Sao Paulo Medical Journal最新文献

Background: This retrospective cohort study evaluated the prognostic significance of the GrowthBased Grade (GBG) system compared to International Federation of Gynecology and Obstetrics (FIGO) grading in ovarian mucinous carcinoma (OMC). Although FIGO grading is commonly used, its prognostic value remains controversial. The GBG system, which classifies tumors as low-grade (G1) or high-grade (G2) based on the proportion of infiltrative growth, has emerged as a potential prognostic tool.

Objectives: To assess the prognostic significance of GBG and compare it with FIGO grading in OMC.

Design and setting: This retrospective cohort study included 37 women with OMC treated at a single institution between 2009 and 2022.

Methods: GBG was determined by a histopathological review of hematoxylin and eosin-stained slides. Clinical and demographic data, including FIGO stage, CA125 levels, surgical procedures, and follow-up information, were collected. Kaplan-Meier analysis and Cox regression were used to assess the associations between GBG grading, FIGO stage, and survival outcomes.

Results: GBG 2 tumors were significantly associated with elevated CA125 levels, advanced FIGO stage (III), and bilaterality. Multivariate analysis showed that GBG 2 conferred a 5.4-fold higher risk of recurrence compared with GBG 1. While FIGO stage III was predictive of overall survival, FIGO grading was not associated with recurrence risk.

Conclusion: This study suggests a potential prognostic value of the GBG system in mucinous ovarian carcinoma. GBG 2 tumors showed a higher risk of recurrence than GBG 1 tumors, whereas FIGO grading showed no such association. These findings align with previous reports and should be interpreted in the context of additional studies to clarify the system's clinical relevance.

Background: Acute kidney injury is one of the main systemic complications of severe coronavirus disease 2019 (COVID-19).

Objectives: To examine histopathological changes in post-mortem kidney biopsies of patients who died as a result of the disease caused by SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2).

Design and setting: A case-control study was conducted at a tertiary hospital located in Curitiba, Paraná, Brazil.

Methods: The study group, called "COVID," consisted of kidney biopsy samples obtained from deceased patients with COVID-19, with a "Control" group included for comparison. Samples were selected based on sex, age, and comorbidities, with an emphasis on diabetes mellitus and systemic arterial hypertension (SAH). Morphological evaluation was performed by pathologists using preestablished criteria with glomerular, tubular, and vascular characteristics among the parameters.

Results: Tubular atrophy and interstitial fibrosis, markers of chronic kidney injury, were observed with equal frequency in both groups, probably because of the initial pairing of the samples. These findings are in line with what would be expected from chronic exposure to proteinuria. In relation to SAH, the main identification was interstitial vascular damage, particularly arteriolosclerosis/arteriosclerosis. Acute tubular injury was the most frequently observed feature in patients in the COVID group, which was probably related to ischemic damage.

Conclusion: This study demonstrated that the main change identified in the renal parenchyma of patients with COVID-19 was acute tubular injury, which was expected considering the context of severe systemic ischemia to which these patients are subjected, with the other findings being the consequences of chronic damage.

Background: Postoperative delirium (POD) is a severe complication and the most frequent adverse event in older patients, particularly those with cancer. With the increase in the older surgical population and cancer diagnoses, the incidence of POD is expected to increase.

Objectives: To identify and evaluate major risk factors for POD in patients with cancer.

Design and setting: Narrative review conducted at the A.C.Camargo Cancer Center in São Paulo, Brazil.

Methods: PubMed, LILACS, and Embase database searches were conducted using relevant keywords from June 2023, to September 2024. We identified 279 studies; after screening and applying the eligibility criteria, 49 studies were included in the analysis.

Results and discussion: POD risk factors in patients with cancer are associated with inflammation and the cumulative burden of intensive therapeutic modalities. These factors can be categorized into three domains: directly related to cancer, indirectly related to cancer, and preexisting predisposing factors. Among these factors, age is important. Additional relevant contributors include frailty, cognitive impairment, sarcopenia, pain, anxiety, and depression. A complex interaction exists between these factors that renders POD management in patients with cancer challenging; however, the impact of each factor remains unclear.

Conclusions: Multiple overlapping risk factors often contribute to POD development in patients with cancer. Age is a significant risk factor, as reported in the literature. Other relevant factors have been described; however, the relative contribution of each factor to the etiology of POD remains unclear. Further research is required to address this knowledge gap.

Background: Chagas disease is a significant public health challenge in Brazil that is characterized by substantial morbidity and mortality rates, coupled with limited etiological treatment options.

Objective: To describe and assess the occurrence of adverse reactions resulting from benznidazole treatment in patients from the Western Potiguar mesoregion of Brazil.

Design and setting: This retrospective, longitudinal, descriptive observational study included 106 individuals with Chagas disease who attended the Chagas Disease Outpatient Clinic of the Universidade do Estado do Rio Grande do Norte.

Results: Among patients subjected to etiological treatment with benznidazole, 40.5% (43/106) experienced adverse reactions, manifesting in 13 distinct forms. The most prevalent reactions occurred primarily in the dermatological and hematological systems. Thus, despite the notable frequency of adverse reactions, their severity remained low, as evidenced by the minimal treatment suspension rate. The treatment demonstrated potential benefits to those affected by the disease.

Conclusions: This study characterized the most frequent adverse reactions to benznidazole, mainly dermatological and hematological reactions, which were mostly mild and rarely led to treatment suspension. Recognizing these events is essential for guiding professionals, enhancing patient confidence, and improving adherence to etiological treatments for Chagas disease.

Background: Accurate T-staging of oral squamous cell carcinoma (SCC) is essential for surgical planning and prognosis. However, conventional computed tomography (CT) may underestimate tumor extent, particularly when performed without dynamic maneuvers.

Objectives: To evaluate the accuracy of CT in predicting the T-staging of primary SCC of the oral cavity by comparing scans in the neutral position and with the mouth open and tongue extended (MOTE) maneuver.

Methods: This prospective cross-sectional study analyzed patients with oral SCC who underwent CT in both positions. Two blinded head-and-neck radiologists measured tumor size and depth of invasion (DOI). An anatomopathological study served as the reference. The accuracy of classifying early and advanced T-stage tumors was determined using diagnostic tests.

Results: Twenty-five patients (72% male, mean age 65.6 ± 11.3 years) were included. Tumor detection sensitivity increased from 72% (95% CI: 51.9-86.9) in the neutral position to 100% (95% CI: 83.4-100) with the MOTE maneuver. Correct T-staging prediction improved from 52-56% in the neutral position to 7276% with MOTE. Accuracy for early-stage (T1/T2) classification rose from 60.0% (95% CI: 39.3-78.1) to 88.0% (95% CI: 68.7-97.4, h = 0.66). Lesion size overestimation decreased from 20.9-23.7% to 15.3-16.1% (p < 0.05), whereas DOI differences were not significant (p > 0.05).

Conclusions: The MOTE maneuver significantly improved both the sensitivity and accuracy of CT in the preoperative T-staging of oral cavity SCC. Its incorporation into diagnostic protocols may enhance lesion detection and staging reliability in daily clinical practice.

Background: Telemedicine can promote access to specialized care and avoid travel to referral centers.

Objectives: To present the environmental impacts and the positive results for the sustainability of the Brazilian public health system after the implementation of the TeleNordeste Project developed by hospital BP - A Beneficência Portuguesa de São Paulo.

Design and setting: A retrospective cohort study was developed in three states in the Brazilian Northeast, Alagoas, Maranhão, and Piauí.

Methods: This study was conducted between August 2022 and December 2023. All patients participating in telemedicine care were selected for this type of care by Primary Health Care (PHC) doctors according to the need for clinical discussion. The variables analyzed were the total distance and time (round trip) saved by telemedicine care, the amount of carbon emissions not released into the environment, gasoline costs, resolution of care through teleconsultation, and evaluation of the Net Promoter Score.

Results: In total, 25,194 consultations were conducted via telemedicine, requiring in-person referral in 775 tele-interconsultations, representing a resolution rate of 96.92%. It saved approximately 10,737,287 miles (17,279,988.6 km) and 264,302 hours for patients and the municipal health department, and reduced carbon dioxide (CO2) emissions according to Environmental Protection Agency (EPA) parameters, estimated at 4,294,915 kg, saving US$ 1,660,068.89 (R$ 8,532,754.09) on gasoline.

Conclusion: To our knowledge, in Brazil, this study is one of the first to present results on the impact of telemedicine on reducing carbon emissions in relation to the movement of patients to reference centers in healthcare networks and the resolution of care provided in health units in the context of the PROADI-SUS TeleNordeste Project developed by BP and promotes reflection on the potential benefits of telemedicine according to current evidence.

Background: Studies have proposed using the leg lateral reach test (LLRT). However, they did not establish a cut-off point for testing.

Objective: To establish a cut-off point for the thoraco-lumbo-pelvic rotation range using the LLRT in patients with chronic low back pain.

Design and setting: Cross-sectional study conducted in Buriticupu, Maranhão, Brazil.

Methods: In the chronic low back pain group (LBPG, n = 35), we included patients aged 18 to 59 years, of both sexes, with scores ≤ 4 on the Baecke Habitual Physical Activity Questionnaire, body mass indeces ≤ 26 kg/m2, disability levels ≥ 3 on the Roland-Morris Disability Questionnaire, and pain levels ≥ 3 on the Numeric Pain Rating Scale. In the healthy control group (HCG, n = 35), the patients had the same characteristics (except for pain and disability). We used receiver operating characteristic curves to check the rate of true versus false positives in different LLRT ranges of motion and found the best LLRT cut-off point using the following mathematical model: (1 - sensitivity)2 + (1 - specificity)2.

Results: The sample was mainly composed of females (HCG = 65.71%; LBPG = 82.85%, P = 0.101), and 68.42% of the characteristics (13 of 19 comparisons between groups) showed a significant difference (P ≤ 0.05), with an effect size ranging from moderate to large (Cohen's d ≥ 0.5). The cut-off value for ideal sensitivity and specificity was ≤ 82.85 cm.

Conclusion: Patients with chronic low back pain and an LLRT range ≤ 82.85 cm have hypomobility regarding thoraco-lumbo-pelvic rotation range.

Background: The Psychological Inflexibility in Pain Scale (PIPS) was developed to measure avoidance and cognitive fusion.

Objectives: To translate, cross-culturally adapt, and analyze the measurement properties of the Psychological Inflexibility in Pain Scale (PIPS) in Brazilian patients with chronic cancer pain.

Methods: Questionnaire translation, cross-cultural adaptation, and validation studies were conducted in two hospitals in northeastern Brazil. The measurement properties tested included structural validity, construct validity, reliability, and internal consistency. The following assessment instruments were used in addition to the PIPS: Pain Catastrophizing Scale (PCS), Barthel Index, Edmonton Symptom Assessment Scale (ESAS), and Hospital Anxiety and Depression Scale (HADS).

Results: The study sample consisted of 122 patients, most of whom were women (65.6%) with a mean age of 49 years. Most patients had uterine cancer (23%) and leukemia (9.8%). We identified problems in the two-dimensional structure of the PIPS by presenting three inadequate fit indices. Adequate reliability was observed in both domains. Regarding the avoidance domain, there was a correlation with a magnitude > 0.30 with the depression domain of the HADS, and correlations with a magnitude < 0.30 with the anxiety domain of the HADS, the PCS domains, and the Barthel Index. The cognitive fusion domain did not correlate with any of these scales (P > 0.05). No ceiling or floor effects were observed.

Conclusion: The Brazilian version of the PIPS is reliable; however, the instrument does not have a valid internal structure and the cognitive fusion domain is not a valid construct.

Background: Prostate biopsy is the recommended diagnostic test for prostate cancer in patients with abnormal findings on digital rectal examinations (DRE) or elevated PSA (prostate-specific antigen) levels. Biopsies can cause severe anxiety and pain.

Objective: To evaluate the effects of music and conversation on pain and anxiety in patients undergoing transrectal ultrasound-guided prostate biopsy.

Design and setting: Prospective trial at a Tertiary University Hospital in Türkiye.

Methods: A prospective randomized controlled study was conducted. Ninety patients who had abnormal findings on DRE and/or a PSA value greater than 2.5 ng/ml and were scheduled to undergo TRUS-PBx were randomly assigned to one of three groups (n = 30) via the sealed envelope randomization method: control, music, and conversation groups. VAS pain, VAS anxiety, and STAI scores were recorded before and after the procedure. Statistical analysis was performed using One-Way ANOVA and Kruskal-Wallis tests. Pairwise comparison tests were conducted for the parameters that yielded significant differences among the control, conversation, and music groups. For all statistical analyses, a P value < 0.05 was considered statistically significant.

Results: Conversation reduced pain and anxiety significantly (P < 0.001 and P = 0.01 respectively). Post-Bx VAS pain and STAI-State scores were lower in the conversation group. Pairwise comparisons revealed significant differences between the music and conversation groups (VAS pain, P < 0.001; STAI-State, P = 0.006). However, pain and STAI-State scores were similar in both the groups (VAS pain P = 0.645; STAI-State P = 0.597).

Conclusions: The study demonstrated that listening to music had no significant effect on pain and anxiety in patients undergoing TRUS-PBx. Conversely, the findings showed that engaging patients in conversation significantly reduced pain and anxiety during the procedure.

Clinical trial or systematic review registration: The trial is registered at clinicaltrials.gov (registration number: NCT07006779) and is accessible at https://clinicaltrials.gov/ct2/show/NCT07006779.

Background: Anterior cruciate ligament (ACL) tears are common knee injuries with a known but vague association with secondary joint injuries. The extent to which these injuries are preventable remains unclear.

Objective: This study aimed to assess the functional differences in knee and ankle dorsiflexion biomechanics with full loading on one leg and to understand whether it could be a key point as a progressive method in ACL reconstruction, considering both legs and three different groups.

Design and setting: A quasi-experimental study of Medical Centers in an outpatient clinic in Portugal.

Methods: The Y balance test (YBT) was used to evaluate and analyze the association between ankle dorsiflexion range of motion (DF-ROM) and knee flexion. DF-ROM and knee flexion were used to compare the deficits between the operated and uninvolved limbs in all three groups (ACL-I, ACL-II, and ACL-III).

Results: Ankle DF-ROM and knee flexion assessed during the YBT were associated with higher knee flexion ROM, identifying individuals who were better prepared for the next phase of the guideline. The study results provide preliminary data for future studies that use prospective longitudinal research and involve large patient populations to establish prognostic biomechanical markers for determining long-term dynamic stability after ACL reconstruction.

Conclusions: In the three groups with a history of ACL injury, compensations and kinematic asymmetries in dorsal flexion and knee flexion were observed in the operated and control legs both at 6 and 8 weeks of treatment.