Einstein-Sao Paulo最新文献

Objective: This study aimed to investigate the effects of sex and time of day on behavioral parameters in healthy rats, focusing on locomotion, cognition, and memory (both spatial and episodic).

Methods: Twenty-four Wistar rats (12 males and 12 females) were divided into morning and afternoon groups. Behavioral tests included actimetry for spontaneous locomotion, novel object recognition test for episodic memory, and the Morris water maze test for spatial memory. Data were analyzed cross-sectionally and longitudinally, considering sex and time of day as variables. The evaluated parameters included fast and slow horizontal and vertical movements, recognition index, average speed, and quadrant preference in the Morris water maze.

Results: Females exhibited higher frequencies of rapid horizontal and vertical movements than males, especially in the morning. Novel object recognition test results showed higher recognition index values in the morning, with females displaying greater exploration of novel objects, while the Morris water maze test results indicated that the time spent in the target quadrant was consistent across groups, but females demonstrated longer latencies in the afternoon.

Conclusion: These results highlight the significant influence of sex and circadian timing on behavioral performance in healthy animals. These factors should be carefully considered when designing and interpreting preclinical behavioral studies to improve experimental consistency and data reproducibility.

Introduction: Acute kidney injury is a common and serious condition in critically ill patients. Current biomarkers, such as serum creatinine, are limited in early detection and prognostic assessment. The neutrophil-to-lymphocyte ratio has emerged as a promising inflammatory biomarker, reflecting systemic inflammation and potentially serving as a tool for risk stratification in high-risk groups.

Objective: To evaluate the prognostic value of the neutrophil-to-lymphocyte ratio in predicting mortality in patients with acute kidney injury through a systematic review and meta-analysis.

Methods: A comprehensive search was conducted in PubMed, Embase, Cochrane, and LILACS databases for full-text articles published from the inception of each database until June 2024, using terms related to neutrophil-to-lymphocyte ratio and acute kidney injury. Studies were included if they evaluated the relationship between neutrophil-to-lymphocyte ratio and mortality in acute kidney injury patients. Data were pooled for meta-analysis using a random-effects model, with sensitivity, specificity, and area under the curve (AUC) calculated.

Results: Of the 806 studies identified, five met the inclusion criteria, encompassing a total of 2,424 patients. The pooled sensitivity and specificity of the neutrophil-to-lymphocyte ratio for predicting mortality were 0.58 (95%CI=0.51-0.65) and 0.65 (95%CI=0.59-0.71), respectively. The AUC was 0.65, suggesting moderate predictive power. Significant heterogeneity was observed across studies owing to differences in neutrophil-to-lymphocyte ratio cutoff points, patient populations, and outcomes analyzed.

Conclusion: An elevated neutrophil-to-lymphocyte ratio is associated with a worse prognosis in patients with acute kidney injury, highlighting its potential as a readily available biomarker for risk stratification.Prospero database registration: CRD42024569162.

Mammoplasty is commonly performed under epidural anesthesia combined with intravenous sedation; however, this carries a risk of dural puncture and post-dural puncture headache. Successful treatment is often achieved with opioids, non-steroidal anti-inflammatory drugs, and caffeine. When conservative treatment fails, an epidural blood patch should be performed; this procedure has a high resolution rate. We report the case of a patient who developed a post-dural puncture headache 25 days after elective breast implant replacement performed under thoracic epidural anesthesia combined with intravenous sedation. The post-dural puncture headache was refractory to conservative treatment and the first epidural blood patch was unsuccessful. This case represents an exceptionally rare presentation of post-dural puncture headache, marked by a delayed onset of nearly four weeks and requiring a second epidural blood patch for symptom resolution.

Lisdexamfetamine, a prodrug used to treat Attention Deficit/Hyperactivity Disorder in children, adolescents, and adults, is an inactive substance that is converted into its active form (dextroamphetamine) after being metabolized. This conversion primarily occurs in the bloodstream through enzymatic cleavage following active absorption from the gastrointestinal lumen. The active metabolite then stimulates the central nervous system by increasing the levels of dopamine and norepinephrine in the brain. It was discovered in 1996 by New River Pharmaceuticals and approved by the FDA in 2007 for the treatment of Attention Deficit/Hyperactivity Disorder in children. In this article, two cases of secondary Raynaud's phenomenon due to the use of lisdexamfetamine are described. Raynaud's disease is the primary form, occurring in the absence of an underlying cause, and differs from secondary Raynaud's phenomenon, which is associated with various medical conditions and pharmacological agents. In the cases reported in this study, the phenomenon occurred during treatment with lisdexamfetamine, where it is listed as an uncommon adverse effect in the prescribing information. In both patients presented in this report, discontinuation of the medication led to resolution of the phenomenon within a few days. This report highlights the fact that one of the patients reported episodes of dizziness during Raynaud's phenomenon, drawing attention to the potential associated complications.

Objective: To evaluate the epidemiology of upper limb vascular trauma across Brazil and evaluate the incidence rates, demographic characteristics, lethality, days of hospitalization, and related healthcare costs.

Methods: This retrospective analysis used data from the Brazilian public health system over sixteen years (2008-2023). Automated data extraction utilized Python-based tools to gather information on vascular trauma procedures identified by ICD-10 codes. Statistical analyses were performed to assess variations in incidence, lethality, and treatment costs across Brazilian regions.

Results: A total of 25,573 cases of upper limb vascular trauma were recorded. Most cases occurred in males (79.8%) with a mean age of 34.7 years. The region in Brazil with the highest incidence of upper limb vascular trauma was the North (16.6 cases per 100,000 inhabitants), while the Southeast had the lowest (10.7 cases per 100,000 inhabitants). The average length of hospital stay was 4.39 days, and 92.8% of the patients did not require admission to the intensive care unit. Among patients admitted to the intensive care unit, the average length of stay was 4.52 days. The overall lethality of upper limb vascular trauma was 2.37%, with higher lethality observed in bilateral upper limb vascular trauma (3.81%).

Conclusion: The incidence of upper limb vascular trauma is higher in Brazil than in developed countries, even after adjusting for population size. However, lethality and hospitalization duration did not appear to differ significantly from those in developed countries.

Objective: To analyze cardiopulmonary resuscitation skill acquisition and retention at 3 and 6-month intervals and determine the optimal training frequency and associated costs.

Methods: Fifth and sixth-year medical students practiced cardiopulmonary resuscitation using a feedback-equipped simulator.

Results: The study included 43 students. Training with a feedback-equipped device significantly improved the performance compared to baseline: overall performance (median=95% [87-98%] versus 60% [18-89%]; p<0.001), compression depth (median=71% [24-92%] versus 13% [0-94%]; p<0.001), and compression rate (median=89% [71-98%] versus 69% [23-96%]; p=0.002. No significant differences were observed in the total recoil (median=93% [78-99%] versus 93% [58-100%]; p=0.991) or hand position (median=99% [100-100%] versus 99% [100-100%]; p=0.754). Over time, the overall performance increased by 12% at 3 months (mean ratio [MR]=1.12; p=0.001) and 10.1% at 6 months (MR=1.101; p<0.001). The compression depth improved by 38.9% at 3 months (MR=1.389; p<0.001) and 24.7% at 6 months (MR=1.247; p=0.010), whereas the compression rate increased only at 6 months (MR=1.086; p=0.026). No significant differences were found between the groups trained every 3 months and those trained every 6 months (p>0.05).

Conclusion: Short-term training with a cardiopulmonary resuscitation feedback-equipped simulator significantly improved cardiopulmonary resuscitation skill acquisition and retention. However, no differences were observed between the 3- and 6-month training intervals, suggesting that a 6-month interval may be sufficient for maintaining proficiency.

Platypnea-orthodeoxia syndrome, first described in 1949, is a rare clinical condition characterized by positional dyspnea and oxygen desaturation in the upright position that improves when lying down. Herein, we report the case of an 86-year-old patient who experienced episodes of dyspnea on assuming an upright position, which limited her daily activities. The patient's oxygen saturation was 82% in the standing position and 91% in the supine position. During diagnostic investigation, a patent foramen ovale was identified using transesophageal echocardiography. The patient underwent percutaneous patent foramen ovale closure with an Amplatzer device, which resulted in significant improvement in her symptoms and oxygen saturation. Diagnosis of this condition requires a high index of clinical suspicion and is confirmed when the syndrome's signs and symptoms correlate with the presence of a right-to-left interatrial shunt. It is predominantly diagnosed using echocardiography with agitated saline injection.

Background: Lymphatic leakage after pelvic lymphadenectomy is a rare complication. Furthermore, in some cases, drainage is not possible or proves insufficient to resolve this complication. Therefore, more effective and minimally invasive interventional treatments are necessary. Accordingly, this case report presents a case of transafferent nodal embolization in a 50-year-old woman who underwent videolaparoscopic total hysterectomy with pelvic lymphadenectomy. The patient developed high post-surgery vaginal flow due to a lymphatic fistula, which was identified after intranodal lymphangiography and treated successfully via transafferent nodal embolization. This case report shows the importance of considering lymphatic leakage as a possible pelvic surgery complication, particularly when accompanied by local lymphadenectomy. Moreover, the case report reveals that intranodal lymphangiography and transafferent nodal embolization are safe and highly effective methods to detect and treat this complication. This prevents the need for follow-up surgery, which may add morbidity to an otherwise uneventful postoperative period.

Level of evidence: Level 5, Case Report.