgM+ samples were found. No cases of hepatitis C and D were found. Conclusion This analysis provided evidence of previous infection by the hepatitis B virus. These findings led to prescription of vaccination against hepatitis B to all participants who were negative for all viral hepatitis B markers, given records of prior hepatitis B vaccination were unreliable.
  • Lung nodule localization in hybrid room before minimally invasive thoracic surgery: series of 20 cases and literature review Original Article

    Gilberto, Guilherme Moratti; Falsarella, Priscila Mina; Andrade, Juliano Ribeiro de; Schmid, Bruno Pagnin; Mariotti, Guilherme Cayres; Terra, Ricardo Mingarini; Campos, Jose Ribas Milanez de; Succi, Jose Ernesto; Garcia, Rodrigo Gobbo

    Abstract in English:

    ABSTRACT Objective To describe an experience in the preoperative localization of small pulmonary nodules and ground-glass lesions to guide minimally invasive thoracic surgery; in addition, a literature review was conducted, including the main advantages and disadvantages of the different agents used, and site marking in a hybrid operating room. Methods A retrospective search was conducted in a Interventional Radiology Department database, between March 2015 and May 2019, to identify patients undergoing preoperative percutaneous marking of lung injuries measuring up to 25mm. Results A total of 20 patients were included and submitted to descriptive analysis. All patients were marked in a hybrid room, at the same surgical-anesthetic time. Most often used markers were guidewire, Lipiodol® and microcoils. Despite one case of coil displacement, two cases of pneumothorax, and one case of hypotension after marking, all lesions were identified and resected accordingly from all patients. Conclusion Preoperative percutaneous localization of lung injuries in hybrid room is an effective and a safe technique, which can have decisive impact on surgical resection. The choice of marker and of the operating room scenario should be based on availability and experience of service. Multidisciplinary discussions with surgical teams, pathologists, and interventional radiologists are crucial to improve outcome of patients.
  • Increase in direct costs for health systems due to lupus nephritis: the case of Colombia Original Article

    Prada, Sergio I; Pérez, Ana M; Nieto-Aristizábal, Ivana; Tobón, Gabriel J

    Abstract in English:

    ABSTRACT Objective Lupus nephritis is one of the most severe complications of systemic lupus erythematosus and it has been estimated that can occur in up to 60% of patients. Direct costs of lupus nephritis have not been studied in developing countries. This study aimed to describe lupus nephritis direct costs in Colombia. Methods Administrative data from two Colombian health maintenance organizations for 2014 and 2015 was obtained. An algorithm based on the International Statistical Classification of Diseases and Related Health Problems 10th revision codes was developed to identify patients with lupus nephritis and lupus nephritis under study. Results The average annual per-patient, all-claims, all-cause direct cost for lupus nephritis was US$ 12,624, 7.5 times higher than the average lupus patient without lupus nephritis. For lupus nephritis cases under study, estimated direct cost was US$ 3,664, 2 times higher than average lupus patient in Colombia. Difference in lupus nephritis patients is mainly accounted for the cost and frequency of procedures, exceeding by a factor of 5 the cost for durable medical equipment and the cost for drugs, respectively. Conclusion Lupus patients who progress to lupus nephritis stage increased seven-fold the average annual per-patient, all-claims, and all-cause direct cost for the Colombian health system.
  • Factors associated with multidrug-resistant bacteria in healthcare-associated infections: a pediatric intensive care unit case-control study Original Article

    Silva, Barbara Barduchi Oliveira da; Silva Júnior, Moacyr; Menezes, Fernando Gatti de; Troster, Eduardo Juan

    Abstract in English:

    ABSTRACT Objective To investigate the prevalence of factors related to healthcare-associated infections, caused by multidrug-resistant bacteria, in a pediatric intensive care unit. Methods A retrospective case-control study conducted from January 1, 2007 to December 31, 2018, in São Paulo (SP), Brazil. The study was carried out at the pediatric intensive care unit of a high-complexity, tertiary care general hospital. The study included patients aged 1 month to 19 years, admitted to the pediatric intensive care unit, diagnosed as healthcare-associated infections. Results There was significant evidence of infection by multidrug-resistant bacteria associated with immunosuppressed patients (p<0.001), in whom the likelihood of multidrug-resistant bacteria infection was estimated to be nine-fold higher than among non-immunosuppressed patients (OR 8.97; 95%CI 2.69-29.94). In the analysis of multiple logistic regression model, we observed that immunosuppressed patients had an 8.5-fold higher chance of multidrug-resistant bacteria infection when compared to non-immunosuppressed patients (OR 8.48; 95%CI 2.54-28.35; p=0.001). There is evidence of association between the Case Group and presence of Gram-positive (p=0.007), coagulase-negative Staphylococcus (p<0.001), and Gram-negative (p=0.041) microorganisms. Conclusion The immunocompromised-state variable is a factor related to healthcare-associated infections caused by multidrug-resistant bacteria, and the Case Group presented higher proportions of Gram-positive microorganisms and coagulase-negative Staphylococcus.
  • Depression in healthcare workers from the COVID-19 Care and Isolation Center - Villa Panamericana: a single-center prospective study in Peru Original Article

    Moya-Salazar, Jeel; Saciga-Saavedra, Walter; Cañari, Betsy; Contreras-Pulache, Hans

    Abstract in English:

    ABSTRACT Objective Depression is a mental problem that affects the well-being of healthcare workers, impacting the quality of care and even leading to commit suicide. We aim to the levels of depression in frontline healthcare workers during the first severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak in Peru. Methods A prospective cohort study was designed in the coronavirus disease 2019 (COVID-19) Care and Isolation Center – Villa Panamericana in eastern Lima. Care and Isolation Center-Villa Panamericana houses about 150 healthcare workers and COVID-19 patients. The Montgomery-Asberg Depression Rating scale was used for depression assessment. Results A total of 96 participants (30±5.6 years) were analyzed: 15 (15.6%) physicians, 39 (40.6%) nurses, 14 (14.6%) medical technologists, and 28 (29.2%) nurse technicians. Mild, moderate, and severe depression were present in 35 (36.5%), 44 (45.8%), and 9 (9.4%) of the cases, respectively. The physicians and nurses reported more severe levels of depression: 8 (53.3%) physicians and 18 (46.2%) nurses presented moderate depression; and 2 (13.3%) physicians and 3 (7.7%) nurses presented severe depression (p=0.005). This study determined greater symptoms of depression according to years of work (p=0.001). Thirty-two healthcare workers had COVID-19, 4 (12.5%) physicians, 9 (28.1%) nurses, 7 (21.9%) medical technologists, and 12 (37.5%) nurse technicians. Twenty-four (75%) participants showed symptoms of COVID-19 and developed moderate (12 [37.5%]) and severe (3 [9.4%]) symptoms of depression (p=0.041). Conclusion This study clearly demonstrated a high prevalence of depression in the Care and Isolation Center-Villa Panamericana frontline healthcare workers during the COVID-19 pandemic in Peru.
  • The effects of COVID-19 stay-at-home orders on physical activity of people with obesity Original Article

    Prado, Wagner Luiz do; Lofrano-Prado, Mara Cristina; Christofaro, Diego Giulliano Destro; Santana, Carla Caroliny de Almeida; Cucato, Gabriel Grizzo; Jackson, Matthew; Shumate, Grace; Shumate, Sarah; Correia, Marilia de Almeida; Botero, João Paulo; Ritti-Dias, Raphael Mendes

    Abstract in English:

    ABSTRACT Objective To verify the association of changes on physical activity levels during coronavirus disease 2019 (COVID-19) outbreak of individuals with normal weight and overweight/obesity, and the influence of sex in this relationship. Methods This cross-sectional study (survey research) was conducted in Brazil between May 5 and May 17, 2020. Participants (n=1,828 / 1,062 women >18 years) were invited through social media to answer a structured questionnaire via Google Forms. The online assessment included self-reported responses to questions on physical activity, overall health, weight, and height. Binary logistic regression analyzed the relationship between overweight/obesity (body mass index ≥25kg/m2), the impact of COVID-19 on physical activity level, and the influence of sex. Results Compared to normal weight people, those with overweight/obesity practice less moderate to vigorous physical activity (p<0.001). There were associations between women and men with overweight/obesity and the impact of COVID-19 on the physical activity practice compared to normal weight people, adjusted by age, education level, social isolation, and previous physical activity level (p<0.017). Conclusion The study found an association of weight and changes in physical activity levels. Individuals with overweight/obesity were more likely to have a lower physical activity level during COVID-19 pandemic, regardless of sex.
  • Headache and rhinitis: pattern search on Google Trends for 17 years Original Article

    Swerts, Diego Belandrino; Barbosa, Guilherme; Peres, Mario Fernando Prieto

    Abstract in English:

    ABSTRACT Objective Headache and rhinitis are highly prevalent and comorbid. The objective of the present study is to analyze the correlation of headache and rhinitis, in addition to the temporal pattern of these diseases in 17 years, using the Google Trends platform. Methods Google Trends was searched from January 2004 to June 2021, using the entry: [“rinite” (rhinitis) + “dor de cabeça” (headache)” + “Alzheimer” + “enxaqueca” (migraine)]. Migraine, primary headache, and Alzheimer’s, with no clear relation with headache, were used as controls. After the descriptive analysis by dispersion diagrams, Pearson’s test and a simple regression model were performed. Subsequently, this study analyzed the seasonality of the volume of research on rhinitis and headache. Results A strong correlation between rhinitis and headache (0.86) was found in the time interval analyzed. In addition, a seasonality was identified in the volume of searches for the term rhinitis with increased volume in the fall and peaks in the month of May, with a decrease in the spring and early summer. Moreover, an increase of searches on headache was observed, suggesting worse burden of this pathology. Conclusion Headaches and rhinitis were correlated in 17 years of research on the Google Trends platform. Circannual variation of both conditions was observed. Additional studies with digital research may be useful to better understand the epidemiology and comorbidities of headache.
  • Real world evidence of the use of metamizole (dipyrone) by the Brazilian population. A retrospective cohort with over 380,000 patients Original Article

    Sznejder, Henry; Amand, Caroline; Stewart, Andrew; Salazar, Ricardo; Scala, Wanessa Alessandra Ruiz

    Abstract in English:

    ABSTRACT Objective To determine under which health conditions metamizole (dipyrone) is used as a single drug or as fixed-dose combination. Methods Two retrospective cohorts of Brazilian patients treated with metamizole between January 2015 and December 2017 were analyzed: a metamizole-based cohort (Cohort 1) and a symptoms-based cohort (Cohort 2). Anonymized patient data was obtained from Amil Clinical Data Warehouse. The number of patients with symptoms was described by age and sex. Results The sample size of the two cohorts consisted of 384,668 patients. In patients using metamizole (Cohort 1), the most common reason for medication was the treatment of some form of pain (81%), followed by fever (19%). Headache was the most common (19%) specified pain class, followed by sore throat (8%), muscular pain (6%), and abdominal pain (5%). In adult patients (n=276,279; 71.8%), metamizole was used as a monotherapy or associated with another drug, for any sort of pain, in over 88% of the patients. General pain was the main reason for metamizole use in children (61%). Conclusion Real world evidence to evaluate Brazilian patients’ therapeutic options is unusual and yet to be more explored using digital tools enabling better data registration. The present study confirmed that metamizole is widely used as a non-anti-inflammatory drug, and also showed the management of pain and fever as the most frequent indications in all age groups studied. Registry in Clinical Trials Database: REBEC Database: 10507
  • C-reactive protein levels and prevalence of leukopenia in patients with inflammatory bowel disease treated with azathioprine and/or mesalazine: a real-life study Original Article

    Santos, Rejani Cristine Faustino dos; Catapani, Wilson Roberto; Takahashi, André Akira Ramos; Waisberg, Jaques

    Abstract in English:

    ABSTRACT Objective To examine serum C-reactive protein levels and the prevalence of leukopenia in patients with Crohn’s disease or ulcerative colitis undergoing treatment with azathioprine and/or mesalazine. Methods Retrospective observational study based on clinical and laboratory data collected from medical records of 76 adult patients with inflammatory bowel disease treated with azathioprine, mesalazine or both. Sex, age, diagnosis, number of blood samples and elevated serum C-reactive protein levels during the follow-up period were recorded. The following variables were analyzed in terms of C-reactive protein levels and leukopenia episodes: sex, age, diagnosis of inflammatory bowel disease and type of drug. Statistical analyses included multiple logistic regression and the Fisher’s exact test for qualitative variables. Results Leukopenia was observed in 18.4% of patients and was associated with older age and higher doses of medication. In 44% of patients, C-reactive protein levels were high. However, symptoms were not associated with abnormal levels of this marker. Conclusion Regardless of symptoms, serum C-reactive protein levels were not a reliable indicator of controlled inflammatory bowel disease. Leukopenia was independently associated with older age and higher doses of medication and is a common side effect, which should be routinely monitored.
  • Post-varicella arterial ischemic stroke in children and neurocognitive performance: a 4-year follow-up study Original Article

    Rodrigues, Regina Maria; Farhat, Sylvia Costa Lima; Lucato, Leandro Tavares; Sakano, Tania Miyuki Shimoda; Plaggert, Paulo Scatulin Gerritsen; Casella, Erasmo Barbante; Paz, José Albino da; Schvartsman, Cláudio

    Abstract in English:

    ABSTRACT Objective To analyze data from children who were previously healthy and presented with post-varicella arterial ischemic stroke upon arrival when admitted to the emergency room, with focus on the clinical/laboratory aspects, and neurocognitive performance after four-year follow-up. Methods Seven children presenting with arterial ischemic stroke after varicella were evaluated at pediatric emergency services in the city of São Paulo (SP), Brazil. Ischemic stroke was determined by magnetic resonance imaging/magnetic resonance angiography in a topography compatible with the areas supplied by the middle cerebral or internal carotid arteries. IgG-class antibodies against varicella zoster virus and varicella-zoster virus DNA by polymerase chain reaction in cerebrospinal fluid were tested. Patients with prothrombotic conditions were excluded. The Pediatric Stroke Outcome Measure was applied upon admission and 4-years after the stroke. Results All patients (age range: 1.3 to 4 years) included presented chickenpox 5.1 (±3.5) months before. All patients had analysis of anti-varicella-zoster-virus-IgG in cerebrospinal fluid, but only three (43%) had a positive result. Of the patients 43% had no vascular lesions identified in magnetic resonance angiography. All patients showed improvement in their sequela scores. After 4 years, five patients displayed good evolution in the Pediatric Stroke Outcome Measure, and only one patient presented with a score of 2 in the sensorimotor and cognition areas. No recurrence of arterial ischemic stroke was observed. Conclusion We reinforced the non-progressive course of post-varicella arterial ischemic stroke after 4-year follow-up. The presence of varicella-zoster-virus-DNA detected by polymerase chain reaction, and/or intrathecal IgG antibody against varicella zoster virus, and angiopathy location in magnetic resonance angiography were not determining for the diagnosis. Invasive tests, with low sensitivity, should be well considered in the diagnosis of post-varicella arterial ischemic stroke.
  • Eye diseases during pregnancy: a study with the medical data warehouse in the eye clinic of the Ludwig-Maximilians-Universität München in Munich in Germany Original Article

    Martins, Thiago Gonçalves dos Santos; Schor, Paulo; Mendes, Luís Guilherme Arneiro; Anschütz, Andreas; Silva, Rufino

    Abstract in English:

    ABSTRACT Objective To analyze the most common ophthalmologic disorders in pregnant women seen in a hospital in Munich in Germany using a big data analysis system, as well as to compare the results obtained with those from other epidemiological studies that used different data acquisition methods. Methods We retrospectively analyzed electronic health records of pregnant women who were seen at the ophthalmology department from 2003 to 2019 at the Ludwig-Maximilians-Universität München hospital. The main complaints that led to ophthalmic consultations during this period were evaluated, and also the variation in intraocular pressure of patients throughout gestational trimesters by analyzing data from the data warehouse system. Results A total of 27,326 electronic health records were analyzed. Of participants, 149 (0.54%) required eye care during pregnancy. Their mean intraocular pressure was 17mmHg in the first trimester, 12mmHg in the second trimester, and 14mmHg in the third trimester. The most prevalent findings were dry eye (29.3%) and conjunctivitis (16%), and ametropia (16%). The most common posterior segment problem was diabetic retinopathy (4.6%). The lower mean intraocular pressure in the second and third trimester found in our study is in accordance with other studies that used other method for data acquisition. Conclusion The most common ophthalmic conditions found in this study population were dry eye, conjunctivitis, and ametropia. The use of data warehouse proved to be useful for acquiring and analyzing data from many patients. This study results are comparable with other studies in published literature that adopted different methodology.
  • Body dissatisfaction among undergraduate medical students in the city of Juiz de Fora, Minas Gerais, Brazil Original Article

    Santos, Bruno Cassiano dos; Almeida, Dominique D’Alessandro Conte de; Guilarducci, Nathália Vital; Machado, Rachel Rocha Pinheiro

    Abstract in English:

    ABSTRACT Objective To assess the level of body dissatisfaction among undergraduate medical students in the city of Juiz de Fora, Minas Gerais, Brazil. Methods A cross-sectional study with 232 volunteers of both sexes at a private college. The Body Shape Questionnaire was used, which is a tool based on the sum of values that allow classifying body dissatisfaction according to the following scores: less than 111, if absence of body dissatisfaction; between 111 and 138, if mild body dissatisfaction; between 139 and 167, if moderate body dissatisfaction, and from 168, if severe body dissatisfaction. In addition, the self-reported body mass index and an assertion were used to assess the degree and perception (insight) of body dissatisfaction. For the statistical analysis, descriptive comparison, and binary logistic regression tests were performed. Results The mean result of the Body Shape Questionnaire among women was 96.0±34.1 and among men, 76.7±24.7, with 26.3% of students with some level of dissatisfaction with self-image. Most participants (76.3%) wished to have a body mass index lower than the real one. Women (odds ratio of 5.7), overweight individuals (odds ratio of 6.1), and individuals with insight into their condition (odds ratio of 89.7) were more likely to be dissatisfied with the body image measured by the Body Shape Questionnaire. Conclusion The search for a thin body among undergraduate medical students is a reality. In addition to overweight individuals, the female population has a significant level of body distortion, being recognized as the highest rate of body dissatisfaction in the sample surveyed.
  • Evaluation of pulse wave velocity and central systolic blood pressure in children and adolescents with chronic kidney disease Original Article

    Brecheret, Ana Paula; Abreu, Ana Lucia Cardoso Santos; Lopes, Renata; Fonseca, Francisco Antônio Helfenstein; Solé, Dirceu; Andrade, Maria Cristina de

    Abstract in English:

    ABSTRACT Objective Investigate pulse wave velocity and central systolic blood pressure among pediatric population with chronic kidney disease. Methods In this cross-sectional study, 57 patients (61.4% male) aged 6.2 to 17.5 years old, 44 with nondialysis chronic kidney disease and 13 on chronic dialysis, were included in the analysis. The pulse wave velocity and the central systolic blood pressure were measured with an oscillometric device with an inbuilt ARC SolverⓇ algorithm and were compared with previously established percentiles. Results The prevalence of elevated pulse wave velocity was 21.1% (95%Cl: 11.4-33.9) and elevated central systolic blood pressure was 28.1% (95%CI: 17.0-41.5). According to the generalized linear model, there was a higher risk of elevated pulse wave velocity in patients undergoing chronic dialysis treatment than nondialysis chronic kidney disease patients (adjPR=4.24, 95%CI: 1.97-9.13, p=<0.001). Hypertensive patients (stage 2) had a higher risk of elevated pulse wave velocity than normotensive ones (adjPR=2.70, 95%CI: 1.05-6.95, p=0.040), as did patients younger than 12 years than the older patients (adjPR=2.95, 95%CI: 1.05-8.40, p=0.041). Hypertensive patients had a higher risk of elevated central systolic blood pressure than normotensives (adjPR=3.29, 95%Cl: 1.36-7.94), as did patients undergoing chronic dialysis treatment when comparing to nondialysis chronic kidney disease patients (adjPR=2.08, 95%Cl: 1.07-4.02). Conclusion Younger age, dialysis, and hypertension in children are independently associated with higher pulse wave velocity. Hypertension and dialysis are independently associated with higher central systolic blood pressure.
  • Matrix-assisted autologous chondrocyte transplantation for treatment of focal chondral lesions in the knee: the Hospital Israelita Albert Einstein experience Original Article

    Zorzi, Alessandro Rozim; Antonioli, Eliane; Kaleka, Camila Cohen; Cohen, Moisés; Godoy, Juliana Aparecida Preto de; Kondo, Andrea Tiemi; Kutner, José Mauro; Lenza, Mario; Ferretti, Mario

    Abstract in English:

    ABSTRACT Objective Phase 1 clinical trial to determine feasibility, safety, and efficacy of a new advanced cell therapy product for treatment of knee articular cartilage injuries. Methods Three participants with knee focal chondral lesions were included, with no signs of osteoarthritis. Chondrocytes were obtained through knee arthroscopy, cultured in collagen membrane for 3 weeks at the laboratory, subjected to tests to release the cell therapy product, and implanted. All patients underwent a specific 3-month rehabilitation protocol, followed by assessments using functional and imaging scales. The main outcome was the incidence of severe adverse events. Results Three participants were included and completed the 2-year follow-up. There was one severe adverse event, venous thrombosis of distal leg veins, which was no associated with therapy, was treated and left no sequelae. The clinical and radiological scales showed improvement in the three cases. Conclusion The preliminary results, obtained with the described methodology, allow concluding that this product of advanced cell therapy is safe and feasible. ReBEC platform registration number: RBR-6fgy76
  • Impacts of the COVID-19 pandemic on elective cataract surgeries Original Article

    Tannous, Marcelo; Mendes, Renata Leonel Freire; Freitas, Ana Vega Carreiro de; Magalhães, Andressa Miranda; Ferrari, Rogério; Miolo, Bruno Luiz; Alves, Milton Ruiz; Avakian, Amaryllis; Carricondo, Pedro Carlos

    Abstract in English:

    ABSTRACT Objective To evaluate the standards of practice of Brazilian cataract surgeons in relation to the protective measures adopted to mitigate the risks of transmission of COVID-19 during cataract surgery, in asymptomatic patients. Methods A descriptive, cross-sectional, quantitative paradigm study, developed from a self-administered electronic questionnaire sent to ophthalmologists and residents/specialists in ophthalmology in Brazil, who performed cataract surgeries in 2019 and 2020, connected through social media and mail listing from local societies. Results Of the 303 participating surgeons, 159 (n=52.2%) performed elective cataract surgeries between March 20th, 2020 to June 1st, 2020. Among the measures adopted by ophthalmologists with the purpose of preventing viral transmission, the patient’s temperature was measured by 84.3% (n=134), and the verification of respiratory symptoms and contact/exposure to cases of COVID-19 by 87.4% (n=139). Most did not submit their patients to laboratory tests to detect COVID-19 (145; 91.2%). In surgery, 44.7% (n=71) used an N95 mask, and 69.2% (n=110) kept their patients with a mask. No stage of phacoemulsification was modified in 144 (90.6%) participants, 13 (8.2%) added methylcellulose under the main incision, and two (1.3%), modified another surgical stage. Conclusion The COVID-19 pandemic significantly interrupted part of cataract surgeries in Brazil from March to June 2020 and measures to prevent viral spread are being heterogeneously adopted by surgeons. Understanding these measures could be the first step to improve strategies to return to pre-pandemic levels.
  • Evaluation of the prematurity retinopathy and other eye changes in the newborn Original Article

    Martins, Thiago Gonçalves dos Santos; Andreghetto, Leticia de Araújo Franco; Brito, Rafael Maciel; Provenzano, Luciane Benitez; Fowler, Susan

    Abstract in English:

    ABSTRACT Objective To assess the prevalence of ophthalmologic manifestations in newborns in a maternity hospital in the city of São Paulo, SP, and the main risk factors related with the development of retinopathy of prematurity. Methods A retrospective, longitudinal study with patients born from 2015 to 2017 who required ophthalmological evaluation. The research variables were obtained by analysis of the newborn medical charts. Results A total of 773 patients were studied. The sample consisted of 288 examinations performed by indication of gestational age ≤32 weeks: 118 (42.4%) in 2015, 105 (42.2%) in 2016, 65 (26.4%) cases in 2017. There were 329 evaluations indicated due to birth weight: 113 (40.6%) in 2015, 108 (43.4%) in 2016, and 108 (43.9%) in 2017. The prevalence of associated risk factors was 97 (34.9%) cases in 2015, 96 (38.6%) in 2016, and 54 (22%) in 2017, followed by mechanical ventilation with 82 (29.5%) cases in 2015, 64 (25.7%) in 2016 and 41 (16.7%) in 2017, and continuous positive airway pressure with 59 (21.2%) cases in 2015, 72 (28.9%) in 2016, and 46 (18.7%) in 2017. For the other indications, the evaluations performed due to congenital syphilis were the majority in the 3-year period of the study, with 55 (19.8%) newborns in 2015, 54 (21.7%) in 2016, and 59 (24.0%) in 2017. The most prevalent ophthalmologic diagnosis was retinopathy of prematurity, with 79 (35.3%) cases in 2015, 64 (32.2%) in 2016, and 41 (24.1%) in 2017. Conclusion Most neonates born in the organization do not present risk factors for ophthalmological manifestations. Retinopathy of prematurity was the disease with greater strength of association found in our study. For the other indications, the evaluations performed due to congenital syphilis prevail in the 3- year period of the study.
  • Relation between red blood cell distribution width and acute kidney injury in patients with sepsis Original Article

    Ramires, Marina Larissa Vettorello; Leite, Manoela Fidelis Batista; Lo, Daniel Zu Yow; Silveira, Leonardo Bonilla da; Ferraz, Leonardo José Rolim; Pardini, Andreia; Sakashita, Araci Massami; Kondo, Andrea Tiemi; Olivato, Guilherme Benfatti; Durão Junior, Marcelino de Souza; Rodrigues, Adelson Marçal; Chiloff, Daniela Mendes; Almeida, Danilo Candido de; Goes, Miguel Angelo

    Abstract in English:

    ABSTRACT Objective The objective of the present study is to evaluate the association of red blood cell distribution width with acute kidney injury in sepsis. Methods This is a retrospective study of 849 critically ill patients with sepsis in intensive care unit. Demographic data, renal function, inflammation, complete blood count, and acid-base parameters were compared between acute kidney injury and non-acute kidney injury groups. Therefore, a multivariate analysis was performed to observe independent predictive factors. Results Comparatively, higher levels of C-reactive protein, lactate, red blood cell distribution width, and Simplified Acute Physiology Score 3 were found in the acute kidney injury group. The study showed a higher frequency of women, hemoglobin (Hgb) concentration, platelets, bicarbonate and PaO2/FiO2 ratio in the non-acute kidney injury group. In addition, there was an independent association of comorbidity-chronic kidney disease [OR 3.549, 95%CI: 1.627-7.743; p<0.001], urea [OR 1.047, 95%CI: 1.036-1.058; p<0.001] and RDW [OR 1.158, 95%CI: 1.045-1.283; p=0.005] with acute kidney injury in sepsis patients. Conclusion As an elective risk factor, red blood cell distribution width was independently associated with sepsis-related acute kidney injury. Thus, red blood cell distribution width acts like a predictive factor for sepsis-induced acute kidney injury in intensive care unit admission.
  • Quality of clinical studies present in the package inserts of coagulation factors used in the treatment of hemophilia Original Article

    Araújo, Yasmin Gonçalves; Paolinelli, João Pedro Vasconcelos; Pichitelli, Janaina Souza Dias; Rios, Danyelle Romana Alves; Baldoni, Nayara Ragi; Baldoni, André Oliveira

    Abstract in English:

    ABSTRACT Objective To identify and analyze the quality of scientific evidence from clinical efficacy studies present in the package inserts of coagulation factors, used in the treatment of hemophilia A and B. Methods Documentary study developed in two stages. The first stage consisted of identifying the medicine packages inserts electronically registered in the Brazilian Health Regulatory Agency, and analyzing the availability of the bibliographic references cited therein. This analysis was conducted in the PubMed, SciELO, Google Scholar, and Web of Science databases. The second step was the analysis of the methodological quality of the efficacy studies. Two trained researchers used the Cochrane Collaboration Risk of Bias version 5.1.0 tools for methodological quality analysis, and Review Manager 5.4 software to generate the risk of bias graph. Results Of the 17 medicines listed, 7 had referenced package inserts. Of these, 10 studies were eligible for analysis of methodological quality. More than half of the analyzed studies did not control for selection, performance, and detection bias. A total of 100% controlled attrition and reporting biases, and 50% had a high risk of conflict of interest. Conclusion The biases present are significant and may have influenced the overestimation of the effects of the outcomes of each of the studies.
  • Incidence of hemoglobinopathies and spatialization of newborns with sickle cell trait in Mato Grosso do Sul, Brazil Original Article

    Cândido-Bacani, Priscila de Matos; Grilo, Patrícia Medeiros Silva; Ramos, Vanessa da Silveira; Zanchin, Michelly; Pereira, Indiara Correia; Oliveira, Josaine Sousa Palmieri; Bacani, Vitor Matheus; Belini Junior, Edis

    Abstract in English:

    ABSTRACT Objective To evaluate the incidence of variant hemoglobins of newborn samples from the Neonatal Screening Center in the state of Mato Grosso do Sul, Brazil, and to analyze the distribution and spatial autocorrelation of newborns with sickle cell trait. Methods Samples from 35,858 newborns screened by the Neonatal Screening Center. The samples with inconclusive diagnosis were submitted to electrophoretic, chromatographic, cytological and molecular analyses. The spatial distribution analysis of newborns with sickle cell trait was performed by spatial autocorrelation. Results A total of 919 newborns showed an abnormal hemoglobin profile; in that, ten genotypes had significant clinical impacts identified. Among the asymptomatic newborns, the sickle cell trait was the most frequent (incidence of 1.885 cases/100 newborns). The highest incidence rates were registered in the municipalities of Terenos, Figueirão, Corguinho and Selvíria. There was positive spatial autocorrelation between the proportion of declared individuals of black race/color and the incidence of newborns with sickle cell trait. Conclusion The early diagnosis by neonatal screening and laboratory tests was very important to identify abnormal hemoglobin profiles and guide the spatial autocorrelation analysis of sickle cell trait newborns in Mato Grosso do Sul, serving as a support to anticipate health measures aimed to discuss efficient therapeutic behaviors and effective planning of municipalities with the greatest need for care, monitoring and orientations for affected families.
  • Accuracy of 68Ga-PSMA PET-CT and PET-MRI in lymph node staging for localized prostate cancer Original Article

    Barbosa, Álan Roger Gomes; Amaral, Breno Santos; Lourenço, Danilo Budib; Bianco, Bianca; Gushiken, Felipe Arakaki; Apezzato, Marcelo; Silva, Júlia Francisco; Cunha, Marcelo Livorsi da; Filippi, Reneé Zon; Baroni, Ronaldo Hueb; Lemos, Gustavo Caserta; Carneiro, Arie

    Abstract in English:

    ABSTRACT Objective To evaluate the predictive value of positron emission computed tomography or magnetic resonance (PET-CT and PET-MRI) using gallium-68-labeled prostate-specific membrane antigen (68Ga-PSMA) in lymph node involvement in prostate cancer. Methods A retrospective study comprising 91 patients diagnosed with prostate cancer between 2016 to 2020, who underwent 68Ga-PSMA PET-CT or PET-MRI for staging before prostatectomy. The patients were divided into Group 1, with 65 patients with satisfactory pathological lymph node analysis, and Group 2, with 91 patients representing the sum of patients with pathological lymph node analysis and those with postoperative prostate-specific antigen within 60 days after surgery. Receiver Operating Characteristic curves were used to assess accuracy of predictive capacity of imaging exams for lymph node involvement. Results Regarding local clinical staging, the groups showed similar results, and 50% were classified as staging T2a. The accuracy of 68Ga-PSMA PET-CT for prostate cancer lymph node staging was 86.5% (95%CI 0.74-0.94; p=0.06), with a sensitivity of 58.3% and specificity of 95%. The accuracy of 68Ga-PSMA PET-MRI was 84.6% (95%CI 0.69-0.94; p=0.09), with a sensitivity of 40% and specificity of 100%. Considering both 68Ga-PSMA PET-CT and PET-MRI, the accuracy was 85.7% (95%CI 0.76-0.92; p=0.015), with sensitivity of 50% and specificity of 97%. Conclusion The imaging tests 68Ga-PSMA PET-CT and PET-MRI were highly accurate to detect preoperative lymph node involvement, and could be useful tools to indicate the need for extended lymph node dissection during radical prostatectomy.
  • Degree of food processing and association with overweight and abdominal obesity in adolescents Original Article

    Souza, Sineide Freitas de; Conceição-Machado, Maria Ester Pereira da; Costa, Priscila Ribas de Farias; Cunha, Carla de Magalhães; Queiroz, Valterlinda Alves de Oliveira; Santana, Mônica Leila Portela de; Leite, Luana de Oliveira; Assis, Ana Marlúcia de Oliveira

    Abstract in English:

    ABSTRACT Objective To evaluate the association between the degree of food processing, overweight, and abdominal obesity in adolescents. Methods This is a cross-sectional study, with 576 adolescents aged 10 to 17 years, of both sexes. Food consumption was collected using the Food Frequency Questionnaire and foods classified as in natura or minimally processed, processed foods associated with culinary ingredients, and ultraprocessed foods. Sociodemographic data, body mass index, waist circumference and waist-to-height ratio were collected. The analysis was evaluated by the Mann-Whitney test and prevalence ratio with 95% confidence interval, considering p<0.05. Results An intake above the third quartile of processed foods associated with culinary ingredients (prevalence ratio of 1.64; 95%CI: 1.12-2.42) and ultraprocessed (prevalence ratio of 1.58; 95%CI: 1.07-2.34) was associated with a higher prevalence of overweight. Consumption above the third quartile of ultraprocessed foods was associated with a higher prevalence of abdominal obesity, assessed by waist circumference (prevalence ratio of 2.48; 95%CI: 1.41-4.36), and waist-height ratio (prevalence ratio of 2.09; 95%CI: 1.11-3.92). Conclusion A higher consumption of processed foods associated with culinary ingredients was related to being overweight, and ultraprocessed foods with overweight and abdominal obesity.
  • Ultrasound classification of thyroid nodules: does size matter? Original Article

    Sakajiri, Raissa Kitaguchi; Rahal Junior, Antonio; Francisco Neto, Miguel José; Queiroz, Marcos Roberto Gomes de; Garcia, Rodrigo Gobbo; Martins, Leandro Aurélio Liporoni; Malerbi, Domingos Augusto Cherino

    Abstract in English:

    ABSTRACT Objective To determine whether the size of thyroid nodules in ACR-TIRADS ultrasound categories 3 and 4 is correlated with the Bethesda cytopathology classification. Methods Thyroid nodules (566) subclassified as ACR-TIRADS 3 or 4 were divided into three size categories according to American Thyroid Association guidelines. The frequency of different Bethesda categories in each size range within ACR-TIRADS 3 and 4 classifications was analyzed. Results Most nodules in both ACR-TIRADS classifications fell in the Bethesda 2 category, regardless of size (90.8% and 68.6%, ACR-TIRADS 3 and 4 respectively). The prevalence of Bethesda 6 nodules in the ACR-TIRADS 4 group was 14 times higher than in the ACR-TIRADS 3 group. There were no significant differences between nodule size and fine needle aspiration biopsy classification in any of the ACR-TIRADS categories. Conclusion Size does not appear to be an important criterion for indication of fine needle aspiration biopsy in thyroid nodules with a high suspicion of malignancy on ultrasound examination.
  • In-hospital outcomes in preterm and small-for-gestational-age newborns: a cohort study Original Article

    Costa, Lo-Ruama Pereira; Costa, Gleise Aparecida Moraes; Valete, Cristina Ortiz Sobrinho; Machado, José Kleber Kobol; Silva, Mariliza Henrique da

    Abstract in English:

    ABSTRACT Objective To compare in-hospital outcomes between small-for-gestational-age and appropriate-for-gestational-age preterm neonates who needed intensive care. Methods A retrospective cohort study with preterm newborns, from January to December 2017. The results are presented as median, frequency, and odds ratio. Numerical variables were compared using the Wilcoxon test. Categorical variables were compared using the χ2 test. We considered p<0.05 as significant. Results Out of 129 preterm newborns included, 20.9% were small-for-gestational-age. Median gestational age was 31 2/7 weeks, birthweight was 1,450g, and length of hospital stay was 39 days. Preterm small-for-gestational-age newborns presented a higher chance of peri-intraventricular hemorrhage (odds ratio of 3.23; p=0.02), retinopathy of prematurity (odds ratio of 2.78 p=0.02), patent ductus arteriosus (odds ratio of 2.50; p=0.04) and a lower chance of presumptive early-onset sepsis (odds ratio of 0.37; p=0.03). Conclusion Preterm small-for-gestational-age neonates were associated with peri-intraventricular hemorrhage, retinopathy of prematurity and patent ductus arteriosus. This emphasizes the need of special care for these neonates.
  • Palliative care to cancer patients: how COVID-19 pandemic could affect quality of care Original Article

    Todaro, Juliana; Nogueira, Camila Viale; Conte, Elisa Rossi; Kaliks, Rafael Aliosha

    Abstract in English:

    ABSTRACT Objective To evaluate the impact of COVID-19 pandemic on the care delivered to hospitalized cancer patients in end-of-life. Methods A retrospective analysis of data of hospitalized patients with advanced solid tumors, who died under exclusive palliative care during first wave (March 2020 to July 2020) compared with the period previous pandemic (January 2018 to February 2020). Results A total of 190 oncologic patients were included, 161 patients before the pandemic, and 29 in the period from March 2020 to July 2020. The average hospitalization was 497.2 patients per month, before the pandemic, and dropped to an average of 46.5 in the pandemic, whereas the death rate decreased from an average of 6.3 patients per month to 4.8. Considering the benchmarks for quality of care during end-of-life care, preferences on life assistance were discussed prior to hospitalization for 34.4%, before the pandemic, and 13.8% during the pandemic (p=0.0298); 9.3% received chemotherapy 15 days prior to the date of death, before the pandemic, and 20.7%, in the pandemic (p=0.1012). Conclusion Based on the present results, despite the decrease in oncology admissions, the advanced-stage cancer patients continued to seek hospital for end-of-life care. However, we could observe in our benchmarking analyses for palliative quality of care that talks about prognosis occurred less often during the pandemic.
  • Telemedicine diagnosis of acute respiratory tract infection patients is not inferior to face-to-face consultation: a randomized trial Original Article

    Accorsi, Tarso Augusto Duenhas; Moreira, Flavio Tocci; Pedrotti, Carlos Henrique Sartorato; Amicis, Karine De; Correia, Renata Farias Vidigal; Morbeck, Renata Albaladejo; Medeiros, Fernanda Ferreira; Souza Jr, José Leão de; Cordioli, Eduardo

    Abstract in English:

    ABSTRACT Objective To analyze telemedicine diagnostic accuracy in patients with respiratory infections during COVID-19 pandemic compared to face-to-face evaluation in the emergency department. Methods Randomized, unicentric study between September 2020 and November 2020 in patients with any respiratory symptom (exclusion criteria: age >65 years, chronic heart or lung diseases, immunosuppressed). Patients were randomized 1:1 for brief telemedicine followed by face-to-face consultation or direct face-to-face evaluation. The primary endpoint was the International Classification of Diseases code. The secondary analysis comprised length of stay, diagnostic test ordering, medical prescription, and proposed destination. Results Ninety-eight patients were enrolled. The mean age was 36.3±9.7 years old, 57.1% were women, and 81.6% had diagnostic test ordered. Mean grouped by International Classification of Diseases code for upper respiratory tract infection, pharyngotonsillitis, and sinusitis showed no difference between study groups or secondary endpoints. The Telemedicine Group was representative of the population usually evaluated in this center. In the Telemedicine Group (n=48), 18.7% patients would be referred for evaluation at the emergency department. The distribution of diagnoses by telemedicine was 67.4% for upper respiratory tract infection, 2.3% for pharyngotonsillitis, and 0% for sinusitis, being statistically similar to the subsequent face-to-face assessment, respectively: 72.1%, 11.6% and 7% (Kappa 0.386 [95%CI: 0.112-0.66]; p=0.536). Telemedicine ordered COVID-19 molecular (RT-PCR) tests in 76.5% versus 79.4% in face-to-face evaluation (Kappa 0.715 [95%CI: 0.413-1]; p>0.999). Conclusion Diagnostic telemedicine consultation of low-risk patients with acute respiratory symptoms is not inferior to face-to-face evaluation at emergency department. Telemedicine is to be reinforced in the health care system as a strategy for the initial assessment of acute patients. ClinicalTrials.gov Identifier: NCT04806477
  • Aging process and central auditory pathway: a study based on auditory brainstem evoked potential and frequency-following response Original Article

    Tessele, Daniélli Rampelotto; Peixe, Bruna Pias; Sanguebuche, Taissane Rodrigues; Malavolta, Vitor Cantele; Garcia, Michele Vargas; Sanfins, Milaine Dominicini

    Abstract in English:

    ABSTRACT Objective To analyze age-related changes in the central auditory pathway in healthy elderly individuals. Methods A prospective, quantitative cross-sectional study. The caseload comprised 18 adults (mean age, 22.78 years) and 18 elderly individuals (mean age, 66.72 years) of both sexes, who met inclusion criteria. Subjects were submitted to basic audiological evaluation and related electrophysiologic tests: brainstem auditory evoked potential with click stimulus and frequency-following response. Results Elderly individuals had higher wave and interpeak latencies (waves I, III and V and interpeaks I-V and III-V) of brainstem auditory evoked potential. Latencies of frequency following response waves A, E, F and O were also higher in elderly individuals. Frequency following response amplitudes were better in A than in D, F and O waves in these subjects. Likewise, interpeak intervals (V-A and V-O) were larger in elderly relative to adult individuals. Lower slope values were observed in elderly individuals. Conclusion Brainstem auditory evoked potential and frequency-following response allowed appropriate assessment of age-related changes in the auditory pathway. Slower neural response to auditory stimuli suggests reduced synchrony between neural structures.
  • T2-weighted imaging hypointensity in an ovarian lesion: is it a benign finding? Original Article

    Alcala, Juan Marcelo Fernandez; Mussi, Thais Caldara; Raiza, Luciana Cristina Pasquini; Baroni, Ronaldo Hueb

    Abstract in English:

    ABSTRACT Objective To evaluate whether the presence of a hypointense signal at T2-weighted imaging in a solid ovarian lesion on magnetic resonance imaging is a predictor of stability and benignity. Methods This is a single center study, prospectively read with retrospective acquired data. The database was searched for patients who underwent magnetic resonance imaging between January 2008 and October 2019 and whose reports mentioned solid ovarian lesions with low signal on T2-weighted imaging. A total of 47 nodules were included. A radiologist who was blinded to the clinical indication for magnetic resonance imaging and original reports evaluated the cases. Objective and subjective criteria of ovarian lesions in magnetic resonance imaging were evaluated. Results Thirty-five nodules were considered benign/stable and 12 were considered non-stable. The analysis showed that the non-stable lesions showed statistically more hyperintensity at T1-weighted imaging compared to the stable lesions. Conclusion T2-weighted imaging hypointensity can be considered a predictor of stability in solid ovarian lesions when associated with iso/hypointensity in T1-weighted imaging.
  • Actinic cheilitis in rural workers: prevalence and associated factors Original Article

    Faria, Maria Helaynne Diniz; Silva, Luanna Mayrany Alves Costa; Mafra, Rodrigo Porpino; Santos, Marquiony Marques dos; Soares, Samara Carollyne Mafra; Moura, Jamile Marinho Bezerra de Oliveira

    Abstract in English:

    ABSTRACT Objective To evaluate the prevalence of actinic cheilitis in rural workers and factors associated with the development of this condition. Methods A cross-sectional study was conducted in a city in Northeastern Brazil. Data were collected by clinical examination and use of a questionnaire validated with 300 rural workers. The χ2 test was employed to identify possible associations between the presence of actinic cheilitis and clinical and demographic variables. Multiple logistic regression analysis was performed using forward stepwise selection. A p value of 0.05 was considered significant. Results The prevalence of actinic cheilitis was 12.0% in the sample. The highest prevalence of actinic cheilitis was observed in white males, with low educational level, and an approximately 40-year history of sun exposure. Chronic lesions were commonly found in the lower lip and were characterized by scaling, dryness, and mild edema. Skin color, sex, educational level of patients, and cumulative sun exposure (in years), were identified as predictors of development of actinic cheilitis. Conclusion Our results suggest the need to implement educational health strategies aimed to orient the population about risk factors and preventive measures of the disease. Appropriate clinical management of patients with actinic cheilitis is important for prevention of lip cancer.
  • Effects of topiramate, bupropion and naltrexone isolated or combined on subcutaneous adipose tissue in obese rats Original Article

    Scudeler, Monica Alhadas; Morreale, Stephania; Doretto-Silva, Lorena; Petri, Giuliana; Santos, José Francisco Ramos dos; Nassis, Cristina; Correa, Olga Maria de Toledo; Veridiano, Juliana Mora

    Abstract in English:

    ABSTRACT Objective: To evaluate the effects of combining topiramate, bupropion and naltrexone in obesity-induced rats on their weight and subcutaneous adipose tissue. Methods: A total of 40 male Wistar rats were induced to obesity for 8 weeks and the animals were divided into 8 groups: Ctr - control, G0 - Sham, G1 - oral saline solution (1.0mL/day), G2 - topiramate (20.0mg/kg) and bupropion (5.0mg/kg), G3 - naltrexone (20.0mg/kg), G4 - topiramate (20.0mg/kg), G5 - bupropion (5.0mg/kg) and G6 - topiramate (20.0mg/kg), bupropion (5.0mg/kg) and naltrexone (20.0mg/kg). During the experiment, all animals were weighed weekly. After 30 days of treatment animals were euthanized and their skin fragments were processed and stained with hematoxylin and eosin for morphological, morphometric and biochemical analyzes. Results: The only group that presented a decrease in the volume of subcutaneous adipose tissue was G3, but this decrease was not significant when compared with the other groups. The G4, the G5 and the G6 presented increased adipose tissue volume. Data showed that until the eighth week all animals increased their weight by approximately 50%. After treatment animals of all groups, except G3, increased their weight from 4% to 9% approximately. The G3 was the only group that lost weight, but this decrease was not significant. Conclusion: The medicines studied were not efficient in reducing weight in obese rats. However, it should be considered that 30-day treatment period is not enough to observe the stronger effects of these drugs.
  • Flexible broncoscopy in patients in supportive therapy with oxygenation by extracorporeal membrane Original Article

    Redivo, Camila França; Lima, Evelise; Ferreira, Anarégia de Pontes; Scordamaglio, Paulo Rogério; Campos, Silvia Vidal; Ho, Yeh-Li; Rodrigues, Ascédio José

    Abstract in English:

    ABSTRACT Objective: To report the experience of performing bronchoscopy in patients who underwent supportive therapy with extracorporeal membrane oxygenation in whom the bronchoscopy was performed. Methods: This was a review of medical records of patients diagnosed with extracorporeal membrane oxygenation and who required diagnostic or therapeutic bronchoscopy. Records included were related to patients admitted to the intensive care unit of Hospital das Clínicas of Faculdade de Medicina of Universidade de São Paulo, between 2014 and 2020. Results: During the study, 16 bronchoscopies were performed in 8 patients admitted to the intensive care unit and who underwent supportive therapy with extracorporeal membrane oxygenation. The mean age of patients was 28.37 years. Four patients were women (50%). A total of 5 (31.25%) therapeutic bronchoscopies and 11 (68.75%) diagnostics were performed. In 5 of patients, material was collected: 4 samples of bronchoalveolar lavage, three collections of transbronchial biopsies, and 1 of endobronchial biopsies. No patient had radiological worsening or hemodynamic complications. One patient (6.25%) had transient desaturation. There was moderate bleeding after transbronchial biopsy in 1 (6.25%) procedure, which was resolved endoscopically. Conclusion: Patients undergoing extracorporeal membrane oxygenation can safely perform diagnostic or therapeutic bronchoscopy provided that they have a detailed indication. Procedures were performed by a specialized bronchoscopy team in intensive care environment and with the assistance of a qualified multidisciplinary team in membrane oxygenation therapy extracorporeal.
  • Bronchoscopy in COVID-19 inpatients: experience of a university hospital in the first outbreak of the disease in Brazil Original Article

    Demarzo, Sergio Eduardo; Melo, Júlia Bamberg Cunha; Carranza, Mariasol Ximena Martínez; Oliveira, Felipe Nominando Diniz; Ferreira, Anarégia de Pontes; Palomino, Addy Lidvina Mejia; Figueiredo, Viviane Rossi; Jacomelli, Marcia

    Abstract in English:

    ABSTRACT Objective: To describe the indications and endoscopic findings of bronchoscopy performed at a reference university hospital for inpatients diagnosed with COVID-19 during the first outbreak of the disease in Brazil. Methods: A retrospective analysis of medical records of adult patients diagnosed with COVID-19 who underwent bronchoscopy at the intensive care units of Instituto do Coração and Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, from March to August 2020. Results: A total of 132 bronchoscopies were performed in 103 patients diagnosed with COVID-19. Mean age was 56.1±14.5 years, and distribution was similar in both sexes. More than one test was performed in 16 patients. The most frequent indications were diagnostic endoscopic evaluation and therapeutic procedures in 78.6% of cases (n=81) and material collection in 21.4% of cases (n=22). The most frequent endoscopic findings were presence of secretion or clots in 34% of cases, the presence of acute inflammatory changes in 22.3%, and tracheal wall laceration in 20.4%. In 27.2% of patients, no relevant bronchoscopic findings were observed. In three patients, bronchoscopy was indicated to assess hemoptysis, but there was only one case of active bleeding. Procedure-related complications were not observed in this group of patients. Conclusion: Bronchoscopy proved to be a safe and effective procedure to assist in treatment of COVID-19 patients, and the most frequent indications were related to investigation of airway involvement or to evaluate infectious and inflammatory pulmonary processes.
  • Impact of blood levels of progesterone on the day of ovulation onset on clinical, laboratory and reproductive parameters of young patients undergoing assisted reproduction: a cross-sectional study Original Article

    Fernandez, Renata Garcia Olmos; Barbosa, Caio Parente; Christofolini, Denise Maria; de Alcantara Sousa, Luiz Vinicius; de Oliveira, Renato; Bianco, Bianca

    Abstract in English:

    ABSTRACT Objective: To assess whether there is an association between the level of progesterone on the day of administration of human chorionic gonadotropin and clinical and laboratory characteristics, in addition to the results of in vitro fertilization of patients with a good prognosis. Methods: A cross-sectional study comprising 103 women who underwent intracytoplasmic sperm injection treatment, between November 2009 and May 2015, aged ≤35 years, with no comorbidities, with fresh embryo transfer. Data were collected from patient medical records. Results: There was a weak positive correlation between the level of progesterone on the day of human chorionic gonadotropin and the number of follicles larger than 14mm (ß=0.02, p=0.001), retrieved oocytes (ß=0.01, p=0.01) and oocytes in metaphase II (MII) (ß=0.02, p=0.02); that is, the increase in progesterone level has a slight association with increased values of these variables. Body mass index was inversely correlated with progesterone level on the day of human chorionic gonadotropin (ß=-0.01, p=0.02). No association was found between the level of progesterone on the day of human chorionic gonadotropin and the protocols used for controlled ovarian stimulation, quality of transferred embryos and the pregnancy rate. Conclusion: There is an association between the value of progesterone on the day of human chorionic gonadotropin administration with body mass index, number of follicles larger than 14mm, number of retrieved oocytes and oocytes in metaphase II. Unlike embryo quality and pregnancy rate, which do not have a statistically significant relation with this value in the population studied.
  • Prognostic factors of worse outcome for hospitalized COVID-19 patients, with emphasis on chest computed tomography data: a retrospective study Original Article

    do Amaral e Castro, Adham; Yokoo, Patrícia; Fonseca, Eduardo Kaiser Ururahy Nunes; Otoni, Jessyca Couto; Haiek, Sarah Lustosa; Shoji, Hamilton; Chate, Rodrigo Caruso; Pereira, Andrea Z; Queiroz, Marcos Roberto Gomes de; Batista, Marcelo Costa; Szarf, Gilberto

    Abstract in English:

    ABSTRACT Objective: To evaluate anthropometric and clinical data, muscle mass, subcutaneous fat, spine bone mineral density, extent of acute pulmonary disease related to COVID-19, quantification of pulmonary emphysema, coronary calcium, and hepatic steatosis using chest computed tomography of hospitalized patients with confirmed diagnosis of COVID-19 pneumonia and verify its association with disease severity. Methods: A total of 123 adults hospitalized due to COVID-19 pneumonia were enrolled in the present study, which evaluated the anthropometric, clinical and chest computed tomography data (pectoral and paravertebral muscle area and density, subcutaneous fat, thoracic vertebral bodies density, degree of pulmonary involvement by disease, coronary calcium quantification, liver attenuation measurement) and their association with poorer prognosis characterized through a combined outcome of intubation and mechanical ventilation, need of intensive care unit, and death. Results: Age (p=0.013), body mass index (p=0.009), lymphopenia (p=0.034), and degree of pulmonary involvement of COVID-19 pneumonia (p<0.001) were associated with poor prognosis. Extent of pulmonary involvement by COVID-19 pneumonia had an odds ratio of 1,329 for a poor prognosis and a cutoff value of 6.5 for increased risk, with a sensitivity of 64.9% and specificity of 67.1%. Conclusion: The present study found an association of high body mass index, older age, extent of pulmonary involvement by COVID-19, and lymphopenia with severity of COVID-19 pneumonia in hospitalized patients.
  • Bolus versus continuous insulin infusion in immediate postoperative blood glucose control in liver transplantation: pragmatic clinical trial Original Article

    Fragoso, Luciana Vládia Carvalhêdo; Araújo, Márcio Flávio Moura de; Lobo, Lidianne Fernandes da Silva; Schreen, Dirk; Zanetti, Maria Lúcia; Damasceno, Marta Maria Coelho

    Abstract in English:

    ABSTRACT Objective: To analyze the effectiveness and safety of two insulin therapy techniques (continuous and intermittent infusion) in the blood glucose control of people who have undergone liver transplantation, in the immediate postoperative period. Methods: The study was a prospective, open, pragmatic clinical trial with 42 participants, divided into two groups of 21 patients each, in the immediate postoperative period following liver transplantation. Participants in the Experimental Group and Control Group received continuous infusion and bolus insulin, respectively, starting at capillary blood glucose ≥150mg/dL. Results: There were no statistically significant differences in the blood glucose reduction time to reach the target range between the Experimental Group and Control Group in the transplanted patients (p=0.919). No statistically significant differences regarding the presence of low blood glucose (p=0.500) and in the initial blood glucose value (p=0.345) were found. The study identified the final blood glucose value in postoperative intensive care unit lower and statistically significant in the continuous infusion pump group in relation to the Bolus Group (p<0.001). Additionally, the variation of blood glucose reduction was higher and statistically significant in the continuous method group (p<0.05). Conclusion: The continuous infusion method was more effective in the blood glucose control of patients in the postoperative period following liver transplantation. Brazilian Registry of Clinical Trials: RBR-9Y5tbp
  • Laboratory variables as predictors of progression in gastroenteropancreatic neuroendocrine tumors in different lines of antineoplastic treatments Original Article

    Armentano, Daniela Pezzutti Domigues; Monteiro, Mariana Ribeiro; Aguiar Jr., Pedro Nazareth; Tsukamoto, Jessica Sayuri; Pio, Raquel Baptista; Arakelian, Renata; Araujo, Raphael Leonardo Cunha; Usón Junior, Pedro Luiz Serrano

    Abstract in English:

    ABSTRACT Objective: To determine the association of red cell blood counts, and liver panel tests to predict outcomes in patients with gastroenteropancreatic neuroendocrine tumors who underwent systemic antineoplastic treatments. Methods: Patients with gastroenteropancreatic neuroendocrine tumors in systemic treatment were assessed according to laboratory tests within the same period. Progression free survival was determined by the period between the beginning of treatment and the date of progression. We used conditional models (PWP model) to verify the association between laboratory tests and tumor progression. The level of significance used was 5%. Results: A total of 30 treatments given to 17 patients in the intention-to-treat population were evaluated. Treatment included octreotide, lanreotide, everolimus, lutetium, and chemotherapy. We had statistically significant results in chromogranin A, neutrophils and platelets-to-lymphocyte ratio. The risk of progression increases by 2% with the addition of 100ng/mL of chromogranin A (p=0.034), 4% with the increase of 100 neutrophil units (p=0.006), and 21% with the addition of 10 units in platelets-to-lymphocyte ratio (p=0.002). Conclusion: Chromogranin A, neutrophils and platelets-to-lymphocyte ratio were associated with disease progression during systemic treatment in gastroenteropancreatic neuroendocrine tumors. Further prospective studies with larger cohorts are necessary to validate our findings.
  • Low platelet reactivity in patients with myocardial infarction treated with aspirin plus ticagrelor Original Article

    Costa, Thiago Guarato Rodrigues; Katz, Marcelo; Lemos Neto, Pedro Alves; Guerra, João Carlos de Campos; Franken, Marcelo; Pesaro, Antonio Eduardo Pereira

    Abstract in English:

    ABSTRACT Objective: Low platelet reactivity levels are associated with higher risk of bleeding in patients receiving dual antiplatelet therapy relative to patients with optimal platelet blockade. This study set out to evaluate the prevalence of low platelet reactivity in patients with acute myocardial infarction treated with ticagrelor and aspirin. Methods: Patients admitted with acute myocardial infarction who were already undergoing dual antiplatelet therapy with aspirin and ticagrelor were enrolled. Blood samples were collected 1 hour before and 2 hours after the maintenance dose of ticagrelor to investigate trough and the peak effects of the drug respectively. Platelet reactivity was measured by three methods: Multiplate®, PFA-100® with Innovance® PFA-P2Y cartridge and PFA-100® with Collagen/ADP cartridge. Platelet reactivity was assessed in the presence of peak levels of ticagrelor and defined according to previously validated cut-offs for each method (<19 AUC, >299 seconds and >116 seconds respectively). The level of significance was set at p<0.05. Results: Fifty patients were enrolled (44% with ST-elevation). Median duration of DAPT was 3 days (interquartile range, 2-5 days). On average, peak and trough platelet reactivity were markedly low and did not differ between different methods. Low platelet reactivity was common, but varied according to analytic method (PFA-100®/Innovance®PFA-P2Y: 86%; Multiplate®: 74%; PFA-100®/Collagen/ADP: 48%; p<0.001). Conclusion: Low platelet reactivity was very common in patients with acute myocardial infarction submitted to dual antiplatelet therapy with ticagrelor and aspirin. Findings of this study justify the investigation of less intensive platelet inhibition strategies aimed at reducing the risk of bleeding in this population, such as lower dose regimens or monotherapy with P2Y12 inhibitors.
  • Exposure to glyphosate-based herbicide during early stages of development increases insulin sensitivity and causes liver inflammation in adult mice offspring Original Article

    Gomes, Ellen Carolina Zawoski; Teleken, Jakeline Liara; Vargas, Rodrigo; Alegre-Maller, Ana Claudia Paiva; Amorim, João Paulo de Arruda; Bonfleur, Maria Lúcia; Balbo, Sandra Lucinei

    Abstract in English:

    ABSTRACT Objective: To investigate the effect of pre and postnatal exposure to a glyphosate-based herbicide on glucose metabolism and liver histology in adult F1 mice offspring. Methods: Female mice (C57Bl/6) received 0.5% of glyphosate (Roundup Original DI®) in drinking water or purified water (Glyphosate Group and Control Group respectively) during pregnancy and lactation. Offspring (F1) were submitted to glucose and insulin tolerance tests and euthanized on postnatal day 150. Body and plasma parameters, and liver histology were analyzed. Results: Exposure to glyphosate reduced maternal body weight gain during pregnancy and lactation, with no impacts on litter size. Pre and postnatal exposure to glyphosate did not affect body parameters but increased glucose tolerance on postnatal day 60. In spite of glucose tolerance normalization by postnatal day 143, this effect was associated with higher insulin sensitivity relative to mice in the Control-F1 Group. Mice in the Glyphosate-F1 Group had mild and moderate lobular inflammation in the liver. Conclusion: Maternal exposure to glyphosate affected insulin sensitivity and caused hepatic inflammation in adult F1 mice offspring.
  • HIV, syphilis, hepatitis B and C in key populations: results of a 10-year cross-sectional study, Southern Brazil Original Article

    Silva, Breno Gonçalves da; Ferreira, Laura Holtman; Ribeiro, Clea Elisa Lopes; Raboni, Sonia Mara

    Abstract in English:

    ABSTRACT Objective: Although the development of prevention and treatment strategies for sexually transmitted infections in key groups has improved over the years, they still remain a challenge for health systems worldwide. In this context, the objective of this study is to assess the seroprevalence in the tested population, with an emphasis on key populations, aiming at identifying the participants’ profile and consequently the development of testing strategies. Methods: The present study analyzed the seroprevalence of HIV, syphilis, and hepatitis B and C, and the epidemiological profiles of key and general populations tested at a reference public health facility for sexually transmitted infections testing and counseling in the city of Curitiba, Southern Brazil. A cross-sectional study was conducted to report data from 2010 to 2019. Results: A total of 67,448 samples were analyzed, 9,086 of these tested positive, 3,633 (56%) for HIV, 4,978 (77%) for syphilis, 340 (5%) for hepatitis C virus (HCV), and 135 (2%) for hepatitis B virus (HBV). Overall, most of the participants were men (79 to 87%), and predominantly white. For HIV and syphilis, the predominant age groups were 21-30 years old (48 and 50%), HBV 21-40 years old (31%), and HCV 41-60 years old (25%). A high seroprevalence of HIV and syphilis was observed in the investigated key populations with a higher frequency in sex workers, men who have sex with men, and transgender. Conclusion: The progressive increase in syphilis cases emphasizes the need for effective interventions to enhance adherence to the use of condoms, and to expand diagnosis and treatment for these key populations.
  • Benign prostatic hyperplasia surgical treatment trends in the Public Health System in São Paulo, Brazil Original Article

    Barbosa, Álan Roger Gomes; Takemura, Lucas Seiti; Amaral, Breno Santos; Wroclawski, Marcelo Langer; Alfer Jr, Wladimir; Gil, Antonio Otero; Monteiro Jr, José; Lourenço, Danilo Budib; Cha, Jonathan Doyun; Apezzato, Marcelo; Barbosa, João Arthur Brunhara Alves; Bianco, Bianca; Lemos, Gustavo Caserta; Carneiro, Arie

    Abstract in English:

    ABSTRACT Objective To describe and compare the number of surgeries, mortality rate, length of hospital stay, and costs of transurethral resection of the prostate and open prostatectomy for the treatment of benign prostatic hyperplasia, between 2008 and 2018, in the Public Health System in São Paulo, Brazil. Methods Ecological and retrospective study using data from the informatics department of the Brazilian Public Health System database. Procedure codes were “open prostatectomy” and “transurethral resection of the prostate.” The outcomes analyzed were compared between transurethral resection of the prostate and open prostatectomy according to the hospital surgical volume and presence or absence of a residency program. Results A total of 18,874 surgeries were analyzed (77% transurethral resection of the prostate) and overall mortality was not statistically different between procedures. Intermediate and high-volume centers had shorter length of hospital stay than low-volume centers for transurethral resection of the prostate (3.28, 3.02, and 6.58 days, respectively, p=0.01 and p=0.004). Length of hospital stay was also shorter for open prostatectomy in high-volume compared to low-volume centers (4.86 versus 10.76 days, p=0.036). Intrahospital mortality was inversely associated with surgical volume for transurethral resection of the prostate. Centers with residency program had shorter length of hospital stay considering open prostatectomy and less mortality regarding transurethral resection of the prostate. Open prostatectomy was 64% more expensive than transurethral resection of the prostate. Conclusion The findings suggest the importance of investing in specialized centers, which could be potential referral centers for surgical cases.
  • Development and validation of predictive model for long-term hospitalization, readmission, and in-hospital death of patients over 60 years old Original Article

    Costa, Maria Luiza Monteiro; Mafra, Ana Carolina Cintra Nunes; Cendoroglo, Maysa Seabra; Rodrigues, Patrícia Silveira; Ferreira, Milene Silva; Studenski, Stephanie A.; Franco, Fábio Gazelato de Mello

    Abstract in English:

    ABSTRACT Objective To develop and validate a high-risk predictive model that identifies, at least, one common adverse event in older population: early readmission (up to 30 days after discharge), long hospital stays (10 days or more) or in-hospital deaths. Methods This was a retrospective cohort study including patients aged 60 years or older (n=340) admitted at a 630-beds tertiary hospital, located in the city of São Paulo, Brazil. A predictive model of high-risk indication was developed by analyzing logistical regression models. This model prognostic capacity was assessed by measuring accuracy, sensitivity, specificity, and positive and negative predictive values. Areas under the receiver operating characteristic curve with 95% confidence intervals were also obtained to assess the discriminatory power of the model. Internal validation of the prognostic model was performed in a separate sample (n=168). Results Statistically significant predictors were identified, such as current Barthel Index, number of medications in use, presence of diabetes mellitus, difficulty chewing or swallowing, extensive surgery, and dementia. The study observed discrimination model acceptance in the construction sample 0.77 (95% confidence interval: 0.71-0.83) and good calibration. The characteristics of the validation samples were similar, and the receiver operating characteristic curve area was 0.687 (95% confidence interval: 0.598-0.776). We could assess an older patient’s adverse health events during hospitalization after admission. Conclusion A predictive model with acceptable discrimination was obtained, with satisfactory results for early readmission (30 days), long hospital stays (10 days), or in-hospital death.
  • Complications associated with the use of temporary pacemaker in patients waiting for definitive device implantation Original Article

    Papp, Silvana Ellen Ribeiro; Torres, Aymée Lustosa Nogueira e; Vasquez, Andres Eduardo Larrovere; Gioli-Pereira, Luciana

    Abstract in English:

    ABSTRACT Objective To determine the rate of complications associated with the use of temporary pacemakers in patients in the waiting list for the definitive pacemaker implantation in a public hospital located in São Paulo, SP, Brazil. Methods Retrospective observational study based on data extracted from medical records of patients admitted to Hospital Municipal Dr. Moyses Deutsch, Hospital Israelita Albert Einstein from January 2014 to December 2018. Patients aged 18 years or older, diagnosed with high degree atrioventricular block upon admission and with indications for definitive pacemaker implantation were included. All-cause mortality, clinical and surgical complications and length of hospital stay while waiting for the procedure were defined as primary outcomes. Results The sample comprised 66 patient allocated to one of two groups: with and without the need of temporary pacemaker while in hospital (n=45 and n=21, respectively). The rate of complications was higher in patients who used a temporary pacemaker (p<0.001). These included primarily pneumonia (p=0.048) and length of hospital stay (p=0.029). Conclusion Patients who required a temporary pacemaker stayed longer in hospital. Longer hospital stay is associated with higher rates of general complications and all-cause mortality.
  • Ultrasonographic evaluation of cecal appendix diameter in pediatric population Original Article

    Queiroz, Marcos Roberto Gomes de; Francisco Neto, Miguel José; Rahal Junior, Antonio; Jabour, Victor Arantes; Andrade, Guilherme Neves Lourenço; Silva, Paulo Savoia Dias da; Garcia, Rodrigo Gobbo; Pereira, Marcelo dos Santos; Santos, Marina Ramos; Luna, Pedro Andrade Alencar; Sameshima, Yoshino Tamaki; Gual, Fabiana; Dutra, Marcelo Guimarães; Germino, Beatriz Placca; Alves, Isabella Ferreira

    Abstract in English:

    ABSTRACT Objective To stratify ultrasound samples in a pediatric population undergoing evaluation for acute appendicitis to examine the variability in cecal appendix diameter, in different age groups, and to determine whether there is a prevalent value for each age group. Methods A retrospective cross-sectional study with 196 children aged 0 to 15 years. Data were extracted from reports of ultrasound examinations carried out between 2008 and 2015. Children with sonographic diagnosis of appendicitis or other signs of periappendiceal inflammation were excluded. Results The evaluation of the anteroposterior measurement of the cecal appendix revealed a mean diameter of 4.14mm (standard deviation: 0.93mm; 95%CI: 3.86-4.14). Cecal appendix diameter did not differ significant between age groups. Conclusion Evaluation of the anteroposterior diameter of the cecal appendix in centimeters in a sample of 196 children aged 0 to15 years revealed a mean diameter of 4.14mm (standard deviation, 0.93mm. There were no significant differences in cecal appendix diameter following stratification by age. Results indicate a single value can be adopted for mean cecal appendix diameter in pediatric populations.
  • Use of potentially inappropriate medications and adverse events in older outpatients with acute conditions Original Article

    Viana, Stéphanie de Souza Costa; Souza, Natália Pereira dos Santos; Aliberti, Márlon Juliano Romero; Jacob-Filho, Wilson

    Abstract in English:

    ABSTRACT Objective To examine associations between potentially inappropriate medication, use and the risk of falls, unplanned hospitalization and death in older patients receiving initial care in a geriatric day hospital due to acute conditions. Methods Cohort study with older adults referred to a geriatric day hospital from 2014 to 2017 due to acute conditions. Patients were submitted to comprehensive geriatric assessment. Use of medications was analyzed according to Beers Criteria 2019. Outcome assessment was based on monthly follow-up telephone calls made over the course of one year. Results In this sample, 40.6% of patients had been prescribed at least one potentially inappropriate medication, particularly proton pump inhibitors (66.5%). Over the course of follow-up, 44.7% of patients receiving potentially inappropriate medications sustained at least one fall (p=0.0043) and 70% visited the emergency department (p=0.0452). These outcomes were more common among patients using two or more of drugs. Use of potentially inappropriate medication was associated with a 64% increase in the odds of unplanned hospitalization and a two-fold increase in risk of death. Conclusion Associations between potentially inappropriate medication use and unfavorable outcomes such as falls and unplanned hospitalizations within one year of admission to a geriatric day hospital support the application of Beers Criteria and emphasize the importance of periodic prescription review, deprescription and rational use of these drugs whenever possible.
  • Effects of glucocorticoids on interstitial glucose concentrations in individuals with hematologic cancer and without known diagnosis of diabetes: a pilot study Original Article

    Toyoshima, Marcos Tadashi Kakitani; Cukier, Priscilla; Souza, Alexandre Barbosa Câmara de; Pereira, Juliana; Hoff, Ana Oliveira; Nery, Marcia

    Abstract in English:

    ABSTRACT Objective To analyze interstitial glucose behavior during glucocorticoid use in non-diabetic patients receiving chemotherapy for hematologic malignancies. Methods Prospective pilot study carried out to assess interstitial glucose levels in 15 non-diabetic individuals with hematologic malignancies who received glucocorticoids in combination with chemotherapy. The FreeStyle Libre flash monitoring system (Abbott Diabetes Care) was used for up to 14 days to measure interstitial glucose. Results Median age and body mass index were 53 (42-61) years and 25 (23-28) kg/m2 respectively. Interstitial glucose levels >180mg/dL lasting at least one hour were detected in 60% of participants. Interstitial glucose profile parameters (median and peak interstitial glucose levels and percentage of time during which interstitial glucose levels were >180mg/dL) were significantly (p<0.01) higher during glucocorticoid use (115mg/dL, 218mg/dL and 10% respectively) than after glucocorticoid discontinuation (97mg/dL, 137mg/dL and 0% respectively). Mean interstitial glucose levels increased in the afternoon and at night during glucocorticoid use. Conclusion This pilot study was the first to evaluate interstitial glucose levels in non-diabetic individuals using glucocorticoids in treatment of hematologic cancer. Glucocorticoid use during chemotherapy significantly increases interstitial glucose levels in these patients.
  • FAST breast magnetic resonance imaging: a new approach for breast cancer screening? Original Article

    Vilar, Vanessa Sales; Gomes, Andressa Inácio; Federicci, Érica Elisângela Françolin; Ribeiro, Renato Leme de Moura; Rudner, Mônica Akahoshi; Racy, Ana Cláudia Silveira

    Abstract in English:

    ABSTRACT Objective To develop an abbreviated breast magnetic resonance imaging protocol (FAST) and to compare it with the complete protocol (FULL) to determine its diagnostic accuracy for detecting malignant or suspicious lesions (BI-RADS 4, 5 and 6) and the time required for image interpretation using BI-RADS categorization. Methods Retrospective study with 100 consecutive women who underwent breast magnetic resonance imaging between January and February 2014. All patients were submitted to a complete breast magnetic resonance imaging protocol, which was then compared with an abbreviated protocol (pre-contrast sequence, second post-contrast sequence and subtraction of pre- from post-contrast images). Results Of 100 patients, 4 were classified as BI-RADS 5 or 6 and 16 as BI-RADS 4. In these 20 patients, there was full agreement among readers regarding the final BI-RADS categorization in both (FAST and FULL) protocols. Conclusion The FAST protocol reduces interpretation time without compromising the accuracy of the method for detection of malignant or suspicious lesions.
  • Cesarean rates according to the Robson classification: analysis in a municipal maternity in São Paulo Original Article

    Ramos, Gabriela Guimarães Franco; Zlotnik, Eduardo; Liao, Adolfo Wenjaw

    Abstract in English:

    ABSTRACT Objective To investigate the distribution of parturients at Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho according to the Robson classification, identify the cesarean rate in each Robson Group, and understand which group contributes more to the prevalence of Cesarean sections. Methods This is a retrospective observational cross-sectional study conducted through the analysis of medical records of parturients admitted to Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho from October 2016 to August 2019. Results A total of 9,794 births were recorded, and 31% were by Cesarean section. The most prevalent Robson Groups were Group 3 (25.7%-2,519), 1 (22.8%-2,234), and 5 (20.5%-2,006). The relative contribution of Cesarean sections was greatest in Groups 5 (39%), 2 (18%), and 1 (12.5%). Conclusion This study demonstrated the Robson classification is useful to lead to a more critical view, identifying the groups that deserve more attention, since they are the major contributors to cesarean rates; hence, the management protocols could be modified aim to reduce cesarean rates.
  • Effect of lateral decubitus acquisition in accuracy and lung severity estimation of chest computed tomography in children with suspected COVID-19 Original Article

    Vaz, André; Pedrazzani, Bruno Maurício; Ledesma, Jorge Alberto; Yagui, Akemi; Schelin, Hugo Reuters

    Abstract in English:

    ABSTRACT Objective To compare inter-rater reliability, diagnostic accuracy, and extension of pulmonary involvement in children with suspected COVID-19 submitted to supine or supine and lateral decubitus computed tomography imaging. Methods Retrospective study carried out between March 2020 and March 2021 with patients submitted to reverse transcription-polymerase chain reaction testing and chest computed tomography. Patients were divided into two groups: supine or supine and lateral decubitus imaging. Standardized reporting systems of computed tomographic findings in COVID-19 and chest computed tomography score were used. Results One hundred and seventeen patients were enrolled. Moderate to substantial inter-rater reliability was observed for standardized reporting systems (weighted kappa, 0.553-0.764; p<0.001). Inter-rater reliability for the chest computed tomography score was substantial (weighted kappa, 0.620-0.670; p<0.001). Standardized reporting systems failed to predict COVID-19 in children, regardless of additional lateral decubitus imaging (area under the receiver operating characteristic curve, 0.491-0.608). Chest computed tomography scores assigned to lateral decubitus images were significantly lower. Conclusion Additional lateral decubitus imaging does not improve the accuracy of standardized reporting systems of computed tomographic findings in COVID-19 but may provide a more accurate estimation of lung involvement in uncooperative patients.
  • Physical exercise as a therapeutic approach for adults with insomnia: systematic review and meta-analysis Original Article

    D’Aurea, Carolina Vicaria Rodrigues; Frange, Cristina; Poyares, Dalva; Souza, Altay Alves Lino de; Lenza, Mario

    Abstract in English:

    ABSTRACT Objective To systematically review the effects (benefits and harms) of different types of physical exercise on insomnia outcomes in adult populations with no mood disorders. Objective and subjective sleep outcomes and related mismatches were analyzed. Methods Systematic review and meta-analysis. Quality of evidence was also examined. Results Six studies including 295 participants with insomnia diagnosis were selected. Yoga, Tai Chi, resistance exercise and aerobic exercise were used in protocols with different duration, intensity and frequency. Studies involved different populations, including inactive or sedentary individuals, older adults and postmenopausal women. Physical exercise improved subjective sleep quality (very low quality of evidence) and reduced insomnia severity (high quality of evidence). Conclusion Findings suggest individualized physical exercise must be addressed to design optimal protocols, with standardized type, duration, intensity, and frequency. For the time being, physical exercise may be considered an alternative and/or ancillary therapeutic modality for patients diagnosed with insomnia. Physical exercise can be used to improve subjective complaints, but not objective sleep outcomes.
  • Impact of passive smoking on renal vascular morphology Original Article

    Moraes, Carlos Alberto de; Thal, Bárbara Valtudes Nogueira; Bannwart, Julia Veronese; Jacomini, Regiane Aparecida; Breda-Stella, Mercia; Carvalho, Cesar Alexandre Fabrega

    Abstract in English:

    ABSTRACT Objective To determine whether passive smoking causes morphological and structural changes in the arcuate arteries of rats exposed for 7 to 28 days. Methods Wistar rats aged eight weeks and weighing 260g on average were allocated to a Control or a Smoker Group. Groups were further divided into 4 groups containing 5 animals each. Morphological-functional analysis of the right kidneys was carried out after 7 and 28 days of exposure to the smoke of 40 cigarettes per day. Cigarettes were burned at set times using automated cigarette-burning equipment (“Smoking Machine” - SM-MC-01). At the end of each exposure period, the kidneys were dissected and submitted to histological processing for morphological and quantitative analysis. Results Exposure to cigarette smoke for 7 days led to a decrease in inner vascular diameter. Decreased thickness of the vascular tunica media was observed after exposure for 28 days. Increased thickness of the tunica adventitia, increased total vascular wall thickness, increased total vascular diameter and qualitative increase in collagen deposition were observed. Vascular volume increased after 28 days of exposure. Conclusion Passive smoking has a negative impact on renal vasculature.
  • Cost-effectiveness analysis of Ado-trastuzumab emtansine for the treatment of residual invasive HER2-positive breast cancer Health Economics And Management

    Magalhães Filho, Marcos Aurélio Fonseca; Aguiar Jr., Pedro Nazareth; Neves, Milena Brachmans Mascarenhas; Lopes Jr., Gilberto de Lima; del Giglio, Auro

    Abstract in English:

    ABSTRACT Objective Human epidermal growth factor receptor 2 (HER2) overexpression occurs in up to 30% of breast cancer cases. Ado-trastuzumab emtansine (T-DM1) is approved to treat residual HER2-positive breast cancer after neoadjuvant therapy. The aim of this study was to determine the quality-adjusted time with symptoms or toxicity and without symptoms or toxicity (Q-TWiST) of T-DM1 compared to trastuzumab for residual invasive HER2-positive breast cancer. Methods The authors developed an analytical model extracting individual patient data and estimated invasive disease-free survival and overall survival over a 30-year time horizon. Only direct costs from adjuvant treatment were considered as well as relapse treatment from Brazilian and American payer perspectives. Heart events were considered for utility and cost analysis. Results The 30-year projection utilizing the Weibull method estimated a mean invasive disease-free survival of 16.4 years for T-DM1 and 10.4 for Trastuzumab, in addition to a mean overall survival of 18.1 and 15.4 years, respectively. We determined a Q-TWiST gain of 3,812 years for the T-DM1 arm when compared to trastuzumab and an Incremental cost-effectiveness ratio per Q-TWiST of US$ 11,467.65 in the United States and US$ 3,332.73 in Brazil. Conclusion Ado-trastuzumab emtansine is cost-effective from both Brazilian and American perspectives.
  • What are the implications of problem-solving capacity at Primary Health Care in older adult health? Health Economics And Management

    Siqueri, Carolina Aguiar Sant’Anna; Pereira, Gabriel Apolinário; Sumida, Giuliana Tamie; Mafra, Ana Carolina Cintra Nunes; Bonfim, Daiana; Almeida, Letícia Yamawaka de; Monteiro, Camila Nascimento

    Abstract in English:

    ABSTRACT Objective To evaluate Primary Health Care attributes and analyze the association between the fulfilment of these attributes and problem-solving capacity of services for elderly patients. Methods A cross-sectional, observational, quantitative study. The Primary Care Assessment Tool, designed to assess Primary Health Care attributes, was employed to evaluate elderly users of Primary Care Units located in the south region of the city of São Paulo (SP). Results Many attributes assessed at the reference services were considered as unsatisfactory by users. Overall scores were also below the cut-off point. “First contact access – use”, “longitudinality” and “coordination – information system” were the only attributes considered as satisfactory. Also, more than half (62.7%) of respondent patients reported having been referred to specialized services. A combined analysis of these three outcomes revealed users referred to other services had a significantly better perception of Primary Health Care attributes. Conclusion The study provides important insights on satisfaction of elderly individuals and the problem-solving capacity of health care services, especially for the study population. Findings reported emphasize the association between Primary Health Care attributes and the problem-solving capacity of health care services at this level.
  • Metformin versus glyburide in treatment and control of gestational diabetes mellitus: a systematic review with meta-analysis Review

    Oliveira, Marina Martins de; Andrade, Kayan Felipe de Oliveira; Lima, Giovanni Henrique Silva; Rocha, Thiago Casali

    Abstract in English:

    ABSTRACT Objective To compare the major outcomes of use of metformin and glyburide in treatment of gestational diabetes mellitus. Methods Studies published in English, in the last 10 years, in the databases MEDLINE®, SciELO, LILACS and Cochrane Library were analyzed, and randomized controlled trials were selected. Health Sciences Descriptors were used to compose the search phrase, and the keywords “Gestational diabetes”, “Glyburide”, “Metformin” and their variations were searched in the Medical Subject Headings. PRISMA systematization was used to prepare this review, and a meta-analysis was conducted aiming to mathematically show the results of fasting blood glucose, postprandial blood glucose, birth weight and weight gain during pregnancy after using metformin and glyburide. Results The studies evaluated birth weight, neonatal hypoglycemia, mode of delivery, need for intensive care, Apgar score, macrosomia, fasting glucose, postprandial glucose and weight gain during pregnancy. In 60% of studies, there were no statistically significant differences regarding safety and efficacy of administration of metformin and glyburide. Meta-analysis demonstrated the absence of statistical differences between these drugs in fasting blood glucose (p=0.821), postprandial blood glucose (p=0.217) and birth weight (p=0.194). However, significant differences were shown in weight gain during pregnancy (p=0.036). Conclusion The methods are effective, but the adverse effects of glyburide are more common; therefore, the use of metformin should be recommended, if in monotherapy.
  • Acute pancreatitis and COVID-19: a new target for infection? Review

    Balthazar, Júlia Aith; Chehter, Ethel Zimberg

    Abstract in English:

    ABSTRACT This review aimed to investigate whether SARS-CoV-2 is capable of infecting the gland and causing acute pancreatitis, and the peculiarities in the management of these cases. The research was conducted through PubMed® database, and 62 articles were systematically selected for analysis. Differences were found in the literature; however, there are important warnings, such as the presence of hyperlipasemia, clinical and imaging findings suggestive of acute pancreatitis in the presence and even in the absence of respiratory symptoms. Attention should be paid to clinical and imaging findings during this virus infection, since it is possible to identify these two diseases early. Therefore, it is possible to detect and isolate these patients more quickly, providing the correct care and decreasing the morbidity and mortality of two potentially severe diseases.
  • Brazilian Guidelines for Nutrition in Cystic Fibrosis Review

    Neri, Lenycia de Cassya Lopes; Simon, Miriam Isabel Souza dos Santos; Ambrósio, Valéria Laguna Salomão; Barbosa, Eliana; Garcia, Monique Ferreira; Mauri, Juliana Ferreira; Guirau, Renata Rodrigues; Neves, Mirella Aparecida; Cunha, Carolina de Azevedo Pedrosa; Nogueira, Marcelo Coelho; Alves, Anna Carolina Di Creddo; Gurmini, Jocemara; Servidoni, Maria de Fatima; Epifanio, Matias; Athanazio, Rodrigo; ,

    Abstract in English:

    ABSTRACT Objective To develop a scientific consensus on nutrition in cystic fibrosis. Methods Sixteen coordinators elaborated relevant questions on nutritional therapy in cystic fibrosis, which were divided into six sections: nutritional assessment, nutritional recommendations, nutritional intervention, dietary counseling, special situations and enzyme replacement, and gastrointestinal manifestations. Two to three specialists in the field were responsible for each section and obtaining answers formulated based on standardized bibliographic searches. The available literature was searched in the PubMed®/MEDLINE database, after training and standardization of search strategies, to write the best level of evidence for the questions elaborated. Issues related to disagreement were discussed until a consensus was reached among specialists, based on the current scientific literature. Results Forty-two questions were prepared and objectively answered, resulting in a consensus of nutritional therapy in cystic fibrosis. Conclusion This work enabled establishing a scientific consensus for nutritional treatment of cystic fibrosis patients.
  • Influence of statins in metastatic castration-resistant prostate cancer patients treated with new antiandrogen therapies: a systematic review and meta-analysis Review

    Mariano Jr, Renato; Tavares, Kevin Lima; Panhoca, Renato; Sadi, Marcus

    Abstract in English:

    ABSTRACT Objective To evaluate whether the addition of statins to the new antiandrogens (enzalutamide or abiraterone) affects overall survival in patients with metastatic castration-resistant prostate cancer. Methods We searched studies in English language including the keywords statins, overall survival, and metastatic castration-resistant prostate cancer, at PubMed® (MEDLINE®), Embase and Cochrane databases. Results A total of 195 articles were initially identified, but only four met the inclusion criteria and were selected for the meta-analysis. A total of 955 patients, 632 on the new antiandrogens only group, and 323 on the new antiandrogens + statins group, were analyzed. In all four studies the combination therapy (new antiandrogens + statin) was well tolerated, regardless of which new antiandrogens were used. Neither the type of statin nor the doses and duration of use were well specified in the studies. The combination therapy in metastatic castration-resistant prostate cancer was associated with an overall survival improvement, and a 46% reduction in death (hazard ratio of 0.54; 95%CI 0.34-0.87; p<0.01) in multivariate analysis. Conclusion There seems to be a clinical benefit with the association of statins to the new antiandrogens in patients with metastatic castration-resistant prostate cancer, suggesting longer overall survival with no important collateral effect. However, due to fragility of the studies available in the literature, we are not yet capable of recommending this combination of drugs in the clinical practice. Further randomized prospective studies are warranted to confirm these beneficial outcomes.
  • Breastfeeding during the COVID-19 pandemic: what do we know so far? Review

    Natarelli, Taison Regis Penariol; Brassarola, Heloisa Gasparini Marigheti; Fonseca, Luciana Mara Monti

    Abstract in English:

    ABSTRACT Objective This study aimed to conduct a literature review on safety in breastfeeding in mothers with COVID-19. An integrative review of national and international literature was carried out. Methods The search took place in the SciELO, LILACS and MEDLINE® databases. Results A total of 25 scientific articles that specifically addressed the theme of breastfeeding and its risk and protective factors for infection by SARS-CoV-2 were selected. According to the studies analyzed, although the presence of viral RNA had already been detected by reverse transcriptase polymerase chain reaction in breast milk samples, there are still no proven cases of vertical transmission via human milk. Conclusion Breastfeeding appears to be safe if practiced according to precaution measures recommended by the World Health Organization. In addition, there is evidence of a potential for immunological protection by transfer of antibodies against SARS-CoV-2 in breast milk. Breastfeeding should continue to be promoted even in cases of mothers with clinical suspicion or confirmation of COVID-19, as well as the provision of expressed breast milk in cases where there is no possibility of direct breastfeeding.
  • Communicating bad news in the practice of nursing: an integrative review Review

    Agnese, Beatriz Lopes; Daniel, Ana Carolina Queiroz Godoy; Pedrosa, Rafaela Batista dos Santos

    Abstract in English:

    ABSTRACT Objective To analyze current scientific knowledge about communication of bad news by nurses. Methods This is an integrative literature review carried out by searching articles published in national and international journals indexed at SciELO, MEDLINE® (PubMed®), Scopus, Bireme and CINAHL, from 2010 to 2020, by crossing the controlled descriptors “communication”, “revelation of the truth”, and “nursing”, and the uncontrolled descriptor “bad news”. Results Ten articles with qualitative and cross-sectional design, as well as case reports were included. The analysis indicated the evidence available in the literature showed the nurses’ lack of ability to communicate bad news, although they are professionals who have close contact with patients and families and who establish a strong bond with them, and often face challenging situations for communicating bad news. Conclusion There is an evident need to invest in training of nurses on skills to communicate bad news and establish a nurse-patient bond when dialoguing with the family. There are few studies in the literature addressing this issue; therefore, it is recommended to perform research that can contribute to improvements in the clinical practice and developing protocols to promote such care.
  • Clinical management of fever in children in Brazil: practical recommendations from an expert panel Review

    Simon Junior, Hany; Pedreira, Marcello Creado; Barbosa, Silvia Maria de Macedo; Fernandes, Tadeu Fernando; Escobar, Ana Maria de Ulhôa

    Abstract in English:

    ABSTRACT The objective of this study was to answer several questions related to the assessment and treatment of fever, as well as other controversies that exist during its management in pediatric patients. First, an advisory board with medical experts was conducted to discuss the clinical journey of these patients, considering the main challenges and possible solutions. After this discussion, a non-systematic literature review was performed, between November 2019 and January 2020, to collect the most relevant evidence available in the scientific databases MEDLINE, Lilacs, and SciELO. A narrative review was carried out based on scientific evidence and on extensive experience of experts in clinical practice. The experts developed a set of recommendations and clarifications about the assessment of the severity of fever in pediatrics, the need for treatment and the choice of the most appropriate antipyretic. The most common controversies in the management of fever in pediatric patients were also addressed, such as alternating antipyretics, persistent fever, and dose equivalence. In primary management of pediatric patients, fever should be seen as a relevant symptom that requires treatment with antipyretics in potentially more complex or severe cases, when it causes discomfort to children or is associated with infectious diseases.
  • Mechanical thrombectomy for acute ischemic stroke: systematic review and meta-analysis Review

    Oliveira, Ananda Jessyla Felix; Viana, Sônia Maria Nunes; Santos, André Soares

    Abstract in English:

    ABSTRACT Objective To evaluate the safety and efficacy of mechanical thrombectomy associated with standard medical treatment compared with standard medical treatment only to treat patients with acute ischemic stroke. Methods This was a systematic review and metaanalysis of randomized controlled trials. An electronic search was performed in the following databases: MEDLINE ® /PubMed ® , Cochrane Library (Trials), LILACS/IBECS (via Biblioteca Virtual em Saúde (BVS)) and Embase. Complementary searches were also conducted. The selection of studies and data collection were done by two investigators independently. Results The final analysis included 16 publications related to 15 studies. The mechanical thrombectomy was associated to a reduction in the risk of death of all cause (16.81% versus 20.13%; relative risk of 0.85; p=0.04), improvement in the number of patients with functional independence after 90 days (45.65% versus 27.45%; relative risk of 1.65; p<0.01), and improvement in the rate of revascularization (76.2% versus 33.85%; relative risk of 2.20; p<0.01). There was no significant difference in terms of symptomatic intracranial hemorrhage (4.78% versus 3.88%; relative risk of 1.27; p=0.21). Conclusion Mechanical thrombectomy associated with standard medical treatment seem to be safe and effective to treat patients with acute ischemic stroke compared with standard medical treatment only.
  • Mysterious ureteral migration of a wooden toothpick from the digestive tract: case report and diagnostic considerations Case Report

    Di Migueli, Ricardo; De La Roca, Ricardo; Korkes, Fernando

    Abstract in English:

    ABSTRACT Migration of foreign bodies into the urinary tract is a rare event. In certain instances, to unravel the way that objects arrived in the urinary tract is not easy. We report the case of an accidentally swallowed wooden toothpick that migrated and was found in the left ureterovesical junction, protruding into the bladder. Even though the computed tomography scan is widely employed to evaluate the urinary tract, this resource does not have a good sensitivity for detecting foreign bodies. Our report presents an insight into the best imaging approach if wooden toothpicks are suspected. In the present case, the endoscopic treatment was possible with an uneventful outcome and a complete resolution of symptoms.
  • COVID-19 related acute genital ulcer: a case report Case Report

    Jacyntho, Cláudia Márcia de Azevedo; Lacerda, Marcela Ignacchiti; Carvalho, Mariana de Sousa Ribeiro de; Ramos, Maria Roberta Meneguetti Seravali; Vieira-Baptista, Pedro; Bandeira, Sandra Helena de Azevedo Durães

    Abstract in English:

    ABSTRACT Acute vulvar ulcer (Lipschütz’s ulcer) is a rare lesion with local hyperimmunoreactivity triggered by infection, which is characterized by acute, painful, and necrotic ulcerations. This condition is usually found in non-sexually active adolescents, and it resolves spontaneously. We report a case of a 35-year-old woman who was diagnosed with COVID-19 who did not have severe symptoms, but had high levels of D-dimer for 9 days. The COVID-19 diagnosis was followed by the appearance of an acute, necrotic, extremely painful vulvar ulcer, although symptoms caused by COVID-19 had improved. We emphasize the importance of the differential diagnosis to exclude diseases such as Behçet’s syndrome, Sexually Transmitted Infections, as well as the presence of viruses that generally trigger Lipschütz’s ulcer, such as Epstein-Barr virus and cytomegalovirus. No treatment is usually necessary, however, in the present report due to the pain experienced by the patient, we successfully used oral prednisone.
  • Allergic contact cheilitis caused by propolis: case report Case Report

    Belluco, Paulo Eduardo Silva; Belluco, Rosana Zabulon Feijó; Reis, Carmelia Matos Santiago

    Abstract in English:

    ABSTRACT Propolis is a lipophilic resin extracted from plants by bees. The purpose of this case report was to show the importance of this substance as cause of allergic contact cheilitis. A 21-year-old female patient complained of pruritic perioral eczema for 5 years. In the past months it also affected the neck. After diagnosing contact dermatitis, she was submitted to a patch test with a Latin American baseline series. The result was strongly positive for propolis (++) and weakly positive for perfume mix I (+). After the test, the patient revealed she had been using propolis drops, per oris, for 10 years. The worsening of the condition was due to increased dose, aiming “to improve immunity”, during the coronavirus disease 2019 (COVID-19) pandemic. The contact allergy to propolis might be increasing due to the widespread use of natural products. Propolis is a sensitizer to be considered in patients with long-lasting cheilitis.
  • The use of convalescent plasma therapy in the management of a pregnant woman with COVID-19: a case report Case Report

    Moura, Lígia Walter; Liao, Adolfo Wenjaw; Negrini, Romulo; Zlotnik, Eduardo

    Abstract in English:

    ABSTRACT The coronavirus disease 19 (COVID-19) is responsible for the current worldwide pandemic. Treatment and prophylaxis are still under investigation. Convalescent plasma therapy could be an alternative. We report a case of a 41-year-old patient, at 28 weeks of gestation, was hospitalized with COVID-19. On the 10th day after onset of symptoms, the clinical picture worsened, and she required high-flow oxygen therapy (30L/minute), with 92% oxygen saturation, and chest X-ray showing mild bilateral opacities at lung bases. Blood tests showed D-dimer 1,004ng/mL, C-reactive protein 81mg/L, pro-calcitonin 0.05ng/mL and interleukine-6 42.9pg/mL. The therapy chosen was Tazocin® 12g/day, vancomycin 2g/day, and methylprednisolone 40mg/day. In addition, convalescent plasma therapy was administered (275mL) uneventfully, including SARS-CoV-2 antibodies and neutralizing antibodies >1:160. The patient had a fast recovery. The early administration of convalescent plasma, with high titers of neutralizing antibodies, may be an alternative option for severe COVID-19 during pregnancy, until further studies demonstrate an efficient and safe treatment or prophylaxis.
  • Omental lipoma in pediatric age group: clinical presentation, image findings and management Case Report

    Falsarella, Priscila Mina; Rahal Junior, Antonio; Dórea, Aline Andrade; Muniz Neto, Francisco Júlio; Francisco Neto, Miguel José; Garcia, Rodrigo Gobbo; Queiroz, Marcos Roberto Gomes de

    Abstract in English:

    ABSTRACT A 2-year-old female patient, admitted in the emergency room, presented diarrhea for 5 days and bloody stools in the last 24 hours. Physical examination revealed no significant findings. Ultrasound was initially performed, showing an elongated, well delimited and solid mass occupying since right hypocondrium until left iliac fossa, displacing adjacent structures. In sequence, magnetic resonance imaging was performed for confirmation of findings suggestive of omentum lipoma. After 1 week, the surgical resection was performed by videolaparoscopic acess. During 2-year follow-up, there was no sign of recurrence.
  • Mammary analogue secretory carcinoma in minor salivary gland Case Report

    Ponso, Lucas Moreno; Zerbinatti, Victor Pereira; Petrarolha, Sílvia Miguéis Picado; Loureiro, Vania; Dedivitis, Rogério Aparecido

    Abstract in English:

    ABSTRACT Mammary analogue secretory carcinoma is a rare neoplasm usually confused with other neoplasms in the salivary glands region. It has great similarity with the breast carcinoma. We report a case of a patient who presented with gingival submucosal bleeding and lesion, with the initial histopathological examination revealing salivary gland neoplasm of low crane. Computed tomography revealed the lesion near the tooth 27, with extension to the floor of the left maxillary sinus and to the palate mucosa. Resection of the infra-structure was performed, with a diagnosis of breast cancer secretory carcinoma in the minor salivary gland.
  • Unexpected improvement of hyperhidrosis with cannabidiol Case Report

    Pitliuk, Rubens; Coelho, Christina Morotomi Funatsu; Fucci, Tatyanny Paula Pinto da Costa Santos

    Abstract in English:

    ABSTRACT Hyperhidrosis is characterized by excessive sweating and it affects almost 5% of the population. The affected age group is wide, and it can affect from children to elderlies. There are two types of hyperhidrosis: generalized and focal. Treatment depends on the symptoms presented. In more severe cases, radiofrequency sympatholysis and bilateral thoracic sympathectomy are the options. However, recurrence is possible or the postoperative appearance of conditions called compensatory hyperhidrosis or reflex hyperhidrosis. We describe two cases of patients treated with Cannabidiol who had significant and unexpected improvement of hyperhidrosis. The first patient received Cannabidiol specific for public presentations at work, and the second patient had a diagnosis of autism spectrum disorder. The hyperhidrosis improved in both patients immediately after using Cannabidiol.
  • Oral ulcers and sarcoid-like reaction in lymph nodes after cemiplimab therapy for locally advanced cutaneous squamous cell carcinoma: a case report Case Report

    Ferreira, Mariana Henriques; Bezinelli, Letícia Mello; Eduardo, Fernanda de Paula; Gobbi, Marcella Ferreira; Corrêa, Luciana; Schvartsman, Gustavo

    Abstract in English:

    ABSTRACT Cemiplimab is a novel programmed death-1 inhibitor recently approved for advanced cutaneous squamous cell carcinoma. Immune-related adverse events derived from cemiplimab are similar to other anti-PD-1 drugs, including gastrointestinal and cutaneous toxicities. Oral immune-related adverse events were not reported with cemiplimab in previous studies; thus this case report warns of the fact that the oral cavity may be a site of immune-related adverse events during programmed death-1 block therapy and that this can lead to significant limitations when not properly treated. The present report describes the case of a patient with locally advanced cutaneous squamous cell carcinoma metastatic to cervical lymph nodes who developed dysphagia due to large and painful oral ulcers after a single dose of cemiplimab. The patient also exhibited a sarcoid-like reaction in mediastinal lymph nodes. No immune-related adverse events were found in any other organs. The oral lesions showed significant improvement after topical and short-course systemic corticosteroids, and low-level laser therapy was also performed in the oral lesions. The patient achieved a near-complete response and treatment was discontinued. This article discusses in detail the clinical outcomes and oral toxicity management of cemiplimab therapy for cutaneous squamous cell carcinoma.
  • Fast growth rate of a right atrial myxoma Case Report

    Gewehr, Douglas Mesadri; Neiverth, Alan; Cavalcanti, Marcela Santos; Maestri, Thiago Ceschin; Haurani, Semi; Kubrusly, Fernando Bermudez; Kubrusly, Luiz Fernando

    Abstract in English:

    ABSTRACT Primary cardiac tumors are rare, with an incidence between 0.0017 and 0.19%, and are asymptomatic in up to 72% of cases. Approximately 75% of tumors are benign, and nearly 50% of these are myxomas. Concerning location, 75% of myxomas are in the left atrium, 15 to 20% in the right atrium, and more rarely in the ventricles. The finding of cardiac myxomas usually implies immediate surgical excision to prevent embolic events and sudden cardiac death. Reports with documented growth rate are rare, and the actual growth rate remains a controversial issue. We report the rapid growth rate of a right atrial myxoma in an oligosymptomatic 69-year-old patient, with negative previous echocardiographic history in the last two years, who refused surgery upon diagnosis, enabling monitoring of myxoma growth.
  • Calcified intrarenal aneurysm simulating urinary lithiasis Case Report

    Mattos, Mário Henrique Elias de; Del Papa, Arthur Cardoso; Lopes Neto, Antonio Corrêa

    Abstract in English:

    ABSTRACT We describe the case of a female patient with calcification in renal topography, initially diagnosed as lithiasis in the left kidney, and later attributed to calcification of intrarenal vascular aneurysm. Next, we discuss the relevance of considering such an entity in the differential diagnoses of intrarenal calcifications before choosing any form of specific interventional treatment.
  • Spontaneous renal artery dissection: angioplasty with stent implantation in one-year follow-up Case Report

    Souza, Katia Pinheiro de; Falsarella, Priscila Mina; Nasser, Felipe; Garcia, Rodrigo Gobbo; Hidal, Jairo Tabacow

    Abstract in English:

    ABSTRACT Spontaneous renal artery dissection is an unusual and idiopathic condition in most cases. In young, mildly symptomatic patients, diagnosis may be difficult, frequently culminating in delay in treatment. This report presents the case of a 40-year-old male patient, with severe hypertension of sudden onset, and difficult management of oral medication. In etiological investigation, Echo-Doppler of renal arteries showed signs of hemodynamically relevant right renal artery stenosis. Arteriography showed presence of double-lumen and thrombus in the vessel lumen, indicating dissection. The proposed treatment was endovascular approach after failure of isolated medical treatment, option which included the aspiration of the thrombus by Penumbra System® device and balloon angioplasty, followed by right renal artery stenting. Improvement of immediate sonographic control of peak systolic velocity and renal-aortic ratio was shown, with a consequent reduction of systemic arterial blood pressure and stabilization of renal function. Within the following year, the patient presented in-stent stenosis and was successfully treated with balloon angioplasty.
  • Report of a clinical and laboratory management of cell therapy for knee cartilage in the face of mycoplasma contamination Case Report

    Zorzi, Alessandro Rozim; Antonioli, Eliane; Godoy, Juliana Aparecida Preto de; Okamoto, Oswaldo Keith; Kondo, Andrea Tiemi; Kutner, José Mauro; Kaleka, Camila Cohen; Cohen, Moisés; Ferretti, Mario

    Abstract in English:

    ABSTRACT To describe a case of autologous chondrocyte implantation after cell culture contamination by Mycoplasma pneumoniae and the measures taken to successfully complete cell therapy in a patient with focal chondral lesion. A 45-year-old male patient, complaining of chronic pain on the knee and no history of trauma. He had a chondral lesion in the trochlear region of the femur and clinical tests compatible with pain in the anterior compartment of the knee. Conservative treatment failed to alleviate symptoms. Surgical treatment was indicated, but due to the size of the lesion, membrane-assisted autologous chondrocyte implantation was the technique of choice. Cartilage biopsies were collected from the intercondylar region of the distal femur. After isolation, chondrocytes were expanded ex vivo in a trained laboratory, for three weeks, and seeded onto a commercially available collagen membrane prior to implantation in the knee. Two days before surgery, a cell culture sample tested positive for Mycoplasma pneumoniae. The source of contamination was found to be autologous blood serum, extracted from the patient´s peripheral vein, and used to supplement the cell culture medium. After treating the patient with antibiotics, all procedures were repeated and the new final cell product, free from contaminants, was successfully implanted. We discuss the strategies available to deal with this situation, and describe the results of this particular case, which led to modifications in the autologous chondrocyte implant protocol.
  • Alopecia and pet: a case report Case Report

    Cukierman, Eduardo; Camargo, Thiago Zinsly Sampaio; Millan, Laís Pereira Bueno; Freire, Marianna Ribeiro de Menezes; Carneiro, Lucas Franco Mendes; Waksman, Renata Dejtiar

    Abstract in English:

    ABSTRACT Dermatophytoses are fungal infections affecting the skin and cutaneous annexes. This clinical case report describes a 7-year-old girl with Kerion celsi, a severe manifestation of Tinea capitis. The patient presented with painful edematous crusty scalp lesions and alopecia, which required surgical debridement and long-term antifungal treatment. Culture of samples collected from scalp and arm skin lesions (patient and patient’s mother respectively) were positive for Trichophyton mentagrophytes. The family owned a pet guinea pig. This particular dermatophytosis is easily transmitted from guinea pigs to humans, with some studies showing up to 34.9% prevalence of Trichophyton mentagrophytes infection in these animals.
  • Transafferent nodal embolization for lymphocele treatment: case report Case Report

    Souza, Katia Pinheiro de; Gilberto, Guilherme Moratti; Mariotti, Guilherme Cayres; Falsarella, Priscila Mina; Galastri, Francisco Leonardo; Korkes, Fernando; Garcia, Rodrigo Gobbo

    Abstract in English:

    ABSTRACT Lymphoceles are collections of lymphatic fluid, mainly caused by major surgical approaches. Most lymphoceles are asymptomatic and limited, but some cases may require a medical management. Among the different techniques, transafferent nodal embolization has emerged as a minimally invasive option, with low morbidity and high resolubility, although it is not widespread in the Brazilian scenario. In this study, we report a case of lymphocele drained percutaneously, with maintenance of high output and requiring transafferent nodal embolization.
  • A review of alternative methods to the use of animals in safety evaluation of cosmetics Reviewing Basic Sciences

    Nabarretti, Barbarah Helena; Rigon, Roberta Balansin; Burga-Sánchez, Jonny; Leonardi, Gislaine Ricci

    Abstract in English:

    ABSTRACT Alternative methods to the use of animals in research have been a global trend, mainly after the publication of the 3R’s principle (Replacement, Reduction, and Refinement), proposed by Russel and Burch. In the cosmetic sector, safety and efficacy assessments using animals have generated controversial debates. For this reason, in vitro research techniques are widely used to assess acute toxicity; corrosivity and irritation; skin sensitization; dermal and percutaneous absorption; repeated dose toxicity; reproductive toxicity; mutagenicity and genotoxicity; carcinogenicity; toxicokinetic studies; photo-induced toxicity; and human data. Although there are many methodologies described, validated, and widely used in the cosmetic area, the evaluation of the safety of cosmetic ingredients and products is still an expanding field. It needs global collaboration among regulatory agencies, universities, and industry, to meet several unmet needs in the fields of sensitization, carcinogenicity, systemic action, among other issues involving safety of users of cosmetic products. This review article will cover the currently most relevant in vitro models regarding irritation, corrosion, sensitization, mutagenicity, genotoxicity, and phototoxicity, to help to choose the most appropriate test for evaluating the safety and toxicity of cosmetic ingredients and products.
  • Challenges in the use of nanostructures as carriers of nucleic acids in clinical practice Reviewing Basic Sciences

    Quintão, Carolina Capobiango Romano; Camargo, Luiz Sérgio de Almeida; Brandão, Humberto de Mello; Saraiva, Naiara Zoccal; Munk, Michele

    Abstract in English:

    ABSTRACT The delivery of nucleic acids to cells is considered a crucial step for the success of genetic modifications aimed at therapeutic purposes or production of genetically modified animals. In this context, nanotechnology is one of the most promising fields of science, with the potential to solve several existing problems. Nanostructures have desirable characteristics to be used as carriers, such as nanometric size, large surface area, cell internalization capacity, prolonged and controlled release, among others. Genetically modified animals can contribute to the production of biopharmaceuticals, through the expression of high-associated-value molecules. The production of these animals, also known as biofactories, further enhances Brazilian agribusiness, since it allows adding value to the final product, and favors the integration between the agricultural market and the pharmaceutical sector. However, there is a growing concern about the safety and possible harmful effects of nanostructures, since data on the safe use of these materials are still insufficient. The objective of this review was to address aspects of the use of nanostructures, mainly carbon nanotubes as nucleic acid carriers, aiming at the production of genetically modified animals, with the certainty that progress in this field of knowledge depends on more information on the mechanisms of interaction between nanostructures, cells and embryos, as well as on its toxicity.
  • MicroRNAs and exosomes: promising new biomarkers in acute myeloid leukemias? Reviewing Basic Sciences

    Araújo, Helena Varela de; Sakamoto, Luis Henrique Toshihiro; Bacal, Nydia Strachman; Epelman, Sidnei; Real, Juliana Monte

    Abstract in English:

    ABSTRACT Despite advances in understanding of carcinogenesis and of treatment of acute myeloid leukemia, this neoplasm still has a lethality of at least 30%. The search for biomarkers that can predict the response to treatment in the early stages of the disease is still necessary. In recent years, a new form of cellular communication between tumor and non-neoplastic cells has been discovered: the exchange of information through extracellular vesicles. These are small vesicles released by membrane-coated cells that carry proteins, lipids, messenger RNAs, microRNA and DNA, which can be internalized and promote biological changes in target cells. Exosomes are qualified as a type of extracellular vesicle and, in tumors, carry immunoinhibitory signals that promote the escape of immune control. Recent studies have showed their involvement in communication with the cells of the tumor microenvironment and with chemoresistance in several tumors. To date, there is no information about immunoregulatory microRNAs transported by exosomes and their correlation with clinical evolution during chemotherapy for acute myeloid leukemia. Knowledge about immunomodulatory microRNAs obtained by leukemic cells and transported by exosomes can direct us towards the design of new diagnostic and treatment tools in this type of leukemia.
  • What is the role of heat shock protein in abdominal organ transplantation? Reviewing Basic Sciences

    Calil, Igor Lepski; Tustumi, Francisco; Sousa, Jorge Henrique Bento de; Tomazini, Bruno Martins; Cruz Jr, Ruy Jorge; Saliba, Gustavo Niankowski; Pécora, Rafael Antonio Arruda; D’Albuquerque, Luiz Augusto Carneiro

    Abstract in English:

    ABSTRACT Ischemia-reperfusion injury is a pathophysiological event occuring after abdominal organ transplantation, and has a significant influence on prognosis and survival of the graft. It is involved in delaying the primary function or non-functioning of the graft. The objective of this study was to provide information on heat shock protein mechanisms in ischemia-reperfusion injuries in abdominal organ transplantations, and to indicate the possible factors involved that may influence the graft outcome. Several classes of heat shock proteins are part of the ischemia and reperfusion process, both as inflammatory agonists and in protecting the process. Studies involving heat shock proteins enhance knowledge on ischemia-reperfusion injury mitigation processes and the mechanisms involved in the survival of abdominal grafts, and open space to support therapeutic future clinical studies, minimizing ischemia and reperfusion injuries in abdominal organ transplantations. Expression of heat shock proteins is associated with inflammatory manifestations and ischemia-reperfusion injuries in abdominal organ transplantations and may influence graft outcomes.
  • Mid-ventricular obstruction in a patient with hypertrophic cardiomyopathy Learning By Images

    Morales, Kevin Rafael De Paula; Romero, Cristhian Vicente Espinoza; Guacho, Williams Roberto Lata; Jaya, David Alejandro Salazar; Fonseca, Eduardo Kaiser Ururahy Nunes
  • Left ventricular noncompaction highlighted by three-dimensional and speckle tracking echocardiography Learning By Images

    Hotta, Viviane Tiemi; Martinelli, Luiz Mário Baptista; Moisés, Valdir Ambrósio; Mady, Charles; Fernandes, Fábio
  • Investigation of nerve fibers in the skin by biopsy: technical aspects, indications, and contribution to diagnosis of small-fiber neuropathy Medical Developments

    Raicher, Irina; Ravagnani, Luís Henrique Casartelli; Correa, Silene Gomes; Dobo, Cristine; Mangueira, Cristóvão Luis Pitangueira; Macarenco, Ricardo Silvestre e Silva

    Abstract in English:

    ABSTRACT Skin biopsy with investigation of small-diameter nerve fibers in human epidermis and dermis has been proven to be a useful method for confirming small-fiber neuropathy. In medical practice, small-fiber neuropathy is increasingly recognized as a leading cause of neuropathic pain. It is a prevalent complaint in medical offices, brought by patients often as a “painful burning sensation”. The prevalence of neuropathic pain is high in small-fiber neuropathies of different etiologies, especially in the elderly; 7% of population in this age group present peripheral neuropathy. Pain and paresthesia are symptoms which might cause disability and impair quality of life of patients. The early detection of small-fiber neuropathy can contribute to reducing unhealthy lifestyles, associated to higher incidence of the disease.
  • Tradução para o português An International Continence Society (ICS) report on the terminology for adult neurogenic lower urinary tract dysfunction (ANLUTD) Artigo Especial

    Fernandes, Ailton; Sacomani, Carlos Alberto Ricetto; Averbeck, Márcio; Prezotti, José Antônio; Ferreira, Ruiter Silva; Moser, Daniel; Gajewski, Jerzy B.

    Abstract in Portuguese:

    RESUMO Introdução A terminologia para disfunção neurogênica do trato urinário inferior em adultos (DNTUIA) deve ser definida e organizada com base clínica em um relatório de consenso. Métodos Este relatório foi criado por um Grupo de Trabalho sob o endosso e diretrizes do Standardization Steering Committee (SSC) da International Continence Society (ICS), auxiliado em intervalos por julgadores externos. Todas as definições relevantes para DNTUIA foram atualizadas com base em pesquisas nos últimos 14 anos. Um extenso processo de 18 rodadas de revisão interna e externa foi realizado para examinar exaustivamente cada definição, com tomada de decisão pela opinião coletiva (consenso). Resultados O Relatório de Terminologia para a DNTUIA, englobando 97 definições (42 novas e oito modificadas), foi desenvolvido. Este relatório é clinicamente baseado nos diagnósticos definidos mais comuns. Clareza e facilidade de uso têm sido os principais objetivos para torná-lo interpretável por profissionais e pessoas em treinamento em todos os diferentes grupos envolvidos não só na disfunção do trato urinário inferior, mas também em muitas outras especialidades médicas. Conclusão Baseado no consenso, o Relatório de Terminologia para a DNTUIA foi produzido para auxiliar na pesquisa e na prática clínica.
  • COVID-19 pandemic: multilevel dental technical guidelines based on new scientific evidence Special Article

    Andrade, Sérgio Araújo; Lima, Raissa Emanuelle; Varotti, Fernando de Pilla; Abdelwahab, Omar; Lwaleed, Bashir Abdulgader

    Abstract in English:

    ABSTRACT The COVID-19 pandemic imposed restrictive measures on dentistry in different regions of the world, ranging from stoppage of care to only permission for urgent and emergency dental services. Thus, new biosafety guidelines for resuming activities, whether in single dental offices, large clinics or dental education activities, are urgently required. In this sense, herein, guidelines that incorporate common points of the main protocols found in the literature for the resumption of dental activities at their different levels, whether in the scope of care or education, are presented. Furthermore, we present the incorporation of measures that allow an increase in the level of biosafety, such as the control of the dental team, the inclusion in the history of conjunctivitis as a possible alert for COVID-19, and the use of the pulse oximeter to assess the risk of silent hypoxemia, which may indicate a complication of COVID-19. In addition, new perspectives for directing research and innovation for biosafety in dentistry are discussed.
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