Pub Date : 2024-07-01eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024AO0223
Pâmela Moraes Volz, Vanise Dos Santos Ferreira Viero, Elizabet Saes-Silva, Bianca Languer Vargas, Fernanda Oliveira Meller, Antônio Augusto Schäfer, Simone Dos Santos Paludo, Lauro Miranda Demenech, Lucas Neiva-Silva, Samuel Carvalho Dumith
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.
{"title":"Adherence to social distancing measures in southern Brazil, 2020/2021: a cross-sectional study.","authors":"Pâmela Moraes Volz, Vanise Dos Santos Ferreira Viero, Elizabet Saes-Silva, Bianca Languer Vargas, Fernanda Oliveira Meller, Antônio Augusto Schäfer, Simone Dos Santos Paludo, Lauro Miranda Demenech, Lucas Neiva-Silva, Samuel Carvalho Dumith","doi":"10.31744/einstein_journal/2024AO0223","DOIUrl":"10.31744/einstein_journal/2024AO0223","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>Approximately one in five respondents adhered to measures of social distancing, and adherence was more prevalent among the risk groups.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11196087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024RC0582
Giovanna Sawaya Torre, Bruna Bonaventura Failla, Felipe Soares Oliveira Portela, Marcelo Passos Teivelis, Nelson Wolosker, Rogerio Iquizli, Carlos Augusto Ventura Pinto, Marcelo Assis Rocha, Adriano Tachibana
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.
本病例报告的重点在于从技术上描述使用动态计算机断层扫描血管造影方案对弓形亨特综合征进行的无创诊断评估,并讨论其优点。此外,我们还旨在通过展示 3D 打印模型的图像来体现研究的质量,以帮助规划患者的手术治疗。动态计算机断层扫描血管成像方案包括第一次图像采集,患者处于头颈部解剖位置。随后进行第二次采集,将头颈部旋转到引发症状的一侧,技术参数与第一次采集相似。采集到的图像被用于打印三维模型,以便为手术团队更好地描述检查结果。本研究中开发的动态计算机断层扫描血管成像方案有助于观察椎基底动脉解剖结构,检测头颈旋转造成的椎动脉狭窄,描述造成动脉狭窄的结构(如骨性结构或膜),研究疾病可能的并发症(如后脑循环梗死)。此外,3D 打印模型能更好地显示狭窄的发现,有助于手术规划。总之,用动态计算机断层扫描血管造影术评估弓形亨特综合征是一种可行的无创技术,可作为传统诊断方法的替代方法。
{"title":"Dynamic computed tomography angiography for noninvasive diagnosis of bow Hunter's syndrome: a case report.","authors":"Giovanna Sawaya Torre, Bruna Bonaventura Failla, Felipe Soares Oliveira Portela, Marcelo Passos Teivelis, Nelson Wolosker, Rogerio Iquizli, Carlos Augusto Ventura Pinto, Marcelo Assis Rocha, Adriano Tachibana","doi":"10.31744/einstein_journal/2024RC0582","DOIUrl":"10.31744/einstein_journal/2024RC0582","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11196086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-24eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024AO0575
Nicoly Marques de Castro, Fernando Moura, Aline Lury Hada, Diogo Garcia, Elivane da Silva Victor, Gustavo Schvartsman, Leonardo Carvalho, Milena Lourenço Coleta Fernandes, Rodrigo de Souza Martins, Elaine Ferreira da Silva, Sarah Silva Mello Batista Dos Santos, Letícia Taniwaki, Patrícia Taranto, Janaina Pontes, Juliana Rodrigues Beal, Ana Carolina Pereira Dutra, João Bosco de Oliveira Filho, Sérgio Eduardo Alonso Araujo, Pedro Luiz Serrano Usón Junior
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.
{"title":"Prognostic value of programmed cell death ligand 1 (PD-L1) expression in patients with stage III non-small cell lung cancer under different treatment types: a retrospective study.","authors":"Nicoly Marques de Castro, Fernando Moura, Aline Lury Hada, Diogo Garcia, Elivane da Silva Victor, Gustavo Schvartsman, Leonardo Carvalho, Milena Lourenço Coleta Fernandes, Rodrigo de Souza Martins, Elaine Ferreira da Silva, Sarah Silva Mello Batista Dos Santos, Letícia Taniwaki, Patrícia Taranto, Janaina Pontes, Juliana Rodrigues Beal, Ana Carolina Pereira Dutra, João Bosco de Oliveira Filho, Sérgio Eduardo Alonso Araujo, Pedro Luiz Serrano Usón Junior","doi":"10.31744/einstein_journal/2024AO0575","DOIUrl":"10.31744/einstein_journal/2024AO0575","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11196088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141451892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-24eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024AO0450
Marcela Tengler Carvalho Takahashi, Joana Bisol Balardin, Paulo Rodrigo Bazán, Danielle de Sá Boasquevisque, Edson Amaro Junior, Adriana Bastos Conforto
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.
研究目的本研究旨在评估脑卒中后接受阴性经颅直流电刺激后上肢运动障碍的改变以及运动区域之间的连接性:方法:比较了13名患者(主动=6;假性=7)在接受6次阴极经颅直流电刺激之前和之后的Fugl-Meyer评估评分、未受影响半球和受影响半球初级运动皮层之间的连接性以及未受影响半球初级运动皮层和前运动皮层之间的连接性的变化;这种方式针对中风后早期未受影响半球的初级运动皮层:结果:在临床上观察到的 Fugl-Meyer 评估评分差异(≥9 分),假体组多于活性组。组间 Fugl-Meyer 评估得分的变化差异无统计学意义(Mann-Whitney 检验,P=0.133)。在积极组和无效组中,分别有 5/6 和 2/7 的受影响半球和未受影响半球初级运动皮层的 ROI 与 ROI 之间的相关性在治疗后有所增加。在上述区域之间的连接性改变方面,组间差异无统计学意义。与积极组相比,无效组的运动表现更频繁地得到提高:这项假设性研究的结果表明,连通性的增强可能不会转化为中风后的早期临床获益,这对设计更大规模的队列研究以探索这种干预措施的影响机制至关重要。ClinicalTrials.gov Identifier:NCT02455427。
{"title":"Effect of transcranial direct current stimulation in the initial weeks post-stroke: a pilot randomized study.","authors":"Marcela Tengler Carvalho Takahashi, Joana Bisol Balardin, Paulo Rodrigo Bazán, Danielle de Sá Boasquevisque, Edson Amaro Junior, Adriana Bastos Conforto","doi":"10.31744/einstein_journal/2024AO0450","DOIUrl":"10.31744/einstein_journal/2024AO0450","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11196089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141451891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-10eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024AO0433
Priscila Montesano Cunha Crispim, Julia Yaeko Kawagoe, Ana Cristina Rosseti, Fernando Gatti de Menezes
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.
{"title":"Factors underlying the high occupational risk of healthcare personnel for COVID-19 infection.","authors":"Priscila Montesano Cunha Crispim, Julia Yaeko Kawagoe, Ana Cristina Rosseti, Fernando Gatti de Menezes","doi":"10.31744/einstein_journal/2024AO0433","DOIUrl":"10.31744/einstein_journal/2024AO0433","url":null,"abstract":"<p><p>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.</p><p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11155719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141312032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-10eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024AE0780
Vítor Carminatti Romano, Natália Tavares de Melo Barros Lima, Victor Arantes Jabour, Guilherme Ciconelli Del Guerra, Paulo Rogério Barboza Silvério, Rodrigo Gobbo Garcia, Yoshino Tamaki Sameshima, Miguel José Francisco Neto, Marcos Roberto Gomes de Queiroz
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.
{"title":"Lessons from the pandemic and the value of a structured system of ultrasonographic findings in the diagnosis of COVID-19 pulmonary manifestations.","authors":"Vítor Carminatti Romano, Natália Tavares de Melo Barros Lima, Victor Arantes Jabour, Guilherme Ciconelli Del Guerra, Paulo Rogério Barboza Silvério, Rodrigo Gobbo Garcia, Yoshino Tamaki Sameshima, Miguel José Francisco Neto, Marcos Roberto Gomes de Queiroz","doi":"10.31744/einstein_journal/2024AE0780","DOIUrl":"10.31744/einstein_journal/2024AE0780","url":null,"abstract":"<p><p>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.</p><p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11155724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141312033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-10eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024GS0413
Ana Clara Maia Palhano, Ninna Medeiros Gutierrez, Nicolas Sousa Vecchio Dos Santos, Rita Narikawa, André Ballalai, Dimitri Luz Felipe da Silva
Palhano et al. demonstrate the feasibility of incorporating secukinumab and ustekinumab into the Clinical Protocol and Therapeutic Guidelines for moderate to severe psoriasis in pediatric patients.
Objective: Therefore, this study aimed to evaluate the impact of secukinumab and ustekinumab against moderate-to-severe plaque psoriasis in a Brazilian pediatric population with access to public healthcare.
Methods: A survey of immunobiological treatments registered for use against pediatric psoriasis at the National Health Surveillance Agency was conducted. These treatments were compared to the list available in the same treatment category in the public health system through the Clinical Protocol and Therapeutic Guidelines for psoriasis. A quantitative analysis of the data of patients treated with immunobiological drugs the previous year in accordance with the Clinical Protocol and Therapeutic Guidelines was performed using data available in the DATASUS portal.
Results: The public budget impact scenarios analyzed were comparable to the investment already planned for acquiring the only available drug option.
Conclusion: The incorporation of two therapeutic options in the Clinical Protocol and Therapeutic Guidelines list for moderate-to-severe pediatric psoriasis was feasible in a horizon of 5 years compared to the investment into the single option available to pediatric patients. These findings can facilitate the local analysis of budgetary impact and discussions on the feasibility of this therapeutic incorporation at the state level. Incorporation of secukinumab and ustekinumab was economically feasible. These drugs are options for those who do not respond to or have contraindications to etanercept.
{"title":"Unmet need for and impact of adopting immunobiological drugs for moderate to severe plaque psoriasis in a pediatric population.","authors":"Ana Clara Maia Palhano, Ninna Medeiros Gutierrez, Nicolas Sousa Vecchio Dos Santos, Rita Narikawa, André Ballalai, Dimitri Luz Felipe da Silva","doi":"10.31744/einstein_journal/2024GS0413","DOIUrl":"10.31744/einstein_journal/2024GS0413","url":null,"abstract":"<p><p>Palhano et al. demonstrate the feasibility of incorporating secukinumab and ustekinumab into the Clinical Protocol and Therapeutic Guidelines for moderate to severe psoriasis in pediatric patients.</p><p><strong>Objective: </strong>Therefore, this study aimed to evaluate the impact of secukinumab and ustekinumab against moderate-to-severe plaque psoriasis in a Brazilian pediatric population with access to public healthcare.</p><p><strong>Methods: </strong>A survey of immunobiological treatments registered for use against pediatric psoriasis at the National Health Surveillance Agency was conducted. These treatments were compared to the list available in the same treatment category in the public health system through the Clinical Protocol and Therapeutic Guidelines for psoriasis. A quantitative analysis of the data of patients treated with immunobiological drugs the previous year in accordance with the Clinical Protocol and Therapeutic Guidelines was performed using data available in the DATASUS portal.</p><p><strong>Results: </strong>The public budget impact scenarios analyzed were comparable to the investment already planned for acquiring the only available drug option.</p><p><strong>Conclusion: </strong>The incorporation of two therapeutic options in the Clinical Protocol and Therapeutic Guidelines list for moderate-to-severe pediatric psoriasis was feasible in a horizon of 5 years compared to the investment into the single option available to pediatric patients. These findings can facilitate the local analysis of budgetary impact and discussions on the feasibility of this therapeutic incorporation at the state level. Incorporation of secukinumab and ustekinumab was economically feasible. These drugs are options for those who do not respond to or have contraindications to etanercept.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11155720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141312034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-24DOI: 10.31744/einstein_journal/2024ED01003
Consolato M Sergi
{"title":"Rudolph Virchow's Public Health Engagement and Theodor Khoury's Legacy.","authors":"Consolato M Sergi","doi":"10.31744/einstein_journal/2024ED01003","DOIUrl":"10.31744/einstein_journal/2024ED01003","url":null,"abstract":"","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11155722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-24eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024AO0676
Felipe Soares Oliveira Portela, Carlos Augusto Rossetti, Thulio Fernandes de Souza, Arthur Souza Magnani, Marcelo Fiorelli Alexandrino da Silva, Maria Fernanda Cassino Portugal, Marcelo Passos Teivelis, Nelson Wolosker, Cynthia de Almeida Mendes
Objective: Through a retrospective analysis of 1,203 cases of referral from primary healthcare units to a specialized quaternary vascular surgical service, the findings of this study revealed a high proportion of inappropriate referrals, which may represent a substantial subutilization of this highly complex service. Consequently, in this study, we aimed to evaluate 1,203 cases of referral to a quaternary vascular surgical service, in São Paulo, Brazil, over a 6-year period, to assess the appropriate need for referral; in addition to the prevalence of surgical indications.
Methods: In this retrospective analysis, we reviewed the institutional records of participants referred from Basic Healthcare Units to a vascular surgical service inside the Brazilian Unified Health System, between May 2015 and December 2020. Demographic and clinical data were collected. The participants were stratified, as per the reason for referral to the vascular surgical service, previous imaging studies, and surgical treatment indications. Referral appropriateness and complementary examinations were evaluated for each disease cohort. Finally, the prevalence of cases requiring surgical treatment was defined as the outcome measure.
Results: Of the 1,203 referrals evaluated, venous disease was the main reason for referral (53%), followed by peripheral arterial disease (19.4%). A considerable proportion of participants had been referred without complementary imaging or after a long duration of undergoing an examination. Referrals were regarded as inappropriate in 517 (43%) cases. Of these, 32 cases (6.2%) had been referred to the vascular surgical service, as the incorrect specialty. The percentage of referred participants who ultimately underwent surgical treatment was 39.92%. Carotid (18%) and peripheral arterial diseases (18.4%) were correlated with a lower prevalence of surgical treatments.
Conclusion: The rate of referral appropriateness to specialized vascular care from primary care settings was low. This may represent a subutilization of quaternary surgical services, with low rates of surgical treatment.
{"title":"Retrospective analysis of 1,203 cases of referral to a quaternary vascular surgery outpatient clinic within the Unified Health System, São Paulo, Brazil.","authors":"Felipe Soares Oliveira Portela, Carlos Augusto Rossetti, Thulio Fernandes de Souza, Arthur Souza Magnani, Marcelo Fiorelli Alexandrino da Silva, Maria Fernanda Cassino Portugal, Marcelo Passos Teivelis, Nelson Wolosker, Cynthia de Almeida Mendes","doi":"10.31744/einstein_journal/2024AO0676","DOIUrl":"10.31744/einstein_journal/2024AO0676","url":null,"abstract":"<p><strong>Objective: </strong>Through a retrospective analysis of 1,203 cases of referral from primary healthcare units to a specialized quaternary vascular surgical service, the findings of this study revealed a high proportion of inappropriate referrals, which may represent a substantial subutilization of this highly complex service. Consequently, in this study, we aimed to evaluate 1,203 cases of referral to a quaternary vascular surgical service, in São Paulo, Brazil, over a 6-year period, to assess the appropriate need for referral; in addition to the prevalence of surgical indications.</p><p><strong>Methods: </strong>In this retrospective analysis, we reviewed the institutional records of participants referred from Basic Healthcare Units to a vascular surgical service inside the Brazilian Unified Health System, between May 2015 and December 2020. Demographic and clinical data were collected. The participants were stratified, as per the reason for referral to the vascular surgical service, previous imaging studies, and surgical treatment indications. Referral appropriateness and complementary examinations were evaluated for each disease cohort. Finally, the prevalence of cases requiring surgical treatment was defined as the outcome measure.</p><p><strong>Results: </strong>Of the 1,203 referrals evaluated, venous disease was the main reason for referral (53%), followed by peripheral arterial disease (19.4%). A considerable proportion of participants had been referred without complementary imaging or after a long duration of undergoing an examination. Referrals were regarded as inappropriate in 517 (43%) cases. Of these, 32 cases (6.2%) had been referred to the vascular surgical service, as the incorrect specialty. The percentage of referred participants who ultimately underwent surgical treatment was 39.92%. Carotid (18%) and peripheral arterial diseases (18.4%) were correlated with a lower prevalence of surgical treatments.</p><p><strong>Conclusion: </strong>The rate of referral appropriateness to specialized vascular care from primary care settings was low. This may represent a subutilization of quaternary surgical services, with low rates of surgical treatment.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11155721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-24eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024AO0637
Juliana Carvalho Segato Marincolo, Daniela de Assumpção, Mariana Reis Santimaria, Ivan Aprahamian, Mônica Sanches Yassuda, Anita Liberalesso Neri, Ligiana Pires Corona, Flávia Silva Arbex Borim
Objective: Marincolo et al. showed that older adults without limitations in basic activities of daily living at baseline presented with an 11.7% concomitant presence of functional dependence, slow gait speed, and low muscle strength at follow-up. Slow gait speed remains a predictor of dependence in basic activities of daily living. To determine whether low muscle strength and low gait speed increase the risk of disability related to basic activities of daily living in community-dwelling older adults.
Methods: A longitudinal study (9 years of follow-up) was conducted with 390 older adults who were independent in basic activities of daily living at baseline and answered the Katz Index at follow-up. Associations were determined using Pearson's χ2 test with a 5% significance level and logistic regression analysis.
Results: Increases in prevalence between baseline and follow-up were observed for low muscle strength (17.5%-38.2%), slow gait speed (26.0%-81.1%), and functional dependence (10.8%-26.6%). At follow-up, 11.7% of the participants had concomitant functional dependence, slow gait speed, and low muscle strength. Slow gait speed remained a predictor of dependence in basic activities of daily living (odds ratio=1.90; 95% confidence interval=1.06-3.41).
Conclusion: Slow gait speed is a predictor of functional dependence, constituting an important variable for screening functional decline.
{"title":"Low grip strength and gait speed as markers of dependence regarding basic activities of daily living: the FIBRA study.","authors":"Juliana Carvalho Segato Marincolo, Daniela de Assumpção, Mariana Reis Santimaria, Ivan Aprahamian, Mônica Sanches Yassuda, Anita Liberalesso Neri, Ligiana Pires Corona, Flávia Silva Arbex Borim","doi":"10.31744/einstein_journal/2024AO0637","DOIUrl":"10.31744/einstein_journal/2024AO0637","url":null,"abstract":"<p><strong>Objective: </strong>Marincolo et al. showed that older adults without limitations in basic activities of daily living at baseline presented with an 11.7% concomitant presence of functional dependence, slow gait speed, and low muscle strength at follow-up. Slow gait speed remains a predictor of dependence in basic activities of daily living. To determine whether low muscle strength and low gait speed increase the risk of disability related to basic activities of daily living in community-dwelling older adults.</p><p><strong>Methods: </strong>A longitudinal study (9 years of follow-up) was conducted with 390 older adults who were independent in basic activities of daily living at baseline and answered the Katz Index at follow-up. Associations were determined using Pearson's χ2 test with a 5% significance level and logistic regression analysis.</p><p><strong>Results: </strong>Increases in prevalence between baseline and follow-up were observed for low muscle strength (17.5%-38.2%), slow gait speed (26.0%-81.1%), and functional dependence (10.8%-26.6%). At follow-up, 11.7% of the participants had concomitant functional dependence, slow gait speed, and low muscle strength. Slow gait speed remained a predictor of dependence in basic activities of daily living (odds ratio=1.90; 95% confidence interval=1.06-3.41).</p><p><strong>Conclusion: </strong>Slow gait speed is a predictor of functional dependence, constituting an important variable for screening functional decline.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11155723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}