Einstein-Sao Paulo最新文献

Objective: To leverage passively collected retrospective smartphone location data to accurately identify malaria transmission hotspots through the development of a novel tool, the Sickness Positioning System.

Methods: We collected anonymized location history data from over 200 malaria-infected individuals using Google Takeout. Sickness Positioning System applies density-based clustering techniques to this passively collected data to identify areas of elevated infection risk. The identified hotspots were subsequently validated through field investigations.

Results: Sickness Positioning System successfully pinpointed multiple areas of increased malaria transmission risk. Field validation confirmed two previously unrecognized mosquito breeding sites as active sources of transmission. When compared to Brazil's federal surveillance system - which updates data annually - Sickness Positioning System provided a more precise and timely spatial assessment of malaria spread.

Conclusion: Sickness Positioning System demonstrates a cost-effective, objective, and timely method for identifying malaria transmission hotspots. This approach has the potential to significantly enhance disease surveillance and facilitate more targeted public health interventions.

Objective: To evaluate the diagnostic accuracy of optical coherence tomography angiography for the identification of choroidal neovascularization in age-related macular degeneration.

Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 recommendations. A literature search of the PubMed/MEDLINE, Scientific Electronic Library Online (SciELO), EMBASE, Cochrane Library, CAPES Periodicals, and LILACS scientific databases was conducted to identify relevant full-text articles published in English and Portuguese from January 2012 to January 2025. To comprehensively evaluate the effectiveness and the performance of optical coherence tomography angiography in terms of sensitivity and specificity, fundus fluorescein angiography (the gold standard for detecting choroidal neovascularization) was used as the comparator. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) 2 tool was used to assess methodological quality and risk of bias.

Results: Eleven articles were included in the systematic review. The patients' mean age ranged from 58.5 to 79.7 years. The sensitivity ranged from 50.0% to 94.0%, and the specificity ranged from 67.6% to 100.0%. The risk of bias was low, and the methodological quality of the studies was good, suggesting that optical coherence tomography angiography holds promise for the diagnosis of choroidal neovascularization.

Conclusion: Optical coherence tomography angiography exhibited high sensitivity and specificity, demonstrating its potential for the detection of choroidal neovascularization in patients with age-related macular degeneration. However, current scientific evidence suggests that optical coherence tomography angiography is not superior to fundus fluorescein angiography and should not be used as a substitute. Extended and affordable protocols to analyze different subtypes of choroidal neovascularization and the performance of optical coherence tomography angiography devices should be evaluated.

Prospero database registration: CRD420251046669.

Objective: To evaluate a simplified exercise program for patients with knee osteoarthritis in terms of pain, functionality, muscle strength, and quality of life. The correlation of serum levels of molecules and cytokines was evaluated after the exercise program.

Methods: Overall, 47 patients with knee osteoarthritis participated in this single-arm interventional study. Outcomes were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index, Quality of Life, Visual Analog Scale, Timed Up and Go functional test, and muscle strength assessment. Serum levels of molecules and cytokines were analyzed using enzyme-linked immunosorbent assays.

Results: The program resulted in improvements in pain and physical function (0.21 points; 95%CI=-0.26; -0.17), Visual Analog Scale (1.50; 95%CI=-1.90; -1.10), EuroQol-5 Dimension 3-Level (0.16; 95%CI=0.100; 0.227), and Timed Up and Go test (0.40; 95%CI=-0.57; -0.23). Significant differences were noted in the isokinetic knee flexion peak torque (0.16; 95%CI=0.10; 0.22), isometric knee extension (0.31; 95%CI=0.20; 0.43), and flexion (0.18; 95%CI=0.12; 0.23) peak torques for osteoarthritis. However, there was no significant difference in serum biomarker levels after the program, and there was no correlation between serum biomarker levels and clinical improvement outcomes.

Conclusion: The simplified exercise program for patients with knee osteoarthritis patients effectively improved pain, functionality, muscle strength, and quality of life. However, biomarkers do not provide evidence of clinical improvement.

Clinicaltrials.gov identifier: NCT02964624.

The 48,XXYY syndrome is a rare sex chromosome aneuploidy associated with diverse physical, developmental, and endocrine abnormalities. This case report highlights a 15-year-old male with 48,XXYY syndrome presenting with hypopituitarism and a Rathke's cleft cyst, offering insights into the interplay between genetic syndromes and pituitary dysfunction. The patient exhibited hyperprolactinemia, central hypothyroidism, central hypoadrenalism, and elevated gonadotropin levels. Brain magnetic resonance imaging revealed a cystic lesion within the sella turcica, consistent with a Rathke's cleft cyst. The patient also had autism and severe essential tremor. Physical examination revealed a reduced testicular volume without gynecomastia, and genetic analysis confirmed a 48,XXYY karyotype. Hormone replacement therapy with prednisone and levothyroxine was initiated, resulting in adequate hormonal replacement. Follow-up magnetic resonance imaging demonstrated stability of the pituitary cyst, with no evidence of progression. This case highlights the importance of hormonal evaluation in patients with rare sex chromosome aneuploidies. Routine pituitary hormone evaluation and imaging should be integral to the care of individuals with 48,XXYY syndrome. These findings highlight the value of a multidisciplinary approach that integrates endocrinology, genetics, and neurology to address the complex needs of these patients. The association between 48,XXYY syndrome and Rathke's cleft cyst raises intriguing questions about the potential links between sex chromosome aneuploidies and pituitary abnormalities. This report emphasizes the need for comprehensive endocrine and structural assessments to optimize patient outcomes by contributing to the limited literature on 48,XXYY syndrome.

Objective: To assess the intra- and inter-observer reliabilities of cervical sagittal radiographic measurements performed by evaluators with varying levels of clinical experience.

Methods: This study analyzed lateral cervical radiographs from 14 patients who had undergone single-level anterior cervical discectomy and fusion. Four evaluators, a spine surgeon, radiologist, spine surgery resident, and medical student, measured five sagittal alignment parameters (C2-C7 Cobb angle, T1 slope, cervical sagittal vertical axis, cervical sagittal vertical axis via C-shape, and T1- C2-C7 Cobb angle). Intra-observer variability was calculated as the deviation from the median measurements. Inter-observer reliability was assessed using intra-class correlation coefficients.

Results: Intra-observer variability was lowest among experienced evaluators (13% for both the spine surgeon and radiologist) and highest for the medical student (19.4%). The intra-class correlation coefficients ranged from 0.54 to 0.96, indicating moderate to excellent agreement. When only the two most experienced evaluators were included in the analysis, intra-class correlation coefficients exceeded 0.88 for all parameters.

Conclusion: Observer experience significantly influences the reliability of sagittal cervical radiographic measurements. Although less experienced evaluators demonstrate higher variability, their performance remains within acceptable limits. Standardized training protocols may help improve consistency across different levels of expertise.

Objective: This study aimed to analyze the effects of two proposed telerehabilitation interventions on the functional capacity of patients with chronic obstructive pulmonary disease.

Methods: A randomized clinical trial was conducted with 60 patients of both sexes equally distributed into two groups: G1, submitted to a protocol of breathing exercises and health education; and G2, submitted only to health education. The interventions were performed remotely through videoconferencing with patients in their homes for 8 weeks.

Results: When comparing the pre- and post-intervention moments of G1 and G2, significant differences were found in the functional capacity scores in both cases (p=0.0001), however, when comparing the post-intervention moment of the two groups, the improvement was more significant in G1 (p=0.0007).

Conclusion: Both telerehabilitation with a respiratory exercise protocol associated with health education, and telerehabilitation with only a health education protocol are beneficial for the functional capacity of patients with chronic obstructive pulmonary disease. However, the telerehabilitation with a breathing exercise protocol associated with health education had a greater impact on the improvement of patients with chronic obstructive pulmonary disease.

Thalidomide exerts immunomodulatory properties that may be used to treat various conditions. Although its effectiveness in treating Crohn's disease in pediatric patients has been reported, its safety for off-label use is not well established. This study aimed to analyze the efficacy and safety of thalidomide in children and adolescents with inflammatory bowel disease, specifically Crohn's and ulcerative colitis. A narrative review of clinical trials and observational studies published between January 2001 and May 2023 that investigated thalidomide use in pediatric patients with Crohn's or ulcerative colitis was conducted. The results of clinical trials showed statistically significant remission rates and clinical improvement in patients. The most reported adverse event was peripheral neuropathy, resulting in discontinuation of medication in some cases. Other adverse effects, such as sedation, constipation, dizziness, and allergic reactions, were observed but were not serious. Thalidomide can be considered an alternative treatment option for pediatric patients with refractory inflammatory bowel disease. However, monitoring for peripheral neuropathy and potential dose adjustments are necessary. No new or unknown adverse reactions related to the medication were identified in this review.

Objective: To analyze the factors associated with invasive ventilation in infants admitted to the hospital with acute bronchiolitis and identify the treatments administered before and during hospitalization.

Methods: This single-center observational retrospective study included 266 infants with acute bronchiolitis who were admitted to the pediatric ward of a university hospital in São Paulo between January 2020 and March 2023. Multivariate logistic regression analysis was used to investigate the factors associated with invasive ventilation, and Prais-Winsten regression was used to analyze the temporal trends of cases. Statistical significance was set at p<0.05.

Results: Of 266 participants, 16 (6%) were intubated. The multivariate analysis revealed that younger age (adjusted odds ratio (AOR)=0.71; 95% confidence interval (95%CI)=0.53-0.96; p=0.02), higher Wood-Downes-Ferres scores at admission (AOR=2.02; 95%CI=1.03-3.95; p=0.03), and the presence of atelectasis on radiography (AOR=26.4; 95%CI=3.85-182.18; p=0.001) were associated with invasive ventilation. Increased bronchodilator use (30.0% versus 79.7%, p<0.001) and decreased corticosteroid use (27.8% versus 25.5%, p=0.004) were observed before and after admission, respectively. Temporal analysis revealed a stationary trend (p=0.41).

Conclusion: In infants with acute bronchiolitis, younger age, presence of atelectasis, and higher Wood-Dowes-Ferres scores at admission were associated with invasive ventilation. Medications were frequently administered to the patients before and during hospitalization. This study emphasizes the need to consider these factors when caring for these infants and for clinical protocols to reduce the use of medications before and during hospitalization.

Objective: The aim of the present study is to assess whether the intensity of local inflammation relates to the presence of thin-cap fibroatheromas.

Methods: Retrospective, single-center study of patients that underwent optical coherence tomography imaging and had either de novo or in-stent neoatherosclerosis. Intensity of macrophage accumulation and volume of neovascularization were measured for all lesions. Logistic binary regressions were used for uni- and multivariate analysis.

Results: A total of the 92 lesions in 84 patients were selected. The degree of macrophage accumulation was higher in thin-cap fibroatheromas than non- thin-cap fibroatheromas lesions (5.0 versus 2.17; p<0.01). Neovascularization was more frequent in thin-cap fibroatheromas than non-thin-cap fibroatheromas lesions (87.5% versus 65.7%, p=0.04), and thin-cap fibroatheromas had a larger volume of neovascularization than non- thin-cap fibroatheromas plaques (92.2 versus 23.0 x 1000μm3/mm, p<0.01). At multivariate logistic analysis, neovascularization volume and degree of macrophage accumulation remained independently associated with thin-cap fibroatheromas. The dataset was divided according to the highest tercile of neovascularization volume (≥87.2 x 1000μm3/mm) and macrophage accumulation score (≥4.6). Plaques with low levels of neovascularization and macrophages were classified as thin-cap fibroatheromas in 14% of cases. Thin-cap fibroatheromas was present in 61.5% of plaques with high macrophagic and neovascularization content.

Conclusion: Lesions with more macrophage accumulation and higher volumes of neovascularization are more likely to be thin-cap fibroatheromas.

This report presents a case of a 59-year-old male diagnosed with metastatic esophagogastric junction adenocarcinoma, who presented with mild dysphagia and vertigo. Brain magnetic resonance imaging initially showed no abnormalities. Upper gastrointestinal endoscopy revealed a vegetative lesion in the distal esophagus, and concurrent colonoscopy identified a laterally-spreading tumor in the transverse colon. Immunohistochemistry confirmed a poorly differentiated adenocarcinoma, suggesting an upper gastrointestinal origin. Further investigation of the worsening neurological symptoms led to the identification of leptomeningeal carcinomatosis via cerebrospinal fluid analysis. Somatic genetic testing detected TP53 mutations and CDK6 amplification; however, no germline mutations were identified. The patient received first-line treatment with 5-fluorouracil, leucovorin, oxaliplatin, and nivolumab, followed by whole-brain radiotherapy due to rapid progression of the leptomeningeal disease. Despite aggressive treatment, the patient experienced multiple complications, including pulmonary embolism and seizures, and died from disease progression after six cycles of therapy. This case highlights the diagnostic challenges and poor prognosis of metastatic esophagogastric junction adenocarcinomas with de novo meningeal and colonic involvement and underscores the importance of early diagnosis and comprehensive evaluation of atypical presentations to optimize patient management.