Einstein-Sao Paulo最新文献

Objective: This study aimed to evaluate the association between pre-transplant parathyroid hormone levels and renal function 1-year after kidney transplantation.

Methods: This retrospective cohort study was conducted at a tertiary public university hospital and included all patients who underwent kidney transplantation between May 2012 and September 2020. Patients under 18 years of age and those who received a transplant from a living donor were excluded. The primary outcome was renal function at 1 year, as assessed using the CKD-EPI formula. Univariate and multivariate analyses were performed to identify predictors of graft function at one year clinical and laboratory variables.

Results: During the study period, 1,128 kidney transplants were performed. After applying exclusion criteria, 382 patients from six dialysis centers were included in the final analysis. Pre-transplant parathyroid hormone levels were not associated with renal function in either univariate or multivariate analyses (p=0.968 and p=0.616, respectively). In the multivariate analysis, recipient age (Coefficient: -0.41, 95% CI= -0.63 to -0.20, p<0.001) and Kidney Donor Profile Index (Coefficient: -0.44, 95%CI= -0.54 to -0.33, p<0.001) were significantly associated with graft function at 1 year.

Conclusion: Pre-transplant serum levels of intact parathyroid hormone levels were not associated with renal function 1 year after transplantation. Conversely, recipient age and Kidney Donor Profile Index showed significant associations with graft outcomes, highlighting the importance of individualized risk assessment in transplant evaluation.

Objective: To develop and validate a comprehensive mobile health App (mHealth App) to increase the health literacy and care engagement of patients undergoing bariatric surgery.

Methods: App development required identifying patient needs, conducting a literature review, benchmarking, and designing the App through a multi-professional team. A prototype was created and validated by healthcare and information technology specialists, and patients undergoing bariatric surgery.

Results: The Baritrip App contained 188 screens divided into eight sections, covering clinical, surgical, nutritional, mental health, and speech therapy domains. The overall content validity index of the App as assessed by experts was 0.99. Bariatric surgery patients assessed the layout, language, content organization, and engagement of the App, with an overall agreement rate of 89.1%.

Conclusion: The Baritrip mobile health App showed good content validity and cultural appropriateness for bariatric surgery patients.

Introduction: Cataracts are the leading cause of reversible blindness worldwide, with age-related cataracts being the most common type. With advancements in digital workflows, new alternative surgical processes aim to enhance efficiency and patient outcomes.

Objective: This study aimed to evaluate the effectiveness of digital versus manual workflows for cataract surgery through a systematic review and meta-analysis focusing on preoperative assessment time, surgery planning time, intraoperative duration, and transcription frequency.

Methods: The study was performed in accordance with PRISMA guidelines and identified relevant studies published until July 2024 in the PubMed, Embase, Web of Science, and Cochrane databases.

Results: Digital workflows significantly reduced preoperative assessment and intraoperative times for astigmatic cataracts (mean difference (MD)=80.94 s, p<0.01; MD=107.13 s, p=0, respectively) and planning times (MD=130.52 s, p=0.43). Additionally, digital workflows decreased transcription requirements for conventional and post-refractive cataracts. Heterogeneity was notable, especially in the preoperative assessments (I2 >90%).

Conclusion: The findings suggest that digital workflows for cataract surgery improve efficiency; however, further large-scale, long-term studies are required to assess the broader applicability and cost-effectiveness of these workflows. Digitalization has the potential to streamline the surgical management of cataracts and enhance patient outcomes.

Prospero database registration: ID CRD42024590552.

Objective: To analyze the post-exercise effects of self-selected exercise intensity compared with the intensity recommended by guidelines on blood pressure and heart rate variability in participants with peripheral artery disease.

Methods: This was a randomized crossover trial. Twenty participants with peripheral artery disease (52.6% men; 69.1±7.9 years; ankle-brachial index 0.59±0.15) underwent three experimental sessions: self-selected exercise intensity, intensity recommended by guidelines, and a control session (no exercise). Blood pressure (auscultatory method), heart rate, and heart rate variability were measured before and after the intervention.

Results: Acute reductions in systolic blood pressure were observed in the exercise sessions compared to the control (p<0.005). The heart rate decreased after control and increased after exercise sessions (p<0.001). The absolute heart rate increase after exercise sessions were higher than that in the Control Group p<0.001. Heart rate recovery showed a progressive decrease post-session over 300 s (p<0.001), with the root mean square of successive differences significantly decreasing up to 60 seconds in both exercise sessions (p<0.05).

Conclusion: Acute walking exercise sessions prescribed at self-selected exercise intensity had similar effects on reducing systolic blood pressure and heart rate recovery compared with walking exercise session performed at the guideline-recommended intensity.

Clinicaltrials.gov identifier: NCT04333615.

Objective: To analyze the association between calf circumference and cardiovascular indicators in men and women with symptomatic peripheral artery disease.

Methods: This cross-sectional study included 259 patients with peripheral artery disease (65% men; mean age, 67 [±12] years; ankle brachial index, 0.58 [0.26]). We measured calf circumference, brachial and central blood pressure, arterial stiffness indicators (carotid-femoral pulse wave velocity and augmentation index), and heart rate variability parameters. Multiple linear regression was used to evaluate the association between calf circumference and cardiovascular indicators after adjusting for age, ankle-brachial index, and walking capacity.

Results: In women, calf circumference was inversely associated with central blood pressure (systolic: β=-1.91 [0.70] mmHg, p=0.008; diastolic: β=-0.97 [0.29] mmHg, p=0.001), augmentation index (β=-1.06 [0.28]%, p<0.001), and augmentation index corrected by 75 bpm (β=-0.90 [0.23]%, p<0.001), independent of age, ankle brachial index, and walking capacity. After further adjustments for anti-hypertensive medication use and body mass index, carotid-femoral pulse wave velocity was the only parameter associated with calf circumference (β=-0.41 [0.15] m/s, p=0.010). In men, no significant association was observed between calf circumference and cardiovascular indicators (p>0.05).

Conclusion: In women with peripheral artery disease, calf circumference was inversely associated with arterial stiffness. This finding suggests that a lower calf circumference may serve as an indicator of increased arterial stiffness in women with peripheral artery disease.

Objective: Convulsive status epilepticus is the most common neurological emergency in children with high morbidity and mortality rates. Intranasal midazolam administration using an atomizer is the preferred treatment method. However, Brazilian pediatric emergencies often require rapid midazolam instillation using syringes. We aimed to compare the plasma midazolam levels in children who received intranasal medication with an atomizer and those who received medication via rapid instillation using only a syringe to treat seizures.

Methods: This exploratory cross-sectional study was conducted between January 2022 and March 2024 at the emergency department of a hospital in Southern Brazil. Thirteen children with tonic-clonic status epilepticus received intranasal midazolam via either an atomizer or syringe, at similar dosages. The peak plasma midazolam concentrations, measured approximately 10 min following intranasal administration, were compared between the groups.

Results: No significant difference was observed in the plasma midazolam concentrations (ng/mL) between the syringe and atomizer groups (median and interquartile range: 148.8 [126.3-293.7] ng/mL versus 133.3 [76.4-176.3] ng/mL; p=0.414), as well as in the time from administration to sampling (8.0 [7.75-10.0] min versus 9.5 [6.75-10.0] min; p=0.710) or in weight-adjusted dose (0.48 [0.44-0.50] mg/kg versus 0.49 [0.47-0.56] mg/kg; p=0.414).

Conclusion: This study is the first to validate the common Brazilian practice of using syringes alone for rapid nasal midazolam delivery during pediatric emergencies. Future studies should elucidate the clinical outcomes of this approach.

Objective: To analyze changes in surgical volume across different specialties in Brazil before, during, and after the COVID-19 pandemic.

Methods: This descriptive observational study compared surgical volumes for the specialties with the highest number of procedures each year from 2019 to 2023. Data were sourced from the Department of Informatics of the Unified Health System (DATASUS - TabNet).

Results: A total of 2,117,383 surgical procedures across 13 operation types were analyzed. Between 2019 and 2020, surgical volume declined by 35%, with reductions ranging from -1% to -54% depending on the procedure. Although volumes increased by 2023, this was insufficient to address the backlog of delayed surgeries. Otorhinolaryngology and urology were the most affected specialties, while cholecystectomy saw a net post-pandemic increase.

Conclusion: The COVID-19 pandemic significantly disrupted all analyzed surgical procedures in Brazilian Public Health System, resulting in a 35% overall decline. Despite partial recovery, the persistent surgical deficit remains a major challenge, reflecting patterns observed internationally.

Objective: To analyze the overall and disease-free survival of patients with oropharyngeal squamous cell carcinoma.

Methods: Sociodemographic and clinical data, HPV status, and alcohol/tobacco consumption were assessed among patients treated at AC Camargo Cancer Center, São Paulo, Brazil. Absolute and relative frequencies, overall survival, and disease-free survival at 5 and 7 years were calculated using Kaplan-Meier analysis, and Cox regression was used to estimate the risk of death.

Results: The 7-year overall survival rate was 61.6% for patients with oropharyngeal squamous cell carcinoma (67.5% for HPV-positive cases and 51.1% for HPV-negative cases). Among HPV-positive cases, the risk of death was 5.29-fold higher for smokers than that for non-smokers (p<0.001) and 4.42-fold higher for patients with metastasis than that for those without (p=0.108). Among HPV-cases, those with clinical stage T3/T4 disease had a 1.8-fold higher risk of death than those with T1/T2 disease (p=0.039), and those with metastasis exhibited a 4.62-fold higher risk than those without (p<0.001). The 7-year disease-free survival rate for oropharyngeal squamous cell carcinoma was 88.6% (90.1% for HPV-positive cases and 85.9% for HPV-negative cases). Among HPV-positive cases, patients with metastasis had an 11.75-fold higher risk of recurrence than those without (p<0.001); among HPV-negative cases, patients with metastasis had a 4.62-fold higher risk than those without (p=0.004).

Conclusion: Patients with HPV-positive oropharyngeal squamous cell carcinoma had higher overall survival and increased recurrence rates within the first 3 years but lower recurrence rates beyond 5 years than patients with HPV-negative disease. More frequent follow-ups after 5 years are recommended for patients with HPV-positive disease. Tobacco and alcohol consumption negatively affect the overall survival of patients with HPV-positive oropharyngeal squamous cell carcinoma.

Objective: Clinical, imaging, and laboratory differentiation between non-functioning pituitary adenomas (NFPAs) and prolactinomas can be challenging in clinical practice because of their similar presentation and eventual overlap in prolactin levels. The degree of prolactin suppression after a single low-dose cabergoline administration may be useful as a test to discriminate between these two clinical conditions and to determine the choice of therapy (dopamine agonist versus neurosurgery).

Methods: This retrospective cohort study included 19 patients with macroadenomas (11 NFPAs and 8 prolactinomas) whose prolactin levels were evaluated at baseline and 48 h after receiving a single dose of 0.25mg cabergoline. A receiver operating characteristic curve was generated for sensitivity and specificity analyses.

Results: The baseline median prolactin level was 58ng/mL (range, 32.5-151.2ng/mL) in the NFPA Group, which was significantly lower than that observed in the Prolactinoma Group (733.7 [range, 180-6941ng/mL]) (p<0.001). After the cabergoline disconnection test, the NFPA Group exhibited a lower absolute prolactin level (p<0.001) and a higher percentage of prolactin reduction (p=0.004). The post-test prolactin level ≥26.3ng/mL had 100% sensitivity and specificity in identifying prolactinomas. When using the percentage of reduction, post-test prolactin reduction ≥85.6% had 54.5% sensitivity and 100% specificity to differentiate NFPAs from prolactinomas.

Conclusion: A single low-dose oral cabergoline is a fast and inexpensive test for use in daily clinical practice to discriminate between hyperprolactinemia due to NFPAs and prolactinomas, with high sensitivity and specificity.

Objective: To conduct an ex-ante cost-benefit analysis of implementing Vendor Neutral Archive technology in the Brazilian Public Health System.

Methods: The cost-benefit analysis involves monetizing the potential costs and benefits of implementing Vendor Neutral Archive in the Brazilian Public Health System, focusing on comparing these values using the return on investment measure.

Results: The aggregate analysis at the Brazilian Public Health System level reveals that the estimated return on investment for the first year after Vendor Neutral Archive implementation is 5.63%, rising to 10.12% after three years. The results indicate a positive correlation between the number of imaging exams conducted and the financial gains for the health institution under analysis. A minimum number of approximately 11,500 exams is required to implement Vendor Neutral Archive technology to generate positive returns in the first year after implementation.

Conclusion: Despite the importance of interpreting results cautiously owing to assumptions and methodological limitations, the findings highlight the strategic significance of Vendor Neutral Archive in enhancing the efficiency and sustainability of the Brazilian Public Health System. Adopting cloud-based medical image storage requires a significant upfront investment but promises substantial benefits. Within the Brazilian Public Health System, the return on this investment can be realized in less than one year, correlated with the volume of imaging exams performed. This underscores the importance of scalability in the healthcare system, where wider adoption of Vendor Neutral Archive results in higher returns.

Background: ■ Vendor Neutral Archive implementation has an return on investment of 5.63% in the first year and 10.12% after three years.

Background: ■ At least 11,500 exams are needed annually for a positive return on investment in the first year after implementation.

Background: ■ Vendor Neutral Archive enhances interoperability and efficiency by standardizing and centralizing image storage.

Background: ■ Scalability is key: higher adoption of Vendor Neutral Archive leads to greater financial and operational benefits.

Background: Vendor Neutral Archive is a centralized, cloud-based solution that enables interoperable storage and management of medical images. Vendor Neutral Archive enhances data accessibility and long-term cost efficiency, supporting a more scalable and sustainable healthcare infrastructure. This study conducts a cost-benefit analysis of implementing Vendor Neutral Archive technology in the Brazilian Public Health System.