Revista da Associação Médica Brasileira, Volume: 68, Número: 7, Publicado: 2022
  • Actinic cheilitis or squamous cell carcinoma of the lip? Practical recommendations on how to avoid a trap Editorial

  • Comment on “Are inflammatory and malnutrition markers associated with metabolic syndrome in patients with sarcoidosis?” Letter To The Editor

    Tu, Juncai; Li, Xiaofei
  • Can grading method of BASRI-hip based on X-ray examination better identify hip involvement? Letter To The Editor

    Wang, Linyou; Wu, Liang
  • Comment on: “Relationship of the prenatal psychosocial profile with postpartum maternal duties and newborn care” Letter To The Editor

    Jiang, Jiannan; Ke, Shengxia
  • Prognostic Value of T-wave Positivity in Lead aVR in COVID-19 Pneumonia Original Article

    Sivri, Fatih; Özdemir, Burcu; Çelik, Mehmet Murat; Aksoy, Fatih; Akçay, Burakhan

    Resumo em Inglês:

    SUMMARY OBJECTIVE: T-wave positivity in the lead aVR is a marker of ventricular repolarization abnormality and provides information on short- and long-term cardiovascular mortality in heart failure patients, those with anterior myocardial infarction, and patients who underwent hemodialysis for various reasons. The aim of this study was to investigate the relationship between T-wave positivity in the lead aVR on superficial electrocardiogram and mortality from COVID-19 pneumonia. METHODS: This study retrospectively included 130 patients who were diagnosed with COVID-19 and treated as an outpatient or in the thoracic diseases ward in a single center between January 2021 and June 2021. All patients included in the study had clinical and radiological features and signs of COVID-19 pneumonia. The COVID-19 diagnosis of all patients was confirmed by polymerase chain reaction detected from an oropharyngeal swab. RESULTS: A total of 130 patients were included in this study. Patients were divided into two groups: survived and deceased. There were 55 patients (mean age: 64.76–14.93 years, 58.18 male, 41.12% female) in the survived group and 75 patients (mean age: 65–15 years, 58.67 male, 41.33% female) in the deceased group. The univariate and multivariate regression analyses showed that positive transcatheter aortic valve replacement (OR 5.151; 95%CI 1.001–26.504; p=0.0012), lactate dehydrogenase (OR 1.006; 95%CI 1.001–1.010; p=0.012), and d-dimer (OR 1.436; 95%CI 1.115–1.848; p=0.005) were independent risk factors for mortality. CONCLUSION: A positive transcatheter aortic valve replacement is useful in risk stratification for mortality from COVID-19 pneumonia.
  • Diagnostic value of serum levels of galanin and obestatin in patients with gastric cancer Original Article

    Uygur, Furkan Ali; Dişçi, Esra; Peksöz, Rıfat; Öztürk, Nurinnisa; Yildirgan, Mehmet İlhan; Albayrak, Yavuz

    Resumo em Inglês:

    SUMMARY OBJECTIVE: Gastric cancer ranks the third among the cancer-related deaths. It is diagnosed at advanced stage in many patients due to malignant proliferation and has a poor prognosis. Currently, no instrument or biomarker has been proven to diagnose the disease before the advanced stages. This study aimed to measure the serum levels of galanin and obestatin, which were examined in various studies including cancer studies, and to discuss their diagnostic value in gastric cancers. METHODS: In this study, 30 adult patients with gastric cancer and 30 healthy adults in the control group were examined prospectively. The demographic characteristics and serum levels of galanin and obestatin in the patient and control groups were recorded. RESULTS: The mean serum level of galanin in the patient and control groups was 19.73±5.04 and 35.59±10.94 pg/mL, respectively. The mean serum level of obestatin in the patient and control groups was 40.21±5.82 and 15.15±3.32 ng/mL, respectively. A significant difference was found between the groups (p<0.001). CONCLUSION: Serum levels of galanin were lower and serum levels of obestatin were higher in patients with gastric cancer compared to the healthy individuals. Serum levels of obestatin and galanin can be used as potential biomarkers in the diagnosis of gastric cancer.
  • Analysis of related factors of behavioral problems in children with congenital pseudarthrosis of tibia Original Article

    Xie, Jian-Hui; Mei, Hai-Bo; Liu, Kun; Zhu, Guang-Hui; Ouyang, Ya-Qi; Huang, Yuan; Hou, Shu-Ting; Wang, Lan-Ying; Yi, Ying-Zhi

    Resumo em Inglês:

    SUMMARY OBJECTIVE: This study aimed to investigate the factors associated with behavioral problems in children with congenital pseudarthrosis of the tibia. METHODS: Random sampling is utilized to obtain a sample of 90 patients. The behavioral problems of the patients are detected by Achenbach Children's Behavior Scale. Parental emotional problems are investigated by the Self-Rating Depression Scale and Self-Rating Anxiety Scale. RESULTS: The results demonstrate that the detection rate of behavioral problems in children with congenital pseudarthrosis of the tibia is 53.3% (48/90). Among these behavioral problems, an abnormal rate is higher in the four dimensions: thinking, violation of discipline, social interaction, and aggression. The anxiety and depression scores of caregivers are statistically higher in the abnormal group than in the normal group. The results of the multivariate analysis show that the anxiety degree of the parents had a significant impact on the behavior of the children. CONCLUSIONS: Children with congenital pseudarthrosis of the tibia are facing the issues of high rates of behavioral problems. Parents of children with congenital pseudarthrosis of the tibia had higher levels of anxiety and depression than parents of normal children. The anxiety and depressive state of mind of parents or caregivers had a significant impact on the behavior of children with congenital pseudarthrosis of the tibia.
  • Premenstrual Syndrome and Childbirth Fear Prior to Pregnancy in Young Women: An Association and Cross-Sectional Study Original Article

    Ataman, Hacer; Dişsiz, Melike

    Resumo em Inglês:

    SUMMARY OBJECTIVE: The aim of the study was to determine the association between premenstrual syndrome and the childbirth fear prior to pregnancy. METHODS: This was an association and cross-sectional study conducted on 327 university students. Data were collected using “Participant Information Form,” “Premenstrual Syndrome Scale,” and “Childbirth Fear-Prior to Pregnancy Scale.” RESULTS: It was found that the childbirth fear had increased in students with premenstrual syndrome. The Women Childbirth Fear-Prior to Pregnancy Scale score was statistically significantly higher among students who preferred caesarean section than those who preferred vaginal delivery. There was a weak, positive, and statistically significant correlation between the students’ depressive sensation, anxiety, fatigue, nervousness, depressive thoughts, pain, appetite changes, sleep pattern changes, and bloating subscales of Premenstrual Syndrome Scale and Women Childbirth Fear-Prior to Pregnancy Scale. CONCLUSION: The score of the Women Childbirth Fear-Prior to Pregnancy Scale increases with an increase in the score of the Premenstrual Syndrome subscale. It should be evaluated whether or not women experiencing premenstrual syndrome have the childbirth fear prior to pregnancy.
  • Braden scale for predicting pneumonia after spontaneous intracerebral hemorrhage Original Article

    Ding, Yunlong; Ji, Zhanyi; Liu, Yan; Niu, Jiali

    Resumo em Inglês:

    SUMMARY OBJECTIVE: Stroke-associated pneumonia is an infection that commonly occurs in patients with spontaneous intracerebral hemorrhage and causes serious burdens. In this study, we evaluated the validity of the Braden scale for predicting stroke-associated pneumonia after spontaneous intracerebral hemorrhage. METHODS: Patients with spontaneous intracerebral hemorrhage were retrospectively included and divided into pneumonia and no pneumonia groups. The admission clinical characteristics and Braden scale scores at 24 h after admission were collected and compared between the two groups. Receiver operating characteristic curve analysis was performed to assess the predictive validity of the Braden scale. Multivariable analysis was conducted to identify the independent risk factors associated with pneumonia after intracerebral hemorrhage. RESULTS: A total of 629 intracerebral hemorrhage patients were included, 150 (23.8%) of whom developed stroke-associated pneumonia. Significant differences were found in age and fasting blood glucose levels between the two groups. The mean score on the Braden scale in the pneumonia group was 14.1±2.4, which was significantly lower than that in the no pneumonia group (16.5±2.6), p<0.001. The area under the curve for the Braden scale for the prediction of pneumonia after intracerebral hemorrhage was 0.760 (95%CI 0.717–0.804). When the cutoff point was 15 points, the sensitivity was 74.3%, the specificity was 64.7%, the accuracy was 72.0%, and the Youden's index was 39.0%. Multivariable analysis showed that a lower Braden scale score (OR 0.696; 95%CI 0.631–0.768; p<0.001) was an independent risk factor associated with stroke-associated pneumonia after intracerebral hemorrhage. CONCLUSION: The Braden scale, with a cutoff point of 15 points, is moderately valid for predicting stroke-associated pneumonia after spontaneous intracerebral hemorrhage.
  • The Baecke Habitual Physical Activity Questionnaire (BHPAQ): a valid internal structure of the instrument to assess healthy Brazilian adults Original Article

    Rocha, Daniel Santos; Dibai-Filho, Almir Vieira; Pinheiro, Jocassia Silva; Azevedo, Lisiane Fernanda Simeão de; Falcai, Angela; Tavarez, Rudys Rodolfo de Jesus; Rego, Adriana Sousa; Santana, Gabriela Nascimento de; Gomes, Cid André Fidelis de Paula; Bassi-Dibai, Daniela

    Resumo em Inglês:

    SUMMARY OBJECTIVE: This study aimed to validate the internal structure of the Brazilian version of the Baecke Habitual Physical Activity Questionnaire. METHODS: A cross-sectional study was conducted with individuals over 18 years old of both sexes, with Brazilian Portuguese as their native language. The structure of the Baecke Habitual Physical Activity Questionnaire was tested by confirmatory factor analysis. The model fit was evaluated by the following indices: root mean square error of approximation, comparative fit index, Tucker-Lewis index, standardized root mean square residual, and χ²/degrees of freedom. We used the Akaike information criterion and Bayesian information criterion to compare different structures of the Baecke Habitual Physical Activity Questionnaire. RESULTS: A total of 241 individuals participated in this study. The original structure of the Baecke Habitual Physical Activity Questionnaire with 16 items and 3 domains was compared to a structure with 14 items and 3 domains. The internal structure of the Baecke Habitual Physical Activity Questionnaire with 14 items showed better fit indices and lower Akaike information criterion and Bayesian information criterion values. CONCLUSION: The best internal structure of the Brazilian version of the Baecke Habitual Physical Activity Questionnaire in adults presents 3 domains and 14 items.
  • Efficacy of fetal left ventricular modified myocardial performance index in predicting adverse perinatal outcomes in intrahepatic cholestasis of pregnancy Original Article

    Gök, Koray; Takmaz, Taha; Köse, Osman; Kapudere, Bilge; Tüten, Nevin; Bostancı, Mehmet Sühha; Özden, Selçuk

    Resumo em Inglês:

    SUMMARY OBJECTIVE: This study aimed to evaluate the effectiveness of fetal left ventricular modified myocardial performance index in predicting adverse perinatal outcomes for intrahepatic cholestasis of pregnancy. METHODS: A cross-sectional study was conducted, including 51 women with intrahepatic cholestasis of pregnancy and 80 healthy controls. Using Doppler ultrasonography, E-wave, A-wave, isovolumetric contraction time, isovolumetric relaxation time, and ejection time were recorded and the left ventricular modified myocardial performance index was measured. RESULTS: Findings showed that the mean left ventricular modified myocardial performance index, isovolumetric contraction time, and isovolumetric relaxation time values were statistically significantly higher while the ejection time and E/A ratios were statistically significantly lower in the intrahepatic cholestasis of pregnancy group than the control group. In the intrahepatic cholestasis of pregnancy group, a statistically significant positive correlation was found between left ventricular modified myocardial performance index and adverse perinatal outcomes in the intrahepatic cholestasis of pregnancy group (r=0.478, p<0.001), while a statistically significant negative correlation was found between the E/A ratio and adverse perinatal outcomes (r=-0.701, p<0.001). CONCLUSIONS: For intrahepatic cholestasis of pregnancy cases, high fetal left ventricular modified myocardial performance index values were an indicator of ventricular dysfunction, and this correlated with negative perinatal outcomes.
  • Lower urinary system symptoms and affecting factors in female students staying in a dormitory Original Article

    Özcan, Handan; Beji, Nezihe Kizilkaya

    Resumo em Inglês:

    SUMMARY OBJECTIVE: The aim of the study was to determine the lower urinary system symptoms and the factors affecting it among young women living in the dormitory. METHODS: This is a descriptive and cross-sectional study. A total of 355 women attending education in a public university were interviewed, considering a 95% confidence interval. Data were collected using the descriptive form and the Bristol Female Lower Urinary Tract Symptoms Scale. Necessary permissions were obtained, and appropriate analyses were carried out using the SPSS-22 program. RESULTS: Findings showed that 71.6% of women have problems with urine storage, 29.7% have urinating disorders, 18.4% have urinary incontinence, 8.8% have sexual life problems, and 37.2% have symptoms related to quality of life. Factors affecting the symptoms include history of chronic disease (such as neurological diseases and depression), smoking, low income, history of urinary incontinence in childhood, the presence of symptoms in the mother or family history, the presence and number of urinary tract infections, chronic constipation, and not paying attention to toilet cleaning. CONCLUSION: It is recommended to carry out community-based studies to raise awareness of women, support priority risk groups by screening, and increase the number of specialist healthcare personnel for quality care and treatment.
  • Self-reported symptoms and seroprevalence against SARS-CoV-2 in the population of Mato Grosso: a household-based survey in 2020 Original Article

    Terças-Trettel, Ana Cláudia Pereira; Muraro, Ana Paula; Andrade, Amanda Cristina de Souza; Oliveira, Elaine Cristina de

    Resumo em Inglês:

    SUMMARY OBJECTIVE: This study aimed to analyze the association between self-reported symptoms and seroprevalence against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the population of Mato Grosso. METHODS: A household-based survey was conducted on 4,206 adults from 10 municipalities of Mato Grosso, in the Brazilian Midwest, who were selected by cluster sampling in three stages. Questionnaires were applied between September and October 2020, and chemiluminescence was used for the quantitative determination of immunoglobulin G (IgG) antibodies against the S1 and S2 proteins of SARS-CoV-2. RESULTS: Approximately half (47.0%) of individuals with SARS-CoV-2 antibodies (12.5%) reported having no symptoms. The most prevalent symptoms among individuals with antibodies were body pain (37.0%), fever (32.9%), and smell and taste change (28.7%). The search for a basic health unit was predominant (45.0%) as the first service, and only 5.3% reported being hospitalized. CONCLUSION: A high proportion of asymptomatic cases of coronavirus disease 2019 (COVID-19) was identified in the general population, even among older adults and individuals with comorbidities.
  • Custom-made finger splint versus prefabricated finger splint: finger flexion stabilization Original Article

    Güven, Enver; Suner-Keklik, Sinem

    Resumo em Inglês:

    SUMMARY OBJECTIVE: Finger splints are used as a treatment option in tendon, bone, and soft tissue injuries. For immobilization, custom-made splints and prefabricated finger splints are used. In splints made for immobilization, it is aimed to limit joint movement. The aim of our study is to reveal how much custom-made splints and prefabricated finger splints limit joint motion (flexion angle in proximal interphalangeal and distal interphalangeal joints). METHODS: Custom-made splints and prefabricated finger splints were applied to the second fingers of the dominant side in a total of 40 individuals, 20 women and 20 men, not having any health problems. Individuals were asked to flex and joint motion was measured with the iPhone compass application. RESULTS: The mean distal interphalangeal joint angle values of the participants measured by prefabricated finger splints were found to be 24.27±8.29, and the mean distal interphalangeal joint angle values measured by custom-made splints was 0.52±1.50. There was a difference between the participants’ distal interphalangeal joint angle values measured by prefabricated finger splints and custom-made splints (p<0.001). distal interphalangeal joint angle values measured with custom-made splints were significantly smaller than those measured with prefabricated finger splint. The mean of the participants’ proximal interphalangeal joint angle values measured by prefabricated finger splints was 16.55±7.90, and the proximal interphalangeal joint angle values measured by custom-made splints was “0” for all participants. There was a difference between the participants’ proximal interphalangeal joint angle values measured by prefabricated finger splints and custom-made splints (p<0.001). Distal interphalangeal joint angle values measured with custom-made splints were significantly smaller than those measured with prefabricated finger splints. CONCLUSION: According to our study, custom-made splints can significantly reduce the flexion of the finger interphalangeal joints compared to prefabricated finger splints.
  • Antitumor activity of irinotecan with ellagic acid in C6 glioma cells Original Article

    Cetin, Abdurrahman; Biltekin, Burcu; Ozevren, Huseyin

    Resumo em Inglês:

    SUMMARY OBJECTIVE: Irinotecan-based combination chemotherapies in malignant gliomas need to be examined. The aim of this study was to investigate the synergetic effect of ellagic acid, a natural polyphenolic antioxidant compound, with irinotecan, an inhibitor of topoisomerase I enzyme, on the growth, cadherin switch, and angiogenic processes of a glioma cell line. METHODS: A combination of 100 μM ellagic acid and 100 μM irinotecan was applied to rat C6 glioma cells for 24th, 48th, and 72nd h. The cell proliferation was evaluated by 5-bromo-2′-deoxyuridine immunocytochemistry. The expression levels of vascular endothelial growth factor, E-cadherin, and N-cadherin were measured using real-time polymerase chain reaction and their immunoreactivities using immunocytochemistry. RESULTS: The treatment of irinotecan with combining ellagic acid enhanced antitumor activity and the synergistic effect of these reduced the cell proliferation of C6 glioma by inhibiting the cadherin switch and promoting the antiangiogenic processes. CONCLUSIONS: Further research is required to prove a negative relationship between C6 glial cell proliferation and irinotecan with ellagic acid application. Our preliminary data suggest that even with the extremely short-term application, irinotecan with ellagic acid may affect glioma cells at the level of gene and protein expression.
  • A model for training ultrasound-guided fine-needle punctures Original Article

    Luz, Felipe Montevechi; Yacoub, Vinicius Ramos Daoud; Silveira, Kairo Alves Alexandre; Reis, Fabiano; Dertkigi, Sergio San Juan

    Resumo em Inglês:

    SUMMARY OBJECTIVE: To evaluate the efficacy of a training program in ultrasound-guided fine needle puncture using a cost-effective model. METHODS: We evaluated the training of 20 resident radiology physicians, based on a theoretical course and a practical simulation part with models that focused on the puncture technique of thyroid nodules. The total time to perform the procedure, the number of punctures on the model surface, and the application of a questionnaire were used to assess the performance and confidence of the resident physicians in performing the procedure. RESULTS: The training model used was easy to reproduce, inexpensive, versatile, and capable of simulating the echotexture of thyroid tissue. There was a significant reduction in the total time needed to perform the procedure with a mean of 173.7 s±91.28 s from R1 and 112.8 s±17.66 s from R2 before the course vs. 19.2 s±112.8 s and 14.3 s±9.36 s, respectively, after the course (p<0.0001); as well as the number of superficial punctures, with a mean of 2.2 punctures±0.92 from R1 and 1.5 punctures±0.32 from R2 before the course vs 1.1 punctures±0.71 and 1.0 puncture±0.0, respectively, after the course (p<0.0001). There was also a subjective improvement in the performance and confidence in performing this procedure. CONCLUSIONS: An inexpensive and easy-to-reproduce gelatin-based model enabled adequate training of resident physicians and proved capable of improving their skills and confidence in simulating the procedure, even with a short period of training.
  • Effect of accelerated rehabilitation surgery nursing on laparoscopic radical surgery for elderly patients with colorectal cancer Review Article

    Shi, Cunxia; Cai, Baojia; Huang, Xin; Hou, Junfang
  • Cross talk mechanisms of aerobic exercise training on obesity, type 2 diabetes, and Alzheimer's disease: the role of insulin resistance Review Article

    Sousa, Ricardo Augusto Leoni De; Magalhães, Caíque Olegário Diniz de; Dias, Isabella Rocha; Oliveira, Lucas Renan Sena de; Improta-Caria, Alex Cleber; Cassilhas, Ricardo Cardoso
  • Comment on: "Evaluating treatment options in managing thyroid nodules with indeterminate cytology of TBSRTC in thyroidology: addendum aut non?" Commentary

    Sengul, Ilker; Sengul, Demet
  • Comment on: “Comparison of C-reactive protein and C-reactive protein-to-albumin ratio in predicting mortality among geriatric coronavirus disease 2019 patients” Commentary

    Çınar, Tufan; Hayıroğlu, Mert İlker; Çiçek, Vedat; Selçuk, Murat
  • ERRATUM Erratum

  • Human enteroviral infection in fibromyalgia: a case-control blinded study Original Article

    Puri, Basant K.; Lee, Gary S.; Schwarzbach, Armin

    Resumo em Inglês:

    SUMMARY OBJECTIVE: This study aimed to test the hypothesis that fibromyalgia is associated with a human enteroviral infection. METHODS: Venous peripheral blood samples from 27 patients fulfilling the American College of Rheumatology revised diagnostic criteria for fibromyalgia and from 26 age- and sex-matched controls, who underwent immunofluorescence assays for coxsackievirus A7 IgG, coxsackievirus B1 IgG, coxsackievirus A7 IgA, coxsackievirus B1 IgA, echovirus IgG, and echovirus IgA. These immunological tests were performed blind to group status. RESULTS: There were no significant differences between the patient and control groups in respect of positive results for coxsackievirus A7 IgG (p=0.467), coxsackievirus B1 IgG (p=0.491), coxsackievirus A7 IgA (p=0.586), coxsackievirus B1 IgA (p=0.467), echovirus IgG (p=0.236), and echovirus IgA (p=1). CONCLUSIONS: The results of this systematic study do not support the hypothesis that fibromyalgia is associated with infection by a human enterovirus.
  • Continuous clonidine infusion: an alternative for children on mechanical ventilation Original Article

    Neves, Cinara Carneiro; Fiamenghi, Verônica Indicatti; Fontela, Patricia Scolari; Piva, Jefferson Pedro

    Resumo em Inglês:

    SUMMARY OBJECTIVE: This study aimed to assess the clonidine infusion rate in the first 6 h, as maintenance dose (first 24 h), and in the pre-extubation period (last 24 h), as well as the cumulative dose of other sedatives and the hemodynamic response. METHODS: This is a retrospective cohort study. RESULTS: Children up to the age of 2 years who were admitted to the pediatric intensive care unit of a tertiary referral hospital in the south region of Brazil, between January 2017 and December 2018, were submitted to mechanical ventilation, and received continuous clonidine infusions were included in the study. The initial, maintenance, and pre-extubation doses of clonidine; the vasoactive-inotropic score; heart rate; and systolic and diastolic blood pressure of the study participants were assessed. A total of 66 patients with a median age of 4 months who were receiving clonidine infusions were included. The main indications for mechanical ventilation were acute viral bronchiolitis (56%) and pneumonia associated with acute respiratory distress syndrome (15%). The median of clonidine infusion in the first 6 h (66 patients) was 0.53 μg/kg/h (IQR 0.49–0.88), followed by 0.85 μg/kg/h (IQR 0.53–1.03) during maintenance (57 patients) and 0.63 μg/kg/h (IQR 0.54–1.01) during extubation period (42 patients) (p=0.03). No differences were observed in the doses regarding the indication for mechanical ventilation. Clonidine infusion was not associated with hemodynamic changes and showed no differences when associated with adjuvants. CONCLUSION: Clonidine demonstrated to be a well-tolerated sedation option in pediatric patients submitted to mechanical ventilation, without relevant influence in hemodynamic variables.
  • Evaluation of the cardioprotective and antihypertensive effect of AVE 0991 in normotensive and hypertensive rats Review Article

    Silva, Matheus Vinicius Barbosa da; Sousa Júnior, Célio Pereira de; Silva, Heverton Valentim Colaço da; Santos, Vanessa Maria dos; Feijao, Francisco Israel Magalhães; Bernardino, Amanda de Oliveira; Melo, José Augusto Calafell Roig Tiburcio de
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