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Revista da Associação Médica Brasileira, Volume: 69, Número: 6, Publicado: 2023
  • Comments on “Demonstration of kinesio taping effect by ultrasonography in neck pain” Letter To The Editor

    Pontes-Silva, André
  • Clinical effects of knee arthroplasty Letter To The Editor

    Bezerra, Josiane Costa Pereira; Santos, Maristela Linhares Costa dos; Rocha, Emannuel Alcides Bezerra; Sanchis, Gerônimo Bouza; Lopes, Johnnatas Mikael
  • Answers to comments on “Comparison of severe acute respiratory syndrome coronavirus 2 (COVID-19) vaccine side effects by age groups” Letter To The Editor

    Tosun, Fadime; Bülbül, Mehmet; Tosun, İsmail
  • Correspondence on the evaluation of patients with COVID-19 vaccine side effects Letter To The Editor

    Kleebayoon, Amnuay; Wiwanitkit, Viroj
  • Comment on “Continuous clonidine infusion: an alternative for children on mechanical ventilation” Letter To The Editor

    Zhao, Yanxue; Shang, Li
  • Comments on “Overweight status, abdominal circumference, physical activity, and functional constipation in children” Letter To The Editor

    Pontes-Silva, André; Zharikov, Yury
  • Comment on “The prognostic impact of tumor necrosis in non-muscle invasive bladder cancer” Letter To The Editor

    Wang, Dexin; Liu, Yiming
  • Brazilian Portuguese version of Eating Pathology Symptoms Inventory Letter To The Editor

    Oliveira, Jônatas de
  • Comment on “Prognostic value of T-wave positivity in lead aVR in COVID-19 pneumonia” Letter To The Editor

    Chen, Weihua
  • Mean arterial pressure and outcomes in critically ill patients: is there a difference between high and low target? Point Of View

    Palacios, Diana Cristina Buendía; Silva, João André Freitas; Sarmento, Ana Francisca Torres; Sierra, Michael Gregorio Ortega
  • Palliative extubation experience in a community hospital in southern Brazil Short Communication

    Antonio, Ana Carolina Peçanha; Antonio, Juliana Peçanha
  • What is important in family counseling in cases of fetuses with congenital heart disease? Short Communications

    Dias, Marcela Bezerra; Tuda, Luisa Tiemi Souza; Carvalho, Luana Izabela Azevedo de; Estevam, Thayla Lais; Mori, Bruno; Novelleto, Ana Luiza Menezes Teles; Araujo Júnior, Edward; Amorim, Luciane Alves da Rocha
  • A retrospective analysis: the outcome of renal replacement therapies in critically ill children Original Article

    Çeleğen, Kübra; Çeleğen, Mehmet

    Resumo em Inglês:

    SUMMARY OBJECTIVE: A few pediatric studies were present which focused on renal replacement therapy used for critically ill children. This research aimed to determine the ratio of utilization of intermittent hemodialysis, continuous renal replacement therapy, and peritoneal dialysis, and to study the properties and outcomes of critically ill pediatric patients who underwent renal replacement therapy. METHODS: Critically ill children admitted to the intensive care unit and received renal replacement therapy from February 2020 to May 2022 were included. The children were divided into three groups: hemodialysis, continuous renal replacement therapy, and peritoneal dialysis. RESULTS: A total of 37 patients (22 boys and 15 girls) who received renal replacement therapy met the criteria for this study. Continuous renal replacement therapy was used in 43%, hemodialysis in 38%, and peritoneal dialysis in 19%. In all, 28 (73%) children survived and 9 (27%) died in intensive care unit. The mean systolic blood pressure was significantly lower among children who received continuous renal replacement therapy (p<0.001). The need for inotropic medications and a higher PRISM III score were found to be the greatest indicators of mortality. CONCLUSION: The outcome of children receiving renal replacement therapy seems to be related to their needs for vasoactive drugs and the severity of the underlying disease in the continuous renal replacement therapy group relative to the other groups.
  • Immunostaining of stromal CD56 cells in ovarian malignancies Original Article

    Lima, Cid Almeida de; Jammal, Millena Prata; Etchebehere, Renata Margarida; Murta, Eddie Fernando Candido; Nomelini, Rosekeila Simões

    Resumo em Inglês:

    SUMMARY OBJECTIVES: The aim of this study was to evaluate CD56 immunostaining in the stroma of benign and malignant ovarian epithelial neoplasms and associate the CD56 immunostaining with prognostic factors and survival in ovarian cancer. METHODS: Patients with ovarian epithelial neoplasia (n=77) were studied with a prospective cohort. The CD56 immunostaining was evaluated in the peritumoral stroma. Two groups were evaluated: benign ovarian neoplasms (n=40) and malignant ovarian neoplasms (n=37). Data were recorded for histological type and grade, International Federation of Gynecology and Obstetrics staging, molecular subtype, and lymph node metastases. Fisher’s exact test and Kaplan-Meier survival curves were used, with a significance level of ≤0.05. RESULTS: We found greater CD56 stromal immunostaining in malignant neoplasms when compared to the group of benign neoplasms (p=0.00001). There was no significant difference in relation to the prognostic factors and survival. CONCLUSION: Malignant ovarian neoplasms showed higher stromal CD56 immunostaining. As the prognostic value of natural killer in ovarian cancer is controversial, knowing the specific function of each cell present both in the tumor tissue and systemically may help guide successful immunotherapies in the near future.
  • Accuracy of intrapartum cardiotocography in identifying fetal acidemia by umbilical cord blood analysis in low-risk pregnancies Original Article

    Tomich, Michaela Franco; Leoni, Renato Silva; Meireles, Pedro Teixeira; Petrini, Caetano Galvão; Araujo Júnior, Edward; Peixoto, Alberto Borges

    Resumo em Inglês:

    SUMMARY OBJECTIVE: The aim of this study was to evaluate the accuracy of intrapartum cardiotocography in identifying fetal acidemia by umbilical cord blood analysis in low-risk pregnancies. METHODS: This is a retrospective cohort study of low-risk singleton pregnancies in labor after performing intrapartum cardiotocography categories I, II, and III. The presence of fetal acidemia at birth was identified by analyzing the pH of umbilical cord arterial blood (pH<7.1). RESULTS: No significant effect of the cardiotocography category on the arterial (p=0.543) and venous (p=0.770) pH of umbilical cord blood was observed. No significant association was observed between the cardiotocography category and the presence of fetal acidemia (p=0.706), 1-min Apgar score <7 (p=0.260), hospitalization in the neonatal intensive care unit (p=0.605), newborn death within the first 48 h, need for neonatal resuscitation (p=0.637), and adverse perinatal outcomes (p=0.373). Sensitivities of 62, 31, and 6.0%; positive predictive values of 11.0, 16.0, and 10.0%; and negative predictive values of 85, 89.0, and 87.0% were observed for cardiotocography categories I, II, and III, respectively. CONCLUSION: The three categories of intrapartum cardiotocography presented low sensitivities and high negative predictive values to identify fetal acidemia at birth in low-risk pregnancies.
  • Does telecounseling reduce anxiety and depression during pregnancy? A randomized controlled trial Original Article

    Koc, Emine; Baltaci, Nazlı; Bal, Sümeyye

    Resumo em Inglês:

    SUMMARY OBJECTIVE: This study aims to examine the effect of telecounseling in reducing the anxiety and depression experienced by pregnant women. METHOD: This randomized control trial was conducted on 100 pregnant women (50 in each intervention and control group). The intervention group received telecounseling with regard to the mother and the fetus as needed between 08:00 h and 20:00 h for 6 weeks at home. The control group received only routine care. Anxiety and depression levels were evaluated at the beginning and end of the study using the Hospital Anxiety Depression Scale. RESULTS: Anxiety and depression levels were found to be lower in the intervention group than in the control group (p<0.001). In the control group, the anxiety score increased from 5.62 to 7.16, and the depression score increased from 4.92 to 5.76 without any intervention (p<0.001). CONCLUSION: This study shows that telecounseling may have an effect on reducing the level of anxiety and depression of pregnant women.
  • Comparison of hepatitis B surface antigen, anti-hepatitis B surface, and anti-hepatitis C virus prevalence in Syrian refugee pregnant women and Turkish pregnant women Original Article

    Hansu, Kemal; Cikim, Ismail Gurkan

    Resumo em Inglês:

    SUMMARY OBJECTIVE: In this study, we aimed to determine and compare hepatitis B surface antigen level, anti-hepatitis B surface, and anti-hepatitis C virus positivity in Turkish pregnant women and Syrian refugee pregnant women residing in Turkey. METHODS: The study was conducted on Syrian refugee pregnant women aged 15–45 years and Turkish pregnant women who applied to state hospital's gynecology and obstetrics outpatient clinics between April 30, 2012, and April 30, 2022. In our study, 136,376 pregnant women (104,629 Turkish and 31,747 Syrian) tested for hepatitis B surface antigen, 72,035 pregnant women (53,070 Turkish and 18,965 Syrian) tested for anti-hepatitis B surface, and 120,611 pregnant women (92,514 Turkish and 28,097 Syrian) tested for anti-hepatitis C virus were included. The patients were divided into six groups for hepatitis B surface antigen, anti-hepatitis B surface, and anti-hepatitis C virus results based on their age: <20 years, 20–24 years, 25–29 years, 30–34 years, 35–39 years, and >40 years. For each age group, the results of Syrian refugee pregnant women and Turkish pregnant women were compared. RESULTS: Hepatitis B surface antigen positivity and anti-hepatitis B surface positivity were significantly higher in Turkish pregnant women compared to Syrian refugee pregnant women. Anti-hepatitis C virus positivity was significantly higher in Syrian refugee pregnant women compared to Turkish pregnant women. CONCLUSION: Based on the available data, we think that hepatitis B surface antigen, anti-hepatitis B surface, and anti-hepatitis C virus tests should be done routinely for pregnant women. Raising awareness among Syrian refugees about the hepatitis B virus vaccine as well as encouraging them to be vaccinated may reduce the negative impact of migration.
  • Is there an association between endometriosis and thyroid autoimmunity? Original Article

    Şerifoğlu, Hilal; Arinkan, Sevcan Arzu; Pasin, Ozge; Vural, Fisun

    Resumo em Inglês:

    SUMMARY OBJECTIVE: It has been suggested that non-uterine endometrial implants can express thyroid-stimulating hormone receptors, thus inducing the formation of thyroid-stimulating immunoglobulin. We aimed to compare the autoantibody positivity in patients with and without endometriosis and to determine whether there is a difference in the incidence of thyroid diseases. METHODS: This prospective observational study was conducted on 102 women who had been operated on for benign gynecological diseases. Cases enrolling in the study were divided into two groups: the study group with endometriosis (n=51) and the control group without endometriosis (n=51). The blood tests for thyroid-stimulating hormone, free thyroxine (fT4), thyroid-stimulating immunoglobulin, and anti-thyroid peroxidase antibody levels were checked. RESULTS: The mean thyroid-stimulating immunoglobulin level was found to be higher in the endometriosis group than in the control group. However, this difference was not statistically significant. No significant difference was detected between endometriosis and control groups in terms of anti-thyroid peroxidase antibody and thyroid-stimulating hormone levels. The mean fT4 value (0.97±0.13 ng/dL) of the endometriosis patients was found to be significantly lower than the control group (1.08±0.21 ng/dL) (p=0.002; p<0.05). The mean anti-thyroid peroxidase antibody value of cases with bilateral endometrioma (82.21±252.29 IU/mL) was significantly higher than cases with unilateral endometrioma (15.81±83.13 IU/mL) (p=0.028; p<0.05). There is a positive and significant relationship between the size of endometriosis and anti-thyroid peroxidase antibody values (p=0.011; p<0.05). CONCLUSION: This study points to an association between endometrioma diameter and anti-thyroid peroxidase antibody values which can be a stepping stone for new studies evaluating this hypothesis further.
  • Thrombocytosis in children Original Article

    Babacan, Altay; Şenol, Feray Ferda

    Resumo em Inglês:

    SUMMARY OBJECTIVE: We aimed to investigate the frequency and causes of thrombocytosis in patients admitted to the Department of Pediatric Hematology and Oncology of Elazig Fethi Sekin City Hospital, Elazig, Turkey. METHODS: Between 2019 and 2021, the laboratory parameters of 2,500 patients admitted to the Hematology Department were studied. During this examination, 319 (12.76%) patients were found to have thrombocytosis. Demographic characteristics (age and gender), hematologic parameters (hemoglobin, white blood cells, and platelets), and ultimate diagnoses ot the cases were recorded from their files. RESULTS: Of these 319 patients with thrombocytosis, 197 (1.8%) were male and 122 (38.2%) were female, and the mean age was 72.0±69.0 (1–216) months. The median platelet count of the patients was 590.43±280.12/μL (450,000–750,000). The most common cause of secondary thrombocytosis was infection, accounting for 37.9% of all patients. Other common causes were sickle cell anemia (21%), iron deficiency anemia (15.4%), colloid tissue disease (6.6%), hemolytic anemia (5.0%), splenectomy (4.5%), and other causes (9.7%). CONCLUSION: In our study, infections were the most common cause of thrombocytosis. In addition to infections, sickle cell anemia and iron deficiency anemia should also be considered in the differential diagnosis of thrombocytosis.
  • “Zooming” in the association between rosacea and fibromyalgia syndrome: ıs it worth mentioning? Original Article

    Kulaklı, Sevgi; Oğuz, Işıl Deniz; Sarı, Ilker Fatih; Sengul, Ilker; Kulaklı, Fazıl; Akşan, Burak; Sengul, Demet

    Resumo em Inglês:

    SUMMARY OBJECTIVE: We aimed to detect the frequency of fibromyalgia syndrome in patients with rosacea and determine whether this frequency was affected by the severity of rosacea and the quality of life. METHODS: In this prospective, controlled, cross-sectional study, a total of 94 consecutive rosacea cases and 87 age- and sex-matched controls were enrolled. The severity of rosacea was assessed in light of the findings of the National Rosacea Society Ethics Committee. Dermatology Life Quality Index and Rosacea-specific Quality-of-Life instrument had been applied to the cases of rosacea. The diagnosis of fibromyalgia syndrome was established according to the 2016 revised fibromyalgia diagnostic criteria, and the Fibromyalgia Impact Questionnaire was used to determine the functional disability. RESULTS: The frequency of fibromyalgia syndrome was higher in the rosacea group than in the control group (p=0.01), and Dermatology Life Quality Index and Rosacea-specific Quality-of-Life instrument were higher in patients with rosacea with fibromyalgia syndrome (p=0.006 and p=0.004, respectively). A statistically significant weak positive correlation was observed between Dermatology Quality-of-Life Index, Rosacea-specific Quality-of-Life instrument, and Fibromyalgia Impact Questionnaire; symptom severity scale scores; and fibromyalgia score (r=0.35, r=0.259, and r=0.32 and r=0.376, r=0.305, and r=0.312, respectively). CONCLUSION: The patients with rosacea have higher rates and disability scores of fibromyalgia syndrome than healthy controls, independent of rosacea severity, and quality of life is correlated with fibromyalgia scores. We might point out that fibromyalgia syndrome accompanying rosacea has more restrictions in their daily routine activities than rosacea alone. As such, physicians should be aware of the possible coexistence of rosacea and fibromyalgia syndrome.
  • miR-21, miR-221, and miR-222 upregulation in lung cancer promotes metastasis by reducing oxidative stress and apoptosis Original Article

    Tepebaşı, Muhammet Yusuf; Öztürk, Önder

    Resumo em Inglês:

    SUMMARY OBJECTIVE: The purpose of our research was to observe the effects of miR-21, miR-221, and miR-222, as well as their target genes on oxidative stress, lung cancer formation, and metastasis. METHODS: Positron emission tomography/computed tomography, fiberoptic bronchoscopy, and/or endobronchial ultrasonography were performed on a total of 69 lung cancer patients to detect the presence or absence of metastasis, and the patients were classified based on the types of cancer. Total RNA and miRNA were isolated from the obtained biopsy samples. The quantitative analysis of hsa-miR-21-5p, hsa-miR-222-3p, and hsa-miR-221-3p and their target genes was performed by the RT-qPCR method. In determining oxidative stress, total antioxidant status and total oxidant status in tissue and total thiol and native thiol in blood were determined spectrophotometrically. OSI and disulfide were calculated. RESULTS: We discovered that the metastasis group had higher levels of hsa-miR-21-5p, hsa-miR-221-3p, and hsa-miR-222-3p (p<0.05). While TIMP3, PTEN, and apoptotic genes decreased in metastasis, anti-apoptotic genes increased (p<0.05). In addition, while oxidative stress decreased in the metastasis group, no change was found in the serum (p>0.05). CONCLUSION: Our findings show that upregulation of hsa-miR-21-5p, hsa-miR-221-3p, and hsa-miR-222-3p effectively contributes to both proliferation and invasion by influencing oxidative stress and mitochondrial apoptosis.
  • Maternal-fetal outcomes of women with hypertensive disorders of pregnancy Original Article

    Xavier, Ivete Matias; Simões, Ana Carolina Zimmermann; Oliveira, Ronnier de; Barros, Yasha Emerenciano; Sarmento, Ayane Cristine Alves; Medeiros, Kleyton Santos de; Costa, Ana Paula Ferreira; Korkes, Henri; Gonçalves, Ana Katherine

    Resumo em Inglês:

    SUMMARY OBJECTIVE: The objective of this study was to determine adverse maternal and perinatal outcomes in pregnant women with hypertensive disorders of pregnancy. METHODS: An analytical cross-sectional study was conducted on women admitted with hypertensive disorders of pregnancies to a university maternity hospital from August 2020 to August 2022. Data were collected using a pretested structured questionnaire. Variables associated with adverse maternal and perinatal outcomes were compared using multivariable binomial regression. RESULTS: Of 501 women with pregnancies, 2, 35, 14, and 49% had eclampsia, preeclampsia, chronic hypertension, and gestational hypertension, respectively. Women with preeclampsia/eclampsia had significantly higher risks of cesarean section (79.4 vs. 65%; adjusted RR, 2,139; 95%CI, 1,386–3,302; p=0.001) and preterm delivery at <34 weeks’ gestation (20.5 vs. 6%; adjusted RR, 2.5; 95%CI, 1.19–5.25; p=0.01) than those of women with chronic/gestational hypertension. Risks of prolonged maternal hospitalization (43.9 vs. 27.1%), neonatal intensive care unit admission (30.7 vs. 19.8%), and perinatal mortality (23.5 vs. 11.2%) were higher among women with preeclampsia/eclampsia. CONCLUSIONS: Women with preeclampsia/eclampsia had a higher risk of adverse maternal and neonatal outcomes than those with chronic or gestational hypertension. This major maternity care center requires strategies for preventing and managing preeclampsia/eclampsia to improve pregnancy outcomes.
  • Perception of newly graduated physicians toward ethical education in medical schools: a Brazilian cross-sectional nationwide study Original Article

    Gameiro, Gustavo Rosa; Gameiro, Giovana Rosa; Miotto, Bruno Alonso; Guilloux, Aline Gil Alves; Cassenote, Alex Jones Flores; Scheffer, Mario César

    Resumo em Inglês:

    SUMMARY OBJECTIVE: The objective of this study was to evaluate fresh medical graduates’ perceptions regarding the general aspects of ethics teaching in Brazilian medical schools. METHODS: A structured questionnaire was applied to 4,601 participants among the 16,323 physicians who registered in one of the 27 Regional Medical Councils of Brazil in 2015. Answers to four questions regarding general aspects of ethics education in medical school were analyzed. Sampling procedures involved two stratification variables: legal nature (public vs. private) of medical schools and monthly household income higher than 10 minimum wages. RESULTS: A large percentage of the participants had witnessed unethical behaviors during contact with patients (62.0%), toward coworkers (51.5%), and in relationships with patients’ families (34.4%) over the course of their medical training. Even though most of the responders (72.0%) totally agreed that patient-physician relationship and humanities education were part of their medical school curriculum, important topics such as conflicts of interest and end-of-life education were not satisfactorily addressed in the participants’ medical training. Statistically significant differences were found between the answers of public and private school graduates. CONCLUSION: Despite great efforts to improve medical ethics education, our findings suggest the persistence of deficits and inadequacies in the ethics training currently given in medical schools in Brazil. Further modifications in ethics training must be made to address the deficiencies shown in this study. This process should be accompanied by continuous evaluation.
  • Feminization of science: female pioneering in the healthcare area Review Article

    Marquini, Gisele Vissoci; Oliveira, Letícia Maria de; Takano, Claudia Cristina; Dias, Marcia Maria; Silva, Eduarda Vilela; Nunes, Ana Beatriz Amorim; Bella, Zsuzsanna Ilona Katalin de Jármy-Di; Sartori, Marair Gracio Ferreira
  • Management of fecal incontinence: what specialists need to know? Review-Article

    Murad-Regadas, Sthela Maria; Reis, Doryane Lima dos; Fillmann, Henrique Sarubbi; Lacerda Filho, Antonio
  • Auricular vagus nerve stimulation: a new option to treat inflammation in COVID-19? Review Article

    Sant’Anna, Fernando Mendes; Resende, Rodrigo César Lima; Sant’Anna, Lucas Bonacossa; Couceiro, Sérgio Lívio Menezes; Pinto, Romero Bonacossa Soares; Sant’Anna, Mariana Bonacossa; Chao, Liaw Wen; Szeles, Jozsef Constantin; Kaniusas, Eugenijus
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