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.

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.