Acessibilidade / Reportar erro
Revista da Associação Médica Brasileira, Volume: 67, Número: 9, Publicado: 2021
  • The influence of essential fatty acids on the female health Editorial

    Lopes, Ceci Mendes Carvalho; Hime, Lucia de Fatima Cahino da Costa; Baracat, Edmund Chada; Soares-Júnior, Jose Maria
  • Revisiting optimal needle size for thyroid fine-needle aspiration cytology: not much finer, less non-diagnostic? Letter To The Editor

    Sengul, Ilker; Sengul, Demet; Veiga, Eduardo Carvalho de Arruda
  • Abdominal ultrasound, physical examination, and intraabdominal fluid Letter To The Editor

    Yale, Steven Howard; Tekiner, Halil; Yale, Eileen Scott
  • Burnout, engagement & leadership Short Communication

    Chan, Sónia
  • Urban mobility and COVID-19 in Brazil: Comparison between 2020 and 2021 Short Communication

    Armstrong, Anderson da Costa; Souza, Carlos Dornels Freire de; Santos, Márcio Bezerra; Santos, Lucas Gomes; Carmo, Rodrigo Feliciano do

    Resumo em Inglês:

    SUMMARY OBJECTIVE: The aim of this study was to analyze and compare the indicators of urban mobility and the number of new cases of COVID-19 recorded daily between 2020 and 2021. METHODS: An observational study was carried out involving new cases of COVID-19 registered daily in the state of Pernambuco, Brazil between March 12, 2020 and March 28, 2021 and six indicators of urban mobility. For analysis, the study was divided into two periods: the first was composed of 295 days and represents the year 2020 and the second was composed of 86 days and represents the year 2021. Spearman's non-parametric correlation was used. RESULTS: In 2021, the greatest reductions in relation to the baseline were observed in parks (-29.0) and in retail and recreation areas (-28.7). However, these reductions were smaller than those observed in the previous year, indicating a greater circulation of people in 2021 when compared with mobility in 2020. In contrast, in residential areas, there was a reduction in the percentage change in relation to the previous year (11.2 in 2019 and 7.6 in 2021). In grocery and pharmacy, there was an increase 1.8 times greater than that observed in 2020 (9.1 in 2020 and 17.0 in 2021). It is also noteworthy that the daily average of new cases almost doubled in value (753.4 in 2020 and 1409.1 in 2021). CONCLUSION: More vigorous measures must be taken to adequately control the pandemic.
  • Vitamin D levels and SARS-CoV-2 assay results in health care workers in Brazil Short Communication

    Lira, Aline Cavalcante de; Silva, Alexsandro Pedro da; Diniz, Madi Veiga; Nascimento, Arione Vieira do; Silva, Wagner Roberto Cirilo da; Pereira, Caroline Louise Diniz; Rodrigues, Milena Lima; Campelo Júnior, Evônio de Barros; Lima, Kledoaldo
  • Effects of the COVID-19 on the public interest in medical specialties in Brazil Original Article

    Verde, Lise Queiroz Lima; Barbosa, José de Paula; Silva, Paulo Goberlânio Barros; Ribeiro, João Crispim

    Resumo em Inglês:

    SUMMARY OBJECTIVE: The aim of this study was to evaluate the effects of the COVID-19 pandemic and the social isolation on the interest rates of different medical specialties in Brazil. METHODS: The research was performed using the terms “Médico” (Doctor), “Infectologista” (Infectologist), “Cirurgião” (Surgeon), “Geriatra” (Geriatrician), “Otorrinolaringologista” (Otolaryngologist), and “Oftalmologista” (Ophthalmologist), related to several medical specialties, and “COVID-19,” which represented the public interest for the disease, utilizing the Brazilian version of Google Trends, where the data were acquired. The time range of this analysis was from 29 September, 2019 to 20 September, 2020. The data were tabulated in Microsoft Excel, exported to the Statistical Package for the Social Sciences software, and correlated with searches for the term “COVID-19” using Pearson's correlation. 95% confidence interval was used for all analyses. RESULTS: “Geriatra” (72.26±16.42) and “Cirurgião” (72.15±12.53) remained with the higher means among the evaluated specialties. In terms of standard deviation, “Oftalmologista” (64.71±16.72) and “Infectologista” (22.03±16.60) presented the most significant changes. After utilizing the Pearson's analysis to identify the correlation between each medical specialty and the term “COVID-19,” all the evaluated specialties presented significant statistical correlations. “Oftalmologista” (r= -0.607) was notoriously the most negatively affected, while “Infectologista” (r=0.504) was pointed to have the highest positive correlation with the term. CONCLUSIONS: Several changes in the interest rates of different medical specialties in Brazil were found during the time range of the COVID-19 pandemic.
  • Muscle mass and cellular membrane integrity assessment in patients with nonalcoholic fatty liver disease Original Article

    Barreto, Iasmin dos Santos; Santos, Raquel Oliveira dos; Rocha, Raquel; Souza, Claudineia de; Almeida, Naiade; Vieira, Luiza Valois; Leiróz, Rafael; Sarno, Manoel; Daltro, Carla; Cotrim, Helma Pinchemel

    Resumo em Inglês:

    SUMMARY OBJECTIVE: To evaluate the association between muscle mass depletion and compromising of the cell membrane integrity and clinical–anthropometric characteristics in patients with nonalcoholic fatty liver disease. METHODS: This observational study evaluated waist circumference, body mass index, and waist-to-height ratio in patients with nonalcoholic fatty liver disease. Skeletal mass index corrected by weight and impairment of cell membrane integrity were assessed using bioelectrical impedance analysis. RESULTS: In 56 patients, muscle mass depletion was observed in 62.5% and cell membrane impairment in 28.6%. The metabolic syndrome and elevated aspartate aminotransferase were the only clinical factors associated with mass depletion (p<0.05). The linear regression analysis showed association between skeletal mass index and waist-to-height ratio and waist circumference, after adjustments (p<0.05). The phase angle value was not different between those with and without mass depletion, and also it did not have correlation with skeletal mass index and clinical parameters (p>0.05). CONCLUSIONS: The prevalence of mass depletion and cell membrane impairment was higher in patients with nonalcoholic fatty liver disease. The muscle mass depletion was associated with central obesity, aspartate aminotransferase elevated, and metabolic syndrome; however, the phase angle is not associated with clinical and anthropometric data.
  • Height adjustment reduces occurrence of low bone mineral density in children and adolescents with HIV Original Article

    Andrade, Leonardo Bandeira de; Nogueira, Thiago Fachini; Vargas, Deisi Maria

    Resumo em Inglês:

    SUMMARY OBJECTIVE: The aim of this study was to quantify the reduction of bone mineral density with and without height adjustment. METHODS: A cross-sectional study was performed with 69 Brazilian children and adolescents vertically infected by HIV. Bone mineral density was measured by dual-energy absorptiometry in the lumbar spine. Anthropometric, demographic, and clinical variables were analyzed. A specific calculator was used for height adjustment. RESULTS: The majority of participants (52.2%) were adolescents and did not present with immunological alterations (61%). Reduced bone mineral density (Z-score <-1) was present in 23.2% and low bone mass (Z-score <-2) in 5.8%. After height adjustment, these occurrences decreased to 11.6% and 0%, respectively. Patients with reduced bone mineral density had a higher mean age and lower body mass index than patients with normal bone mineral density. CONCLUSION: The occurrence of reduced bone mineral density decreased after adjustment for height.
  • Comparison of standard balloon and drug-coated balloon angioplasty in patients with the below-the-knee peripheral artery disease Original Article

    Kaygin, Mehmet Ali; Halici, Ümit

    Resumo em Inglês:

    SUMMARY OBJECTIVE: The objective of this study was to compare the interventions of percutaneous transluminal drug-coated balloon angioplasty (DCB PTA) and standard PTA in the treatment of patients with the below-the-knee peripheral artery disease (BTK PAD). METHODS: Overall, 196 patients (113 males and 83 females; mean age: 63.56±11.94 years; 45–83 years) were treated with PTA for BTK PAD between June 2014 and March 2019. RESULT: Standard PTA (group 1; 96 patients) and DCB PTA (group 2; 100 patients) results were analyzed and compared retrospectively. No statistically significant difference was found between the mean ages of group 1 and 2 patients (p=0.371, p>0.05). Demographic and clinical data were compared and no any statistically significant differences was found between the two groups. Comparing in terms of the iliac lesion, there was no statistically significant difference between the two groups. However, a statistically significant difference was found between the two groups in terms of frequency of popliteal lesions (p=0.001; p<0.05). There was not a statistically significant difference between the two groups in terms of other lesions. In addition, limb salvage rates were 82.0% (18 amputations) and 65.6% (33 amputations) in the drug-release balloon group and the naked balloon group, at the end of 1 year, respectively. No distal embolism, limb-threatening ischemia, and mortality were observed in any patients. CONCLUSIONS: Based on this study, patients in the DCB group had significantly higher rates of primary patency as compared with the other patients.
  • Associations of high-mobility group box 1 and receptor for advanced glycation end products with acute lung injury in patient with acute aortic dissection Original Article

    Zeng, Zhaofan; Zhang, Kun; Cai, Junhong; Wu, Hongfei; Yue, Jie

    Resumo em Inglês:

    SUMMARY OBJECTIVE: To investigate the associations of high-mobility group box 1 and its specific receptor, receptor for advanced glycation end products with acute lung injury in patients with acute aortic dissection. METHODS: A total of 96 acute aortic dissection patients were divided into acute aortic dissection with acute lung injury group (38 cases) and acute aortic dissection without acute lung injury group (58 cases), according to partial pressure of oxygen/fraction of inspired oxygen. In addition, 44 healthy individuals were selected for the control group. The blood samples were taken. The serum high-mobility group box 1 and receptor for advanced glycation end products levels were detected by enzyme-linked immunosorbent assay, and the partial pressure of oxygen/fraction of inspired oxygen was measured. RESULTS: 24 h after admission, the high-mobility group box 1 and receptor for advanced glycation end products levels in acute aortic dissection with acute lung injury and acute aortic dissection without acute lung injury groups were significantly higher than those in the control group, respectively (p<0.05), and each index in acute aortic dissection with acute lung injury group was significantly higher than that in acute aortic dissection without acute lung injury group (p<0.05). At each time point within 96 h after admission, compared with acute aortic dissection without acute lung injury group, in acute aortic dissection with acute lung injury group, the high-mobility group box 1 and receptor for advanced glycation end products levels were increased, respectively, and the partial pressure of oxygen/fraction of inspired oxygen was decreased. The correlation analysis showed that, in acute aortic dissection patients, the high-mobility group box 1 and receptor for advanced glycation end products levels were negatively correlated with partial pressure of oxygen/fraction of inspired oxygen, respectively (p<0.05). CONCLUSIONS: The serum high-mobility group box 1 and receptor for advanced glycation end products levels may be associated with the occurrence of acute lung injury in acute aortic dissection patients. Monitoring the high-mobility group box 1 and receptor for advanced glycation end products levels can evaluate the risk of acute aortic dissection with acute lung injury.
  • Efficacy and safety of combined doxofylline and salbutamol in treatment of acute exacerbation of chronic obstructive pulmonary disease Original Article

    Du, Xianrong; Bao, Hongju; Zhao, Daguo

    Resumo em Inglês:

    SUMMARY OBJECTIVE: The aim of this study was to investigate the efficacy and safety of combined doxofylline and salbutamol in the treatment of acute exacerbation of chronic obstructive pulmonary disease. METHODS: A total of 68 acute exacerbation of chronic obstructive pulmonary disease patients were randomly divided into control group (34 cases) and experimental group (34 cases), who received the doxofylline treatment and combined doxofylline and salbutamol treatment for 1 week, respectively. During the treatment, the remission time of typical respiratory manifestations was recorded, and the adverse reactions were observed. At the end of treatment, the treatment efficacy was evaluated. Before and after treatment, the pulmonary function indexes and serological indicators were detected. RESULTS: After treatment, compared with control group, in experimental group, the effective rate of treatment was significantly increased (p<0.05), the remission time of typical respiratory manifestations was significantly shortened (p<0.05), the pulmonary function indexes were significantly improved (p<0.05), the serum high-sensitivity C-reactive protein and cystatin C levels were significantly decreased, respectively (p<0.05), and the serum prealbumin level was significantly increased (p<0.05). In addition, the adverse reaction rate had no significant difference between two groups (p>0.05). CONCLUSIONS: In the treatment of acute exacerbation of chronic obstructive pulmonary disease, the combined use of doxofylline and salbutamol can quickly relieve the respiratory symptoms, mitigate the pulmonary dysfunction, and reduce the inflammatory response, thus promoting the outcome of patients.
  • Health care professionals and end-of-life care during the COVID-19 pandemic Original Article

    Ferreira, Esther Angélica Luiz; Valete, Cristina Ortiz Sobrinho; Santos, André Filipe Junqueira dos; Passarini, Juliana Nalin de Souza; Silva, Alexandre Ernesto; Miwa, Michelle Uchida

    Resumo em Inglês:

    SUMMARY OBJECTIVE: The aim of this study was to estimate self-perception of anguish and low quality of life among health care professionals who cared for the dying patients during the COVID-19 pandemic and to determine the characteristics of health care professionals and patients and end-of-life care. METHODS: An online survey that included health care professionals who cared for the dying patient from July 1 to October 31, 2020 was conducted. Low quality of life, anguish, characteristics of patients and health care professionals, and end-of-life care were recorded. Poisson regression was performed to assess the predictors of anguish and low quality of life. RESULTS: A total of 102 health care professionals, including 14 males (13.7%), with a median age of 37 years, composed of 41 physicians (40.2%), 36 physiotherapists (35.3%), and 25 nurses (24.5%) were included in this study. Self-perception of anguish occurred in 69.6% and was associated with physicians and disagreement with end-of-life care offered. Low quality of life was reported in 64.7% and was associated with not having time to talk to patients’ relatives. The agreement that medical care was enough reduced self-perception of low quality of life. CONCLUSION: Self-reported anguish was more frequent in physicians and when the disagreement about end-of-life care occurred. Low quality of life was more frequent when health care professionals did not have time to talk to patients’ relatives and was less frequent when health care professionals agreed that medical care was enough. Strategies should be done by health services to reduce the impact of the pandemic on health care professionals.
  • Impact of the COVID-19 pandemic on mental health of pregnant women with diabetes mellitus and hypertension Original Article

    Borges, Roberta de Pádua; Reichelt, Angela de Azevedo Jacob; Brito, Ariane de; Molino, Gabriela Oliveira Gonçalves; Schaan, Beatriz D.

    Resumo em Inglês:

    SUMMARY OBJECTIVE: Psychological effects of the coronavirus disease 2019 (COVID-19) pandemic on pregnant women with diabetes and hypertension are not yet studied. Besides the pregnancy, these women have additional risk factors for severe acute respiratory syndrome due to COVID-19 and are considered a particularly vulnerable, unique population. We aimed to assess their mental health during this pandemic. METHODS: This is a cross-sectional study carried out at a Brazilian tertiary hospital. Women with pregnancies complicated by hypertension and/or diabetes were evaluated. The primary outcome was anxiety, and depressive symptoms evaluated with the State-Trait Anxiety Inventory and Patient Health Questionnaire. Perception of changing habits during quarantine was evaluated as a secondary outcome. RESULTS: Seventy-nine patients were included. The prevalence of State-Trait Anxiety Inventory ≥40 was 79.7% and that of Patient Health Questionnaire ≥10 was 59.2%. Lower social support was correlated with higher scores on both scales. Time spent with electronic devices was perceived as greater by 62% of the women. CONCLUSIONS: Pregnant women with diabetes and hypertension presented high levels of anxiety and depressive symptoms during the COVID-19 pandemic. Considering that these symptoms can affect both the mother's and offspring's health, it is necessary to implement tools to improve their mental health.
  • Evolution of anthropometric data and quality of life in active bariatric individuals Original Article

    Poletto, Jéssica Eloá; Rizzo, Daniela Tezoto; Almeida, Ana Maria Neder de; Cândido, Elaine Cristina; Cazzo, Everton; Chaim, Élinton Adami

    Resumo em Inglês:

    SUMMARY Obesity is a disease characterized by the accumulation of abnormal or excessive fat that can damage health. Bariatric surgery, an effective and safe way to treat this disease, requires multidisciplinary monitoring with an educational nature to change lifestyle. Adherence to routine physical activity can be a part of adopting a healthier lifestyle and can assist in the treatment of this disease and its related comorbidities. OBJECTIVE: Thus, the aim of this study was to analyze the correlation between the evolution of anthropometric variables and the domains of quality of life at different times, including at one year after bariatric surgery in very active and irregularly active individuals. METHODS: This was a longitudinal, observational, prospective, and analytical study. The collected data included anamnesis, level of physical activity (International Physical Activity Questionnaire Short Form), height, weight, body mass index (BMI), average waist circumference, percentage of fat, and the World Health Organization Quality of Life Assessment Bref. RESULTS: Seven female individuals were evaluated and divided into two groups: a very active group and an irregularly active group. In the very active individuals, significant results were found in the evolutionary variables: weight (p<0.001); body mass index (p<0.001); average waist circumference (p<0.001); percentage of fat (p<0.001); and quality of life general (p=0.001). In the irregularly active individuals, a significant result was found only in one evolutionary variable: body mass index (p<0.001). CONCLUSION: Thus, it is evident that the improvement and maintenance of good health is more effective in bariatric individuals who maintain a routine with regular physical activity.
  • The efficiency of a mixed exercise program on quality of life and fatigue levels in patients with breast cancer Original Article

    Köse, Elif; Aydin, Menşure; Köse, Osman; Aksu, Maksut Görkem; Sekban, Gülşah

    Resumo em Inglês:

    SUMMARY OBJECTIVE: Exercise is a nonpharmacological supportive therapy which has been specifically identified to reduce postoperative complications or adverse events of cancer or treatments. Although there are few studies combining resistance and aerobic exercise in cancer survivors, exercise programs are very rare in different places in the literature. This study aims to investigate the effects of mixed-type exercise in different venues on weight, body mass index, fatigue, and quality of life in cancer survivors. METHODS: This is a descriptive, intervention study. Participants were included in the study, and the exercise process was between January and November 2019. The exercise group consisted of 32 patients who had just completed their breast cancer treatment and did not have distant metastases, and they applied a mixed exercise program including resistance at home and aerobic exercise in the fitness center for 12 weeks. The patients with breast cancer in the control group (30 patients) did not receive any exercise program. RESULTS: Subjective feelings of fatigue and decrease in concentration, motivation, and physical activity significantly decreased after exercise (p<0.001, p<0.001, p=0.006, p=0.008, and p<0.001, respectively) in the study group. The results also showed that physical health, general health status, and emotional and social health status significantly increased with the exercise program (p<0.001, p<0.001, p=0.004, and p=0.003, respectively). CONCLUSION: Our results show that a mixed (fitness center and home) 12-week exercise program provides an improvement in general health and reduces the side effects of the treatments and fatigue in patients with breast cancer. For a good prognostic process after medical treatment, exercise can be recommended in every accessible area.
  • Evaluation of factors affecting the frequency and clinical course of COVID-19 in patients using anti-TNF-alpha agents Original Article

    Baslılar, Seyma; Pehlivan, Ozlem

    Resumo em Inglês:

    SUMMARY OBJECTIVES: Patients being treated with anti-tumor necrosis factor-alpha (anti-TNF-alpha) agents were reported to have better prognosis related to COVID-19. We evaluated the factors affecting the frequency, clinical course, and outcome of COVID-19 in patients treated with anti-TNF-alpha agents. METHODS: Patients with rheumatoid diseases and chronic inflammatory bowel diseases treated with anti-TNF-alpha agents were evaluated retrospectively. The laboratory data in routine visits, frequency of COVID-19, pneumonia, hospitalization and/or intensive care unit (ICU) follow-up and, mortality were recorded. The factors related to COVID-19 frequency and clinical outcome were evaluated. RESULTS: A total of 324 patients (177 males [54.6%] and 147 females [45.4%], mean age: 45.3±12.16 years) was included in the study. In all, 44 (13.6%) patients had COVID-19; of these, 11 (25%) developed pneumonia, 7 (15.9%) were hospitalized, and 1 (2.3%) was followed up in ICU. There was no mortality. The patients with COVID-19 pneumonia were older (mean age: 52±11 years versus 41±12 years, p=0.01), had hypertension and coronary artery disease more frequently (5 cases [55.6%] versus 4 cases [44.4], p=0.02 and 2 cases [100%] versus 0 cases [0%], p=0.014, respectively), and lower eosinophil % (1.35±1.79% versus 2.3±1.45%, p=0.016). The diabetes mellitus was more frequent (66.7 versus 33.3%, p=0.013), and mean eosinophil % was lower among inpatients compared with outpatients (1.29±2.22% versus 2.19±1.37%, p=0.02). CONCLUSIONS: We concluded that the patients treated with anti-TNF-alpha agents having COVID-19 might have mild clinical course and better prognosis.
  • Risk factors for radiological hip involvement in patients with ankylosing spondylitis Original Article

    Chen, Shijun; Deng, Lei

    Resumo em Inglês:

    SUMMARY OBJECTIVE: Our study aimed to explore the potential risk factors for radiological hip joint involvement in patients with ankylosing spondylitis (AS). METHODS: This cross-sectional convey collected the clinical data, laboratory indicators, and radiographic data of patients with AS. Radiographic hip joint involvement was defined as a Bath Ankylosing Spondylitis Radiology Hip Index (BASRI-hip) score ≥2. Multivariate logistic regression analyses were conducted to explore the potential risk factors for radiological hip involvement in patients with AS. RESULTS: Based on BASRI-hip score, all enrolled 386 patients with AS were classified as patients involving with radiological hip joint involvement (BASRI-hip ≥2; n=203) and those without it (BASRI-hip ≤1; n=183). Mean age of enrolled patients with AS were 36.7±11.9 years, and 320 (82.9%) patients were male. Mean course of disease was 10.7±8.3 years, and 349 (90.4%) patients were with a positive HLAB27. Multivariate analyses indicated that Juvenile onset (onset age ≤16 years) (odds ratio [OR]=4.159, 95% confidence interval [CI], 1.779-9.721, p<0.001), body mass index (BMI) <18.5 kg/m2 (OR=1.986, 95%CI 1.187-3.323, p=0.009), continuous nonsteroidal anti-inflammatory drug (NSAID) use (OR=0.351, 95%CI 0.155-0.794, p=0.012), and bone mass below the expected range for age (Z score ≤-2) (OR=2.791, 95%CI 1.456-5.352, p=0.002) were independently associated with radiological hip joint involvement in patients with AS. CONCLUSIONS: The potential risk factors for radiological hip joint involvement were juvenile onset, lower BMI, and bone mass below the expected range for age. Furthermore, continuous NSAID use was the protective factor for radiological hip joint involvement in these population.
  • The effectiveness of dexamethasone on the prognosis of dialysis patients with severe COVID-19 Original Article

    Toçoglu, Aysel; Dheir, Hamad; Demirci, Taner; Kurt, Rumeysa; Salihi, Salih; Yaylaci, Selçuk; Çakar, Gözde Çakırsoy; Toptan, Hande; Karabay, Oguz; Sipahi, Savas

    Resumo em Inglês:

    SUMMARY OBJECTIVE: This study aimed to investigate the effectiveness of dexamethasone in dialysis patients with COVID-19 and whether it predicts mortality. METHODS: This is a comparative cross-sectional study of 113 consecutive patients with COVID-19 with severe pneumonia signs. The patients were divided into two groups according to the use of dexamethasone treatment: group 1 (n=45) included patients who were treated with dexamethasone and group 2 (n=68) who did not receive dexamethasone. RESULTS: The mean age of both groups was 67.0±10.6 and 67.2±13.0 years, respectively (p=0.947). With respect to demographic and laboratory findings, there were no significant differences between the two groups (p>0.05). The hospitalization time of patients in group 1 was longer than that in group 2 (11 [7–17] days vs. 8 [5.3–14] days, p=0.093]. The 28-day survival rate was 54.2% in the group receiving dexamethasone treatment and 79.5% in the group not receiving dexamethasone treatment (p=0.440). CONCLUSION: Dexamethasone did not reduce mortality rates and the requirement for intensive care unit in dialysis patients with COVID-19. Larger prospective randomized clinical trials are required to associate personalized medicine with the corticosteroid treatment to select suitable patients who are more likely to show a benefit.
  • The prognostic significance of erythrocyte sedimentation rate in COVID-19 Original Article

    Kaya, Tezcan; Nalbant, Ahmet; Kılıçcıoğlu, Gizem Karataş; Çayır, Kübra Tuğba; Yaylacı, Selçuk; Varım, Ceyhun

    Resumo em Inglês:

    SUMMARY OBJECTIVE: There are limited data about the significance of erythrocyte sedimentation rate as a single prognostic parameter for the prognosis and mortality of COVID-19. This study aimed to investigate the diagnostic utility of erythrocyte sedimentation rate as a prognostic factor for the disease severity and mortality in patients with COVID-19. METHODS: A total of 148 consecutive patients with a confirmed diagnosis of COVID-19 and hospitalized at the intensive care unit or non-the intensive care unit were included in the study. The patients were allocated to groups as severe/critical disease versus nonsevere disease and survivors and nonsurvivors. The prognostic role and predictable values of erythrocyte sedimentation rate were analyzed. RESULTS: Erythrocyte sedimentation rate was found to be higher among patients with severe/critical disease compared to those with nonsevere disease (p<0.001) and among nonsurvivors compared to survivors (p<0.001). The logistic regression analysis showed that erythrocyte sedimentation rate was an independent parameter for predicting disease severity and mortality. The role of erythrocyte sedimentation rate in the assessment of severity and mortality in patients with COVID-19 was analyzed using the receiver operating characteristic curve and was found to be significant in both. The analyses suggested that the optimum erythrocyte sedimentation rate cutoff point for disease severity and mortality were 52.5 mm/h with 65.5% sensitivity and 76.3% specificity and 56.5 mm/h with 66.7% sensitivity and 72.5% specificity. CONCLUSION: Our results suggest that erythrocyte sedimentation rate was an independent prognostic factor for severity and mortality in patients with COVID-19.
  • Association between fragmented QRS and postprocedural rhythm disturbances in patients who underwent transcatheter aortic valve implantation Original Article

    Duran, Mustafa; Ziyrek, Murat; Alsancak, Yakup; Ayhan, Hüseyin

    Resumo em Inglês:

    SUMMARY INTRODUCTION: According to recent studies, the rate of atrioventricular block requiring permanent pacing in patients following transcatheter aortic valve implantation varied between 5.7% and 42.5%. Fragmented QRS is a useful marker of myocardial scar and can predict adverse cardiac events. In this study, we examined association between f ragmented QRS and postprocedural rhythm disturbances and the need for permanent pacing in patients who underwent transcatheter aortic valve implantation. OBJECTIVE: In this study, we examined association between fragmented QRS and postprocedural rhythm disturbances and the need for permanent pacing in patients who underwent transcatheter aortic valve implantation’ sentence is enough for it. METHODS: We retrospectively analyzed standard 12-lead electrocardiographic recordings of 124 consecutive patients in whom a CoreValve prosthesis was implanted. We examined 12-lead electrocardiogram before and after procedure along with one- and six-month follow-up. We documented QRS fragmentation and postprocedural rhythm disturbances. RESULTS: There was a significant increase in the frequency of left bundle branch block, (21.1 versus 0%, p<0.05) and the incidence of atrioventricular blocks requiring permanent pacing (21.1 versus 0%, p<0.05) following transcatheter aortic valve implantation in patients whose preprocedural electrocardiogram recordings revealed fragmented QRS compared to those without fragmented QRS. Based our collected data, the presence of QRS fragmentation in anterior derivations was the only independent factor associated with postprocedural rhythm disturbances (B-value 0.217; OR 0.805; 95%CI 0.136–4.78; p=0.004). CONCLUSION: Our data showed an increased risk for the development of new-onset left bundle branch block and atrioventricular blocks following transcatheter aortic valve implantation in patients whose baseline electrocardiogram recordings demonstrated QRS fragmentation.
  • COVID-19 vaccine hesitancy among Chinese residents under the free vaccination policy Original Article

    Liu, Huan; Zhou, Zhiqing; Tao, Xiubin; Huang, Long; Zhu, Ergang; Yu, Liang; Zhang, Ming

    Resumo em Inglês:

    SUMMARY OBJECTIVE: This study aimed to assess the attitudes of Chinese residents toward COVID-19 vaccines and explore the potential drivers for Chinese residents' vaccine hesitancy. METHODS: A cross-sectional survey was conducted from February 16 to March 16, 2021, by administering an online questionnaire to the Chinese residents. RESULTS: Of 5240 residents who completed the survey, 464 (8.9%) participants reported to have had one shot, and 348 (6.6%) reported to have had 2 shots. At the time the questionnaire was administered, 2298 (43.9%) participants reported they wanted to get vaccinated, while 2255 (43.0%) declared that they still did not know, and 687 (13.1%) respondents declared vaccine refusal. Overall, 2255 (43%) participants were categorized as vaccine hesitancy. Female participants (p=0.000), <20 years old (p=0.000), have low risk of COVID-19 (p=0.000) infection and strong associations of vaccine hesitancy. eHealth literacy was a protective factor. CONCLUSIONS: The results of this study show high rates of vaccine hesitancy in China. This could pose a serious threat to the preventive measures that aimed at controlling COVID-19 spread in the country. The government and different media platforms should encourage the dissemination of correct information about vaccines, the communities and medical staff to improve residents' knowledge about vaccines, and strive to improve residents' electronic health literacy.
  • Effect of del nido cardioplegia use on kidney injury after coronary bypass operations Original Article

    Kağan AS, Ahmet; Engin, Mesut; Amaç, Bişar; Aydın, Ufuk; Eriş, Cüneyt; Ata, Yusuf; Türk, Tamer

    Resumo em Inglês:

    SUMMARY OBJECTIVE: After cardiac surgery, acute kidney injury is observed at a rate of 5–30%, and the second most common cause of acute kidney injury in intensive care units is cardiac surgery. In this study, we aimed to investigate the effect of del Nido cardioplegia solution use on postoperative acute kidney injury development in patients who underwent coronary artery bypass grafting operation with cardiopulmonary bypass. METHODS: Consecutive patients who underwent an elective coronary artery bypass grafting operation with cardiopulmonary bypass in our clinic between March 15, 2019, and March 15, 2020, were included in the study retrospectively. The patients were divided into two groups as those who received del Nido cardioplegia solution (Group 1) and blood cardioplegia (Group 2), and factors affecting the development of renal failure were examined. RESULTS: A total of 350 consecutive patients were included in the study. There were 156 patients in the del Nido cardioplegia group and 194 patients in the blood cardioplegia group. Among the patient group, 74 (21.1%) patients developed acute kidney injury. The total acute kidney injury development rate was significantly higher in Group 2 (p=0.018). In multivariate logistic regression analysis, advanced age (OR 1.128; 95%CI 1.044–1.217; p=0.042), increased blood product use (OR 1.318; 95%CI 1.154–1.998; p=0.019), preoperative creatinine elevation (OR 2.434; 95%CI 1.655–4.639; p=0.005), and increased cardioplegia volume (OR 1.254; 95%CI 1.109–2.980; p=0.009) were independent predictors of acute kidney injury. CONCLUSION: With this study, we showed that the use of del Nido cardioplegia solution can reduce the incidence of acute kidney injury.
  • Incidental lung findings in coronary computed tomography angiography Original Article

    Eldeş, Tuğba; Kara, Bilge Yilmaz

    Resumo em Inglês:

    SUMMARY OBJECTIVE: In coronary computed tomography angiography, a part of the lung parenchyma also enters the image area which is called the field of view. The aim of this study was to evaluate the rate of pulmonary abnormalities and document their association with demographic features in subjects undergoing multislice coronary computed tomography angiography obtained for the assessment of coronary artery disease. METHODS: This was a retrospective observational study evaluating the coronary computed tomography angiography scans of 1,050 patients (58.5% males and 47.3% smokers) with a mean age of 52.2±11.2 years, obtained between January 2018 and March 2020. Pulmonary abnormalities were reported as nodules, focal consolidations, ground-glass opacities, consolidations, emphysema, cysts, bronchiectasis, atelectasis, and miscellaneous. RESULTS: In total, 274 pulmonary abnormalities were detected in 266 patients (25.3%). The distribution of incidental lung findings was as follows: pulmonary nodules: 36.4%, emphysema: 15.6%, bronchiectasis: 11%, ground-glass opacities: 7.2%, atelectasis 7.2%, focal consolidations: 5%, cysts: 6%, consolidations: 2.5%, and miscellaneous: 9.1%. The patients with pulmonary pathology were older (55.5±11.4 versus 51.0±10.9 years), and the percentage of smokers was higher (60.1 versus 43.2%). The possibility of the presence of any incidental lung findings in field of view of coronary computed tomography angiography increases significantly over the age of 40.5 years (p<0.001, AUC 0.612, 95%CI 0.573–0.651). CONCLUSION: Multislice coronary computed tomography angiography can give important clues regarding pulmonary diseases. It is essential for the reporting radiologist to review the entire scan for pulmonary pathological findings especially in patients with smoking history and over the age of 40.5 years.
  • Reflection of vaccine and COVID-19 fear in young groups in the COVID-19 pandemic Original Article

    Can, Remziye; Kurtuluş, Şerif

    Resumo em Inglês:

    SUMMARY OBJECTIVE: This study aims to determine the fear of COVID-19 through the opinions of individuals under the age of 18 on the COVID-19 vaccine and vaccination. METHODS: This cross-sectional study was conducted on 290 high school students studying in a central district between February 15, 2021, and March 1, 2021. The questionnaire consisted of questions about the sociodemographic characteristics of the students and COVID-19 infection and the Fear of COVID-19 Scale. RESULTS: The age of the participants ranged from 14–18; 76.9% of the study group consisted of female students; and 76.9% of the participants declared that they live in middleincome households. Participants reported that they lived in the same house with at least 2 and a maximum of 12 people; 9.7% of the participants reported that they had a COVID-19 infection; 62.4% of the participants reported that they want to get the COVID-19 vaccine; and 55.2% of the participants reported that the COVID-19 vaccine will reduce the transmission. The mean obtained from the Fear of COVID-19 Scale is 3.38±4.75 in the whole group. It was determined that there was a significant difference between genders, the effect of the vaccine on the incidence, the status of having a COVID-19 infection, and the score of the Fear of COVID-19 Scale. CONCLUSION: The attitudes of young individuals, who are one of the vulnerable groups during pandemic periods, toward vaccination are important in terms of infecting those they come into contact with and increasing the rate of infection.
  • Maternal autonomy and the rights of the unborn child: a necessary discussion Original Article

    Cabar, Fábio Roberto; Binotti, Gabriela Aparecida Marson

    Resumo em Inglês:

    SUMMARY OBJECTIVE: This study aimed to compare the opinion of freshmen and fifth-year students of the University of Sao Paulo School of Law in relation to the respect for maternal autonomy and knowledge of the existence and the need to protect the unborn child. METHODS: Information was obtained from a questionnaire; responses were compared with appropriate statistical methods. RESULTS: In total, 403 students answered the questionnaire, 75.2% being first-year students; 58.6% of the students were against State intervention in maternal autonomy, with no difference between groups. However, 55.1% of students were in favor of the defense of the welfare of the unborn, with the statistical difference between groups. CONCLUSIONS: Among the first-year students, there is a contradiction about respect for maternal autonomy. Among the fifth-year students, most of them were unreservedly in favor of respect for maternal autonomy.
  • Recovery of motor function in rats with complete spinal cord injury following implantation of collagen/silk fibroin scaffold combined with human umbilical cord-mesenchymal stem cells Original Article

    Deng, Wu-Sheng; Liu, Xiao-Yin; Ma, Ke; Liang, Bing; Liu, Ying-Fu; Wang, Ren-Jie; Chen, Xu-Yi; Zhang, Sai

    Resumo em Inglês:

    SUMMARY OBJECTIVE: This study aimed to assess the effect of the collagen/silk fibroin scaffolds seeded with human umbilical cord-mesenchymal stem cells on functional recovery after acute complete spinal cord injury. METHODS: The fibroin and collagen were mixed (mass ratio, 3:7), and the composite scaffolds were produced. Forty rats were randomly divided into the Sham group (without spinal cord injury), spinal cord injury group (spinal cord transection without any implantation), collagen/silk fibroin scaffolds group (spinal cord transection with implantation of the collagen/silk fibroin scaffolds), and collagen/silk fibroin scaffolds + human umbilical cord-mesenchymal stem cells group (spinal cord transection with the implantation of the collagen/silk fibroin scaffolds co-cultured with human umbilical cord-mesenchymal stem cells). Motor evoked potential, Basso-Beattie-Bresnahan scale, modified Bielschowsky's silver staining, and immunofluorescence staining were performed. RESULTS: The BBB scores in the collagen/silk fibroin scaffolds + human umbilical cord-mesenchymal stem cells group were significantly higher than those in the spinal cord injury and collagen/silk fibroin scaffolds groups (p<0.05 or p<0.01). The amplitude and latency were markedly improved in the collagen/silk fibroin scaffolds + human umbilical cord-mesenchymal stem cells group compared with the spinal cord injury and collagen/silk fibroin scaffolds groups (p<0.05 or p<0.01). Meanwhile, compared to the spinal cord injury and collagen/silk fibroin scaffolds groups, more neurofilament positive nerve fiber ensheathed by myelin basic protein positive structure at the injury site were observed in the collagen/silk fibroin scaffolds + human umbilical cord-mesenchymal stem cells group (p<0.01, p<0.05). The results of Bielschowsky's silver staining indicated more nerve fibers was observed at the lesion site in the collagen/silk fibroin scaffolds + human umbilical cord-mesenchymal stem cells group compared with the spinal cord injury and collagen/silk fibroin scaffolds groups (p<0.01, p< 0.05). CONCLUSION: The results demonstrated that the transplantation of human umbilical cord-mesenchymal stem cells on a collagen/silk fibroin scaffolds could promote nerve regeneration, and recovery of neurological function after acute spinal cord injury.
  • SARS-CoV-2 association with hemoglobin and iron metabolism Review Article

    Mancilha, Elaine Maria Borges; Oliveira, José Salvador Rodrigues de
  • Prophylactic blood transfusion prior to elective invasive procedures Review Article

    Santos-Veloso, Marcelo Antônio Oliveira; Souza, Gustavo Lago Oliveira de; Sá, Alessandra Ferraz de
  • Thoracoscopy in the treatment of persistent arterial ductus arteriosus in neonates Review Article

    Velho, Giovanna Costa Moura; Gouveia, Ana Luísa Barbosa; Pinto, Arthur Bispo de Almeida; Levy, João Guilherme Marques Castello Branco; Jorge, Mayara Maranhão; Trindade, Alberto Vilar; Amaral, Antônio Claudio Dias
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    Azevedo, Thomás Cavalcanti Pires de; Melo, Vanessa Santos Cavalcante; Silva, Renata Maciel da; Barbosa, Beatriz Guerra de Holanda; Christofoletti, Lucas Zloccowick de Melo; Nascimento, Giovanna Maria Correia Silva do; Oliveira, Guilherme Santos Lins de; Barbosa, Fabiano Timbó; Sousa-Rodrigues, Célio Fernando de; Ramos, Fernando Wagner da Silva
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    Costa-Silva, Danylo Rafhael; Barros-Oliveira, Maria da Conceição; Silva, Benedito Borges da
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