Einstein-Sao Paulo最新文献

Spinal muscular atrophy is a rare hereditary neurodegenerative disease characterized by progressive motor neuron loss. The most common form of SMA is linked to 5q (5q-SMA) and is classified into subtypes according to the age of onset and maximum motor function achieved. The severity ranges from progressive infantile paralysis and premature death (type 1) to limited motor neuron loss in adults (type 4). The LATAM RegistrAME protocol is an observational, retrospective, prospective international multicenter clinical registry study involving Latin Americans. We will include 5q-SMA patients across all age groups, from pediatric to adult, to describe their clinical characteristics and disease progression. The protocol will use an international clinical research form based on the Treat Neuromuscular Disease Global Academic Network (TREAT-NMD), which focuses on advancing research on neuromuscular disorders in patients with spinal muscular atrophy. The study will include six countries in Latin America, sampling a total of 415 patients with SMA and 5q-SMA types 1, 2, 3, and 4 of all ages and both sexes who have genetically confirmed 5q-SMA. The mean follow-up period was 24 months. The primary outcomes will be the description of general clinical characteristics, access to medications capable of modifying the course of the disease, functional assessments, motor milestones, and ventilatory support. This study will provide insights into 5q spinal muscular atrophy patients in Latin America to better understand their clinical characteristics, use of medications, and outcomes while supporting further clinical management protocols and clinical trials. ClinicalTrials.gov Identifier: NCT05475691.

Objective: To evaluate the incidence of malfunction and colonization rates of fully implantable long-term catheters left unflushed during the COVID-19 pandemic; and to evaluate the average cost of transporting each patient to the hospital for flushing.

Methods: During the COVID-19 pandemic, patients reduced the number of hospital visits and stopped flushing their catheters periodically with saline solution. After the pandemic stabilized in 2022, patients who completed chemotherapy treatment had their long-term catheters removed. We evaluated the catheters' function and colonization rates. To evaluate the incidence of malfunctions and the colonization rate of these catheters, we tested the flow and reflux during removal surgery, before removal, and by culturing their tips. These catheters were divided into two groups: a standard group, in which the last flushing occurred before 90 days, and another group, in which the last flushing occurred after 90 days. We analyzed the correlation between the time at which these catheters were closed, the incidence of malfunction, and the colonization rate of these catheters. To avoid confusion due to the reduced sample size, a second analysis was performed between the group of catheters that did not work and those that worked, evaluating the time they were closed and the catheter tip culture. We also analyzed the financial costs for each patient from home to the hospital.

Results: Among the 66 patients included in the study, 28 spent >90 days without catheter flushing, and 38 spent <90 days. The incidence of infection occurred in two patients with >90 days of flushing and in three patients with <90 days of flushing. Catheter malfunction occurred in 4 patients in the group with >90 days without flushing and in 5 patients with <90 days of flushing. In the secondary analysis, the group with a functioning catheter (n=52) had a mean time of 152 days, whereas for the group with a non-functioning catheter (n=9), the mean time was 229 days (p=0.51). No differences were statistically significant. No correlation was found between the colonization rate of catheter in the group with a functioning or non-functioning catheter, as the group with a functioning catheter had three cases of positive catheter tip culture and the group with a non-functioning catheter had one case of positive catheter tip culture. The average cost for each patient to travel from home to the hospital was 39.01 reais (approximately 7.50 USD).

Conclusion: Among the patients followed up at our hospital during the COVID-19 pandemic, no statistically significant difference was observed in the function and colonization rate of long-term catheters between those who underwent flushing at intervals of <90 days and those with intervals of >90 days.

Objective: To objectively evaluate sweat intensity in patients with primary hyperhidrosis by measuring electrodermal activity using a continuous exosomatic technique without external stimuli.

Methods: This prospective and transversal study analyzed 10 patients with palmoplantar hyperhidrosis (HH Group) and 10 individuals without it (Control Group) between January and August 2023. All participants underwent one clinical evaluation and completed two multiple-test questionnaires without any intervention from the interviewer, based on their own estimates of sweat perception and anxiety or depression symptoms. Then, the electrodermal activity was measured with the MP36R, a portable instrument from Biopac Systems Inc. (USA), using exosomatic and direct current techniques. Data were tested for normality using the Shapiro-Wilk test. Descriptive statistics were expressed as medians and interquartile ranges (p25-75) for numerical variables and as absolute and relative frequencies for categorical variables. Fisher's exact test and Mann-Whitney U test were used to compare the groups. Statistical significance was set at p<0.05.

Results: Palmoplantar sweating was significantly higher in the HH Group than in the Control Group (p<0.01). There were no statistically significant differences in anxiety and depression levels between the groups (p=0.87; p=0.32). Continuous exosomatic electrodermal activity resulted in significantly higher skin conductance in patients with hyperhidrosis than in controls.

Conclusion: Continuous exosomatic electrodermal activity without external stimuli proved to be suitable for the objective analysis of patients with hyperhidrosis in a non-invasive and sensitive manner.

Introduction: Transdifferentiation is the conversion of a specific somatic cell into another cell type, bypassing a transient pluripotent state. This implies a faster method to generate cells of interest with the additional benefit of reduced tumorigenic risk for clinical use.

Objective: We describe protocols that use small molecules as direct conversion inducers, without the need for exogenous factors, to evaluate the potential of cell transdifferentiation for pharmacological and clinical applications.

Methods: In this systematic review, using PRISMA guidelines, we conducted a personalized search strategy in four databases (PubMed, Scopus, Embase, and Web Of Science), looking for experimental works that used exclusively small molecules for transdifferentiation of non-neural cell types into neural lineage cells.

Results: We explored the main biological mechanisms involved in direct cell conversion induced by different small molecules used in 33 experimental in vitro and in vitro transdifferentiation protocols. We also summarize the main characteristics of these protocols, such as the chemical cocktails used, time for transdifferentiation, and conversion efficiency.

Conclusion: Small molecules-based protocols for neuronal transdifferentiation are reasonably safe, economical, accessible, and are a promising alternative for future use in regenerative medicine and pharmacology.

Objective: Identify potential negative impacts arising from implementing an electronic medical record system, classify them according to the level of criticality, and analyze method's effectiveness after implementation.

Methods: The research involved identifying the negative impacts, classifying them according to the criteria for criticality, stratifying them as high, medium, or low severity, and finally, analyzing the effectiveness of the identification and classification methods.

Results: Findings confirmed that 89.20% of identified impacts occurred as predicted, and 88.94% of impacts had a level of criticality compatible with the severity of the problem.

Conclusion: Predicting and classifying negative impacts are important stages in implementing electronic health records in hospitals. The method for identification and classification of impacts were, in most cases, considered effective.

Objective: The optimal approach to the treatment of colorectal carcinoma and synchronous liver metastases remains controversial. The objective of this review was to analyze the outcomes of adopting the liver-first approach for the treatment of patients with colorectal cancer with synchronous hepatic metastases who initially underwent systemic chemotherapy and/or resection of the metastatic lesions and primary colorectal carcinoma.

Methods: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The MEDLINE, EMBASE, LILACS, and Cochrane Central Register of Controlled Trials databases were searched for the identification and retrieval of eligible studies. Studies that included details of using the liver-first approach for the treatment of synchronous liver metastases of colorectal cancer and its outcomes, including the patients' survival data, were included. Proportional meta-analysis was performed using the random-effects restricted maximum likelihood method to summarize the three- and five-year overall survival and recurrence rates of the patients.

Results: Eight hundred and fifty-five articles describing the results of studies on the liver-first approach were identified. Three independent reviewers screened the titles and abstracts of the articles and excluded 750 articles. Thereafter, 29 retrospective and comparative studies that met the inclusion criteria were included. No randomized controlled trials were identified in the database search.

Conclusion: Neoadjuvant treatment with systemic chemotherapy for hepatic metastasis can prepare a patient for resection of liver metastases, offering the opportunity for potentially curative treatment of synchronous hepatic metastases initially considered unresectable. The decision regarding the resection of primary colorectal carcinoma and liver metastases should be based on individualized patient response. Prospero database registration ID: CRD42022337047 (www.crd.york.ac.uk/prospero).

Autologous platelet concentrates are rich in growth factors and have shown potential for high anatomical success rates in macular hole treatment. However, no systematic review has yet assessed its impact. Therefore, this study aimed to conduct a comprehensive review and meta-analysis on the comparative efficacy and safety of autologous platelet concentrates in treating macular hole. A systematic review of the literature on autologous platelet concentrate therapy for macular hole was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines on September 9, 2023. Databases, including PubMed, the Cochrane Library, Web of Science, and Embase, were queried. A meta-analysis of random effects was performed. Efficacy was evaluated through anatomical closure, reopening of the macular hole at 6 months, average improvement of 2 lines, and visual field loss. Safety was evaluated by monitoring complications. A systematic search of multiple databases identified six studies (three randomized controlled trials and three non-randomized cohort studies) involving 616 patients (626 eyes). Autologous platelets concentrate therapy significantly improved macular hole closure compared to that in the controls (OR=4.35; 95%CI=2.08-9.10; p<0.0001; I²=9%). No significant differences were observed in hole reopening at 6 months, post-operative visual acuity improvement by 2 lines or more, or visual field loss between autologous platelets concentrate and control groups. The overall complication rates were similar between groups. Thus, autologous platelet concentrate therapy shows promise for promoting macular hole closure, particularly in smaller holes. Further research with standardized protocols, prolonged follow-ups, and larger sample sizes is needed to fully understand its benefits and limitations in macular hole closure. (https://www.crd.york.ac.uk/prospero/) under ID CRD42023455815.

Objective: To evaluate psychostimulant drug use among academics in the health area of a higher education institution in Minas Gerais, Brazil.

Methods: We conducted an online cross-sectional study of 389 university students from various health-related fields. This study used a questionnaire to investigate the social and behavioral aspects associated with using psychostimulants.

Results: The prevalence of psychostimulant use was 21%, primarily in men (23.07%), medicine students (19.70%), and psychology students (18.91%). Methylphenidate was the most commonly used drug (57%). Concomitant use of psychostimulants was reported in 37% and 35% of participants who started using them during graduation. A justifiable medical diagnosis was reported by 65% of the participants; however, a large portion had no indication for their use, and 77% acquired the medication without a medical prescription. The most frequently reported effects by users included lack of appetite (68%), tachycardia (58%), insomnia (43.5%), and agitation (50%). More than 70% of users also reported concurrent use of alcohol and illicit drugs, as well as depression and anxiety, which are contraindications for psychostimulant use. Additionally, 75% of students reported using psychostimulants for neuroenhancement purposes, with the majority (52%) perceiving their course performance as good and believing that it would be different without the drug (75.8%).

Conclusion: Psychostimulant use in the study population revealed significant risks, including a lack of a valid diagnosis, unsupervised use, drug interactions, and side effects. Therefore, the data obtained in this study may contribute to the development of educational policies focused on preventing and controlling the indiscriminate use of these medications.