Einstein-Sao Paulo最新文献

Objective: To systematically review the effects of recruitment maneuvers on patients with acute respiratory distress syndrome.

Methods: This systematic review and meta-analysis using the PICO methodology with keywords (respiratory distress syndrome, recruitment maneuvers, lung recruitment, acute respiratory distress syndrome, alveolar recruitment, and adult acute respiratory distress syndrome). Studies involving patients >18 years, regardless of sex, with acute respiratory distress syndrome, mechanically ventilated for at least 24 h, published in English, Portuguese, and Spanish, with no year restrictions, were included. Studies that combined recruitment maneuvers with other techniques and those conducted in animals were excluded. Boolean operators "AND" and "OR" were used.

Results: Fifteen studies were included. The recruitment maneuver proved to be effective in oxygenating patients (mean difference=45.05 mmHg (95% confidence interval (95%CI): 31.37-58.74)), but there was no statistically significant difference in the rate of mortality OR=0.89 (95%CI=0.74-1.08) and barotrauma RR=0.93 (95%CI=0.56-1.54).

Conclusion: Recruitment maneuvers should not be used routinely in the care of patients with acute respiratory distress syndrome, but it is a good rescue strategy when other methods fail to improve oxygenation.

Prospero database registration: (www.crd.york.ac.uk/prospero) under ID CRD42021227231.

Epiphyseal displacement of the distal humerus is rare and difficult to diagnose. In addition, the literature on the prognosis and treatment is limited. Here, we present a case of distal humeral physeal separation with significant displacement in a neonate. A favorable outcome was obtained following closed reduction and percutaneous fixation with Kirschner wires assisted by arthrography. This report adds valuable information on this subject to the existing literature.

Objective: To evaluate the risk factors for healthcare-related infections during the COVID-19 pandemic in intensive care units, to investigate the impact of COVID-19 on Central Line-Associated Bloodstream Infection, Catheter-Associated Urinary Tract Infection, and ventilator-associated pneumonia, and to describe healthcare-associated infections in the waves of the COVID-19 pandemic.

Methods: This nested case-control study was conducted in a 137-bed adult medical/surgical intensive care unit at a private hospital in São Paulo, Brazil, between January 11, 2019, and May 21, 2022. Case patients were identified using the Nosocomial Infection Control Committee database and control patients were identified using the intensive care unit's EPIMED system. For the analysis of risk factors, the chi-square test, multiple logistic regression model, and Kaplan-Meier method were used to identify independent risk factors, considering p<0.05.

Results: The Case Group consisted of 189 healthcare-associated infections, including ventilator-associated pneumonia (61.4%), Central Line-Associated Bloodstream Infection (30.1%), Catheter-Associated Urinary Tract Infection (8.5%), and the Control Group consisted of 6,834 patients. The independent risk factors were COVID-19 infection (OR=2.84, 95%CI=1.92-4.23, p<0.01), length of stay in intensive care greater than 14 days (OR=3.15, 95%CI=1.95-5.14, p<0.01), length of hospital stay greater than 30 days (OR=3.64, 95%CI=2.44-5.51, p<0.01), and patients who were in the third wave (OR=1.72, 95%CI=1.05-2.91, p=0.04). Ventilator-associated pneumonia was the only healthcare-related infection for which COVID-19 infection was an independent risk factor (OR=3.32, 95%CI=1.92-5.94, p<0.01).

Conclusion: COVID-19 and length of hospital stay were independent risk factors for healthcare-associated infections, and only ventilator-associated pneumonia was affected by the COVID-19 pandemic.

Objective: This integrative review article examines the efficacy of adoptive cell therapy using tumor-infiltrating lymphocytes, with a particular focus on the treatment of melanomas and other solid tumors.

Methods: The methodology encompasses theme definition, comprehensive database searches, and a critical review of pertinent literature. Of the 1,947 articles initially identified, 15 were meticulously selected based on stringent inclusion and exclusion criteria.

Results: The findings suggest that tumor-infiltrating lymphocytes-based therapy is particularly effective in treating metastatic melanomas, as noted by its tailored approach and substantial potential. However, the applicability of these findings to other solid tumor types remains limited.

Conclusion: This review indicates that adoptive cell therapy using tumor-infiltrating lymphocytes demonstrates efficacy, especially in the treatment of metastatic melanoma, and shows considerable promise for treating solid tumors.

This case report discusses the migration of a foreign body from the breast to the mediastinum, which is rarely reported, and highlights complications associated with Okibari acupuncture. This technique involves the insertion of metal fragments into the skin. A 53-year-old woman underwent mammography showing acupuncture-related metallic fragments in the breast. Cardiac evaluation revealed the presence of metallic fragments in the right ventricle and myocardium. Despite the fragments' location in the mediastinum, the patient remained asymptomatic, leading us to take a conservative approach. This case highlights the importance of awareness of the potential complications of foreign bodies and emphasizes the need for careful monitoring.

Objective: This study aimed to investigate the relationship between depression and erectile dysfunction while controlling for sociodemographic, physical health, psychological, and lifestyle factors. Additionally, it aimed to compare erectile dysfunction with other clinical, laboratory, and behavioral variables among individuals with depression in the same population.

Methods: We included 21,139 men (≥40 years) who underwent continuous health screening in a quaternary hospital in São Paulo between January 2008 and December 2018. The analysis included laboratory, clinical, and behavioral profile data.

Results: The multivariate model indicated that alcohol consumption, perceived stress, lower urinary tract symptoms, erectile dysfunction, body mass index, and triglyceride levels were independent and strong factors associated with depression in men. Additionally, higher levels of physical activity were found to be an independent and strong factor associated with reduced odds of depression in men (all p<0.001). Additionally, depressed men had a higher body mass index (28.50±4.35 versus 27.65±3.93kg/m², p=0.003), and increased prevalence of hypertension, diabetes mellitus , lower urinary tract symptoms, metabolic syndrome, nonalcoholic fatty liver, sedentary physical activity levels, active tobacco use, risk of alcohol consumption, and perceived stress.

Conclusion: Erectile dysfunction was an independent and strong factor associated with depression in Brazilian men, highlighting the need for integrated treatment approaches addressing both conditions.

Objective: Abdominal ultrasonography is widely used to evaluate suspected cases of appendicitis. Objective descriptions of the direct and indirect signs of appendicitis result in varied assessments of its likelihood. This study introduces the Appendix Imaging Reporting and Data System (APENDIC-RADS) to standardize the reporting of appendix ultrasound findings.

Methods: This single-center retrospective study included consecutive patients of all ages who underwent abdominal ultrasonography for the investigation of acute appendicitis. The primary outcome was histopathological confirmation of acute appendicitis post-surgery. The imaging findings were classified into five categories: APENDIC-RADS 0, where the appendix cannot be visualized; APENDIC-RADS 1, indicating a normal appendix; APENDIC-RADS 2, describing an appendix that is likely normal but only partially visualized; APENDIC-RADS 3, appendicitis cannot be ruled out due to uncertain features and APENDIC-RADS 4, acute appendicitis.

Results: A total of 747 patients were assessed for suspected acute appendicitis using ultrasonography. Of the diagnosed patients, 52% were male, primarily exhibiting symptoms such as nausea and/or vomiting (60%), right iliac fossa pain (54%), and sudden decompression in the right iliac fossa (24%). Stratification into APENDIC-RADS categories revealed a significant variation in the incidence of acute appendicitis, with incidence rates of 4.5% for category 0 and 0.7%, 2.2%, 11.5%, and 93.5% for categories 1 to 4, respectively (p<0.001). The APENDIC-RADS showed excellent discriminative ability, evidenced by an area under the receiver operating characteristic curve of 0.950 (95%CI=0.899-1).

Conclusion: APENDIC-RADS categorization demonstrated excellent performance in standardizing the ultrasound-determined probability of acute appendicitis. Its implementation could improve physician communication and standardization of patient management.

A nephropulmonary fistula is a rare complication of a non-functioning kidney, associated with a history of infection. Medical literature describes it as an adult disease in the pre-antibiotic era, and nowadays, is a rare complication. This study reports the case of a patient with nephrolithiasis who developed a nephropulmonary fistula resulting in the migration of renal coralliform stones to the lung parenchyma. The treatment included posterior mini-thoracotomy with partial costectomy of the 9th right costal arch, pneumonotomy for the lung abscess, stone removal, abscess drainage with a Foley probe, and pleural drainage with a tubular drain.

Objective: To investigate differences in the prevalence of frailty between LGBT+ and non-LGBT+ older adults.

Methods: A cross-sectional study involving Brazilians aged 50 and over was performed. The participants were invited to participate in an anonymous online survey between August 2019 and January 2020. The survey was widely distributed in neighborhood associations, day centers, non-governmental organizations, and social media. Those who identified as homosexual, bisexual, pansexual, non-heterosexual, transgender, travesti, or non-binary were grouped as LGBT+. Participants who were both cisgender and heterosexual were categorized as non-LGBT+. Frailty was measured using the FRAIL scale, and the participants were categorized as robust, prefrail, or frail. Generalized ordered logistic models were used to examine the adjusted association between LGBT+ status and frailty according to age and sex.

Results: The study sample included 6,693 participants with a median age of 60 years. Overall, 1,332 patients were LGBT+ (19.9%), and 5,361 were non-LGBT+ (80.1%). Pre-frailty or frailty was observed in 656 (49%) LGBT+ participants and 2,460 (46%) non-LGBT+ participants (p=0.03). Multivariate analyses showed that being LGBT+ was independently associated with frailty in female participants aged ≥50 years (OR=1.52, 95%CI=1.08-2.13, p=0.02) and male participants aged ≥60 years (OR=2.83, 95%CI=1.41-5.69, p=0.004). Non-cisgender participants were also more likely to be frail than cisgender participants (OR=2.21, 95%CI=1.42-3.42, p<0.001).

Conclusion: LGBT+ status was independently associated with frailty in female adults aged >50 years and males aged > 60 years. More research in this area and inclusive government policies are needed to promote the healthy aging of the LGBT+ population.

Objective: This study aimed to evaluate the association between physical activity levels and lower urinary tract symptoms in 20,732 Brazilian men.

Methods: This cohort study included 20,732 men of ≥40 years of age, who participated in health screening between January 2008 and December 2018. Standardized health data (anthropometric, laboratory, clinical, and lifestyle data) were collected. A logistic regression model was used to examine associations based on the occurrence of lower urinary tract symptoms.

Results: Depressive symptoms (p<0.001), age (p<0.001), erectile dysfunction (p<0.001), and total prostate-specific antigens (p<0.001) were associated with higher odds of lower urinary tract symptoms in men, after adjusting the other factors. However, physical activity levels were associated with lower odds of developing lower urinary tract symptoms (low active, p<0.001; active, p=0.002; and high active, p=0.005).

Conclusion: All physical activity levels were associated with lower odds of lower urinary tract symptoms in 20,732 Brazilian men.