Einstein-Sao Paulo最新文献

Objective: To assess medical students' attitudes, knowledge, opinions, and expectations regarding medical artificial intelligence solutions, according to their sex and year of study.

Methods: This cross-sectional survey was a single-center study conducted at a medical school in São Paulo, Brazil, using an online questionnaire.

Results: Of 145 medical students who completed the survey (female, n=108/145, 74%; age, 18-25 years, n=129/145, 89%), 71 (49%) classified their artificial intelligence knowledge as intermediate, 137 (95%) wished that artificial intelligence would be regulated by the government. If artificial intelligence solutions were reliable, fast, and available, 74% (107/145) intended to use artificial intelligence frequently, but fewer participants approved artificial intelligence when used by other health professionals (68/145, 47%) or directly by patients (26/144, 18%). The main benefit of artificial intelligence is in accelerating diagnosis and disease management (116/145, 80%) and problem is overreliance on artificial intelligence and loss of medical skills (106/145, 73%). Students believed that artificial intelligence would facilitate physicians' work (125/145, 86%); increase the number of appointments (76/145, 53%); decrease their financial gain (63/145, 43%); and not replace their jobs but be an additional source of information (102/145, 70%). According to 88/145 (61%) participants, legal responsibility should be shared between the artificial intelligence manufacturer and physicians/hospitals.

Conclusion: Medical students showed positive perceptions of and attitudes towards artificial intelligence in healthcare. They presented interest in artificial intelligence and believed in its incorporation in daily clinical practice, if regulated, is user-friendly and accurate. However, concerns regarding this technology must be addressed.

Objective: To compare mortality rates between sexes in a cohort of patients with intermittent claudication residing in a metropolitan city in Brazil.

Methods: In this study, we included 215 patients (mean age 67±10 years, 65.3% men) who were followed for an average of 5.2 years (95% confidence interval [95%CI]: 4.8-5.5 years). At baseline, sociodemographic data, comorbidities, and clinical characteristics were recorded. The six-minute walk test was administered, with results reported as both absolute and relative walking distances, the latter based on reference values for healthy individuals with similar characteristics. Deaths were documented throughout the follow-up period. Cox regression analysis was used to estimate hazard ratios (HRs) and 95%CIs, adjusting for potential confounding factors.

Results: A total of 105 patients (58.9% men) died, with cardiovascular diseases accounting for the leading cause of death (32.0%). Deceased patients were older, had a higher prevalence of hypertension, and demonstrated shorter absolute and relative walking distances. Men had a significantly higher risk of all-cause mortality compared to women, independent of age, chronic obstructive pulmonary disease, six-minute walking distance, and ankle-brachial index (HR: 2.774; 95%CI= 1.316-5.847).

Conclusion: In patients with peripheral artery disease, men with intermittent claudication symptoms exhibit a higher risk of all-cause mortality compared to women. Future research should focus on identifying sex-specific risk factors associated with mortality in this population. Such insights are critical for developing targeted interventions aimed at reducing mortality, particularly among men with intermittent claudication in low- and middle-income countries.

Objective: To evaluate whether integrated palliative care is associated with improved overall survival and better end-of-life care in patients with upper aerodigestive tract malignancies. Secondary outcomes included the proportion of deaths in the intensive care unit, number of emergency department visits, chemotherapy use in the last 30 days of life, and the need for palliative sedation.

Methods: This retrospective, non-randomized cohort study included patients with upper aerodigestive tract malignancies who died during a five-year period. Patients were categorized based on whether they received outpatient follow-up by a specialized palliative care team. Healthcare and clinical outcomes were compared between the two groups.

Results: Among the 1,313 consecutive patients, 292 (22.2%) received outpatient palliative care. These patients had a median overall survival 4.7 months longer than those not followed up by palliative care. They also received less chemotherapy in the last 30 days of life, had fewer emergency department visits, had fewer intensive care unit deaths, and required less palliative sedation.

Conclusion: Outpatient follow-up by a specialized palliative care team was associated with longer survival and better end-of-life care. These findings highlight the potential benefits of integrating palliative care earlier in the treatment of patients with upper aerodigestive tract cancers.

Objective: This study aimed to analyze the expression profiles of miR-23a and miR-146a in women with premature ovarian insufficiency and to evaluate their value as biomarkers of the disease for early diagnosis and prognosis, as well as effective therapies.

Methods: The global expression profiles of peripheral blood samples from 10 patients with premature ovarian insufficiency and 10 normovulatory women were analyzed for the targets miR-23a and miR-146a and the endogenous control miR-U6 using real-time quantitative polymerase chain reaction. Statistical analysis was performed using analysis of variance and Bonferroni tests for group analysis. Welch's t-test was used to adjust for unequal variances between groups, and the Friedman test was used to confirm variance similarity.

Results: Increased miR-23a levels were observed in patients with premature ovarian insufficiency. An inverse correlation was observed for relative miR-146a expression, which showed decreased levels in the premature ovarian insufficiency group compared with the normovulatory group. The ratios of the relative expression levels of miR-23a and miR-146a significantly differed in the premature ovarian insufficiency group but not in the normovulatory group. These findings were reaffirmed by accuracy assessment, with a positive predictive value of 0.92.

Conclusion: Expression analysis of mir-23a and mir-146a demonstrates their potential use as biomarkers for premature ovarian insufficiency, owing to their relationship with the regulation of apoptosis and inflammation, follicular development, and cellular autoimmunity. This correlation can be assessed in larger sample sizes to confirm its importance in the early diagnosis, monitoring, and identification of potential therapeutic targets for premature ovarian insufficiency.

Objective: Posterior cervical spine surgery is used to decompress and/or stabilize the spine for the treatment of various spinal diseases. The aim of this study was to evaluate the clinical characteristics, surgical indications, and complications of patients who underwent posterior cervical spine surgery at a tertiary center.

Methods: This retrospective cohort/case series study included data from patients who underwent posterior cervical spine surgery at a tertiary hospital to treat different cervical diseases.

Results: A total of 161 patients were included. One hundred six (65.8%) patients were men, and mean age was 45.1 years. Patients with neoplastic diseases had the lowest mean age, whereas those with traumatic and degenerative diseases had the highest (p<0.001). Thirty-six patients (22.3%) experienced at least one complication. Serious adverse effects were infrequent despite six deaths (3.7%), and among the non-serious complications, surgical site infection (6.2%) and the need for late reoperation (4.3%) were the most common. No specific patient characteristics were associated with complications; however, a trend toward complications in urgent procedures was noted (p=0.085).

Conclusion: Posterior cervical spine surgery was more common in men, and patients with degenerative diseases had a higher average age. There was no statistically significant association between complications and patient characteristics, with a trend toward more clinical complications during urgent procedures. Serious complications were infrequent in elective procedures; however, a small risk of death was noted, particularly in patients with trauma-related cervical spine injuries. Understanding the epidemiology and complications is fundamental for preoperative counseling and the prevention of complications.