Abstract in English:

ABSTRACT BACKGROUND: Oxygen is widely used to treat hypoxemia. OBJECTIVE: To determine the frequency of inappropriate oxygen administration in patients admitted to Internal Medicine (IM) wards and intensive care units (ICU). DESIGN AND SETTING: Single-center prospective, observational study in a tertiary university hospital in Ankara, Türkiye. METHODS: Patients who were hospitalized in the IM wards and ICU and were receiving oxygen were recruited. Every 6 hours, the oxygenation parameters were noted, and the averages over the first 24 hours of oxygen usage were recorded. Inappropriate usage was defined as oxygen flow rates > 6 L/min in the nasal cannula and < 5 L/min and > 10 L/min in the simple face mask, application of the simple face mask in chronic obstructive lung disease (COPD) exacerbation, SpO2 > 98% in general, or SpO2 > 92% in COPD exacerbation. RESULTS: Of the 397 patients, 20% in the IM wards and 50% of 124 in the ICU received oxygen. The oxygen method used was nasal cannula in 51%, simple face mask in 21%, and high-flow nasal cannula in 4% of the patients. Among the simple face mask applications, 46% were < 5 L/min and 5% were > 10 L/min. Among the 62% of patients with COPD exacerbations, the SpO2 was > 92%. CONCLUSION: The frequency of oxygen use was 20% among patients hospitalized in IM wards and 50% among patients in the ICU. Almost half of the simple face mask applications were inappropriate.

Abstract in English:

ABSTRACT BACKGROUND: The Surprise Question (SQ), “Would I be surprised if this patient were to die in the next 12 months?”, identifies patients at high risk of death who might benefit from palliative care (PC). However, little is known about its application in oncohematology. OBJECTIVES: To evaluate the performance of the SQ among inpatients with hematologic malignancies. DESIGN AND SETTING: A prospective cohort study was conducted between September and December 2021, including patients admitted to the Hematology Ward of the University Hospital in Salvador, Brazil. METHODS: Physicians answered the SQ (not surprised (SQ+) or surprised (SQ–)). Mortality data were assessed after one year. RESULTS: Eighty-one patients were included (56% SQ+ and 44% SQ–). At study closure, 36 patients (44%) had died. Median survival was 10.8 months (95%CI = 9.7–11.8) for SQ– and 5.6 months (95%CI = 4.1–7.1) for SQ+. Sensitivity was 86.1%, specificity 68.9%, positive predictive value 68.8%, negative predictive value 86.1%, and accuracy 76.5%. At the time of the interview, only 15 (18.5%) patients had consulted a PC specialist. By the study’s end, 48% had been referred to PC. These patients had poorer performance status (82% vs. 40%, P < 0.001) and more advance care planning records (87% vs. 14%, P < 0.001). CONCLUSIONS: Despite the prognostic uncertainty of hematologic malignancies, the SQ effectively estimates mortality and serves as a valuable tool for early PC integration in oncohematology.

Abstract in English:

ABSTRACT BACKGROUND: Heart failure with reduced ejection fraction (HFrEF) represents a compelling cause of hospital morbidity and mortality in Brazil. There is low adherence to guideline-directed medical therapy (GDMT), which in turn, can result in higher morbidity and mortality. OBJECTIVES: The present study aims to evaluate adherence to GDMT in patients with HFrEF in a Brazilian University hospital service. DESIGN AND SETTINGS: Observational, cross-sectional, single-center study conducted at the Hospital Universitário Professor Edgard Santos (HUPES), Salvador, BA, Brazil. METHODS: The study was conducted with convenience sampling at the cardiology outpatient clinic of a university hospital service. Patients with left ventricular ejection fraction (LVEF) < 40% who had reverse remodeling were excluded. RESULTS: 289 patients were included, with mean age 63 years, 54.7% were male, 56,4% mixed-race and 27,7% had Chagasic cardiomyopathy. 93.1% were prescribed ACEi, ARB or ARNi, 95.8% betablockers, 69.2% spironolactone and 8% the combination hydralazine/isosorbide-dinitrate. 71,7% were using enalapril, losartan or ARNi above 50% of GDMT target doses; 81,2% were using beta-blockers and 100% were using spironolactone. Only 21,2% were prescribed GDMT target doses of enalapril, losartan or ARNi and 52,3% of beta-blockers. 98,5% of spironolactone prescriptions reached GDMT target doses. CONCLUSIONS: We found high frequencies of prescription of GDMT for HFrEF, considering the therapeutic goals recommended by cardiology guidelines, but, prescription of target doses were low in ACEi, ARB or ARNi and beta-blockers.

Abstract in English:

ABSTRACT BACKGROUND: No study has reported about the prevalence and factors associated with dynapenic abdominal obesity in patients with pre-dialysis chronic kidney disease (CKD). OBJECTIVE: Evaluation of the prevalence of dynapenic abdominal obesity and its relationship with sociodemographic, lifestyle, clinical, and nutritional variables in patients with CKD not dependent on dialysis. DESIGN AND SETTING: A cross-sectional study was conducted at the Nutrition and Nephropathy Outpatient Clinic (public service) in Bahia, Brazil. METHODS: This cross-sectional study was conducted on 102 patients of both sexes, aged ≥ 20 years. Dynapenic abdominal obesity (DAO) was defined as the simultaneous presence of dynapenia (handgrip strength less than the first tertile of the sample itself, according to sex and age) and increased waist circumference. Differences between groups with and without DAO were assessed using the Student’s Mann–Whitney t-test, Pearson’s chi-square test, or Fisher’s exact test. Associations were tested using bivariate and multivariate models with Poisson regression to calculate the prevalence ratio and 95% confidence intervals (PR; 95% CI). RESULTS: The mean age of the patients was 58.7 (standard deviation = 11.69); 50.5% were male, 51.6% were elderly, 41.8% had diabetes, 5.5% were smokers, 58.2% were abdominally obese, and 38.5% were dynapenic. DAO was identified in 18.7% of participants and was associated with diabetes mellitus (PR = 2.8; 95% CI = 1.12-6.99) and smoking (PR = 3.22; 95% CI = 1.16-8.96). CONCLUSION: Non-dialysis dependent patients with CKD showed a significant prevalence of DAO associated with smoking and diabetes mellitus.

Abstract in English:

ABSTRACT BACKGROUND: Cardiovascular diseases, especially ischemic heart disease and stroke, are the main causes of mortality in older people. OBJECTIVES: To estimate the prevalence of stroke in older people in Brazil, we investigated its associations with sociodemographic factors, health-related behaviors, chronic diseases, body mass index and self-rated health and determined the frequency of limitations related to disease and care practices. DESIGN AND SETTING: This population-based, cross-sectional study used data from the 2019 Brazilian National Health Survey. METHODS: This study included older people aged ≥ 60 years (n = 22,728) who answered the question, “Has any doctor ever given you a diagnosis of stroke?” Adjusted odds ratios were estimated using logistic regression. RESULTS: The prevalence of stroke was 5.6% (95% confidence interval = 5.1-6.1) and was higher in men, individuals aged ≥ 70 years, those with a lower income, those without health insurance, ex-smokers, physically inactive individuals, those with excess weight/obesity, those who rated their own health as fair/poor/very poor and those who reported hypertension, diabetes, kidney failure, depression and heart disease. The most adopted care practices were follow-ups by a healthcare provider (60.8%), medication use (59.3%) and diet (47.2%). Only 17.0% of patients underwent physiotherapy, and 53.7% reported limitations in habitual activities. CONCLUSIONS: Subgroups of people more affected by stroke were identified, which included older individuals, those with lower socioeconomic status, ex-smokers and those with neuroendocrine and cardiovascular comorbidities. Less than 20% of patients underwent physiotherapy, which underscores the need to expand multidisciplinary care in the health network.

Abstract in English:

ABSTRACT BACKGROUND: Evidence on frailty prevalence in Brazilian patients with kidney transplant (KT) is scarce. OBJECTIVES: To estimate frailty prevalence in pre-KT patients and its association with functional, cognitive, and laboratory anomalies. DESIGN AND SETTING: Cross-sectional descriptive study included adult KT candidates assessed within 24 hours before KT, at two medical centers in Northeast Brazil. METHODS: Frailty was classified as non-frail (scores 0–1), intermediate frail (score 2), or frail (scores 3–5), using Fried et al. criteria. Patients were divided into: Non-frail (0–1) and Frail (≥ 2) groups. Katz and Lawton’s scales assessed the dependence on basic (ADLs) and instrumental (IADLs) activities of daily living, respectively. Montreal Cognitive Assessment was used to evaluate cognition. Laboratory tests were performed during pre-KT evaluation. RESULTS: Among 82 patients, most were male (80.5%), mixed-race (76.8%), and 48.8 ± 14.9-years-old. The Frail group (63.4%) comprised 34.1% intermediate frail, and 29.3% frail individuals. This group had a higher prevalence of hypertension (90.4% vs. 70%, P = 0.018), rheumatological diseases (15.4% vs. 0%, P = 0.024), cognitive impairment (71.0% vs. 40.7%, P = 0.020), dependence on ADLs (32% vs. 0%, P < 0.001) and IADLs (82% vs. 56.7%, P = 0.014), lower hemoglobin (11.9 ± 2.7 g/dL vs. 13.4 ± 1.8 g/d, P = 0.005), and lower creatinine levels (7.1 mg/dL, IQR 6–10 vs. 9.1 mg/dL, IQR 7–11, P = 0.044). CONCLUSIONS: Pretransplant frailty was prevalent and associated with functional disability, cognitive impairment, and biomarkers indicating sarcopenia. Early frailty assessment and identification of modifiable factors are essential.

Abstract in English:

ABSTRACT BACKGROUND: Interventions capable of modulating the heat shock response (HSR), such as physical exercise and heat therapy (HT), are potential therapeutic strategies for the prevention and treatment of diabetes. OBJECTIVE: This study aims to evaluate the effects of resistance training (RT) and HT on HbA1c levels, metabolic and inflammatory profiles, gut microbiota, and HSR in patients with type 2 diabetes mellitus (T2DM). DESIGN AND SETTING: A randomized, double-blind, parallel clinical trial will be conducted for 12 weeks in southern Brazil. METHODS: Participants with T2DM will be randomized into control (any intervention), RT, or HT groups. In the RT group, participants will perform supervised exercise, and the HT group will undergo whole-body heat treatment in an environmental chamber initially set at 55.0°C, both on three non-consecutive days of the week (60 min). Blood samples will be collected before and after 12 weeks of treatment. Heat shock response, body composition and physical fitness, glycemic control, lipid profile, gut microbiota composition and diversity, inflammatory markers, and flow-mediated dilation will be evaluated. CONCLUSION: Since the HSR response is decreased in individuals with diabetes, we believe that improving the HSR may be important in preventing chronic complications associated with T2DM. This randomized clinical trial will determine the efficacy of HT compared to RT in improving HSR when combined with conventional therapy in individuals with T2DM. Multiple HT and RT effects may contribute to a lower mortality risk in these individuals. CLINICAL TRIAL REGISTRATION: Unique Identifier NCT05847075. https://clinicaltrials.gov/study/NCT05847075.

Abstract in English:

ABSTRACT BACKGROUND Physical activity (PA) and sedentary behavior (SB) are key determinants of health outcomes in individuals living with type 1 diabetes (T1D). However, the influence of sociodemographic and clinical factors on engagement in these behaviors is not yet well understood. OBJECTIVE This study aimed to analyze the associations of sociodemographic factors, body mass index, and both the duration and age at diagnosis of diabetes with SB, light-intensity physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) in Brazilian adults. DESIGN AND SETTING A cross-sectional study was conducted at the Diabetes and Metabolism Service of a public secondary care unit in Rio de Janeiro. METHODS One hundred adults diagnosed with T1D had their daily awake time spent in SB, LPA, and MVPA measured using triaxial accelerometers. Sociodemographic and clinical factors were assessed using questionnaires. Generalized Linear Models were used to analyze the relationships of these factors with SB, LPA, and MVPA. RESULTS Significant associations were found between age, education level, and employment status with SB and LPA, but not with MVPA. On average, each additional year of age was associated with decreased time in SB and increased time in LPA. Higher education levels and unemployment were linked to more SB and less time in LPA. CONCLUSIONS Age, education level, and employment status emerged as key sociodemographic predictors of SB and LPA in Brazilian adults living with T1D. These findings contribute to a better understanding of the sociodemographic determinants associated with SB and PA in individuals diagnosed with T1D.

Abstract in English:

ABSTRACT BACKGROUND The mismatch between the supply and demand for organs and tissues for transplantation is one of the reasons for the high rates of donation refusal. A more recent contributing factor has been the COVID-19 pandemic. OBJECTIVES To analyze, through the Terms of Donation of Organs and Tissues, the rates and trends of specific refusals for each organ and tissue from brain-dead donors between 2001 and 2020 in an Organ Procurement Organization. DESIGN AND SETTING This was a cross-sectional, exploratory, and retrospective quantitative study on specific donation refusals conducted in one of the ten Organ Procurement Organizations in São Paulo, Brazil. METHODS The variables collected included year, age, gender, cause of death, type of hospital, and organs and tissues donated and refused. The data were transferred to Stata software for descriptive and inferential analysis, using generalized linear regression to examine time trends. A significance level of P lt; 0.05 was adopted. RESULTS Bones and skin had the highest rates of tissue donation refusal, at 56.40% and 55.37%, respectively. Among solid organs, the pancreas (4.05%) and lungs (5.23%) had the highest refusal rates. In the first decade analyzed, there were increasing time trends in refusals of valves, heart, pancreas, and lungs. In contrast, during the second decade, refusals of valves, kidneys, and pancreas showed decreasing trends. In 2020, the number of refusals for all tissues declined. CONCLUSION To reduce tissue-specific refusals, it is important to address and mitigate family beliefs, myths, and negative attitudes toward organ and tissue donation.

Abstract in English:

ABSTRACT BACKGROUND: There are several randomized controlled trials (RCTs) in the literature on musculoskeletal rehabilitation that compare different types of exercise; however, the comparison is not relevant because the groups generally perform different physical efforts, and the researchers are not aware of this, nor do they control for the confounding variables. OBJECTIVES: To discuss the methods of comparison of different types of exercises in musculoskeletal rehabilitation. DESIGN AND SETTINGS: Short communication developed at the Universidade Federal de São Carlos (UFSCar), São Carlos (SP), Brazil. METHODS: A narrative review of the motion cadence, time-under-tension, actual duration of an exercise session, and total physical effort was conducted. RESULTS: To compare the different types of exercise, it is crucial that the parameters of the proposed exercises are the same between the groups, i.e., the exercise intensity, total physical effort, and actual duration of the exercise session. CONCLUSION: It is correct to compare different types of exercise, however, in the field of musculoskeletal rehabilitation, RCTs adequately controlled for these variables are lacking.

Abstract in English:

ABSTRACT BACKGROUND: Cardiovascular disease (CVD) and stroke are among the leading causes of death worldwide. OBJECTIVE: This article presents a review of the application of artificial intelligence in identifying biomarkers for CVD and stroke. DESIGN AND SETTING: Narrative review conducted by a research group at the Universidade Federal de São Paulo, São Paulo, Brazil. METHODS: A literature search was conducted to identify the main applications of artificial intelligence in ophthalmology, using the keywords “artificial intelligence,” “prediction,” “biomarker,” “cardiovascular disease,” “retina,” and “stroke,” covering the period from January 1, 2018, to July 3, 2023. The Medical Literature Analysis and Retrieval System Online (MEDLINE, via PubMed) and the Latin American and Caribbean Literature in Health Sciences (Literatura Latino-Americana e do Caribe em Ciências da Saúde, LILACS, via the Virtual Health Library) were used to identify relevant articles. RESULTS: A total of 30 references were retrieved, of which 14 were considered eligible for intensive review and critical analysis. CONCLUSIONS: Artificial intelligence has proven effective in identifying non-invasive biomarkers through the analysis of patients’ retinal examinations. These findings contribute to a better understanding of the pathophysiology of CVD and stroke.