Einstein-Sao Paulo最新文献

Introduction: Chronic kidney disease is a progressive and irreversible loss of kidney function and considerably affects the lives of patients and their families. Its high incidence necessitates efficient public policies for prevention and treatment. However, policies for chronic kidney disease education and awareness are scarce.

Objective: To evaluate global public policies for the prevention and treatment of chronic kidney disease adopted in various regions, aiming to comprehend the differences between various models.

Methods: This integrative review followed PRISMA recommendations and included papers published between 2016 and 2021 across several databases.

Results: The 44 selected articles were categorized into three themes: structural and financial aspects of the organization of renal healthcare, access to renal healthcare or management of chronic kidney disease, and coping strategies for chronic kidney disease or kidney health. Critical analysis of the papers revealed global neglect of kidney disease in political agendas. Considerable policy variations exist between different countries and regions of the same country. Our research highlighted that free and universal health coverage, especially for the most vulnerable patients, is crucial for accessing treatment owing to the prohibitively high treatment costs.

Conclusion: Social, economic, and ethnic inequalities strongly correlate with disease occurrence, primarily affecting minority groups who lack health support, especially for the prevention and treatment of chronic kidney disease.

Objective: To evaluate the psychiatric alterations resulting from deep brain stimulation of the subthalamic nucleus in the management of Parkinson's disease.

Methods: Articles were searched using three databases: Public/Publisher MEDLINE, Virtual Health Library, and Cochrane Library.

Results: Eleven studies were included in the analysis. Manic syndrome alone was reported in two of the 11 studies analyzed. Psychosis alone was not reported in any of them, but it was found in association with other psychiatric alterations in two studies, not including manic syndrome. In one case report, hypersexuality was associated with depression and self-alienation. Depressive disorder was the most frequent psychiatric disorder after deep brain stimulation of the subthalamic nucleus, according to five of the reviewed articles, encompassing 26 patients. In four of these articles, depression was associated with other psychiatric disorders, such as psychosis, suicidal ideation, hypersexuality, and anxiety. Hypomanic syndrome was reported in two cases.

Conclusion: More common psychiatric disorders related to the neuroanatomy of the nucleus were observed, probably because of the microlesions caused by the implantation of deep brain stimulation and the regulation of the stimulation of the device. The most common disorders include depression, mania/hypomania, psychosis, anxiety, suicidal ideation, and hypersexuality.

Objective: This study aimed to evaluate whether severity changes with colposcopic lesion size, regardless of age.

Methods: This retrospective comparative study reviewed the records of 428 women with altered cytopathology reports who were directed by primary health care. Only those women with colposcopic alterations were evaluated (n=411). Histopathological analyses were restricted to patients who underwent excisional treatment (n=345). According to their age, they were grouped into the following: <21, 21-24, 25-35, and >35 years, and also, ≤24 and ≥25 years. The cytopathological, colposcopic, and histopathological findings were grouped according to severity. Lesion size was subjectively assessed from the colposcopic drawing recorded in the chart and according to the number of quadrants of the total cervical surface affected by colposcopic alterations in the transformation zone. Statistical significance was set at p<0.05.

Results: The evaluations suggested that the lesion size was directly related to the severity of the cytopathology, colposcopy, and histopathology reports for the age groups ≤24 or ≥25 years. We observed associations between lesion size and severity of the cytopathology (≤24 years, p=0.037) and histopathology (≥25 years, p=0.003) findings.

Conclusion: The size of the lesion was directly related to the severity of the histopathological lesion in patients aged ≥25 years and cytopathological in patients aged ≤24 years.

Objective: The quality of care and safety for Telemedicine-discharged patients with suspected respiratory infections are closely related to low rates of prescriptions of unjustified and high-risk medications. This retrospective study aimed to assess adherence to the current COVID-19 guidelines in direct-to-consumer telemedicine encounters at a large center using multidrug stewardship protocols.

Methods: A quarterly electronic survey utilizing medical records of individual physician care assessed various quality indicators. Physicians received ongoing adaptive feedback based on personal metrics, with Telemedicine Center recommendations derived from the 2020 Infectious Diseases Society of America guidelines. The study included all consecutive adults with new respiratory symptoms in the last 14 days who sought spontaneous Telemedicine consultations between March 2020 and August 2021. This study analyzed patients with suspected or confirmed COVID-19 and other airway infections.

Results: Of the 221,128 evaluated patients, 42,042 (19%) had confirmed COVID-19; 104,021 (47%) were suspected to have COVID-19; and, 75,065 (33%) had other diagnoses. Patients with suspected or confirmed COVID-19 had a mean (+DP) age of 35±12 years. A total of 125,107 (85.65%) patients were managed at home, 2,552 (1.74%) were referred for non-urgent in-office reassessment, and 17,185 (11.7%) were referred to the emergency department for whom there was no further treatment recommendation. The antibiotic rate in confirmed or suspected COVID-19 cases was 0.46%/0.65% and that for non-evidence-based prescriptions was 0.01%/0.005%.

Conclusion: Guideline training and Telemedicine consultation feedback may lead to lower antibiotic and antimicrobial prescriptions in suspected and confirmed COVID-19 cases. Multidrug stewardship protocols may improve guideline adherence and reinforce the quality of care and safety in Telemedicine encounters.

Objective: We aimed to analyze the frequency of adherence to social distancing and individual protection measures of adult and older populations in two cities in southern Brazil and to characterize the sociodemographic aspects of these individuals.

Methods: This cross-sectional, population-based study was conducted in the cities of Rio Grande, RS, and Criciúma, SC, Brazil. The outcome measure was the frequency of adherence to social distancing measures. Fisher's exact test (5% significance) was used to calculate the differences in prevalence according to exposure variables.

Results: Among the 2,170 participants over the age of 18, the prevalence of adherence to social distancing was 18.5%. Adherence was significantly higher among women; older adults; single, divorced, or widowed people with a low educational level; people of lower socioeconomic status; and people affected by multiple chronic diseases.

Conclusion: Approximately one in five respondents adhered to measures of social distancing, and adherence was more prevalent among the risk groups.

The focus of this case report is to technically describe a noninvasive diagnostic evaluation of bow Hunter's syndrome using a dynamic computed tomography angiography protocol and discuss its advantages. In addition, we aimed to exemplify the quality of the study by presenting images of a 3D-printed model generated to help plan the surgical treatment for the patient. The dynamic computed tomography angiography protocol consisted of a first image acquisition with the patient in the anatomic position of the head and neck. This was followed by a second acquisition with the head and neck rotated to the side that triggered the symptoms, with technical parameters similar to the first acquisition. The acquired images were used to print a 3D model to better depict the findings for the surgical team. The dynamic computed tomography angiography protocol developed in this study helped visualize the vertebrobasilar arterial anatomy, detect vertebral artery stenosis produced by head and neck rotation, depict the structure responsible for artery stenosis (e.g., bony structure or membranes), and study possible complications of the disease (e.g., posterior cerebral circulation infarction). Additionally, the 3D-printed model better illustrated the findings of stenosis, aiding in surgical planning. In conclusion, dynamic computed tomography angiography for the evaluation of bow Hunter's syndrome is a feasible noninvasive technique that can be used as an alternative to traditional diagnostic methods.

Objective: Currently programmed cell death protein 1 (PD-1) inhibitors in combination with other therapies are being evaluated to determine their efficacy in cancer treatment. However, the effect of PD-ligand (L) 1 expression on disease outcomes in stage III (EC III) non-small cell lung cancer is not completely understood. Therefore, this study aimed to assess the influence of PD-L1 expression on the outcomes of EC III non-small cell lung cancer.

Methods: This study was conducted on patients diagnosed with EC III non-small cell lung cancer who underwent treatment at a tertiary care hospital. PD-L1 expression was determined using immunohistochemical staining, all patients expressed PD-L1. Survival was estimated using the Kaplan-Meier method. Relationships between variables were assessed using Cox proportional regression models.

Results: A total of 49 patients (median age=69 years) with EC III non-small cell lung cancer and PD-L1 expression were evaluated. More than half of the patients were men, and most were regular smokers. The patients were treated with neoadjuvant chemotherapy, surgery, or sequential or combined chemotherapy and radiotherapy. The median progression-free survival of the entire cohort was 14.2 months, and the median overall survival was 20 months. There was no significant association between PD-L1 expression and disease progression, clinical characteristics, or overall survival.

Conclusions: PD-L1 expression was not correlated with EC III non-small cell lung cancer outcomes. Whether these findings differ from the association with immune checkpoint inhibitors remains to be addressed in future studies.

Objective: This study aimed at assessing the alterations in upper limb motor impairment and connectivity between motor areas following the post-stroke delivery of cathodal transcranial direct current stimulation sessions.

Methods: Modifications in the Fugl-Meyer Assessment scores, connectivity between the primary motor cortex of the unaffected and affected hemispheres, and between the primary motor and premotor cortices of the unaffected hemisphere were compared prior to and following six sessions of cathodal transcranial direct current stimulation application in 13 patients (active = 6; sham = 7); this modality targets the primary motor cortex of the unaffected hemisphere early after a stroke.

Results: Clinically relevant distinctions in Fugl-Meyer Assessment scores (≥9 points) were observed more frequently in the Sham Group than in the Active Group. Between-group differences in the alterations in Fugl-Meyer Assessment scores were not statistically significant (Mann-Whitney test, p=0.133). ROI-to-ROI correlations between the primary motor cortices of the affected and unaffected hemispheres post-therapeutically increased in 5/6 and 2/7 participants in the Active and Sham Groups, respectively. Between-group differences in modifications in connectivity between the aforementioned areas were not statistically significant. Motor performance enhancements were more frequent in the Sham Group compared to the Active Group.

Conclusion: The results of this hypothesis-generating investigation suggest that heightened connectivity may not translate into early clinical benefits following a stroke and will be crucial in designing larger cohort studies to explore mechanisms underlying the impacts of this intervention. ClinicalTrials.gov Identifier: NCT02455427.

Crispim et al. demonstrated the independent risk factors for acquiring COVID-19 among healthcare personnel. They also showed the importance of infection prevention training to avoid acquiring COVID-19 in this population.

Objective: To verify the rate of COVID-19 infection among healthcare personnel at high and low risk of COVID-19 infection and identify the underlying risk factors.

Methods: This cross-sectional study was conducted between December 1, 2020 and February 28, 2021. Associations were verified between the levels of risk (high or low) of occupational COVID-19 infection and participant characteristics using the World Health Organization risk assessment questionnaire and adjusted using logistic regression models in single and multiple approaches.

Results: Of the 486 participants, 57.4% were classified as having a high occupational risk for SARS-CoV-2 infection, with a diagnosis rate of 12.1%. The factors identified in the multivariate analysis for high occupational risk were age up to 29 years (odds ratio [OR] = 2.7, 95% confidence interval [95%CI] = 1.63-4.47), monthly family income greater than eight times the basic salary (OR= 1.8, 95%CI= 1.07-3.16), and healthcare personnel who did not participate in initial training to work in the area of patients with COVID-19 infection (OR= 2.39, 95%CI= 1.53-3.75).

Conclusion: Encouraging training for occupational infection prevention is very important to reduce the impact of infectious diseases on healthcare personnel, especially young health professionals. COVID-19 infection among healthcare personnel has impacted the workforce in hospitals. Knowledge of the risk factors for COVID-19 infection is important for disease prevention measures. Failure to train healthcare personnel is an important risk factor for acquiring COVID-19.

Implementing a structured COVID-19 lung ultrasound system, using COVID-RADS standardization. This case series exams revealed correlations between ultrasonographic and tomographic findings. Ventilatory assessments showed that higher categories required second-line oxygen. This replicable tool will aid in screening and predicting disease severity beyond the pandemic.

Objective: We aimed to share our experience in implementing a structured system for COVID-19 lung findings, elucidating key aspects of the lung ultrasound score to facilitate its standardized clinical use beyond the pandemic scenario.

Methods: Using a scoring system to classify the extent of lung involvement, we retrospectively analyzed the ultrasound reports performed in our institution according to COVID-RADS standardization.

Results: The study included 69 thoracic ultrasound exams, with 27 following the protocol. The majority of patients were female (52%), with ages ranging from 1 to 96 years and an average of 56 years. Classification according to COVID-RADS was as follows: 11.1% in category 0, 37% in category 1, 44.4% in category 2, and 7.4% in category 3. Ground-glass opacities on tomography correlated with higher COVID-RADS scores (categories 2 and 3) in 82% of cases. Ventilatory assessment revealed that 50% of cases in higher COVID-RADS categories (2 and 3) required second-line oxygen supplementation, while none of the cases in lower categories (0 and 1) utilized this support.

Conclusion: Lung ultrasound has been widely utilized as a diagnostic tool owing to its availability and simplicity of application. In the context of the pandemic emergency, a pressing need for a focused and easily applicable assessment arose. The structured reporting system, incorporating ultrasound findings for stratification, demonstrated ease of replicability. This system stands as a crucial tool for screening, predicting severity, and aiding in medical decisions, even in a non-pandemic context. Lung ultrasound enables precise diagnosis and ongoing monitoring of the disease. Ultrasound is an effective tool for assessing pulmonary findings in COVID-19. Structured reports enhance communication and are easily reproducible.