Einstein-Sao Paulo最新文献

Objective: This study evaluated the association between cognitive function and quantitative magnetic resonance imaging analyses, including brain volume, white matter hyperintensity volume, and diffusivity metrics.

Methods: This retrospective analysis included 504 older adults from São Paulo, Brazil, who underwent 3T magnetic resonance imaging scans. Image analysis was performed using the FMRIB Software Library (FSL), with peak width of mean diffusivity assessed via a public script. FLAIR signal changes were quantified using the Lesion Segmentation Tool and Fazekas scale. Cognitive performance was assessed using MMSE and 3MS tests. Multiple linear regression, adjusting for control variables, was used to evaluate the relationships between magnetic resonance imaging measurements and cognitive scores, validated against a UK Biobank sample.

Results: Magnetic resonance imaging demonstrated strong correlations with UK Biobank dataset. Fractional anisotropy, mean diffusivity, and peak width of the mean diffusivity values were significantly associated with white matter hyperintensities (Spearman's rho: -0.630, 0.750, and 0.747, p<0.001). Specific brain regions demonstrated strong links between fractional anisotropy and mean diffusivity values and cognitive performance. Fractional anisotropy findings correlated positively with neuropsychological scores (r=0.315 for 3MS and r=0.285 for MMSE, p<0.001).

Conclusion: Diffusivity metrics, including fractional anisotropy, mean diffusivity, and peak width of the mean diffusivity significantly correlated with brain volume, white matter hyperintensities, and cognitive scores. These findings may serve as potential imaging markers for monitoring cognitive decline and dementia.

Objective: This retrospective observational study analyzed satisfaction with a telehealth service in older individuals living in a metropolitan city in Brazil.

Methods: Sociodemographic, clinical, and telehealth service details (number of clinical appointments for each patient during a year) were collected. Satisfaction with the telehealth service was evaluated using the Questionnaire for the Evaluation of Patient Satisfaction Via Telemedicine (QAS-Tele) in 203 older individuals (59.1% women; 75.6±7.9 years old). A subanalysis was performed with patients divided into two groups: low score on QAS-Tele (first quartile) and high score on QAS-Tele (other quartiles).

Results: The questionnaire items and average total QAS-Tele score suggested high patient satisfaction (average total score of 4.71±0.54 out of 5). The patients with high QAS-Tele scores had a lower average age (74.4±7.8 versus 78.3±7.5 years, p≤0.001) and a higher proportion of individuals currently working (30.9% versus 9.4%, p≤0.001) and of individuals with four or more associated comorbidities (21.6% versus 0%, p≤0.001) than patients with the low QAS-Tele scores.

Conclusion: Patients in the present study reported high satisfaction with the telehealth service. Higher satisfaction with the telehealth service was reported by older adults in a younger age range, by individuals currently working, and by individuals who had a higher number of comorbidities. These findings suggest the importance of considering these factors in the planning of telehealth services in older individuals.

Objective: Telemedicine via teleconsultations enhances access to specialized care. However, the degree of satisfaction among patients and providers with this method remains unclear. This study assessed patient and on-site physician satisfaction with the Comprehensive Specialist Teleconsultation Program (Telemedicine Expert Consultation) developed by Hospital Israelita Albert Einstein to reduce healthcare disparities in Brazil's Northern and Central-Western regions.

Methods: A retrospective, single-center analysis employed the Net Promoter Score as the primary metric for evaluating satisfaction. Data were collected from patients and on-site physicians over three years through voluntary surveys with three focused questions. These assessed telemedicine effectiveness, fulfillment of patient needs, and satisfaction with project support. Additional analyses included response rates, demographics, and Net Promoter Score distribution across predefined performance zones.

Results: Of the 1,144 surveys distributed to physicians, 469 (41%) were received. Among the respondents, 459 (97.8%) either agreed or strongly agreed that patient needs were adequately met, and 462 (98.6%) expressed overall satisfaction, resulting in a three-year average Net Promoter Score of 91. For patients, 35,743 (32%) responses were obtained from 111,730 distributed surveys. Among patient respondents, 35,493 (99.3%) indicated that their needs were met, with 26,200 (73.3%) rating the service as "excellent," with an average Net Promoter Score of 85 over the three years. Satisfaction scores from both groups fell within the Net Promoter Score "zone of excellence," underscoring the program's high performance in meeting expectations.

Conclusion: The Telemedicine Expert Consultation program successfully achieved high satisfaction rates among patients and on-site physicians.

Objective: This study aimed to evaluate the percutaneous preoperative localization of lung masses suspected to be nonpalpable with a wedge-shaped wire (Somatex® Lung Marker System).

Methods: Patients underwent CT-guided lung mass localization with the Somatex® Lung Marker System prior to resection of pulmonary lesions by video-assisted thoracoscopy. The characteristics of the lung masses, complication profiles, histological analysis, and surgical success were reviewed.

Results: Forty lung masses were percutaneously localized preoperatively in 38 patients. Eight patients did not have malignancies. Major complications were not observed. All lung masses were fully resected after preoperative localization.

Conclusion: The findings support the feasibility and safety of the Somatex® Lung Marker System for the preoperative localization of lung lesions.

Objective: This study aimed to evaluate whether clinical, laboratory, and radiological data could effectively identify struvite stones without the need for crystallographic analysis.

Methods: Stone fragments obtained using endourological procedures were subjected to crystallographic analysis. A prospective evaluation and comparison were conducted between patients with and without struvite stones. Sex, age, comorbidities, Hounsfield Unit Coefficient, stone size, urine culture, and urinary pH were analyzed.

Results: Among the 221 stones enrolled, 18% were struvite. Among patients with struvite stones, 95% were women, whereas in the group without struvite stones, 51% were women. The average age was 40.6 years among patients with struvite stones, and 51.5 years in the other group (p<0.001). The stone size in the struvite group (24.9 mm) was significantly larger than that in the non-struvite group (15.6 mm) (p<0.001). The urinary pH was significantly higher in the struvite group than in the non-struvite group (p<0.001). Patients with a positive urine culture had a 3.78 times greater chance of having a struvite stone than those with a negative urine culture (p<0.01). Multivariate analysis considering pH, age, and stone size yielded an AUC value of 0.83, sensitivity of 0.39, specificity of 0.95, and accuracy of 0.85. There was no significant difference between the groups in terms of the Hounsfield Unit Coefficient and comorbidities.

Conclusion: Our analysis further supports the conclusion that characteristics such as pH, age, stone size, and urine culture have notable specificity but low sensitivity for identifying struvite stones.

A total of 89% of the 3,136 legal demands sought medication. Androgen inhibitors amounted to 78.8% of all lawsuits, particularly abiraterone. There is a growth tendency in judicialization, with a 30-fold increase over 4 years. The estimated annual financial burden of judicialization on the Brazilian United Public Health System has reached BRL 783 million.

Nursing workload is high with patients undergoing extracorporeal membrane oxygenation. The initial 24 hours of extracorporeal membrane oxygenation have the highest workload, quantified using the Nursing Activities Score. Presence of COVID-19 and delayed extracorporeal membrane oxygenation initiation increase the workload in the initial 24 hours of extracorporeal membrane oxygenation. Extracorporeal membrane oxygenation care demands adjustments in the nurse-to-patient ratio in the intensive care unit.

Previous studies have correlated inflammation with complications after percutaneous coronary intervention. In patients with stable coronary disease, percutaneous coronary intervention leads to elevated inflammatory biomarker levels. The inflammatory response is significantly correlated with myocardial injury.

Public hospitals in Brazil performed 37,741 hallux valgus surgery procedures between January 2008 and October 2024. The study population consisted of 79.7% females, with the most common age group being 40-69 years (67.7%). The mean length of stay was 1.7 days. The study population consisted of 79.7% females, with the most common age group being 40-69 years (67.7%). The mean length of stay was 1.7 days. The mean cost per patient was US$ 141.53. The overall mortality count was nine, corresponding to a death rate of 0.024%.

Introduction: The controversy surrounding the potential benefits of the basic saline solution vs. Ringer's lactate solution for patients undergoing phacoemulsification for cataracts prompted a systematic review and meta-analysis for comparing the two solutions.

Objective: This systematic review and meta-analysis aimed to compare the basic saline solution with Ringer's lactate for irrigation in phacoemulsification for cataracts.

Methods: We searched the Embase, PubMed, and Cochrane databases for randomized controlled trials comparing basic saline solution with Ringer's lactate in relation to central corneal thickness and loss of endothelial cell density after elective cataract surgery.

Results: Four studies involving 322 patients who underwent phacoemulsification were included in the analysis. Of the participants, 161 (50%) received Ringer's lactate as the irrigation solution, and 161 (50%) received basic saline solution. No differences were noticed between Ringer's lactate and basic saline solution regarding the loss of endothelial cell density within 28 days.

Conclusion: In patients undergoing phacoemulsification for cataracts, no significant differences in the loss of endothelial cell density and changes in central corneal thickness were observed between groups irrigated with Ringer's lactate and balanced salt solution.Prospero database registration: ID CRD42024554821.