Pub Date : 2024-09-30eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024AO0562
Jéssica Isabelle Santos Dutra, Marcelo Cardoso de Souza, Caio Alano Almeida Lins, Anna Cecília Queiroz de Medeiros
Background: Chikungunya fever compromises the functionality and quality of life in the affected individuals, even one year after the acute phase of the disease. Chronically affected people experience direct impairment in performing daily activities, along with a risk of developing other morbidities.
Background: ◼ Even after a year, chikungunya fever-affected people experience damage to their physical and mental health.
Background: ◼ Positive screening for depression risk was 13.5 times more likely in chronically affected.
Background: ◼ Patients with chronic chikungunya fever had a 76 times higher risk of walking impairments.
Objective: To evaluate the impact of chronic illness caused by chikungunya fever on the quality of life and functionality of affected individuals.
Methods: A cross-sectional and comparative study was conducted in which two groups were investigated: a Chikungunya Group comprising 25 patients with chronic fever screened after 1 year of illness via a telephonic survey, and a Healthy Group comprising 25 healthy individuals matched for sex and age by face-to-face interview. The Stanford HAQ 20-Item Disability Scale (HAQ) and the Short Form Health Survey (SF-12) questionnaires were administered to both groups. Generalized Linear Models, Pearson χ2 tests, and odds ratios were used to evaluate the test results.
Results: Significant differences in functional capacity and quality of life were observed between the Chikungunya and Healthy Groups. The chance of some impairment in functionality was also much higher in the Chikungunya Group in four of the HAQ categories, especially in the "walking" category (adjusted OR= 109.40). Further, the Chikungunya Group had a higher chance of presenting a below-average score in the mental component summary of the SF-12 (adjusted OR= 16.20) and of being positive in depression risk screening (adjusted OR= 34.57).
Conclusion: Even one year after the acute phase, chikungunya fever can compromise the functionality and quality of life in affected individuals, with direct impairment in performing daily activities. Studies and therapeutic plans for chikungunya fever should consider the long-term impacts of this disease.
{"title":"Impact of chronic illness caused by chikungunya fever on quality of life and functionality.","authors":"Jéssica Isabelle Santos Dutra, Marcelo Cardoso de Souza, Caio Alano Almeida Lins, Anna Cecília Queiroz de Medeiros","doi":"10.31744/einstein_journal/2024AO0562","DOIUrl":"10.31744/einstein_journal/2024AO0562","url":null,"abstract":"<p><strong>Background: </strong>Chikungunya fever compromises the functionality and quality of life in the affected individuals, even one year after the acute phase of the disease. Chronically affected people experience direct impairment in performing daily activities, along with a risk of developing other morbidities.</p><p><strong>Background: </strong>◼ Even after a year, chikungunya fever-affected people experience damage to their physical and mental health.</p><p><strong>Background: </strong>◼ Positive screening for depression risk was 13.5 times more likely in chronically affected.</p><p><strong>Background: </strong>◼ Patients with chronic chikungunya fever had a 76 times higher risk of walking impairments.</p><p><strong>Objective: </strong>To evaluate the impact of chronic illness caused by chikungunya fever on the quality of life and functionality of affected individuals.</p><p><strong>Methods: </strong>A cross-sectional and comparative study was conducted in which two groups were investigated: a Chikungunya Group comprising 25 patients with chronic fever screened after 1 year of illness via a telephonic survey, and a Healthy Group comprising 25 healthy individuals matched for sex and age by face-to-face interview. The Stanford HAQ 20-Item Disability Scale (HAQ) and the Short Form Health Survey (SF-12) questionnaires were administered to both groups. Generalized Linear Models, Pearson χ2 tests, and odds ratios were used to evaluate the test results.</p><p><strong>Results: </strong>Significant differences in functional capacity and quality of life were observed between the Chikungunya and Healthy Groups. The chance of some impairment in functionality was also much higher in the Chikungunya Group in four of the HAQ categories, especially in the \"walking\" category (adjusted OR= 109.40). Further, the Chikungunya Group had a higher chance of presenting a below-average score in the mental component summary of the SF-12 (adjusted OR= 16.20) and of being positive in depression risk screening (adjusted OR= 34.57).</p><p><strong>Conclusion: </strong>Even one year after the acute phase, chikungunya fever can compromise the functionality and quality of life in affected individuals, with direct impairment in performing daily activities. Studies and therapeutic plans for chikungunya fever should consider the long-term impacts of this disease.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eAO0562"},"PeriodicalIF":1.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11461011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366930","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 : 2024-09-30eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024AO0682
Max Duarte de Oliveira, Wellington Segheto, Hélcio Kanegusuku, Aline Mendes Gerage, Nelson Wolosker, Marilia de Almeida Correia, Raphael Mendes Ritti-Dias
Background: We examined the sedentary behavior and physical activity of 260 patients with peripheral artery disease. Women engaged in more light physical activity than men did. Light physical activity was associated with lower arterial stiffness in men only, while no significant associations were found between sedentary behavior, moderate-vigorous physical activity, and cardiovascular outcomes.
Background: ◼ Women with peripheral artery disease exhibited higher blood pressure and arterial stiffness than men.
Background: ◼ Low levels of physical activity, particularly moderate to vigorous activity, were observed in individuals with peripheral artery disease.
Objective: To analyze the association between the time spent in sedentary behavior and physical activity of different intensities with cardiovascular health in men and women with peripheral artery disease.
Methods: Two hundred and sixty patients with peripheral artery disease and claudication symptoms (65.7% men; 66±1 years; ankle brachial index 0.57±0.18) were evaluated. Physical activity and sedentary behavior were assessed using an accelerometer. Physical activity was classified into light and moderate-vigorous intensities. The cardiovascular outcomes included blood pressure (oscillometric method), cardiac autonomic modulation (heart rate variability), and arterial stiffness (pulse wave velocity).
Results: Women spent more time engaged in light physical activity than men (341±14 min/day versus 306±9 min/day; p=0.040, respectively). There was no significant difference in the time spent on sedentary behavior and moderate-vigorous physical activity. Women had a higher systolic blood pressure (p=0.025), higher augmentation index (p<0.001), and lower sympathovagal balance (p=0.047) than men. Pulse wave velocity was only negatively associated with light physical activity (β= -4.66; 95%CI= -8.57; -0.76) in men. Light and moderate-vigorous physical activity and sedentary behavior were not associated with other cardiovascular outcomes.
Conclusion: Higher levels of light physical activity were associated with lower arterial stiffness in men with peripheral artery disease.
{"title":"Association between physical activity performed at different intensities and cardiovascular health in patients with peripheral artery disease: an observational study.","authors":"Max Duarte de Oliveira, Wellington Segheto, Hélcio Kanegusuku, Aline Mendes Gerage, Nelson Wolosker, Marilia de Almeida Correia, Raphael Mendes Ritti-Dias","doi":"10.31744/einstein_journal/2024AO0682","DOIUrl":"10.31744/einstein_journal/2024AO0682","url":null,"abstract":"<p><strong>Background: </strong>We examined the sedentary behavior and physical activity of 260 patients with peripheral artery disease. Women engaged in more light physical activity than men did. Light physical activity was associated with lower arterial stiffness in men only, while no significant associations were found between sedentary behavior, moderate-vigorous physical activity, and cardiovascular outcomes.</p><p><strong>Background: </strong>◼ Women with peripheral artery disease exhibited higher blood pressure and arterial stiffness than men.</p><p><strong>Background: </strong>◼ Low levels of physical activity, particularly moderate to vigorous activity, were observed in individuals with peripheral artery disease.</p><p><strong>Objective: </strong>To analyze the association between the time spent in sedentary behavior and physical activity of different intensities with cardiovascular health in men and women with peripheral artery disease.</p><p><strong>Methods: </strong>Two hundred and sixty patients with peripheral artery disease and claudication symptoms (65.7% men; 66±1 years; ankle brachial index 0.57±0.18) were evaluated. Physical activity and sedentary behavior were assessed using an accelerometer. Physical activity was classified into light and moderate-vigorous intensities. The cardiovascular outcomes included blood pressure (oscillometric method), cardiac autonomic modulation (heart rate variability), and arterial stiffness (pulse wave velocity).</p><p><strong>Results: </strong>Women spent more time engaged in light physical activity than men (341±14 min/day versus 306±9 min/day; p=0.040, respectively). There was no significant difference in the time spent on sedentary behavior and moderate-vigorous physical activity. Women had a higher systolic blood pressure (p=0.025), higher augmentation index (p<0.001), and lower sympathovagal balance (p=0.047) than men. Pulse wave velocity was only negatively associated with light physical activity (β= -4.66; 95%CI= -8.57; -0.76) in men. Light and moderate-vigorous physical activity and sedentary behavior were not associated with other cardiovascular outcomes.</p><p><strong>Conclusion: </strong>Higher levels of light physical activity were associated with lower arterial stiffness in men with peripheral artery disease.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eAO0682"},"PeriodicalIF":1.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11461016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366926","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 : 2024-09-30eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024GS0683
Guilherme Cayres Mariotti, Guilherme Eduardo Gonçalves Felga, Rodrigo Gobbo Garcia, Priscila Mina Falsarella, Bruno Pagnin Schmid, Daniel Tavares Malheiros, Ronaldo Hueb Baroni, Ary Serpa Neto
Objective: This study assessed the cost-effectiveness of radiofrequency ablation compared with percutaneous ethanol injection in patients with early hepatocellular carcinoma in relation to the objective response rate and costs related to the procedure.
Methods: This was a prospective single-center randomized trial. The primary outcome was cost-effectiveness. Secondary outcomes were the complete response rate according to the modified response evaluation criteria in solid tumors 60 days after randomization and the complication rate within 180 60 days.
Results: Fifty patients were placed into the following groups: percutaneous ethanol injection (n=23) and radiofrequency ablation (n=27). Fifty-four nodules were randomized (mean follow-up: 205.37 days). The estimated mean hospital cost was US$ 1854.11 and US$ 2770.96 for the Radiofrequency Ablation and Percutaneous Ethanol Injection Groups, respectively. The incremental cost-effectiveness ratio was US$ -2674.59, which is advantageous for radiofrequency ablation. After 60 d, 28 of 29 nodules in the Radiofrequency Ablation Group achieved complete response versus 12 of 22 in the Percutaneous Ethanol Injection Group (RD, 42.01 [95%CI= 20.55-63.24]; p<0.001). Only four early complications were observed among patients treated by percutaneous ethanol injection (p<0.05). Late complications occurred in two and one patient(s) in the Radiofrequency Ablation and Percutaneous Ethanol Injection Groups (p>0.05), respectively.
Conclusion: Radiofrequency ablation was more cost-effective and achieved higher complete response and lower complication rates than the Percutaneous Ethanol Injection Group within this cohort.
{"title":"Cost-effectiveness of radiofrequency ablation versus percutaneous ethanol injection for early hepatocellular carcinoma in a resource-poor setting: a randomized trial.","authors":"Guilherme Cayres Mariotti, Guilherme Eduardo Gonçalves Felga, Rodrigo Gobbo Garcia, Priscila Mina Falsarella, Bruno Pagnin Schmid, Daniel Tavares Malheiros, Ronaldo Hueb Baroni, Ary Serpa Neto","doi":"10.31744/einstein_journal/2024GS0683","DOIUrl":"10.31744/einstein_journal/2024GS0683","url":null,"abstract":"<p><strong>Objective: </strong>This study assessed the cost-effectiveness of radiofrequency ablation compared with percutaneous ethanol injection in patients with early hepatocellular carcinoma in relation to the objective response rate and costs related to the procedure.</p><p><strong>Methods: </strong>This was a prospective single-center randomized trial. The primary outcome was cost-effectiveness. Secondary outcomes were the complete response rate according to the modified response evaluation criteria in solid tumors 60 days after randomization and the complication rate within 180 60 days.</p><p><strong>Results: </strong>Fifty patients were placed into the following groups: percutaneous ethanol injection (n=23) and radiofrequency ablation (n=27). Fifty-four nodules were randomized (mean follow-up: 205.37 days). The estimated mean hospital cost was US$ 1854.11 and US$ 2770.96 for the Radiofrequency Ablation and Percutaneous Ethanol Injection Groups, respectively. The incremental cost-effectiveness ratio was US$ -2674.59, which is advantageous for radiofrequency ablation. After 60 d, 28 of 29 nodules in the Radiofrequency Ablation Group achieved complete response versus 12 of 22 in the Percutaneous Ethanol Injection Group (RD, 42.01 [95%CI= 20.55-63.24]; p<0.001). Only four early complications were observed among patients treated by percutaneous ethanol injection (p<0.05). Late complications occurred in two and one patient(s) in the Radiofrequency Ablation and Percutaneous Ethanol Injection Groups (p>0.05), respectively.</p><p><strong>Conclusion: </strong>Radiofrequency ablation was more cost-effective and achieved higher complete response and lower complication rates than the Percutaneous Ethanol Injection Group within this cohort.</p><p><strong>Registry of clinical trials: </strong>NCT06450613.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eGS0683"},"PeriodicalIF":1.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11461008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366928","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 : 2024-09-30eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024AO0508
Fábio Ribeiro Queiroz, Letícia da Conceição Braga, Carolina Pereira de Souza Melo, Matheus de Souza Gomes, Laurence Rodrigues do Amaral, Paulo Guilherme de Oliveira Salles
Background: Queiroz et al. showed that the application of cluster methodology for classifying gastric cancer is suitable and efficient within a Brazilian cohort, which is known for its population heterogeneity. The study highlighted the potential utilization of this method within public health services due to its low-cost, presenting a viable means to improve the diagnosis and prognosis of gastric cancer.
Background: Our Brazilian cohort with gastric cancer has a distinct distribution between mutated and normal p53.
Background: New genetic marker-based classifications improve gastric cancer diagnosis accuracy.
Background: Machine learning integration enhances predictive value in gastric cancer diagnosis.
Objective: Gastric adenocarcinoma remains an aggressive disease with a poor prognosis, as evidenced by a 5-year survival rate of approximately 31%. The histological classifications already proposed do not accurately reflect the high biological heterogeneity of this neoplasm, particularly in diverse populations, and new classification systems using genetic markers have recently been proposed. Following these newly proposed models, we aimed to assess the cluster distribution in a Brazilian cohort. Furthermore, we evaluated whether the inclusion of other clinical and histological parameters could enhance the predictive value.
Methods: We used a previously described four-immunohistochemistry/EBER-ISH marker to classify a cohort of 30 Brazilian patients with gastric adenocarcinoma into five different clusters and compared the distribution with other genetically diverse populations. Furthermore, we used artificial intelligence methods to evaluate whether other clinical and pathological parameters could improve the results of the methodology.
Results: Disclosing the genetic variability between populations, we observed a more balanced distribution of the aberrant/normal p53 ratio (0.6) between patients negative for the other markers tested, unlike previous studies with Asian and North American populations. In addition, decision tree analysis reinforced the efficiency of these new classifications, as the stratification accuracy was not altered with or without additional data.
Conclusion: Our study underscores the importance of local research in characterizing diverse populations and highlights the complementary role of molecular biomarkers in personalized medicine for gastric adenocarcinoma, enhancing diagnostic accuracy and potentially improving survival rates.
{"title":"Cluster classification of a Brazilian gastric cancer cohort reveals remarkable populational differences in normal p53 rate.","authors":"Fábio Ribeiro Queiroz, Letícia da Conceição Braga, Carolina Pereira de Souza Melo, Matheus de Souza Gomes, Laurence Rodrigues do Amaral, Paulo Guilherme de Oliveira Salles","doi":"10.31744/einstein_journal/2024AO0508","DOIUrl":"10.31744/einstein_journal/2024AO0508","url":null,"abstract":"<p><strong>Background: </strong>Queiroz et al. showed that the application of cluster methodology for classifying gastric cancer is suitable and efficient within a Brazilian cohort, which is known for its population heterogeneity. The study highlighted the potential utilization of this method within public health services due to its low-cost, presenting a viable means to improve the diagnosis and prognosis of gastric cancer.</p><p><strong>Background: </strong>Our Brazilian cohort with gastric cancer has a distinct distribution between mutated and normal p53.</p><p><strong>Background: </strong>New genetic marker-based classifications improve gastric cancer diagnosis accuracy.</p><p><strong>Background: </strong>Machine learning integration enhances predictive value in gastric cancer diagnosis.</p><p><strong>Background: </strong>Molecular biomarkers complement clinical decisions, advancing personalized medicine.</p><p><strong>Objective: </strong>Gastric adenocarcinoma remains an aggressive disease with a poor prognosis, as evidenced by a 5-year survival rate of approximately 31%. The histological classifications already proposed do not accurately reflect the high biological heterogeneity of this neoplasm, particularly in diverse populations, and new classification systems using genetic markers have recently been proposed. Following these newly proposed models, we aimed to assess the cluster distribution in a Brazilian cohort. Furthermore, we evaluated whether the inclusion of other clinical and histological parameters could enhance the predictive value.</p><p><strong>Methods: </strong>We used a previously described four-immunohistochemistry/EBER-ISH marker to classify a cohort of 30 Brazilian patients with gastric adenocarcinoma into five different clusters and compared the distribution with other genetically diverse populations. Furthermore, we used artificial intelligence methods to evaluate whether other clinical and pathological parameters could improve the results of the methodology.</p><p><strong>Results: </strong>Disclosing the genetic variability between populations, we observed a more balanced distribution of the aberrant/normal p53 ratio (0.6) between patients negative for the other markers tested, unlike previous studies with Asian and North American populations. In addition, decision tree analysis reinforced the efficiency of these new classifications, as the stratification accuracy was not altered with or without additional data.</p><p><strong>Conclusion: </strong>Our study underscores the importance of local research in characterizing diverse populations and highlights the complementary role of molecular biomarkers in personalized medicine for gastric adenocarcinoma, enhancing diagnostic accuracy and potentially improving survival rates.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eAO0508"},"PeriodicalIF":1.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11461015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366927","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 : 2024-09-30eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024CE0952
Marcela Lopes Frade, Luciana Assis Pires Andrade Vale, Letícia Candançan Corrêa, Felipe de Souza Rossi, Celso de Moraes Terra, José Colleti Junior
{"title":"Use of electrical impedance tomography to set positive end-expiratory pressure in a pediatric patient with severe acute respiratory distress syndrome.","authors":"Marcela Lopes Frade, Luciana Assis Pires Andrade Vale, Letícia Candançan Corrêa, Felipe de Souza Rossi, Celso de Moraes Terra, José Colleti Junior","doi":"10.31744/einstein_journal/2024CE0952","DOIUrl":"10.31744/einstein_journal/2024CE0952","url":null,"abstract":"","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eCE0952"},"PeriodicalIF":1.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11460999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366933","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 : 2024-09-30eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024AO0687
Luis Eduardo Magalhães, Ana Júlia Favarin, Pedro Andriolo Cardoso, Bruna Kaori Yuasa, Welder Zamoner, André Luís Balbi, Daniela Ponce
<p><strong>Background: </strong>Magalhães et al. demonstrated that the incidence of acute kidney injury was high in hospitalized patients with COVID-19 and that the second wave was associated with greater severity; however, the mortality rates were similar between the two periods. This may reflect both the effectiveness of vaccines and the constant learning that frontline professionals gained throughout the pandemic to provide greater support to their patients.</p><p><strong>Background: </strong>◼ Renal involvement was frequent in patients with COVID-19 and related to worse outcomes.</p><p><strong>Background: </strong>◼ Diuretic use, mechanical ventilation, proteinuria, hematuria, age, and creatine phosphokinase and D-dimer levels were risk factors for acute kidney injury.</p><p><strong>Background: </strong>◼ Acute kidney injury, mechanical ventilation, elevated SOFA Score, and elevated ATN-ISS were associated with mortality.</p><p><strong>Background: </strong>◼ The second wave was associated with greater severity; however, the mortality rates were similar between the two periods.</p><p><strong>Background: </strong>◼ This may reflect the effectiveness of vaccines and the constant learning that frontline professionals gained throughout the pandemic.</p><p><strong>Objective: </strong>This study aimed to evaluate the incidence of acute kidney injury in hospitalized Brazilian patients with COVID-19 and identify the risk factors associated with its development and prognosis during the two waves of the disease.</p><p><strong>Methods: </strong>We performed a prospective cohort study of hospitalized patients with COVID-19 at a public university hospital in São Paulo from March 2020 to May 2021.</p><p><strong>Results: </strong>Of 887 patients hospitalized with COVID-19, 54.6% were admitted to the intensive care unit. The incidence of acute kidney injury was 48.1%, and the overall mortality rate was 38.9%. Acute kidney replacement therapy was indicated for 58.8% of the patients. The factors associated with acute kidney injury were diuretic use (odds ratio [OR] 2.2, 95%CI= 1.2-4.1, p=0.01), mechanical ventilation (OR= 12.9, 95%CI= 4.3-38.2, p<0.0001), hematuria(OR= 2.02, 95%CI= 1.1-3.5, p<0.0001), chronic kidney disease (OR= 2.6, 95%CI= 1.2-5.5, p=0.009), age (OR= 1.03, 95%CI= 1.01-1.07, p=0.02), and elevated creatine phosphokinase (OR= 1.02, 95%CI= 1.01-1.07, p=0.02) and D-dimer levels (OR= 1.01, 95%CI= 1.01-1.09, p<0.0001). Mortality was higher among those with acute kidney injury (OR= 1.12, 95%CI= 1.02-2.05, p=0.01), elevated Sequential Organ Failure Assessment Scores (OR= 1.35, 95%CI= 1.1-1.6, p=0.007), elevated Acute Tubular Necrosis-Injury Severity Score (ATN-ISS; (OR= 96.4, 95%CI= 4.8-203.1, p<0.0001), and who received mechanical ventilation (OR= 12.9, 95%CI= 4.3-38.2, p<0.0001). During the second wave, the number of cases requiring mechanical ventilation (OR= 1.57, 95%CI= 1.01-2.3, p=0.026), with proteinuria (OR= 1.44, 95%CI= 1.01-2.1, p=0.04), and
{"title":"Acute kidney injury in coronavirus disease: a comparative study of the two waves in Brazil.","authors":"Luis Eduardo Magalhães, Ana Júlia Favarin, Pedro Andriolo Cardoso, Bruna Kaori Yuasa, Welder Zamoner, André Luís Balbi, Daniela Ponce","doi":"10.31744/einstein_journal/2024AO0687","DOIUrl":"10.31744/einstein_journal/2024AO0687","url":null,"abstract":"<p><strong>Background: </strong>Magalhães et al. demonstrated that the incidence of acute kidney injury was high in hospitalized patients with COVID-19 and that the second wave was associated with greater severity; however, the mortality rates were similar between the two periods. This may reflect both the effectiveness of vaccines and the constant learning that frontline professionals gained throughout the pandemic to provide greater support to their patients.</p><p><strong>Background: </strong>◼ Renal involvement was frequent in patients with COVID-19 and related to worse outcomes.</p><p><strong>Background: </strong>◼ Diuretic use, mechanical ventilation, proteinuria, hematuria, age, and creatine phosphokinase and D-dimer levels were risk factors for acute kidney injury.</p><p><strong>Background: </strong>◼ Acute kidney injury, mechanical ventilation, elevated SOFA Score, and elevated ATN-ISS were associated with mortality.</p><p><strong>Background: </strong>◼ The second wave was associated with greater severity; however, the mortality rates were similar between the two periods.</p><p><strong>Background: </strong>◼ This may reflect the effectiveness of vaccines and the constant learning that frontline professionals gained throughout the pandemic.</p><p><strong>Objective: </strong>This study aimed to evaluate the incidence of acute kidney injury in hospitalized Brazilian patients with COVID-19 and identify the risk factors associated with its development and prognosis during the two waves of the disease.</p><p><strong>Methods: </strong>We performed a prospective cohort study of hospitalized patients with COVID-19 at a public university hospital in São Paulo from March 2020 to May 2021.</p><p><strong>Results: </strong>Of 887 patients hospitalized with COVID-19, 54.6% were admitted to the intensive care unit. The incidence of acute kidney injury was 48.1%, and the overall mortality rate was 38.9%. Acute kidney replacement therapy was indicated for 58.8% of the patients. The factors associated with acute kidney injury were diuretic use (odds ratio [OR] 2.2, 95%CI= 1.2-4.1, p=0.01), mechanical ventilation (OR= 12.9, 95%CI= 4.3-38.2, p<0.0001), hematuria(OR= 2.02, 95%CI= 1.1-3.5, p<0.0001), chronic kidney disease (OR= 2.6, 95%CI= 1.2-5.5, p=0.009), age (OR= 1.03, 95%CI= 1.01-1.07, p=0.02), and elevated creatine phosphokinase (OR= 1.02, 95%CI= 1.01-1.07, p=0.02) and D-dimer levels (OR= 1.01, 95%CI= 1.01-1.09, p<0.0001). Mortality was higher among those with acute kidney injury (OR= 1.12, 95%CI= 1.02-2.05, p=0.01), elevated Sequential Organ Failure Assessment Scores (OR= 1.35, 95%CI= 1.1-1.6, p=0.007), elevated Acute Tubular Necrosis-Injury Severity Score (ATN-ISS; (OR= 96.4, 95%CI= 4.8-203.1, p<0.0001), and who received mechanical ventilation (OR= 12.9, 95%CI= 4.3-38.2, p<0.0001). During the second wave, the number of cases requiring mechanical ventilation (OR= 1.57, 95%CI= 1.01-2.3, p=0.026), with proteinuria (OR= 1.44, 95%CI= 1.01-2.1, p=0.04), and ","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eAO0687"},"PeriodicalIF":1.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11461013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366924","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 : 2024-09-30eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024AI1116
Felipe Marques da Costa, Augusto Kreling Medeiros, Marcos Aurélio Fonseca Magalhães Filho
{"title":"Look back in anger: bronchial stenosis secondary to very late recurrence of breast cancer.","authors":"Felipe Marques da Costa, Augusto Kreling Medeiros, Marcos Aurélio Fonseca Magalhães Filho","doi":"10.31744/einstein_journal/2024AI1116","DOIUrl":"10.31744/einstein_journal/2024AI1116","url":null,"abstract":"","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eAI1116"},"PeriodicalIF":1.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11461000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366932","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 : 2024-09-30eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024AO0688
Priscila Mina Falsarella, Marcelo Katz, Breno Boueri Affonso, Francisco Leonardo Galastri, Marcelo Froeder Arcuri, Joaquim Mauricio da Motta-Leal-Filho, Sérgio Eduardo Alonso Araujo, Rodrigo Gobbo Garcia, Felipe Nasser
Background: Angiography of the superior rectal artery showed that its branches were divided into four main branches (two left and two right) in 46.8%; the second most frequent variation was one right and two left branches in 26.6%, followed by two branches to the right and one to the left in 20%; the most uncommon variations were one to the right and one to the left without further subdivision in 6.6%.
Background: ◼ The superior rectal artery, when it reaches the rectum, divides into two or more branches.
Background: ◼ Four patterns were observed in the angiographic anatomy of the superior rectal artery.
Background: ◼ Understanding the angiographic anatomy of the superior rectal artery is important to achieve optimal embolization results.
Objective: To describe angiographic findings of the superior rectal artery, its branches, and anatomical variations in the hemorrhoidal plexus in patients undergoing rectal artery embolization for hemorrhoidal disease treatment.
Methods: Angiographic findings of 15 patients were obtained from a single-center, prospective clinical study that compared superior rectal artery embolization with the Ferguson technique for hemorrhoidal disease between July 2018 and March 2020.
Results: Angiography of the superior rectal artery showed that in seven patients (46.8%), its branches were divided into four main branches (two left and two right), while in four patients (26.6%), the branches divided into one right and two left branches. The most uncommon variation observed in three cases (20%) was the branches divided into two branches to the right and one to the left; no further subdivision into the main branches was observed in one case (6.6%).
Conclusion: Four patterns were observed in the angiographic anatomy of the superior rectal arteries. Knowledge of the angiographic anatomy of this region and its variations is essential to improve the effectiveness of superior rectal artery embolization.
{"title":"Angiographic description of the superior rectal artery and its anatomical variations in patients undergoing embolization of the superior rectal arteries in hemorrhoidal disease treatment.","authors":"Priscila Mina Falsarella, Marcelo Katz, Breno Boueri Affonso, Francisco Leonardo Galastri, Marcelo Froeder Arcuri, Joaquim Mauricio da Motta-Leal-Filho, Sérgio Eduardo Alonso Araujo, Rodrigo Gobbo Garcia, Felipe Nasser","doi":"10.31744/einstein_journal/2024AO0688","DOIUrl":"10.31744/einstein_journal/2024AO0688","url":null,"abstract":"<p><strong>Background: </strong>Angiography of the superior rectal artery showed that its branches were divided into four main branches (two left and two right) in 46.8%; the second most frequent variation was one right and two left branches in 26.6%, followed by two branches to the right and one to the left in 20%; the most uncommon variations were one to the right and one to the left without further subdivision in 6.6%.</p><p><strong>Background: </strong>◼ The superior rectal artery, when it reaches the rectum, divides into two or more branches.</p><p><strong>Background: </strong>◼ Four patterns were observed in the angiographic anatomy of the superior rectal artery.</p><p><strong>Background: </strong>◼ Understanding the angiographic anatomy of the superior rectal artery is important to achieve optimal embolization results.</p><p><strong>Objective: </strong>To describe angiographic findings of the superior rectal artery, its branches, and anatomical variations in the hemorrhoidal plexus in patients undergoing rectal artery embolization for hemorrhoidal disease treatment.</p><p><strong>Methods: </strong>Angiographic findings of 15 patients were obtained from a single-center, prospective clinical study that compared superior rectal artery embolization with the Ferguson technique for hemorrhoidal disease between July 2018 and March 2020.</p><p><strong>Results: </strong>Angiography of the superior rectal artery showed that in seven patients (46.8%), its branches were divided into four main branches (two left and two right), while in four patients (26.6%), the branches divided into one right and two left branches. The most uncommon variation observed in three cases (20%) was the branches divided into two branches to the right and one to the left; no further subdivision into the main branches was observed in one case (6.6%).</p><p><strong>Conclusion: </strong>Four patterns were observed in the angiographic anatomy of the superior rectal arteries. Knowledge of the angiographic anatomy of this region and its variations is essential to improve the effectiveness of superior rectal artery embolization.</p><p><strong>Registry of clinical trials: </strong>NCT03402282.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eAO0688"},"PeriodicalIF":1.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11461003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366925","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 : 2024-09-20eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024CE1115
Hinpetch Daungsupawong, Viroj Wiwanitkit
{"title":"Comment to: ChatGPT: immutable insertion in health research and researchers' lives.","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.31744/einstein_journal/2024CE1115","DOIUrl":"10.31744/einstein_journal/2024CE1115","url":null,"abstract":"","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eCE1115"},"PeriodicalIF":1.1,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11461009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336872","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}