• Interpretations on a rare localization of endometriosis: labium minus Editorial

    Sengul, Ilker; Sengul, Demet; Soares, José Maria
  • A beacon for the COVID-19 epidemic control in Brasil: seroepidemiological population-based surveys Letter to the Editor

    Donalisio, Maria Rita
  • COVID-19-induced de novo nephritic syndrome Letter to the Editor

    Yasri, Sora; Wiwanitkit, Viroj
  • Hypofractionated radiotherapy recommendations for localized prostate cancer in Brasil Guidelines in Focus

    Palhares, Daniel Moore Freitas; Pimentel, Leonardo Cunha Furbino; Castilho, Marcus Simões; Costa, Andréa Barleze da; Reisner, Márcio Lemberg; Kuhnen, Felipe Quintino; Pássaro, Anderson; Leite, Elton Trigo Teixeira; Faustino, Fábio de Lima Costa; Obst, Fernando Mariano; Costa, Flávio Napoleão Buarque Barbosa Ferro; Pioner, Giovani Thomaz; Carvalho, Ícaro Thiago de; Silva, João Luís Fernandes da; Morikawa, Lisa Karina Kokay; Zanuncio, Pedro Henrique da Rocha; Hanriot, Rodrigo de Morais; Rosa, Arthur Accioly

    Resumo em Inglês:

    SUMMARY OBJECTIVE: Several prospective randomized trials have shown that hypofractionation has the same efficacy and safety as the conventional fractionation in the treatment of localized prostate cancer. There are many benefits of hypofractionation, including a more convenient schedule for the patients and better use of resources, which is especially important in low- and middle-income countries like Brasil. Based on these data, the Brazilian Society of Radiotherapy (Sociedade Brasileira de Radioterapia) organized this consensus to guide and support the use of hypofractionated radiotherapy for localized prostate cancer in Brasil. METHODS: The relevant literature regarding moderate hypofractionation (mHypo) and ultra-hypofractionation (uHypo) was reviewed and discussed by a group of experts from public and private centers of different parts of Brasil. Several key questions concerning clinical indications, outcomes and technological requirements for hypofractionation were discussed and voted. For each question, consensus was reached if there was an agreement of at least 75% of the panel members. RESULTS: The recommendations are described in this article. CONCLUSION: This initiative will assist Brazilian radiation oncologists and medical physicists to safely treat localized prostate cancer patients with hypofractionation.
  • Epidemiological, neurofunctional profile and prevalence of factors associated with the occurrence of physical disabilities due to leprosy in a reference center in Northeast Brasil: a sectional study Rapid Communications

    Matos, Thais Silva; Moura, José Carlos de; Fernandes, Tânia Rita Moreno de Oliveira; Souza, Carlos Dornels Freire de

    Resumo em Inglês:

    SUMMARY OBJECTIVE: To describe the epidemiological and neurofunctional profile, as well as the prevalence of factors associated with the occurrence of physical disabilities due to leprosy in a reference center in Northeast Brasil. METHODS: A cross-sectional study including 50 leprosy patients diagnosed in Juazeiro-Bahia. Variables analyzed: sex, age, history of leprosy in the family, time to diagnosis, clinical form, operational classification, degree of disability, eyes-hand-foot score, peripheral nerve function, muscle strength and sensitivity. Descriptive statistics and inferential statistics (χ² test or Fisher’s exact, Poisson regression with robust estimation and prevalence reason were used. Significance of 5%). RESULTS: An equal distribution was found between men and women of economically active age and low education; multibacillary forms in men (64%) and paucibacillary forms in women (60%). 78% of individuals had some degree of disability and 64% had a compromised ulnar nerve. Plantar sensitivity was decreased in 66% of patients. The predictors of disability were: age ≥45 years (PR 1.44; p=0.005), no education (PR 1.21; p=0.013) and OMP score ≥6 (PR 1.29; p<0.001). CONCLUSION: The findings show the importance of monitoring neural functions and developing measures that allow early diagnosis, the opportune method and the prevention of disabilities, especially in the male population.
  • Transcranial direct current stimulation as a strategy to manage COVID-19 pain and fatigue Rapid Communications

    Silva, Edson; Moura, Stephanney; Santos, Amilton da Cruz; Brasileiro-Santos, Maria do Socorro; Albuquerque, Jéssica Andrade de

    Resumo em Inglês:

    SUMMARY The novel coronavirus disease (COVID-19) has infected millions of people worldwide and generated many sequels in the survivors, such as muscular pain and fatigue. These symptoms have been treated through pharmacological approaches; however, infected people keep presenting physical limitations. Besides, the COVID-19 damage to the central nervous system has also been related to the presence of some physical impairment, so strategies that focus on diverse brain areas should be encouraged. Transcranial Direct Current Stimulation (tDCS) is a non-pharmacological tool that could be associated with pharmacological treatments to improve the central nervous system function and decrease the exacerbation of the immune system response. tDCS targeting pain and fatigue-related areas could provide an increase in neuroplasticity and enhancements in physical functions. Moreover, it can be used in infirmaries and clinical centers to treat COVID-19 patients.
  • First case of extracorporeal membrane oxygenation in cardiorespiratory arrest in an emergency room in Brasil: a possible reality? Rapid Communications

    Soeiro, Alexandre; Leal, Tatiana; Paula, Leonardo de; Lage, Rony; Goldstein, Priscila; Scudeler, Thiago; Boros, Gustavo; Pedreira, Fábio; Pereira, Thiago; Polastri, Thatiane; Furtado, Armando; Santana, Pedro; Tenório, Davi; Dantas, Cristiano; Galas, Filomena; Steffen, Samuel; Carvalho, Carlos; Kalil, Roberto; Soares, Paulo

    Resumo em Inglês:

    SUMMARY The extracorporeal membrane oxygenation (ECMO) is a procedure that has been used for a long time in reference centers worldwide. Its fundamental precept is to serve as a bridge to a definitive treatment in patients with severe, but potentially reversible, clinical conditions. Despite this, its use in cardiopulmonary arrest (ECPR) is still a matter of debate, especially when indicated in the emergency department. There is not yet a sufficient level of evidence to support its routine use. In Brasil, the procedure stopped being considered an experimental technique by the Federal Council of Medicine only in 2017. The objective of the present case is to share the pioneering spirit of a Brazilian reference center with ECPR in the emergency room and to discuss the future challenges of the ECMO technique.
  • Does parental opinion differ from the health care team regarding cosmesis after hypospadias repair? Original Article

    Costa, Eduardo; Fraga, José Carlos; Salle, João Pippi; Rosito, Nicolino

    Resumo em Inglês:

    SUMMARY OBJECTIVE: Hypospadias is the most common malformation of the male genitalia. Surgical correction has traditionally focused on anatomic and functional outcomes, with less attention being paid to cosmetic results. Our purpose is to compare the cosmetic results of hypospadias repair among different groups of observers, namely the patient’s family and the health care team, using photography and a simple rating scale. METHODS: Prospective observational study included 9 boys undergoing Snodgrass hypospadias repair. Photographs of the penis taken before, immediately after, and six months after surgery were assessed by a panel of 15 observers (parents and health care team) and a scale including three questions with diagrams for comparison with the pictures was used. Observers also assigned an overall postoperative score for the cosmetic result. RESULTS: Interobserver agreement was noted for the group of parents of other children with hypospadias regarding the shape of the glans (k=0.404; p=0.008) and for the group of pediatric surgeons regarding the degree of residual curvature (k=0.467; p=0.005). Two observers in the pediatrician group have indicated good performance in the assessment of residual curvature (k=0.609; P=0.024). In the overall assessment of cosmetic outcomes, the highest scores were assigned by observers in the parents group and in the pediatrician group, while the pediatric surgeons group has one of the lowest scores (p<0.001). CONCLUSIONS: Photography appears to be suitable for documenting corrections of hypospadias regarding penile curvature, and postoperative cosmetic result. Surgeons seem more concerned about cosmesis than parents.
  • Postoperative transient elevation of serum cancer antigen 125 in non-small cell lung cancer patients Original Article

    Ye, Yiwang

    Resumo em Inglês:

    SUMMARY OBJECTIVE: The aim of this retrospective study was to investigate the correlation of transiently elevated postoperative serum cancer antigen 125 levels and prognosis in patients with non-small cell lung cancer. METHODS: A total of 181 non-small cell lung cancer patients with normal levels of preoperative serum cancer antigen 125 were statistically summarized in this study. RESULTS: Out of the analyzed patients, 22 (12.2%) showed elevation of serum cancer antigen 125 within one month after surgery. Serum cancer antigen 125 level decreased to normal at three months postoperation. Serum cancer antigen 125 was positively correlated with pro-brain natriuretic peptide in non-small cell lung cancer postoperative patients (p=0.00035). Univariate analysis did not find significant difference in disease progression survival between those who experienced cancer antigen 125 elevation in the early postoperation and those who did not (p=0.646). CONCLUSIONS: In conclusion, transient elevation of cancer antigen 125 is associated to pro-brain natriuretic peptide increase after pulmonary surgery in non-small cell lung cancer patients.
  • Hyperglycemia in pregnancy: sleep alterations, comorbidities and pharmacotherapy Original Article

    Façanha, Cristina; Bruin, Veralice de; Bruin, Pedro de; Façanha, Arthur; Rocha, Hellen Cristina; Araujo, Mariana; Forti, Adriana; Macêdo, Rejane

    Resumo em Inglês:

    SUMMARY OBJECTIVE: To investigate sleep alterations and associated factors in pregnant diabetic women (n=141). METHODS: Sleep profile, sociodemographics and clinical information were collected. Poor sleep quality (Pittsburgh Sleep Quality Index >5) and excessive daytime sleepiness (Epworth Sleepiness Scale ≥10), sleep duration (h), sleep latency (min), frequent sleep interruption and short sleep (≤6 h) were assessed in type 1 diabetes mellitus (16.3%), type 2 diabetes mellitus (25.5%) and gestational diabetes mellitus (58.2%). RESULTS: Poor sleep quality was found in 58.8% of patients and daytime sleepiness in 25.7%, regardless of hyperglycemia etiology. No correlation existed between daytime sleepiness and poor sleep quality (Pearson correlation r=0.02, p=0.84). Short sleep duration occurred in 1/3 of patients (31.2%). Sleep interruptions due to frequent urination affected 72% of all and sleep interruptions due to any cause 71.2%. Metformin was used by 65.7% of type 2 diabetes mellitus and 28.7% of gestational diabetes mellitus. In gestational diabetes mellitus, parity number was independently associated with poor sleep quality (p=0.02; OR=1.90; 95%CI 1.07-3.36) and metformin use was also independently associated with poor sleep quality (p=0.03; OR=2.36; 95%CI 1.05-5.29). CONCLUSIONS: Our study originally shows that poor sleep quality and excessive daytime sleepiness are frequent in diabetic pregnancy due to different etiologies. Interestingly, only in gestational diabetes mellitus, metformin therapy and higher parity were associated with poor sleep quality.
  • Prevalence of Hashimoto's thyroiditis in psoriasis patients Original Article

    Valduga, Júlia Amanda Guzatti; Rebeiko, Leticia Boçon; Skare, Thelma Larocca

    Resumo em Inglês:

    SUMMARY OBJECTIVE: To study the prevalence of Hashimoto’s Thyroiditis in a sample of psoriasis patients. METHODS: Cross-sectional observational study of 120 individuals (60 with psoriasis and 60 control subjects) paired by gender and age for thyroid function (thyroid stimulating hormone, free T4), antithyroperoxidase and antithyroglobulin tests and physical examination. Psoriasis Area and Severity Index and Nail Psoriasis Severity Index were evaluated simultaneously. Epidemiological, clinical and treatment data was collected from medical records. Patients with documented hypothyroidism and/or goiter associated with positive antithyroperoxidase antibody were considered to have Hashimoto’s Thyroiditis. RESULTS: The prevalence of Hashimoto’s Thyroiditis in the group with psoriasis was 21.6%; in the control group, it was 4/60 (6.6%) with p=0.03 (OR=3.8; 95%CI 1.18-12.6). In the group of patients with psoriasis, Hashimoto’s Thyroiditis was more common in women (p=0.002) and less common in those who had polyarticular arthropathic psoriasis (p=0.05) and plaque psoriasis (p=0.005). A logistic regression showed that the only independent variable associated with Hashimoto's thyroiditis was plaque psoriasis. CONCLUSIONS: There is a high prevalence of Hashimoto’s Thyroiditis in psoriatic patients, especially in women. Hashimoto’s Thyroiditis is less common in patients with the plaque form of psoriasis.
  • Comparison of early and long-term follow-up results of percutaneous mitral balloon valvuloplasty and mitral valve replacement Original Article

    Usta, Emrah; Erdim, Refik; Görmez, Selçuk; Dogan, Ali; Ezelsoy, Mehmet; Kahraman, Serkan; Bayram, Muhammed; Yazicioğlu, Nuran

    Resumo em Inglês:

    SUMMARY BACKGROUND: Percutaneous mitral balloon valvuloplasty and mitral valve replacement have been the treatment options for mitral stenosis for several years, however, studies that compare these two modalities are very rare in the literature. ObjectIve: In this article, we aim to investigate the comparison of clinical results of percutaneous mitral balloon valvuloplasty and mitral valve replacement. Methods: 527 patients with rheumatic mitral stenosis, treated with percutaneous mitral balloon valvuloplasty or mitral valve replacement (276 patients with percutaneous mitral balloon valvuloplasty and 251 patients with mitral valve replacement) from 1991 to 2012 were evaluated. The demographic characteristics, clinical, echocardiographic and catheterization data of patients were evaluated retrospectively. The results of early and late clinical follow-up of patients after percutaneous mitral balloon valvuloplasty and mitral valve replacement were also evaluated. Results: The mean follow-up time of the percutaneous mitral balloon valvuloplasty group was 4.7 years and, for the mitral valve replacement-group, it was 5.45 years. The hospital stay of the percutaneous mitral balloon valvuloplasty group was shorter than that of the mitral valve replacement group (2.02 days vs 10.62 days, p<0.001). The hospital mortality rate of percutaneous mitral balloon valvuloplasty and mitral valve replacement were 0% and 2% respectively (p=0.024). In the percutaneous mitral balloon valvuloplasty group, early postprocedural success rate was 92.1%. The event-free survival of percutaneous mitral balloon valvuloplasty and mitral valve replacement was found to be similar. While reintervention was higher in percutaneous mitral balloon valvuloplasty-group (p<0.001), mortality rate was higher in mitral valve replacement-group (p<0.001). Conclusion: Percutaneous mitral balloon valvuloplasty seems to be more advantageous than mitral valve replacement due to low mortality rates, easy application of the procedure and no need for general anesthesia.
  • The association between the histopathological features and microsatellite instability in young patients with urothelial carcinoma of the bladder Original Article

    Ekmekci, Sümeyye; Küçük, Ülkü; Kaya, Özge; Yörükoğlu, Kutsal

    Resumo em Inglês:

    SUMMARY OBJECTIVE: Bladder cancer under the age of 40 is extremely rare. Bladder cancer development involves complex and multi-stage processes, one of which is the DNA damage repair mechanism. In this retrospective study, we aimed to evaluate the histopathological features of bladder urothelial carcinoma seen in patients under 40 years of age and tumor microsatellite instability status using immunohistochemistry. METHODS: A total of 50 patients under the age of 40 with urothelial bladder carcinoma from two different centers in the same country were included. Expression of the mismatch repair proteins MLH1, MSH2, MSH6, and PMS2 was analyzed by immunohistochemistry. RESULTS: Age at the time of diagnosis ranged from 17 to 40 years old. Most tumors were non-invasive papillary urothelial carcinoma. Two cases had nuclear loss of MSH-6 and PMS-2. We observed that tumor grade, tumor stage, presence of tumor differentiation, and infiltrative growth pattern of the tumor have significant impact on prognosis, but microsatellite instability does not have an effective role in bladder carcinogenesis in young patients. CONCLUSIONS: Our results indicate that the presence of microsatellite instability is not related to the low tumor grade and stage in urothelial neoplasms in young patients, suggesting that urothelial carcinoma of the bladder in young patients may represent a genetically stable form of neoplasia.
  • Assessment of left atrial function by strain in patients with acute ıschemic stroke left atrial function and acute stroke Original Article

    Ozturk, Unal; Ozturk, Onder

    Resumo em Inglês:

    SUMMARY OBJECTIVE: Myocardial speckle-tracking echocardiography can detect subtle abnormalities in the left atrial function. In this study, we aimed to investigate the relationship between left atrial myocardium and tissue function n assessed by two-dimensional speckle-tracking echocardiography and the National Institutes of Health Stroke Scale score in patients with acute ischemic stroke. METHOD: The study was composed of 80 patients (45 men, 35 women, mean age: 67±15 years) with acute ischemic stroke. The patients were divided into two groups based on the calculated National Institutes of Health Stroke Scale score (group 1, National Institutes of Health Stroke Scale score < 16; group 2, National Institutes of Health Stroke Scale score ≥ 16). Demographic, clinical, and laboratory data for all patients were collected. Cardiac functions were evaluated using two-dimensional speckle-tracking echocardiography within 48 hours from admission to the neurology care unit. RESULTS: There were no significant differences between the patients’ clinical parameters. Left ventricular ejection fraction was significantly higher in group 1 than in group 2 (59.2±5.6 to 51.4±6.3, p=0.024). Left atrial longitudinal strain was significantly higher in group 1 than in group 2 (34.48±9.73 to 26.27±7.41, p=0.019). There were no significant differences between other echocardiographic parameters. CONCLUSION: Our results suggest that left atrial longitudinal strain is associated with stroke severity during admission in patients with acute ischemic stroke. Left atrial longitudinal strain is an indicator of left atrial myocardial function.
  • Prevalence of premalignant and malignant skin lesions in oculocutaneous albinism patients Original Article

    Ramos, Andréia Nogueira; Ramos, João Gabriel Rosa; Fernandes, Juliana Dumet

    Resumo em Inglês:

    SUMMARY OBJECTIVE: Oculocutaneous albinism describes a group of pigmentary disorders that lead to skin sensitivity and predisposition to skin malignances. Aims: To analyze clinical and epidemiological data in oculocutaneous albinism patients and to determine the prevalence of malignant skin lesions, assessing possible risk factors for skin cancer. METHODS: Cross-sectional study evaluating epidemiological data, habits of sun exposure and sun protection, and clinical examination of albino patients followed in a reference dermatology outpatient clinic in Brasil. Our primary outcome was the occurrence of malignant skin lesions in biopsied tissues. RESULTS: Of 74 patients analyzed, 11 (15%) had one or more suspicious lesions and were biopsied, of which 8 (72.7%) patients presented with basal cell carcinomas, 7 (63.3%) presented with squamous cell carcinoma, and 1 (9%) presented with melanoma. Moreover, 32(43%) patients presented with actinic keratosis. Age, female gender, previous history of sunburn, history of malignant lesions and history of sun exposure without photoprotection were associated with the presence of malignant lesions. Limitations: Unicentric, non-aleatory sample. CONCLUSIONS: There was a high prevalence of malignant and pre-malignant lesions in this population. Some potentially modifiable risk factors were associated with the occurrence of malignant skin lesions.
  • The role of Clinical-Functional Vulnerability Index-20 to detect quality of life in older adults assisted in primary care Original Article

    Sena, Levi Bezerra; Batista, Larissa Paixão; Fernandes, Flávia Fonseca; Santana, Alfredo Nicodemos Cruz

    Resumo em Inglês:

    SUMMARY OBJECTIVE: To determine the cutoff point of the Clinical-Functional Vulnerability Index-20 to detect poor quality of life in the elderly in Primary Health Care. METHODS: This cross-sectional study was carried out in Primary Health Care units of Ceilândia (DF, Brasil) between September 2019 and January 2020. Four hundred and fifty-eight individuals were included in the study and answered the Clinical-Functional Vulnerability Index-20 (IVCF-20) and the World Health Organization Quality of Life – WHOQOL-BREF (validated to access quality of life) instruments. Based on the WHOQOL-BREF answers, three subgroups were created: poor, good and undetermined quality of life. The receiver operating characteristic curve (using Youden index) showed the IVCF-20 cutoff point to detect poor quality of life (in individuals with good quality of life as the Control Group), and therefore diagnostic tests were performed. RESULTS: The IVCF-20 cutoff point to detect poor quality of life was ≥11. The area under the receiver operating characteristic curve was 0.97 (95%CI 0.95–0.98). The IVCF-20 diagnostic tests showed good sensitivity (88.1%) and specificity (84.9%). CONCLUSIONS: The IVCF-20 ≥11 detected poor quality of life adequately in the elderly in Primary Health Care. These data suggest that elderly individuals with IVCF ≥11 should attend appointments more often in Primary Health Care or geriatrics collaborative care, considering the impact that quality of life can have on the elderly population’s mortality.
  • The impact of visceral fat and levels of vitamin D on coronary artery calcification Original Article

    Rodrigues, Isa Galvão; Pinho, Claudia Porto Sabino; Sobral, Dário; Leão, Ana Paula Dornelas; Oliveira, Maria Cristina Monterio; Barbosa, Gerssica Pina; Siqueira, Aline Alves de; Bandeira, Francisco

    Resumo em Inglês:

    SUMMARY OBJECTIVE: To evaluated calcification of the coronary arteries and its association with visceral fat and 25-hydroxyvitamin D (25(OH)D) serum levels. METHODS: A cross sectional study involving 140 individuals without any previous diagnosis of cardiovascular disease. A biochemical analysis of vitamin D serum levels was carried out, as well as computed tomography to measure coronary artery calcium score and visceral adipose tissue. RESULTS: The mean age of the individuals was 55.9 (±12.4). Coronary artery calcium was observed in 40.7% of the population. Vitamin D presented median serum levels of 30.4 ng/ml (IQ24.5–39.1), with 14,1 and 33.7% of the individuals presenting deficiency and insufficiency, respectively. In the univariate analysis, the calcium score was more prevalent in aged patients (p<0.01), in hypertensive individuals (p<0.01), in diabetics (p=0.02), and in those with a higher concentration of VAT (p=0.02). In the adjusted analysis, it was found that the highest concentration of VAT (OR: 4.0; 95%CI 1.4–11.7), hypertension (OR: 4.8; 95%CI 1.5–15.3), and age (OR: 10.4; 95%CI 3.9–27.6) were predictors of subclinical atherosclerosis, regardless of body mass index, diabetes, and 25OHD. CONCLUSIONS: Excess visceral fat was associated with subclinical atherosclerosis, regardless of other risk factors for cardiovascular disease. Serum levels of 25OHD were not associated with CAD in its early stages.
  • Limited cardiopulmonary capacity in patients with liver cirrhosis when compared to healthy subjects Original Article

    Nasser, Igor; Miranda, Humberto; Perez, Renata de Mello; Cabiddu, Ramona; Malosa, Luciana; Dias, Ingrid; Brown, Amanda; Reis, Michel Silva

    Resumo em Inglês:

    SUMMARY OBJECTIVES: The present study compared cardiorespiratory capacity between cirrhotic patients and healthy subjects. METHODS: Nineteen cirrhotic patients and 19 healthy subjects, paired by age and gender, participated in the study. Volunteers performed an incremental cardiopulmonary test with a ramp protocol, a ventilatory and metabolic variables were obtained and analyzed. The recovery was analyzed by calculating the time needed for 50% of oxygen consumption (VO2) recovery to occur as the median between the peak of the exercise and the end of recovery on the VO2 curve (T1/2). The VE/VCO2 slope were performed by the linear regression of ventilation (VE) and carbon dioxide production (VCO2) data. RESULTS: During resting condition, cirrhotic patients presented significantly higher levels of VO2 compared to healthy subjects. The VE/ VO2 and VE/ VCO2 values were significantly higher in the control group at the anaerobic threshold and at the peak of the test compared to cirrhotic patients. Time under effort was significantly higher for healthy subjects. CONCLUSIONS: Based on these findings, it is possible to conclude that liver cirrhosis can compromise the patients’ quality of life, mainly by inducing metabolic alterations which can impair functional capacity and lead to a sedentary lifestyle.
  • A Simple Risk Scoring Systems to evaluate the presence of aneurysm and one-year mortality in patients with abdominal aortic aneurysm using CHA2DS2-VASc and ATRIA Original Article

    Aksoy, Fatih; Uysal, Dinçer

    Resumo em Inglês:

    SUMMARY OBJECTIVE: We aimed to demonstrate the clinical utility of CHA2DS2-VASc and anticoagulation and risk factors in atrial fibrillation risk scores in the assessment of one year mortality in patients with abdominal aortic aneurysm. METHODS: We designed a retrospective cohort study using data from Suleyman Demirel University Hospital for the diagnosis of abdominal aortic aneurysm. The study included 120 patients with abdominal aortic aneurysm who underwent aortic computed tomography. Patients were divided into two groups according to presence of abdominal aortic aneurysm and the development of mortality. Predictors of mortality were determined by multiple logistic regression analysis. RESULTS: Multivariate regression analysis showed that CHA2DS2-VASc score, advanced age, female gender and elevated white blood cell counts were independent predictors of abdominal aortic aneurysm development while CHA2DS2-VASc score and elevated glucose levels were independent predictors of one year mortality in patients with abdominal aortic aneurysm. The concordance statistics for anticoagulation and risk factors in atrial fibrillation risk Score and CHA2DS2-VASc risk score respectively were 0.96 and 0.97 and could significantly predict one year mortality in patients with abdominal aortic aneurysm (p<0.001, and p<0.001, respectively). CONCLUSIONS: CHA2DS2-VASc and anticoagulation and risk factors in atrial fibrillation risk scores are easily obtained in an emergency setting and can accurately predict one year mortality as a noninvasive follow-up in patients with abdominal aortic aneurysm. These simple scores could be used as a point of care decision aid to help the clinician in counseling patients presenting with abdominal aortic aneurysm and their families on treatment protocols.
  • Risk factors for the lack of adherence to breastfeeding Original Article

    Turke, Karine Corcione; Santos, Lívia Restani dos; Matsumura, Letícia Santos; Sarni, Roseli Oselka Saccardo

    Resumo em Inglês:

    SUMMARY OBJECTIVE: To evaluate the prevalence of breastfeeding in a metropolitan region in Brasil and to identify factors influencing the lack of adherence to exclusive breastfeeding for 6 months and total breastfeeding for 2 years. METHODS: In this cross-sectional study, demographic and socioeconomic characteristics of mothers and children in pediatric outpatient clinics were analyzed. Logistic regression was performed using the backward stepwise method to analyze factors associated with the lack of breastfeeding compliance. RESULTS: In total, 385 mothers who visited the pediatric outpatient clinics were included. Among the mothers, 38.44% reported exclusive breastfeeding for >6 months and 22.6% reported total breastfeeding for 2 years or more. The predictive factors for the lack of adherence to exclusive breastfeeding for 6 months included single mothers (OR=1.976; 95%CI 1.245–3.135; p=0.004), use of a pacifier (OR=2.25; 95%CI 1.436–3.524; p<0.001), and low birth weight (OR=2.21; 95%CI 1.192–4.102; p=0.012). Predictive factors for the lack of adherence to total breastfeeding for 2 or more years included use of a pacifier (OR=4.82; 95%CI 2.722–8.54; p<0.001), planned pregnancy (OR=0.51; 95%CI 0.305–0.875; p=0.014), and breastfeeding in the first hour of life (OR=0.36; 95%CI 0.208–0.641; p<0.001). CONCLUSIONS: The prevalence of exclusive breastfeeding for 6 months and total breastfeeding for 2 years or more was insufficient in the studied population. Several factors were associated with the lower duration of exclusive breastfeeding and total breastfeeding. The use of a pacifier and no breastfeeding in the first hour were preventable factors associated with both modalities.
  • Comparison of two pandemics: H1N1 and SARS-CoV-2 Original Article

    Kant, Aydın; Kostakoğlu, Uğur; Saral, Özlem Bayraktar; Çomoğlu, Şenol; Arslan, Mustafa; Karakoç, Hanife Nur; Erkan, Gönül; Ertunç, Barış; Demir, Hanzade Duygu; Aydin, Murat; Öztürk, Sinan; Yilmaz, Gürdal

    Resumo em Inglês:

    SUMMARY OBJECTIVE: We aimed to compare the clinical, epidemiological, and prognostic features of the H1N1 pandemic in 2009 and the severe acute respiratory syndrome coronavirus 2 pandemic in 2020. METHODS: This retrospective study involved subjects from seven centers that were admitted and found to be positive for H1N1 or COVID-19 real-time polymerase chain reaction test. RESULTS: A total of 143 patients with H1N1 and 309 patients with COVID-19 were involved in the study. H1N1 patients were younger than COVID-19 ones. While 58.7% of H1N1 patients were female, 57.9% of COVID-19 patients were male. Complaints of fever, cough, sputum, sore throat, myalgia, weakness, headache, and shortness of breath in H1N1 patients were statistically higher than in COVID-19 ones. The duration of symptoms until H1N1 patients were admitted to the hospital was shorter than that for COVID-19 patients. Leukopenia was more common in COVID-19 patients. C-reactive protein levels were higher in COVID-19 patients, while lactate dehydrogenase levels were higher in H1N1 ones. The mortality rate was also higher in H1N1 cases. CONCLUSIONS: The severe acute respiratory syndrome coronavirus 2 pandemic is a major public health problem that continues to affect the world with its high rate of contagion. In addition, no vaccines or a specific drug for the benefit of millions of people have been found yet. The H1N1 pandemic is an epidemic that affected the whole world about ten years ago and was prevented by the development of vaccines at a short period. Experience in the H1N1 pandemic may be the guide to prevent the COVID-19 pandemic from a worse end.
  • Race inequalities in maternal mortality in the city of Rio de Janeiro, Brazil: 2010-2019 Original Article

    Alves, Lúcio Gomes Rodrigues; Guimarães, Raphael Mendonça

    Resumo em Inglês:

    SUMMARY OBJECTIVE: To analyze the behavior of maternal mortality according to the race/color variable in the city of Rio de Janeiro, Brazil, between 2010 and 2019. METHODS: This is a cross-sectional study that used microdata collected in the Sistema de Informações sobre Mortalidade and Sistema de Informações sobre Nascidos Vivos. Data were disaggregated by race/color and age groups of childbearing age. Pearson's χ2 test was used to compare the ratio in each category of covariates. In order to explore the differences in the maternal mortality ratio of the respective variables, the data were adjusted using Poisson's model. Polynomial regression models were tested to describe the trend. RESULTS: There were 732 maternal deaths in the city of Rio de Janeiro between 2010 and 2019. The time trend analysis of general maternal mortality showed a significant decline between 2010 and 2018 followed by a new upward trend in 2019. There was a greater maternal mortality ratio for older age groups, especially for women over 40 (prevalence ratio of 18.80, 95%CI 13.54–26.78; p<0.0001) and black ones (prevalence ratio of 2.31, 95%CI 1.90–2.80; p<0.0001). CONCLUSION: There is evidence that maternal mortality is associated with issues of race, which suggests the racial disparity in obstetric care in the city of Rio de Janeiro.
  • Effect of medication withdrawal on pain in Parkinson’s disease patients – an observational study based on a sample of patients without antiparkinsonian medications Original Article

    Lopes, Rosimary Amorim; Oliveira, José Oswaldo de; Porto, Fabio Henrique de Gobbi; Botelho, Ricardo Vieira

    Resumo em Inglês:

    SUMMARY OBJECTIVES: To assess the effect of withdrawal of the antiparkinsonian drug regimen administration on patients with PD and its relation to pain. METHODS: The sample included 22 men and 12 women who were candidates for neurosurgery to control motor signs and symptoms treated with L-dopa as a drug, alone or in combination with others (Cholinergic Antagonists; Dopamine Agents). All of them were examined at two different moments, with and without medication, and analyzed for painful symptoms. The Hoehn and Yahr scale was used for functional staging of the disease. Pain intensity was assessed by using the numerical verbal scale. RESULTS: The mean pain intensity among those on medication {2.17±0.39 (SE)} was significantly lower than in the abstinence group {4.2±0.59 (SE), p=0.006, Wilcoxon}, which corresponded to the increase in the total functional staging score from 93 to 111, respectively. CONCLUSION: The interruption of the administration of specific medications in patients with Parkinson’s disease caused, or increased the intensity of, painful discomfort correlated with the intensity of functional impairment. This effect was also observed in women, but it was statistically relevant only for men. The results suggest that pain may be a “red flag” that points to the need for a therapeutic drug review when its presence or worsening is detected.
  • Importance of esophageal pH monitoring and manometry in indicating surgical treatment of gastroesophageal reflux disease Review Article

    Alves, José Roberto

    Resumo em Inglês:

    SUMMARY OBJECTIVE: To demonstrate the need of performing esophageal pH monitoring and manometry in patients with clinical suspicion of Gastroesophageal reflux disease, as more accurate and practical complementary exams in the indication of surgical treatment. METHODS: A systematic review was carried out in the PubMed/Medline database, based on the recommendations of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol, selecting studies in humans, published in Portuguese, Spanish, and English, from January 1, 2009 to August 5, 2020. The following descriptors were used: “reflux gastroesophageal” AND “surgery” AND “surgical treatment” AND “esophageal manometry” OR “pH monitoring”. After that, retrospective or prospective observational studies with a sample of less than 100 individuals, or with limited access, reports or case series, review articles, letters, comments, or book chapters were excluded. To facilitate the application of the exclusion criteria, the Rayyan management base was used. RESULTS: Out of the 676 studies found, 19 valid and eligible studies were selected to make inferences. CONCLUSIONS: Based on the best evidence, currently, considering national particularities, performing a 24-hour esophageal pH monitoring and esophageal manometry for all patients undergoing anti-reflux surgery.
  • Pure neural leprosy or amyloid neuropathy? Systematic review and clinical case report Review Article

    Santos, Lucas Oliveira dos; Fernandes, Tânia Rita Moreno de Oliveira; Barbosa, Thamyres Rats de Souza; Batista, Jemima Araujo da Silva; Souza, Carlos Dornels Freire de

    Resumo em Inglês:

    SUMMARY OBJECTIVE: To review the literature and to report a clinical case with initial suspicion of pure neural leprosy and final diagnosis of amyloid neuropathy. METHODS: The study was conducted in two stages. In stage one, a systematic literature review was carried out, with searches performed in the PubMed, Medline, and Lilacs databases, as well as in the leprosy sectoral library of the Virtual Health Library, using the following descriptors: neuritic leprosy, pure neural leprosy, primary neural leprosy, pure neuritic leprosy, amyloid polyneuropathy, amyloid neuropathies, and amyloid polyneuropathy. The search was carried out on May 28, 2020. Clinical trials, cohort studies, cross-sectional studies, clinical cases, and case studies published in Portuguese, English or Spanish between 2010 and 2020 were included. Stage two reports a case with initial suspicion of pure neural leprosy. Laboratory tests, electroneuromyography, ultrasound, and biopsy of the sural nerve were requested. RESULTS: Twenty-three scientific texts were included. No publications were found that contained both topics together. The challenging diagnosis of pure neural leprosy and the possibility of using auxiliary resources in diagnosis were the most emphasized themes in the studies. In the clinical case, the patient's electroneuromyography showed sensitive and motor polyneuropathy of the lower limbs, which was predominantly sensory and axonal, symmetrical, of moderate intensity, and the mixed type (axonal-demyelinating). Ultrasonography of the sural nerve revealed changes in the contour of the deep fibular nerves; biopsy of the sural nerve showed an accumulation of amorphous eosinophilic material in the nerve path, and Congo red stain showed apple-green birefringence of the deposit under polarized light. The final diagnosis was amyloid neuropathy. CONCLUSIONS: The final clinical diagnosis was amyloid neuropathy. The diagnosis of pure neural leprosy in endemic areas in Brasil is still a challenge for the health system.
  • Premature birth: topics in physiology and pharmacological characteristics Review Article

    Machado, Joice Silva; Ferreira, Trícia Silva; Lima, Raquel Cristina Gomes; Vieira, Verônica Cheles; Medeiros, Danielle Souto de

    Resumo em Inglês:

    SUMMARY OBJECTIVE: To review the main physiological and pharmacological changes related to prematurity, to promote the evidence-based clinical practice. METHODS: This is a narrative review whose research was carried out in the ScienceDirect and Medline databases via PubMed, searching for articles in any language from January 2000 to February 2020. RESULTS: Premature newborns are born before completing the maturation process that prepares them for extrauterine life, which occurs especially in the last weeks of pregnancy. Therefore, they have their own characteristics in development. Several physiological peculiarities stand out, such as disturbances in glucose regulation, adrenal function, thermoregulation, immunity, in addition to changes in liver, renal and respiratory functions. Pharmacological aspects were also highlighted, involving pharmacokinetics and pharmacodynamics. CONCLUSIONS: Despite the recent advances in prematurity, it is still an area with many uncertainties, since several changes occur quickly and there are ethical issues that make studies difficult. Thus, it is clear that the therapeutic management of premature infants is still very much based on clinical practice.
  • Association between autism spectrum disorder and changes in the central auditory processing in children Review Article

    Gonçalves, Laura Faustino; Paiva, Karina Mary; Patatt, Fernanda Soares Aurélio; Stolz, Janaina Viana; Haas, Patrícia

    Resumo em Inglês:

    SUMMARY OBJECTIVE: To verify the scientific evidence on the association between Autistic Spectrum Disorder and Central Auditory Processing Disorder in children, aiming to answer the following research question: What is the association between Autistic Spectrum and Alteration of Auditory Processing in Children? METHODS: Studies were chosen through the combination based on the Medical Subject Heading Terms (MeSH): [(auditory processing) and (children) and (autism) and (neurological disorders)]. The MEDLINE (PubMed), LILACS, and SciELO databases were used. The analyzed papers covered a ten-year period, from 2010 to 2020. We selected descriptive, cross-sectional, cohort, and case studies. We evaluated the quality of the papers, which had a minimum score of six in the modified scale of the literature. RESULTS: 126 papers were retrieved after the exclusion phase, and 17 of them followed the inclusion criteria. Only two papers answered the guiding question with audiological results. CONCLUSIONS: Patients diagnosed with autistic spectrum disorder may have disturbance central auditory processing, considering that changes were found both in absolute and interpeak latencies in the brainstem evoked response audiometry, as well as in latency and laterality of the N1c wave amplitude. In addition, there were changes in the assessment behavioral auditory processing. Thus, disturbance central auditory processing is common in children with autistic spectrum disorder.
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