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SUMMARY OBJECTIVE: To assess the impact of the metoclopramide-induced hyperprolactinemia in cellular death and proliferation in the harderian gland of female mice. METHODS: Twenty female mice were divided into two groups of 10 animals each and treated: 0.2 mL of saline solution (controls, Ctr) and 200 µg of metoclopramide (experimental, hyperprolactinemia), both for 50 consecutive days and at 12:00 a.m. On the 50th day, the female were euthanized, and the harderian glands were removed and processed for immunohistochemistry for detected ki67 and TUNEL method. Data were statistically analyzed by unpaired Student’s t test (p<0.05). RESULTS: The harderian gland of the hyperprolactinemia group showed increase in the immunoexpression of Ki67 and TUNEL compared to the Ctr group (p<0.05), and there was no significant difference in the amount of porphyrin in the HPrl group compared to the Ctr group. CONCLUSION: The hyperprolactinemia led to increased cell death in the acini the harderian gland and cell proliferation in the stroma glandular, fact that suggesting a reduction process of cellular activity and fibrosis, which suggests impairment in the functioning of the lacrimal harderian.

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SUMMARY OBJECTIVE: Patients with systemic lupus erythematosus present with a higher number of classic risk factors for coronary diseases and a higher prevalence of metabolic syndrome resulting from the disease itself. To evaluate the nutritional indicators of the cardiovascular risk of patients with systemic lupus erythematosus by analyzing eating habits, anthropometry, laboratory data, and disease activity and to describe the prevalence of patients fulfilling the criteria for metabolic syndrome. METHODS: Anthropometric measurements including waist circumference, food recall, and laboratory tests. RESULTS: The population presented an insufficient daily intake of micronutrients. Anthropometry revealed that 37.5% of the patients were classified with degree II obesity by body mass index and 76.8% by abdominal obesity. Regarding metabolic syndrome, 18 patients (16%) fulfilled the diagnostic criteria. CONCLUSIONS: Individuals with systemic lupus erythematosus presented with increased risk factors, as determined using anthropometric measurements and laboratory tests, for cardiovascular disease, indicating the need for nutritional guidance in this population to reduce cardiovascular risk, increase the quality of life, and increase survival of these patients.

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SUMMARY OBJECTIVE: The aim was to investigate the acute effect of kinesthetic motor imagery of the 2-minute walk test on hemodynamic and cardiopulmonary variables in patients with heart failure. METHODS: Twenty participants were recruited for the analysis of these variables before and after the execution and imagination of the 2-minute walk test, with the number of laps executed and imagined being recorded. RESULTS: The main results observed showed that (1) there was no difference in the number of laps executed and imagined (p=0.41), indicating that the participants actually imagined the test and (2) the motor imagery of the 2-minute walk test immediately increased (p<0.001) the heart and respiratory rates. CONCLUSION: The motor imagery seems to have acute effects on the cardiopulmonary anticipatory responses of a patient with heart failure.

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SUMMARY OBJECTIVE: The objective of this study was to estimate the current prevalence of burnout syndrome among medical students at the Federal University of Sergipe and identify its associated factors. METHODS: This cross-sectional study was conducted with medical students randomly selected between April and June 2019. This study compared two medical schools from the same university with different teaching models: the Federal University of Sergipe, Aracaju campus, with a traditional teaching model, and the Federal University of Sergipe Lagarto campus, with a problem-based learning teaching model. An online questionnaire on the sociodemographic characteristics, personal aspects, and educational process of the participants, in addition to the Malash Burnout Inventory-Student Survey questionnaire for screening burnout syndrome, was distributed to the participants. The descriptive analysis of the data, calculation of the prevalence ratios, and multivariate analysis by logistic regression were performed. RESULTS: This study included 213 students with an average age of 23±3.77, and 50.2% of the students were male. Among the sample, 21.6% of the students met the three-dimensional criterion for burnout syndrome and 51.6% met the two-dimensional criterion. Burnout levels were higher in the students who rarely received the emotional support they needed in the program (OR 3.98), those who thought about dropping out of the undergraduate (OR 2.88), and those who considered their academic performance to be regular or weak (OR 12.1). The traditional teaching model was not a factor associated with burnout syndrome. CONCLUSIONS: The results suggest that a high prevalence of burnout syndrome is associated with psychosocial factors and the educational processes of medical students.

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SUMMARY OBJECTIVE: Patients with chronic spontaneous urticaria often want to be informed about dietary modifications. There have been many studies evaluating dietary approaches in chronic spontaneous urticaria. In this study, we aimed to investigate the relationship between adherence to the Mediterranean diet and chronic spontaneous urticaria. METHODS: In this cross-sectional case-control observational study, 100 patients (70 males and 30 females, mean age: 38.6±13.0 years) with chronic spontaneous urticaria and age- and sex-matched 100 healthy controls 70 males and 30 females, mean age: 38.7±13.8 years) were enrolled. A validated 14-item questionnaire evaluating the Mediterranean diet score was used for the assessment of adherence to the Mediterranean diet. The severity and the control of chronic spontaneous urticaria were assessed by Urticaria Activity Score over 7 days and Urticaria Control Test, respectively. RESULTS: The mean Mediterranean diet score in the patient group was 5.40±1.88, whereas in healthy controls it was 6.30±1.39 (p<0.001). The Urticaria Activity Score over 7 days score of the patients was negatively correlated with the Mediterranean diet score, whereas the Urticaria Control Test score was positively correlated. CONCLUSION: We reported that adherence to the Mediterranean diet may be an independent factor that decreases the risk of chronic spontaneous urticaria. It may also reduce the severity of chronic spontaneous urticaria symptoms.

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SUMMARY OBJECTIVE: The aim was to evaluate the changes in the prevalence of physical inactivity in the Brazilian adults from 2009-2017. METHODS: This study used a time-series research design based on the cross-sectional data of 462,498 Brazilian adults from 2009-2017. Participants were classified as physically inactive if they indicated not participating in physical activity in the last three months. The Prais-Winsten regression analyzed physical inactivity trends over time. RESULTS: The overall prevalence of physical inactivity was stable (p>0.05). Physical inactivity increased for women in four state capitals (annual growth rate: Goiânia 1.62%, Campo Grande 3.28%, Porto Velho 0.93%, and Vitória 2.09%) and decreased in one (annual growth rate: Rio Branco 4.50%). Physical inactivity decreased for men in four state capitals (annual growth rate: Campo Grande 4.72%, Natal 2.73%, São Luís 4.94%, and Rio Branco 2.95%). CONCLUSION: The physical inactivity among the Brazilian adults was stable between 2009 and 2017. Physical inactivity increased in women from Goiânia, Campo Grande, Porto Velho, and Vitória and decreased in women from Rio Branco and in men from Campo Grande, Natal, São Luís, and Rio Branco.

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SUMMARY OBJECTIVE: The aim of this study was to determine the prospective capacity and impact of donor risk index, preallocation survival outcomes following liver transplant, donor model for end-stage liver disease, and balance of risk on patients’ 30-day survival after liver transplantation. METHODS: We prospectively analyzed patient survival in a multicentric observational cohort of adult liver transplantation through the year of 2019 at the state of Paraná, Brazil. The receiver operating characteristic curve, the area under the curve, and the best cutoff point (i.e., the Youden’s index) were estimated to analyze the prognostic value of each index. RESULTS: In total, 252 liver transplants were included with an average model for end-stage liver disease score of 21.17 and a 30-day survival of 79.76%. The donor risk index was the only prognostic variable with no relation to patients’ 30-day mortality model for end-stage liver disease and donor model for end-stage liver disease have no prognostic value on receiver operating characteristic curve, but preallocation survival outcomes following liver transplant, survival outcomes following liver transplant, and balance of risk presented good relationship with this observation. The cutoff value was estimated in 11-12 points for balance of risk and 9-12 for preallocation survival outcomes following liver transplant and survival outcomes following liver transplant. The 30-day survival for the group of transplants with scores up to 12 points (n=172) in all the three indexes was 87.79%, and for those transplants with scores higher than 12 it was 36.36%. CONCLUSIONS: The 30-day survival is 79.76%, and balance of risk, survival outcomes following liver transplant, and preallocation survival outcomes following liver transplant are the good prognostic indexes. The cutoff value of 12 points has clinical usefulness to predict the post-liver transplantation results.

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SUMMARY OBJECTIVE: The aims were to compare the red blood cells, platelet count, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, red cell distribution width, and fasting glucose in peripheral blood of patients with benign and malignant uterine neoplasms and to relate these laboratory parameters with prognostic factors and overall survival in cancer. METHODS: The results of the laboratory parameters were analyzed using the Mann-Whitney U test. Receiver operating characteristic curves were used to find the cutoff values. Overall survival was estimated using the Kaplan-Meyer method. RESULTS: Higher values of neutrophil-lymphocyte ratio and fasting glucose were found in cancer patients. Higher platelet-lymphocyte ratio values were associated with other subtypes when compared with endometrioid subtype; higher values of red cell distribution width were found in stage II/IV when compared with stage I; lower hemoglobin values were related to stage II/IV and nonendometrioid histological type. Platelet-lymphocyte ratio <145.56 was associated with longer overall survival. CONCLUSION: Hemoglobin and platelet-lymphocyte ratio values are prognostic factors in uterine corpus cancer.

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SUMMARY OBJECTIVE: Left atrium enlargement is common in hypertension due to left atrium inflammation. Monocyte to high-density lipoprotein cholesterol ratio, an inflammation marker that has become very popular in recent years, is associated with many cardiovascular diseases. The aim of this study is to investigate the monocyte to high-density lipoprotein cholesterol ratio level to predict the Left atrium enlargement in hypertensive patients. METHODS: A total of 216 participants (i.e., 115 hypertensive and 101 control group) were enrolled. Left atrial volumes and left atrial volume indexes were calculated using transthoracic echocardiography. The monocyte to high-density lipoprotein cholesterol ratio was calculated as the ratio of monocyte to high-density lipoprotein cholesterol levels. RESULTS: The left atrial volumes, left atrial volume indexes, and monocyte to high-density lipoprotein cholesterol levels were significantly higher in the hypertensive group than in the control group (43.3±12.4 versus 31.4±7.9, p<0.001; 22.9±5.8 versus 17.1±3.7, p<0.001; 11.4 [4.2-25.0] versus 8.4 [3.5-18.0], p<0.001, respectively). On the multivariate logistic regression analysis, monocyte to high-density lipoprotein cholesterol ratio (OR 1.38; 95%CI 1.20-1.57; p<0.001), (OR 1.28; 95%CI 1.16-1.42; p<0.001), age, and sex (female) were the independent predictors for hypertension. CONCLUSIONS: The increased monocyte to high-density lipoprotein cholesterol ratio level was associated with hypertension and increased left atrial volume indexes. The results of this study supported the presence of inflammation, measured with a readily available and inexpensive marker, in hypertensive patients and revealed the association with left atrial enlargement.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate the intra- and inter-rater reliability of pressure pain threshold measurement on myofascial trigger points in the trapezius muscle in women with chronic neck pain. METHODS: This reliability study involved 30 volunteers with neck pain for more than 90 days. The assessment procedures were performed by blinded researchers. Two examiners, who were previously trained in the use of algometry, independently performed two assessments of the pressure pain threshold at two time intervals, one week apart. RESULTS: The study sample consisted of 30 young adult women. Excellent intra- and inter-rater reliability were found for the pressure pain threshold on myofascial trigger points, with intraclass correlation coefficient values ranging between 0.752 and 0.874, standard error of measurement ranging between 0.18 and 0.22 kg/cm2, and minimum detectable change ranging between 0.45 and 0.62 kg/cm2. CONCLUSION: The present study showed that the assessment of pressure pain threshold through algometry presents satisfactory intraclass correlation coefficient values, considering different time and examiners, contributing to the spread of the use of this tool as a quantitative method of pain evaluation in myofascial trigger points.

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SUMMARY OBJECTIVE: Stress-type and urgency-type urinary incontinence are seen together in mixed-type urinary incontinence. Treatment is usually chosen according to the predominant type of incontinence. The aim of this study is to evaluate the effect of mirabegron and duloxetine combination in the treatment of mixed-type urinary incontinence. METHODS: The data of 88 mixed-type urinary incontinence patients who applied to the urology outpatient clinic between January 2018 and December 2019 were retrospectively analyzed. We applied mirabegron and duloxetine treatment to the patients. The International Consultation of Incontinence Questionnaire-Short Form, Overactive bladder symptom score questionnaire and daily pad count were statistically evaluated before and after the treatment. RESULTS: Statistically significant improvements were observed using the questionnaire forms and decreased daily pad usage after the eight-week treatment (p<0.001). Based on the clinical global effect scale, 62.50% of patients had a partial or complete response to treatment and also the use of daily pads were decreased from 3.7-0.89 on an average. CONCLUSION: Combination use of mirabegron and duloxetine in the treatment of mixed-type urinary incontinence improved symptom scores and decreased pad usage.

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SUMMARY OBJECTIVE: In this study, we aimed to determine fibroblast growth factor 23, soluble alpha klotho, osteocalcin, indoxyl sulphate, sclerostin, Procollagen 1 N Terminal Propeptide, and beta-CrossLaps levels in hemodialysis and peritoneal dialysis patients, and to compare the levels of these markers among hemodialysis and peritoneal dialysis patients, as well as healthy individuals. METHODS: The study included 30 hemodialysis and 23 peritoneal dialysis patients who were followed-up for at least six months at the Sakarya University Hospital, besides 30 healthy volunteers. RESULTS: The participants were divided into three groups with similar characteristics in terms of age, gender and body mass index. Fibroblast growth factor 23, soluble alpha klotho, indoxyl sulphate, beta-CrossLaps, and Procollagen 1 N Terminal Propeptide levels were significantly higher in patients of both the hemodialysis and peritoneal dialysis groups than in the healthy volunteers’ group. There was no difference in levels of these molecules between hemodialysis and peritoneal dialysis groups. CONCLUSIONS: Fibroblast growth factor 23, sclerostin, indoxyl sulphate, beta-CrossLaps, and Paclitaxel-induced neuropathic pain levels were higher in patients of both groups as inflammatory markers. In our study, we found higher soluble alpha klotho levels in patients of both groups than in the healthy volunteers’ group, suggesting that blood soluble alpha klotho levels may not correlate with renal klotho levels.

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SUMMARY OBJECTIVE: The intensity-modulated radiotherapy (IMRT) has been established as the standard external-beam radiation technique to treat prostate cancer in several countries. In Brazil, the public health system and the National Health Agency do not reimburse its utilization. This study compared the cost-effectiveness of IMRT and tridimensional radiotherapy (3D-RT) from a payer’s perspective. METHODS: We built a Markov model to delineate the health states after treatment with IMRT and 3D-RT. The treatment-related toxicity data were extracted from the literature. The sensitivity analyses were performed over potential parameters. RESULTS: The incremental cost of IMRT was R$ 5,553.78. At a time horizon of 5 years, the quality-adjusted life expectancy after IMRT was higher than 3D-RT. The incremental cost-effectiveness ratio (ICER) of IMRT over 3D-RT was R$-296,74/quality-adjusted life year (QALY). Therefore, IMRT was the dominant strategy, which depended on the value of interventional procedures for severe toxicity and the difference between IMRT and 3D-RT reimbursement. The IMRT was still most likely to be cost-effective at a willingness-to-pay R$ 100,000/QALY, with a net monetary benefit (NMB) superior to 3D-RT after R$ 50,000.00, resulting in a difference of R$220.000,00 after 5 years. CONCLUSIONS: IMRT generated more values than 3D-RT for external-beam treatment. Given its potential to reduce late toxicity with hypofractionation, these data reinforce its incorporation to treat prostate cancer in the Brazilian health system from a payer’s perspective.

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SUMMARY OBJECTIVE: The aim was to determine the epidemiological profile of dengue fever in Brazil between the years 2014 and 2019. METHODS: This is an observational, descriptive, cross-sectional, and retrospective study, which was carried out through the analysis of secondary data collected from the National System of Notification Appeals (SINAN) and from SUS Computer Department (DATASUS). RESULTS: The total number of reported cases was 5,867,255, and 2015 was the year with the highest cases (1,696,340). The cases were predominant in the Southeast and Midwest macro-regions, the female sex (55.6%), brown people (48%), and clinical and epidemiological criteria of confirmation (63.8%). Regarding the age group, it was observed that during the study period, the highest prevalence occurred in individuals between 20 and 39 years (38.3%). There was a change of serotype from DENV-1 to DENV-2, and dengue was the most prevalent classification (95.2%). Concerning hospitalization rates, there was a limited necessity of admissions (5.7%), as well as few deaths due to the notified disease (3,444). CONCLUSIONS: There was a significant growth in the number of dengue fever cases in Brazil in 2019, which represents a public health problem.

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SUMMARY OBJECTIVE: Decompressive craniectomy may be a life-saving measure in ischemic stroke patients, who still have several associated complications. The objective of this study is to evaluate a novel decompressive surgery technique for severe hemispheric ischemic stroke. METHODS: For the hinge decompressive craniectomy (HDC), linear durotomies were performed. Vertical (one or two frontal and two parietal), and two horizontal (temporal), with approximately 5 cm long, linear durotomies were carried out. Duroplasty was performed using an autologous subgaleal tissue graft fixed with separate sutures to avoid CSF leak and direct contact of the cortex with the bone flap. The bone flap was fixed in three parietal locations. We compared 10 patients who underwent our modified HDC with 9 patients submitted to classical decompressive craniectomy (CDC). The primary outcome of this study was mortality. RESULTS: Nineteen patients were included, with a mean age of 52.3 years (±8.2). Four (44%) patients from the HDC group had to be reoperated to remove the bone flap because of brain swelling worsening, but none of them died. The average time of HDC was 90 minutes. Overall 14-days mortality was 21.1% (n=4), and cumulative six-months mortality was 42.1% (n=8). Five (50%) patients submitted to CDC died, while 3 (33.3%) submitted to HDC died (χ2=0.07, p=0.79). The mean length of stay was 46.7 days (±32.1) for HDC and 38.7 (±27.1) for CDC (p=0.60). CONCLUSIONS: We present a modified technique of hinge craniectomy with linear vertical and horizontal durotomies, which seems to have reduced operative time and mortality compared to classical decompressive craniotomy, although the difference was not statistically significant.

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SUMMARY OBJECTIVE: The study evaluates psychological responses to the COVID-19 outbreak in the students, professors, and staff due to the social distancing and transition of the classroom activities through online learning. METHODS: 518 participants from a University community in Brazil answered an online survey with questions related to demographic data, psychological responses, and preventive measures. Absolute and relative frequencies described the sample, Chi-square and z-test tested associations between the variables, adopting p<0.05. RESULTS: Female (71.20%), young age -18 to 35 years (82.60%), students (76.10%), living in a family with 1 to 3 members during quarantine (55.40%) were more prevalent respondents. Women, young age, and students had a significantly higher rate of negative feelings in all psychological questions. Curiously, negative feelings during social distances affect the participants, independent of living quarantine alone or with family/friends during the COVID-19 outbreak. CONCLUSIONS: Our findings demonstrated that the COVID-19 outbreak affected the psychological responses in the Brazilian academic community, also, women, young age, and students appear to be a risk group to negative psychological responses. The long-term quarantine due to the COVID-19 pandemic may cause further worsening in the psychological responses, especially in those in the risk group.

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SUMMARY OBJECTIVE: This study examines the changes in anxiety and depression scores of 84 patients subjected to aortic or iliac aneurysm correction with no previous psychiatric history. METHODS: Patients were referred to the evaluation using the Beck Anxiety and Depression Inventories no more than 3 days before surgery (i.e., preoperative [Pre-Op]), 30 days after revascularization (i.e., Early postoperative [PO]), and at least 6 months after revascularization (i.e., Late PO). RESULTS: Mean anxiety scores declined from baseline at both the Early (mean difference: 2.75, p<0.001) and Late PO (mean difference: 2.74, p=0.001). The depression levels showed no significant variation in either evaluation (Early PO; mean difference: −0.84, p>0.05, Late PO: 0.87, p=0.05). A more severe degree of anxiety at baseline was related to better anxiety results both in the Early PO (p=0.041) and Late PO (p=0.008). An endovascular technique was related to the improvement in depression symptoms in the Early PO (p=0.01) but the worsening of the symptoms in the Late PO (p=0.033). CONCLUSIONS: Patients subjected to aortoiliac aneurysm corrections have a higher incidence of anxiety and depressive symptoms. Anxiety symptoms, but not the depressive ones, improved considerably following the successful treatment. The formal psychiatric evaluation may be beneficial for patients with less improvement in the symptom.

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SUMMARY OBJECTIVE: A surgery is essential for the management of early endometrial carcinoma. Due to the comorbidities associated with the disease, the complications of surgery are common. Laparoscopic surgery may reduce surgical complications but also have oncological risks. We aimed to compare recurrence and overall survival (OS) associated with laparoscopy and laparotomy for early endometrial cancer. METHODS: We included women treated for presumed early endometrial carcinoma at the Clinics Hospital of Ribeirão Preto Medical School from January 1998 to December 2017. We designed a 1:2 propensity score-matched case-control and compared the patients’ characteristics, short-term outcomes, recurrence, and OS. RESULTS: A total of 252 women were included in this study, 168 underwent laparotomy, and 84 underwent laparoscopy. The two groups were well balanced according to most of the variables, and obesity was a characteristic of patients in both groups. Laparoscopy was associated with increased surgical time (194.7 min vesus 165.6 min; p<0.001) and reduced rate of surgical complications (6.5% versus 0; p=0.038). Laparoscopic surgery was not associated with the risk of tumor recurrence (HR: 0.41, 95%CI 0.14-1.19, p=0.100) or all-cause mortality (HR: 0.49, 95%CI 0.18-1.35, p=0.170). CONCLUSION: Laparoscopy was safe in terms of oncological outcomes and was associated with a lower rate of surgical complications. Our data support the use of minimally invasive surgery as the preferential approach in the management of early endometrial carcinoma.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate the frequency of teenage pregnancy in all Brazilian regions and states in the period of 2000-2019 among two age groups, namely, 10-14 and 15-19 years old, and correlate it with the human development index. METHODS: A cross-sectional study was performed by using the data from the Live Birth Info System from the National Health System’s database. RESULTS: The percentage of live births from teenage mothers (age 10-19 years) in Brazil decreased by 37.2% (i.e., 23.4 in 2000 to 14.7% in 2019) in all regions. Amazonas and Maranhão were the only states to show increased fertility rates for teens in the age group of 10-14 years. The fertility index decreased from 80.9-48% in all states among mothers aged 15-19 years. Only the Southeast and South regions showed levels below the Brazilian average (i.e., 38.2 and 39%, respectively). The proportion of live birth showed an inversely proportional trend to the human development index score. CONCLUSIONS: Brazil shows a decline in the percentage of live birth among adolescent mothers and the fertility rate. Live birth is inversely proportional to the human development index score. However, the teenage pregnancy numbers are still high, with great regional inequality in the country.

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SUMMARY OBJECTIVE: Several mortality prediction scores are available for patients with upper gastrointestinal bleeding who visited the emergency department; however, most of the available scores include endoscopic data. Endoscopy is difficult or impossible to access for many emergencies departments worldwide. The aim of this study was to evaluate and compare the performance of the albumin, INR, alteration in mental status, systolic blood pressure and age 65 score and the Glasgow-Blatchford score in predicting mortality in patients with upper gastrointestinal bleeding who visited the emergency department and for which endoscopic data were not required. METHODS: The data of patients with acute upper gastrointestinal bleeding who visited the emergency department during the study period were retrospectively analyzed. The data were obtained from the hospital automation system using the international classification of disease codes via computer registration. The prediction accuracy of AIMS65 and Glasgow-Blatchford score was compared using the area under the receiver operating characteristic curve method. RESULTS: There were 422 patients in total; the mean age of these patients was 68.5 while 62.6% were males. The mortality rate was 30 (7.1%). The AIMS65 score performed better with an AUC 0.706 [95%CI 0.660-0.749; p<0.001] compared with the Glasgow-Blatchford score (AUC 0.542; 95%CI 0.4693-0.576; p=0.11). CONCLUSION: In this study, it was revealed that AIMS65, which is a score that can be easily calculated only with the data in the emergency department, outperformed Glasgow-Blatchford score in predicting mortality in patients with acute upper gastrointestinal bleeding who visited the emergency department.