Revista da Associação Médica Brasileira, Volume: 68, Issue: 6, Published: 2022
  • Repercussion of thyroid dysfunctions in thyroidology on the reproductive system: Conditio sine qua non? Editorial

    Sengul, Demet; Sengul, Ilker; Soares Junior, José Maria
  • The use of neutralizing monoclonal antibody in patients with COVID-19: a systematic review and meta-analysis Guidelines

    Tanni, Suzana Erico; Batista, Diane Rezende; Bacha, Hélio Arthur; Barbosa, Alexandre Naime; Bernardo, Wanderley Marques
  • Role of mean platelet volume in differential diagnosis of adult-onset Still's disease and sepsis Letters To The Editor

    Frater, John L; Shirai, Cara Lunn
  • A very simple tool to promote asthma education Letters To The Editor

    Baddini-Martinez, José; Leitão Filho, Fernando Sergio; dos Santos, Amanda Maria Reis; Matias Guimarães, Graciely; Caetano, Lilian Serrasqueiro Ballini
  • Comment on “Diagnostic and prognostic significance of long noncoding RNA LINC00173 in patients with melanoma” Letters To The Editor

    Zhu, Hong; Ma, Qian; Wang, Xianguo
  • Comment on “Relationship between C-reactive protein/albumin ratio and new-onset atrial fibrillation after coronary artery bypass grafting” Letters To The Editor

    Ma, Meilin; He, Lianping; Zhou, Lingling
  • Comment on “Diagnosis of long noncoding RNA LINC00173 in patients with melanoma is controversial” Letters To The Editor

    Zhou, Lingling
  • Artificial intelligence and machine learning in pediatrics and neonatology healthcare Point Of View

    Matsushita, Felipe Yu; Krebs, Vera Lucia Jornada; Carvalho, Werther Brunow de
  • COVID-19 recurrence associated with the virus storage in the Spleen Point Of View

    Petroianu, Andy
  • Cadaveric study of anatomical measurement of isthmus parameters of lumbar spine to guide cortical bone screw placement Original Article

    Rexiti, Paerhati; Aikeremu, Dilimulati; Wang, Shuiquan; Abuduwali, Nueraihemaiti; Kahaer, Alafate; Sheng, Weibin

    Abstract in English:

    SUMMARY OBJECTIVE: To reduce surgical exposure and improve accuracy, this study evaluated the anatomical distance parameter D (including D1, D2, and D3) of the lumbar isthmus for cortical bone screw insertion. METHODS: A total of 25 structurally complete lumbar dry specimens were used for lumbar anatomy measurements. The six cadaver specimens were divided into upper and lower parts on the plane of the T11–T12 vertebrae, and we use the lower parts. Therefore, six lumbar wet specimens and another four complete lumbar dry specimens were selected. The lumbar isthmus tangent point was considered a coordinate origin, and the insertion point was determined through translating the distance of D1 value to the midline of the vertebral body horizontally and then vertically moved toward inferior board of the transverse process with the distance of D3 value. RESULTS: In four dry and six wet intact lumbar specimens, cortical bone screws were placed according to the average value of the isthmus parameter D. A total of 100 trajectories were verified in specimens by X-ray and computed topography scan to evaluate the safety, accuracy, and feasibility of the surgical use of isthmus parameter D. Using this parameter, the rates of excellent screw placement were 95% (38/40) in four dry specimens and 88.7% (53/60) in six wet specimens. CONCLUSION: The isthmus parameter D is easier to use by the operator, which can improve surgical accuracy and reduce operation time. LEVEL OF EVIDENCE: Level IV, prospective study.
  • Knowledge of gynecologists in the public health system care of women victims of violence Original Article

    Maranhão, Débora Davalos Albuquerque; Ramos, Gabriela Guimarães Franco; Galfano, Giulia Siqueira; Troster, Eduardo Juan

    Abstract in English:

    SUMMARY OBJECTIVE: This study aimed to evaluate the knowledge of the obstetricians and gynecologists in the care of women victims of violence in the public health system and the existence of institutional mechanisms to support them. METHODS: A cross-sectional and observational study was conducted with an electronic questionnaire by physicians who provided care in the obstetrics and gynecology emergency unit of the public health system. This study aimed to identify the care for victims of violence who received the institutional mechanisms of support, the difficulties encountered in determining the appropriate care, and estimates of the prevalence of violence against women. RESULTS: Notably, 92 physicians responded to the questionnaire. Of these, 85% had already provided care in one or more cases of violence, and 60% believed that <20% of the women received adequate care in these cases, mainly due to the short-time frame of the consultation, lack of team preparation, and lack of institutional resources. A total of 61% of the participants believed that they were not prepared to provide adequate care in those cases. CONCLUSIONS: Most of the physicians interviewed, although reported to have sufficient knowledge to adequately treat victims of violence, did not provide such care due to lack of institutional support.
  • Shear wave elastography in early diabetic kidney disease Original Article

    Yuksekkaya, Ruken; Celikyay, Fatih; Yuksekkaya, Mehmet; Kutluturk, Faruk

    Abstract in English:

    SUMMARY OBJECTIVE: This study aimed to analyze the kidneys among the subjects with early stages of type 2 diabetic kidney disease by shear wave elastography quantitatively. METHODS: A total of 108 patients with type 2 diabetic kidney disease and 17 control subjects were enrolled. According to the estimated glomerular filtration rate and urinary albumin-to-urinary creatinine ratio, patients were classified into stages 1 to 3 diabetic kidney disease. Grayscale ultrasound andshear wave elastography were performed. The sizes, depths, and shear wave elastography values were recorded. These parameters were compared between the diabetic kidney disease and the control subjects. RESULTS: The mean shear wave elastography values were significantly higher in the diabetic kidney disease group (10.156±1.75 kPa vs. 8.241±1.4 kPa; p<0.001). We obtained statistically significantly higher shear wave elastography values in stages 2 and 3 diabetic kidney disease subjects than control subjects and in patients with stage 3 diabetic kidney disease compared to those with stage 1 diabetic kidney disease (p<0.05 for all). We obtained a cutoff value of 9.23 kPa for predicting diabetic kidney disease in early stages, with a sensitivity of 67% and a specificity of 82%. CONCLUSION: Shear wave elastography may be used as a noninvasive, simple, and quantitative method to provide diagnostic information as a part of routine management of patients with type 2 diabetes mellitus, especially in the early stages of diabetic kidney disease.
  • Profile of hemotherapy care and the safety of the transfusion process Original Article

    Garcia, Josiane; Silva, Sheila Soares; Meneguci, Joilson; Moraes-Souza, Helio

    Abstract in English:

    SUMMARY OBJECTIVE: This study aimed to evaluate the safety of the transfusion process in a public teaching hospital and to outline the profile of the hemotherapy care provided. METHODS: This was an exploratory, descriptive, and prospective study with a quantitative approach and grounded in field research. Data were obtained from medical and nursing records and active search. RESULTS: Concentrated red blood cells were the most transfused blood component. Inadequate indications of blood components were detected in 15% of Concentrated red blood cells transfusions, 20% of fresh plasma, 29.2% of platelet concentrates, and 36.4% of cryoprecipitates. Filling out the blood component request forms, the nursing checklist and the entry book were inadequate in 88.3, 92.8, and 69.5% of the procedures, respectively. CONCLUSIONS: Faults were identified throughout the transfusion process, revealing inadequate compliance with current standards and legislation, essential in minimizing the occurrence of errors and maximizing the safety of transfusion. Studies of this nature reinforce the need for continued research in this field.
  • Comparison of perioperative indicators, treatment efficacy, and postoperative complications between tonsillotomy and tonsillectomy for children with obstructive sleep apnea hypopnea syndrome Original Article

    Ji, Chenqi; Yang, Haibin; Wu, Xiaoli; Hong, Yongjun

    Abstract in English:

    SUMMARY OBJECTIVE: This study aimed to compare the perioperative indicators, treatment efficacy, and postoperative complications between tonsillotomy and tonsillectomy for children with obstructive sleep apnea hypopnea syndrome. METHODS: A total of 134 children with obstructive sleep apnea hypopnea syndrome were divided into tonsillotomy group (n=66) and tonsillectomy group (n=68). The tonsillotomy group received tonsillotomy treatment with a power cutter, while the tonsillectomy group received tonsillectomy treatment. The perioperative indicators, treatment efficacy, and postoperative complications were compared between the two groups. RESULTS: There was no significant difference in operative time between the two groups (p>0.05), with significant difference in amount of blood loss, postoperative Visual Analogue Scale score, food intake amount, and general diet-taking starting time between the two groups (p<0.05). The total effective rate of treatment had no significant difference between the two groups (p>0.05). There was significant difference in postoperative bleeding, upper respiratory tract infection, and pharyngeal scar grade between the two groups (p<0.05). CONCLUSIONS: Compared with tonsillectomy treatment for children with obstructive sleep apnea hypopnea syndrome, tonsillotomy treatment is more beneficial to optimize the perioperative indicators, relieve the postoperative pain, facilitate the postoperative recovery, and reduce the postoperative complications, which is worthy of clinical promotion.
  • Predictive factors for success after supine percutaneous nephrolithotomy: an analysis of 961 patients Original Article

    El Hayek, Kayann Kaled Reda; Perrella, Rodrigo; Ferreira, Daniel Beltrame; Batagello, Carlos Alfredo; Mota, Priscila Kuriki Vieira; Cohen, David Jacques; Murta, Claudio Bovolenta; Claro, Joaquim Francisco de Almeida; Vicentini, Fabio Carvalho

    Abstract in English:

    SUMMARY OBJECTIVE: The aim of this study was to evaluate the predictive factors for success following percutaneous nephrolithotomy in the supine position. METHODS: Patients who underwent percutaneous nephrolithotomy in the supine position from June 2011 to October 2018 were evaluated. Age, sex, body mass index, the American Society of Anesthesiologists physical status classification, hemoglobin level, number of previous surgeries, stone size, and the Guy’s Stone Score were analyzed. Success was considered if no fragments were observed on the computed tomography scan on the first postoperative day. Univariate and multivariate analyses were performed to determine significant parameters. RESULTS: We evaluated 961 patients; of them, 483 (50.2%) underwent previous stone-related surgery, and 499 (51.9%) had Guy’s Stone Score 3 or 4. The overall success rate in a single procedure was 40.7%, and complication rate was 13.7%. The univariate analysis showed that the maximum diameter of the stone (25.10±10 mm; p<0.001), previous percutaneous nephrolithotomy (OR 0.52; p<0.001), number of previous percutaneous nephrolithotomy (OR 0.15; p<0.001), the Guy’s Stone Score (OR 0.28; p<0.001), and the number of tracts (OR 0.32; p<0.001) were significant. In the multivariate analysis, the number of previous percutaneous nephrolithotomy (OR 0.54; p<0.001) and the Guy’s Stone Score (OR 0.25; p<0.001) were statically significant. CONCLUSIONS: Guy’s Stone Score and the number of previous percutaneous nephrolithotomy are predictors of success with the supine position. Complex cases and with previous percutaneous interventions may require technical improvements to achieve higher stone-free rates.
  • Polymorphisms rs2010963 and rs833061 of the VEGF gene in polycystic ovary syndrome Original Article

    Vicente, Anna Luiza Silva Almeida; Marqui, Alessandra Bernadete Trovó de; Gomes, Mariana Kefalas Oliveira; Assunção-Luiz, Alan Vinicius; Balarin, Marly Aparecida Spadotto; Tanaka, Sarah Cristina Sato Vaz; Resende, Elisabete Aparecida Mantovani Rodrigues de; Lima, Marco Fábio Prata; Cintra, Mariangela Torreglosa Ruiz

    Abstract in English:

    SUMMARY OBJECTIVE: The polycystic ovary syndrome is the most common endocrine disorder, characterized by the dysregulation of ovarian angiogenesis. This alteration can be related to changes in the activities of the vascular endothelial growth factor (VEGF) gene. Single-nucleotide polymorphisms have been observed in the promoter, intronic, and untranslated regions of the VEGF gene, and several studies have suggested that these polymorphisms may be associated with the risk of polycystic ovary syndrome. This study aimed to investigate the association between rs2010963 and rs833061 polymorphisms and haplotypes of VEGF in the etiology of polycystic ovary syndrome. METHODS: A total of 210 women, 102 diagnosed with polycystic ovary syndrome and 108 controls, participated in this study. The genotyping of the samples was performed by PCR-RFLP and real-time PCR for rs2010963 and rs833061 polymorphisms, respectively. The statistical analyses were performed by the chi-square test and logistic regression model. RESULTS: The clinical characteristics of the patients showed that 75.8% of the patients did not become pregnant, 36.3% had a family history of polycystic ovary syndrome, 58.6% were obese, and about 60% had clinical characteristics of hyperandrogenism. There were no associations between the distribution of rs2010963 (OR 1.24; 95%CI 0.60–2.57; p=0.56) and rs833061 (OR 0.78; 95%CI 0.32–1.92; p=0.59) in patients and controls. CONCLUSIONS: The patients with polycystic ovary syndrome have similar rates of VEGF polymorphisms rs2010963 and rs833061 on the general population.
  • Serum Prealbumin: a potential predictor of Right Ventricular Dysfunction in patients receiving programmed hemodialysis Original Article

    Gok, Murat; Kurtul, Alparslan; Taylan, Gökay; Sayılar, Emel Işıktaş; Yalta, Kenan

    Abstract in English:

    SUMMARY OBJECTIVE: Prealbumin has been a reliable marker to predict protein energy malnutrition and hypercatabolic state. In this analysis, we particularly aimed to investigate the potential association between serum prealbumin levels and right ventricular dysfunction in patients receiving programmed hemodialysis. METHODS: A total of 57 subjects were included in the analysis. The subjects were then categorized into two groups: right ventricular dysfunction (n=18) and non-right ventricular dysfunction (n=39) groups. In all patients, detailed transthoracic echocardiography (following hemodialysis) were performed along with the evaluation of complete blood count, routine biochemistry parameters, and, in particular, serum prealbumin levels. RESULTS: Mortality rate at 3 years was found to be significantly higher in the right ventricular dysfunction group (p=0.042). Serum prealbumin levels were also significantly lower in the right ventricular dysfunction group compared with the non-right ventricular dysfunction group (23.83±8.50 mg/dL versus 31.38±6.81 mg/dL, p=0.001). In the receiver operating characteristics curve analysis, a prealbumin cutoff value of <28.5 mg/dL was found to predict right ventricular dysfunction, with a sensitivity of 67% and a specificity of 62% (area under the curve: 0.744). In the correlation analysis, a moderate yet significant positive correlation was demonstrated between serum prealbumin and tricuspid annular plane systolic excursion (r=0.365, p=0.005). CONCLUSION: This study suggests that low serum prealbumin might serve as a potential predictor of right ventricular dysfunction (and its clinical consequences) in patients receiving programmed hemodialysis.
  • Potentially inappropriate medication use in hospitalized elderly patients Original Article

    Oliveira, Regina Maria Alexandre Fernandes de; Gorzoni, Milton Luiz; Rosa, Ronaldo Fernandes

    Abstract in English:

    SUMMARY OBJECTIVE: This study aimed to assess the prevalence of potentially inappropriate medication prescription in hospitalized elderly patients according to the 2019 American Geriatrics Society Beers Criteria. METHODS: This study is a prospective analysis of electronic medical records of elderly patients admitted to the Department of Medicine, Hospital Central da Irmandade da Santa Casa de Misericórdia de São Paulo, between 1 September 2020 and 30 April 2021. RESULTS: A total of 142 patients (85 women and 57 men) with a mean age of 74.5±7.3 years (65–99 years) were assessed. Of these, 108 (76.1%) were elderly (age ≥65 years and <80 years) and 34 (23.9%) long-lived (age ≥80 years). The average length of stay found in the sample was 25.3±28.7 days (between 2 and 235 days), and 102 out of the 140 patients assessed remained in the hospital for up to 29 days. Sixteen drugs considered potentially inappropriate medication were found in the patients’ prescriptions, with at least one potentially inappropriate medication having been prescribed to 141 (99.3%) patients. Elderly patients had a mean of 2.57±0.94 potentially inappropriate medication prescribed versus 2.56±0.89 among long-lived patients. The most prescribed potentially inappropriate medication were as follows: regular human insulin as required (85.2%), and omeprazole (73.9%) and metoclopramide as required (61.3%). CONCLUSION: The study sample showed significant percentages of potentially inappropriate medication prescriptions for the elderly admitted to the hospital.
  • Predictors of left ventricular ejection function decline in young patients with ST-segment elevation myocardial infarction Original Article

    Yildiz, Ibrahim; Rencüzoğulları, Ibrahim; Karabağ, Yavuz; Karakayali, Muammer; Artac, Inanc; Gurevin, Mehmet Sait

    Abstract in English:

    SUMMARY OBJECTIVE: A decrease in the left ventricular ejection fraction (≤40%) in the setting of ST-segment elevation myocardial infarction is a significant predictor of mortality in the young ST-segment elevation myocardial infarction population. In this study, we aimed to investigate the predictors of left ventricular ejection fraction reduction and evaluate the long-term mortality rates in young ST-segment elevation myocardial infarction patients with or without decreased left ventricular ejection fraction. METHODS: We enrolled retrospectively 411 consecutive ST-segment elevation myocardial infarction patients aged 45 years or below who underwent primary percutaneous coronary intervention. Young ST-segment elevation myocardial infarction patients were divided into two groups according to their left ventricular ejection fraction (≤40%, n=72 and >40%, n=339), which were compared with each other. RESULTS: Statin use, white blood cell count, C-reactive protein, peak creatine kinase-MB, prolonged ischemia time, left anterior descending artery-related infarction, proximally/ostial located lesion, and no-reflow were independently associated with low left ventricular ejection fraction. Additionally, long-term mortality was considerably higher in the left ventricular ejection fraction ≤40% group than those in the left ventricular ejection fraction>40% group (18.1% versus 2.4%; p<0.001). CONCLUSIONS: In young ST-segment elevation myocardial infarction patients, lesion properties (left anterior descending lesion, proximally located lesion), no-reflow, and prolonged ischemia time appeared to be important determinants for the left ventricular ejection fraction decline, rather than coronary disease severity or demographic and hematological parameters. Statin use may be preventive in the development of left ventricular ejection fraction decline in young ST-segment elevation myocardial infarction patients.
  • Characteristics of patients receiving nutrition care and its associations with prognosis in a tertiary hospital Original Article

    Pérez-Romero, María Teresa; Villanueva-Juárez, José Luis; Serralde-Zúñiga, Aurora Elizabeth; Castillo-Martínez, Lilia

    Abstract in English:

    SUMMARY OBJECTIVE: The aim of this study was to describe the medical nutritional therapy (MNT) of adult non-critically ill hospitalization patients. METHODS: In a retrospective study, adults hospitalized for more than 48 h in non-intensive care unit medical and surgical areas that were classified as being at nutritional risk were included. Malnutrition was defined according to Global Leadership Initiative on Malnutrition (GLIM) criteria. RESULTS: A total of 255 patients, aged 54.13±18.4 years, who were at risk of malnutrition were included in this study. Of these, 50% were males. Notably, 52.5% received oral nutrition supplementation (ONS), 23.5% enteral nutrition (EN), 15% parenteral nutrition (PN), and 9% received enteral and parenteral nutrition (EPN). Patients with EPN presented the highest frequency of malnutrition (52%), and therefore they received more than 100% of energy and protein requirements. The median length of stay was 25 days. Among patients with nutritional risk receiving EPN, no deaths occurred. Patients, identified at nutritional risk, but without malnutrition according to GLIM, and receiving ONS had significantly lower mortality than patients receiving other MNT. CONCLUSIONS: Oral nutrition supplementation was the more frequent MNT prescribed. The frequency of malnutrition and percentage of prescribed energy and protein were higher in patients receiving PN and EPN compared with those receiving ONS.
  • Investigation of serum phoenixin levels in patients with hypertension Original Article

    Akdu, Sadinaz; Can, Ummugulsum; Polat, Esra

    Abstract in English:

    SUMMARY OBJECTIVE: Hypertension is a major modifiable risk factor for cardiovascular disease and premature death worldwide. Phoenixin is a newly identified neuropeptide with multiple bioactivity. However, there was no published data about phoenixin levels in hypertension. The aim of this study was to evaluate the relationship between phoenixin and hypertension. METHODS: This study was performed in 36 patients with hypertension and 36 healthy controls. Serum phoenixin-14 and phoenixin-20 levels were determined by Enzyme-Linked ImmunoSorbent Assay method. RESULTS: Serum phoenixin-14 and phoenixin-20 values were significantly lower in hypertension patients compared with the control group (p<0.001). The levels of phoenixin-14 were negatively correlated with weight (r=-0.376; p<0.005), body mass index (r=-0.407; p<0.001), systolic blood pressure (r=-0.586; p<0.001), and diastolic blood pressure (r=-0.319; p<0.01). There was a negative correlation between serum phoenixin-20 and weight (r=-0.378; p<0.005), body mass index (r=-0.383; p<0.005), systolic blood pressure (r=-0.551; p<0.001), and diastolic blood pressure (r=-0.306; p<0.01). We used receiver operating characteristic curve analyses to compare the diagnosis value of Phoenixin-14 and Phoenixin-20 levels in hypertensive patients. We found that Phoenixin-14 value is an area under the curve of 0.87 (cutoff value 404.7 ng/L, sensitivity 92%, specificity 72%) and Phoenixin-20 value is an area under the curve of 0.83 (cutoff value 209.9 ng/L, sensitivity 86%, specificity 75%). Phoenixin-14 did nearly show equally compared to phoenixin-20 in predicting hypertension. CONCLUSION: Serum phoenixin-14 and phoenixin-20 may be related to the pathogenesis of hypertension. Our findings indicated that serum phoenixin-14 and phoenixin-20 may serve as a novel biomarker for the diagnosis of hypertension.
  • The relation of dermcidin with insulin resistance and inflammation in women with polycystic ovary syndrome Original Article

    Akan, Ozden Yildirim; Bilgir, Oktay

    Abstract in English:

    SUMMARY OBJECTIVE: Polycystic ovary syndrome is the most common endocrinopathy among women of reproductive age. Polycystic ovary syndrome is a metabolic disorder associated with insulin resistance and subclinical inflammation. Dermcidin, an antimicrobial peptide, involves in insulin resistance and inflammatory processes. Dermcidin suppresses the secretion of insulin production from the liver/pancreas and also increases insulin resistance. We aimed to discover whether dermcidin levels were altered in polycystic ovary syndrome women compared to controls and determine the link of dermcidin with hormonal-metabolic parameters in polycystic ovary syndrome women. METHODS: The current research was designed as a case-control study and Rotterdam 2003 criteria were used for diagnosing polycystic ovary syndrome. A total of 75 subjects with polycystic ovary syndrome and 75 age- and body mass index-matched subjects as controls were enrolled in the study. The insulin resistance state was determined using a homeostatic model assessment of insulin resistance and quantitative insulin sensitivity check index. High-sensitivity C-reactive protein levels were assessed to define inflammation. RESULTS: Circulating dermcidin levels were measured by enzyme-linked immunosorbent assay. Dermcidin levels were significantly increased in polycystic ovary syndrome subjects compared to controls (172.53±42.41 ng/mL vs. 108.44±31.69 ng/mL, p<0.001). Homeostatic model assessment of insulin resistance and high-sensitivity C-reactive protein levels were markedly increased, whereas quantitative insulin sensitivity check index levels were notably decreased in women with polycystic ovary syndrome compared to controls. Linear regression analysis revealed that dermcidin exhibited an independent link with homeostatic model assessment of insulin resistance and high-sensitivity C-reactive protein, whereas dermcidin displayed an inversely independent link with quantitative insulin sensitivity check index. CONCLUSION: Increased dermcidin levels were associated with insulin resistance and inflammation in polycystic ovary syndrome women, suggesting that dermcidin may play a role in the pathophysiology of polycystic ovary syndrome.
  • COVID-19: the unmet need for family planning and its effects on sexuality: a cross-sectional study Original Article

    Karaahmet, Aysu Yıldız; Bilgiç, Fatma Şule

    Abstract in English:

    SUMMARY OBJECTIVE: This study was conducted to examine the effect of women’s unmet family planning needs on their sexual functions during the COVID-19 pandemic period. METHODS: A cross-sectional study was conducted with 319 women of childbearing age across Turkey between April and May 2021. Data were obtained through online questionnaires using the “Survey Form” and the Female Sexual Functıon Index. RESULTS: It was observed that 46.77% of the participants had difficulty in accessing the family planning method, the most used family planning method during the pandemic period was the withdrawal method with 52.35%, and there was a significant difference between them and the pre-pandemic method (p<0.05). In the regression analysis, it was shown that a one-unit increase in the difficulty of accessing the family planning method and the place reached parameter would lead to an increase of 0.33 points in the sexual function probability of women. CONCLUSIONS: It was observed that women of childbearing age living in Turkey had limited access to family planning services during the pandemic, those who used modern methods before the pandemic had to prefer the traditional method, and the sexual functions of women who had fear of becoming pregnant were adversely affected.
  • Extended-spectrum beta-lactamases among Klebsiella pneumoniae from Iraqi patients with community-acquired pneumonia Original Article

    Raouf, Faez Erees Abdul; Benyagoub, Elhassan; Alkhudhairy, Miaad K.; Akrami, Sousan; Saki, Morteza

    Abstract in English:

    SUMMARY OBJECTIVE: Beta-lactams resistance is a major clinical problem in treating pneumonia. This study aimed to detect the extended-spectrum beta-lactamases (ESBL) genes in Klebsiella pneumoniae among patients with community-acquired pneumonia (CAP) in Al-Najaf City, Iraq. METHODS: A total of 511 sputum samples were obtained from all suspected patients with CAP in Al-Najaf City, Iraq, from March 2020 to September 2020. Sputum samples were subjected to microbiological tests. The disk diffusion method was used to test antibiotic sensitivity. Production of ESBLs was identified using phenotypic and genotypic methods. RESULTS: The total prevalence of K. pneumoniae was 31.9% (163/511). Using CHROM agar, 41 (25.2%) isolates were ESBL producers. The imipenem 0.0% (n=0/41) and norfloxacin 0.0% (n=0/41) were the most effective antibiotics. The multiplex polymerase chain reaction showed that 46.3% (n=19/41) of isolates harbored ESBL genes. Out of 19 ESBL producers, 47.4% and 15.8% harbored blaCTX-M and blaSHV, respectively. While blaCTX-M and blaSHV genes were detected in 7 (36.8%) isolates, simultaneously. CONCLUSIONS: The imipenem and norfloxacin can be used in empirical treatment of K. pneumoniae isolates in Iraq. The emergence of K. pneumoniae strains harboring ESBL resistance genes necessitates the development of a regular surveillance program to prevent the spreading of these isolates more in Iraqi health care systems.
  • C-reactive protein to lymphocyte count ratio is a promising novel marker in hepatitis C infection: the clear hep-c study Original Article

    Demirkol, Muhammed Emin; Aktas, Gulali; Bilgin, Satilmiş; Kahveci, Gizem; Kurtkulagi, Ozge; Atak, Burcin Meryem; Duman, Tuba Taslamacioglu

    Abstract in English:

    SUMMARY OBJECTIVE: Chronic hepatitis C (CHC) is one of the most important health problems affecting the significant rate of world population and it may lead to cirrhosis and hepatocellular carcinoma. C-reactive protein to lymphocyte count ratio (CLR) is used in estimating inflammatory burden. Therefore, this study aimed to compare CLR values between CHC patients and healthy controls and between CHC patients with and without fibrosis. METHODS: Patients with CHC infection who visited outpatient and inpatient internal medicine clinics of our institution between January 2021 and December 2021 were enrolled to this retrospective study. CLR of the patients with CHC and healthy controls were compared. We further compared CLR of CHC patients with and without fibrosis. RESULTS: Median CLR of CHC and control subjects was 2.61 (5.13%) and 0.31 (0.37%), respectively. CLR of the CHC group was significantly increased compared to the CLR of the controls (p<0.001). There was a significant positive correlation between CLR and APRI score (r=0.15, p=0.04). The sensitivity and specificity of CLR in determining CHC above 0.58% level were 84% and 82%, respectively (AUC: 0.884, p<0.001, 95%CI 0.84–0.93). In subgroup analysis, CLR was 3.97 (6.6%) for CHC patients with fibrosis and 1.7 (4.4%) for CHC subjects without fibrosis (p=0.001). CONCLUSION: Increased CLR in patients with CHC may be an alarming finding of liver fibrosis, as CLR is associated with both CHC and hepatic fibrosis.
  • Impact of coronavirus disease 2019 pandemic on breast cancer screening and detection of high-risk mammographic findings Original Article

    Moterani Júnior, Nino José Wilson; Moterani, Vinicius César; Moterani, Laura Bresciani Bento Gonçalves; Pimentel, Franklin Fernandes; Reis, Francisco José Candido dos

    Abstract in English:

    SUMMARY OBJECTIVE: The coronavirus disease 2019 pandemic has disrupted cancer screening worldwide. This study aims to analyze the changes in the rates of screening mammograms and BIRADS 4 or 5 mammograms during the coronavirus disease 2019 pandemic in the opportunistic scenario. METHODS: We integrated three different public databases from the state of São Paulo, Brazil, to obtain the rate of screening mammograms per 1,000, and the rate of BIRADS 4 or 5 mammograms per 100,000 women aged from 50 to 69 years in the years from January 2017 to December 2020. RESULTS: The mean monthly screening mammograms decreased from 14.8/1,000 in 2019 to 9.25/1,000 in 2020, with the lowest rates being recorded in May 2020 (3.1/1,000). The mean monthly high-risk mammograms decreased from 12.8/100,000 in 2019 to 9.1/100,000 in 2020, with the lowest rates being recorded in April 2020 (4.3/100,000). CONCLUSIONS: Coronavirus disease 2019 pandemic significantly decreased mammography screening in an opportunistic scenario, a warning sign for decreasing diagnosis of breast cancer in early stages, and increasing advanced stage diagnosis and mortality in the future.
  • “Zooming” in strategies and outcomes for trauma cases with Injury Severity Score (ISS) ≥16: promise or passé? Original Article

    Doklestić, Krstina; Lončar, Zlatibor; Coccolini, Federico; Gregorić, Pavle; Mićić, Dusan; Bukumiric, Zoran; Djurkovic, Petar; Sengul, Demet; Sengul, Ilker

    Abstract in English:

    SUMMARY OBJECTIVE: Rescuing severe trauma cases is extremely demanding. The present study purposed to analyze the efficiency of trauma management at Emergency Centre, University Clinical Centre of Serbia, Belgrade, included outcome within 28 days. METHODS: This retrospective study involved 131 intensive care unit trauma cases with total Injury Severity Score ≥16, in terms of administrating the two strategies: (i) definitive surgical repair and (ii) damage control laparotomy. RESULTS: The damage control laparotomy cases revealed statistically higher Injury Severity Score and APACHE II scores, significant brain dysfunction, and hemorrhagic shock on arrival (p<0.001). In addition, the damage control laparotomy had a higher rate of respiratory complications, multiple organ deficiency syndrome, and surgical wound complications (p=0.017, <0.001, and 0.004, respectively), with more days on mechanical ventilation (p=0.003). Overall mortality was 29.8%. Although higher early mortality within ≤24 h in the damage control laparotomy (p=0.021) had been observed, no difference between groups (p=0.172) after the 4th day of hospitalization was detected. CONCLUSIONS: Trauma patients have a high mortality rate in the 1st hours after the incident. Compelling evidence linking host and pathogen factors, such as mitochondrial apoptosis pathways, appears to correlate with loss of organ dysfunction, both cytopathologically and histopathologically. Adequate selection of patients necessitating damage control laparotomy, allowed by the World Society of Emergency Surgery, abdominopelvic trauma classifications, and improvements in resuscitation, may improve the results of severe trauma treatment.
  • Do heart rate variability indices present potential to predict late postmenopausal? A retrospective study Original Article

    Carvalho, Tatiana Dias de; Norberto, Alex Rey; Oliveira, Fernando Rocha; Paiva, Laercio da Silva; Baracat, Edmund Chada; Soares Júnior, José Maria; Vanderlei, Luiz Carlos Marques; Sorpreso, Isabel Cristina Esposito

    Abstract in English:

    SUMMARY OBJECTIVES: This study aimed to compare heart rate variability indices in early and late postmenopausal women and assess their correlation and prognostic value to predict late postmenopausal. METHODS: An observational and retrospective study was performed with the medical records of patients from Hospital das Clínicas, Faculdade de Medicina da Universidade de Sao Paulo between 2018 and 2019. We selected medical records of women with menopause, over 40 years old, which were divided into two groups, according to postmenopausal time, i.e., early and late postmenopausal. RESULTS: We analyzed data from 123 women (55 in the early and 68 in the late postmenopausal group). RRtri (triangular index) was lower in the late postmenopausal group (8.68 vs. 7.15, p=0.040). There was a significant weak negative correlation in SDNN, RRtri, and SD2 and postmenopausal time. RRtri presented the potential to predict late postmenopausal. CONCLUSION: The increase in postmenopausal time decreases global heart rate variability indices. The geometric index RRtri was significantly lower in late postmenopausal women and presented the potential to predict late postmenopausal.
  • Serum vascular endothelial growth factor as a marker for tubal pregnancy Original Article

    Cabar, Fábio Roberto; Pereira, Pedro Paulo; Oliveira, Matheus Abelo de; Francisco, Rossana Pulcinelli Vieira

    Abstract in English:

    SUMMARY OBJECTIVE: The objective of this study was to evaluate whether a single measurement of vascular endothelial growth factor could distinguish between intrauterine pregnancy and ectopic pregnancy and to correlate the levels of vascular endothelial growth factor with serum levels of progesterone andβ-human chorionic gonadotropin in each subgroup. METHODS: Ninety patients with a positive human chorionic gonadotropin test and either abdominal pain or vaginal bleeding were selected; pregnancies were singletons, spontaneously conceived, 42–56 days of gestational age. All patients had a transvaginal ultrasound examination and were divided into three subgroups: abnormal intrauterine pregnancy, tubal pregnancy, and normal intrauterine pregnancy. Tubal pregnancies were surgically treated and histologically confirmed. Blood samples were collected for the determination of β-human chorionic gonadotropin, progesterone, and vascular endothelial growth factor and their concentrations were compared in each subgroup. Receiver operating characteristic curve was calculated by comparing the subgroup of tubal pregnancy to the other groups. A Fisher discriminant function analysis was performed. The level of significance was 5%. RESULTS: One-way analysis of variance revealed a significant correlation between the different subgroups and β-human chorionic gonadotropin, progesterone, and vascular endothelial growth factor serum levels (p<0.001). Vascular endothelial growth factor concentration was significantly higher for patients with tubal pregnancy than for other subgroups (p<0.05). β-Human chorionic gonadotropin and progesterone levels were higher in the subgroup with normal intrauterine pregnancies compared with the subgroups with tubal and abnormal intrauterine pregnancies (p<0.05). Serum vascular endothelial growth factor level >188.7 ng/mL predicted tubal pregnancy with 96.7% sensitivity, 95.0% specificity, 90.6% positive predictive value, and 98.3% negative predictive value. CONCLUSIONS: Serum vascular endothelial growth factor could be a marker in discriminating intrauterine pregnancy from tubal pregnancy; its levels are increased in women with ectopic pregnancy compared with women with normal and abnormal intrauterine pregnancies.
  • Detection of atrial fibrosis using echocardiographic strain: a new pathway Review Article

    Silveira, Maria Mariana Barros Melo da; Cabral, João Victor Batista; Xavier, Amanda Tavares; Costa, Lucas Reis da; Nascimento, Dhouglas José Ferreira do; Castillo, José Maria Del; Vasconcelos, Luydson Richardson da Silva; Sobral Filho, Dário Celestino; Oliveira, Dinaldo Cavalcanti de
  • A narrative review on nonalcoholic fatty liver disease and nonalcoholic steatohepatitis versus hepatocellular carcinoma: do you mind? Review Article

    Toman, Daniel; Sengul, Ilker; Pelikán, Anton; Sengul, Demet; Vavra, Petr; Ihnat, Petr; Roman, Jan; Kayaalp, Cuneyt
  • Comment on “Orthostatic changes in blood pressure and survival in elderly cardiopaths” Commentary

    Zhao, Ming
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