Sao Paulo Medical Journal最新文献

Background: The relationship between thyroid gland volume and hypoparathyroidism after total thyroidectomy remains controversial.

Objective: To evaluate thyroid gland mass as a risk factor for hypoparathyroidism after total thyroidectomy.

Design and setting: A Retrospective cross-sectional observational study was conducted at Centro Universitário Lusíada (UNILUS), Santos/SP, Brazil.

Methods: Patients undergoing total thyroidectomy between January 2022 and September 2023 were retrospectively evaluated for serum levels of ionized calcium and ultrasensitive parathyroid hormone (PTH), measured preoperatively and 30-60 days postoperatively, and thyroid mass, obtained by weighing the specimen.

Results: A total of 174 patients were evaluated, with a predominance of women (89.7%), a median age of 50.5 years, and a median goiter volume of 36.3 mL. A reduction in both PTH and ionized calcium levels was observed in the postoperative period compared with the preoperative period (P < 0.05). No significant changes were observed in PTH levels and volume (P = 0.481). For calcium, there was a tendency towards an association between volume measurements and its change between the pre- and postoperative periods, which was marginally significant (P = 0.051).

Conclusion: There was a marginal association between volume and changes in pre- and postoperative ionized calcium levels, but no significant association with pre- and postoperative PTH measurements.

Background: Acute pancreatitis (AP) is a major cause of gastrointestinal hospitalization, with an annual global incidence of 3.07%. Severe AP develops in up to 20% of cases, with sepsis occurring in 40-70% of such cases, leading to higher mortality. The early detection of sepsis is crucial. Hematocrit (HCT) and albumin (ALB) levels are individually linked to sepsis. Their combined measure, HCT-ALB, indicates blood and nutritional health. HCT-ALB can predict sepsis and infection outcomes; however, its effectiveness in treating AP-related sepsis has not been investigated.

Objective: This study aimed to examine the association between HCT-ALB values and sepsis risk in patients with AP.

Methods: This retrospective cohort study used Medical Information Market for Intensive Care IV database data. The primary outcome was the risk of sepsis in patients with AP. The HCT-ALB value refers to the difference between HCT and ALB levels, which we categorized into three groups according to quantiles: < 0.5, 0.5-7.6, and ≥ 7.6. Logistic regression models were used to assess the association between HCT-ALB values and sepsis. The predictive value of HCT-ALB was assessed using a receiver operating characteristic curve. Subgroup analyses were conducted for different subgroups.

Results: Among 565 patients with AP, 163 developed sepsis. In the multivariable model, HCT-ALB ≥ 7.60 was associated with sepsis risk for patients with AP [odds ratio (OR) 1.82, 95% confidence interval (CI) 1.06-3.14]. The area under the curve (AUC) value of HCT-ALB in predicting sepsis risk among patients with AP was 0.599 (95% CI 0.544-0.654), which was higher than that of the bedside index for severity in acute pancreatitis score (AUC 0.558, 95% CI 0.509-0.607). Subgroup analysis showed that HCT-ALB was only related to sepsis risk in male patients with acute kidney injury and Sequential Organ Failure Assessment in < 2 subgroups.

Conclusion: HCT-ALB values ≥ 7.6 were associated with increased sepsis risk in patients with AP. HCTALB may contribute to identifying the risk of sepsis in patients with AP.

Background: The chemotherapy response score (CRS) is a histopathological tool used to assess the tumor response in patients with high-grade serous ovarian carcinoma (HGSC) undergoing neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS).

Design and setting: This single-center retrospective study was conducted at the Faculty of Medicine at Istanbul University. The study included patients treated between January 1, 2010, and December 31, 2017 at a tertiary care hospital specializing in gynecologic oncology.

Objectives: This study aimed to evaluate the prognostic significance of omental and adnexal CRS in predicting overall survival (OS) and disease-free survival (DFS) in patients with advanced HGSC undergoing NACT followed by IDS.

Methods: Data from 79 patients with advanced HGSC treated with NACT followed by IDS between 2010 and 2017 were analyzed. CRS was applied to both omental and adnexal samples, and its association with OS and DFS was evaluated. Statistical analyses were performed using univariate and multivariate methods with a significance level of P < 0.05.

Results: Omental CRS 1-2 was identified as an independent predictor of decreased OS (hazard ratio 2.69; 95% confidence interval 1.26-5.76, P = 0.010), whereas adnexal CRS 1-2 did not significantly impact DFS or OS in multivariate analysis. Patients with omental CRS 3 had superior outcomes, with a 5-year OS rate of 72%, compared to 30.8% in the CRS 1-2 group. The median DFS of the CRS 1-2 group was 19 months, whereas that of the CRS 3 group was 35 months (P = 0.005).

Conclusions: Omental CRS is a strong independent predictor of OS in patients with advanced HGSC, whereas adnexal CRS has limited prognostic value. CRS should be considered in clinical practice to guide treatment decisions, and further research is warranted to refine its use by using molecular and radiological markers.

Background: Chronic noncommunicable diseases (NCDs) have a multifactorial etiology and are associated with psychosocial factors, such as stress, anxiety, and depression. Sleep quality also influences general health and is associated with obesity and NCDs. Homeopathy, as a medical specialty, is effective in managing these conditions because of its comprehensive approach to individuals.

Objective: To evaluate the influence of homeopathic treatment on sleep quality and levels of stress, anxiety, and depression.

Design and setting: Observational, longitudinal, and prospective study on individuals over 18 years of age with homeopathic medical follow-up for 6 months in the public healthcare service of Guarulhos, São Paulo.

Methods: Participants were evaluated initially (T0) and after 3 (T1) and 6 months (T2) using validated questionnaires (Pittsburgh Sleep Quality Index and the Depression Anxiety and Stress Scale), following all ethical precepts. The scores were compared over time and correlated with each other (P < 0.05).

Results: The mean patient age was 49 years. Initially, 81% of the participants had sleep disorders and severe or extremely severe levels of stress (33.78%), anxiety (28.38%), and depression (27.03%). A total of 26 patients were present at the three evaluation points, which were included as the participants of the study. Homeopathic treatment significantly improved sleep quality and reduced stress, anxiety, and depression. Sleep quality and anxiety were strongly (r = 0.53, P = 0.005) and weakly (r = 0.25, P = 0.021) correlated with stress, respectively.

Conclusion: In the short term, homeopathic treatment had a positive impact on the sample, suggesting that this therapy can be used to prevent NCDs.

Background: Logistic and temperature challenges contribute to organ loss during transplantation. Ensuring the safety of static cold packaging for organ transport is essential to improve patient access to transplants. This study aimed to verify a method for validating the packaging used to transport organs for transplantation.

Design and setting: Validation study and pilot test using experimental surgery on porcine organs.

Methods: Data collection considered the variables related to organ integrity before and after transportation, including temperature (measured thrice with three instruments per organ), macroscopic evaluation (based on photographic and observational assessments), histology (structural analysis of the collected samples), and packaging contamination (triple-swab sampling for microorganism growth). Data analysis was performed using descriptive statistics, visual assessment, histological processing, and microbiological evaluation.

Results: By the end of transportation, all the organs reached the ideal temperature range for transplantation. The similarity in swine weight and size enabled macroscopic comparisons. Histological analysis revealed no significant injuries or morphological changes. Regarding packaging, environmental microorganisms predominate, with sustainable post-transport differences.

Conclusion: The method developed to validate the package used for transporting organs for transplantation was successfully verified. Furthermore, this method addresses the existing gap in the process of documenting a robust validation method for packaging intended for organ transportation.

Background: Actinic keratosis is a common preneoplastic dermatosis and is the third most common reason for dermatological consultations. Identifying the associated factors, diagnosis, and early treatment of actinic keratosis are crucial for reducing the risk of developing skin cancer and costs to the healthcare system.

Objective: To evaluate the prevalence and factors associated with actinic keratosis in individuals treated at a public dermatology service.

Design and setting: A cross-sectional observational study was conducted with 1346 patients treated by a public dermatology service.

Methods: The demographic and dermatological characteristics of patients were recorded. The presence of actinic keratosis was determined by clinical dermatological identification.

Results: Most participants were elderly, white, and exposed to the sun without protection or during occupational activity. The evolution time of cutaneous lesions was <1 year in 46.8% of participants. Actinic keratosis was the most common skin lesion, being present in 29.3% of participants. The main approach adopted was cryotherapy. Keratosis was associated with white skin color, elderly age, personal and family history of skin cancer, exposure to the sun without protection at work, and limb involvement. When the associated factors were analyzed using a regression model, skin color and affected body segments were the main predictors of actinic keratosis.

Conclusions: The prevalence of actinic keratosis was 29.3%, being higher in people with fair skin, more than two affected segments, skin lesions on the limbs, older age, and unprotected sun exposure. These indicators are important for supporting decision-making and contributing to improving public policies.

Background: Children with congenital Zika syndrome (CZS) present severe motor impairment that hinders their caregivers' positioning during activities of daily living (ADLs).

Objective: To assess the posture of children with CZS and their caregivers during ADLs in the home environment.

Design and setting: A cross-sectional pilot study conducted in Campina Grande (PB), Brazil.

Methods: Nine children with CZS (mean age = 36.77 ± 2.94 months) and their caregivers (n = 9, mean age = 27 years) were assessed. Data were collected at the support home of a center for children with microcephaly in Northeast of Brazil. For postural assessment, children and their caregivers were filmed while performing ADLs in the living room and kitchen of the support home.

Results: During the environmental interaction, all children predominantly maintained a sitting position, exhibiting neck and trunk asymmetry; 77.8% (n = 7) showed inadequate postures with elevated arms and shoulders, and none maintained the ankles in a neutral position with supported feet. During feeding, 88.9% (n = 8) of children were positioned on the lap of caregivers, 88.9% (n = 8) exhibited neck and trunk asymmetry, 66.7% (n = 6) displayed inadequate upper-limb posture, and none maintained their ankles in a neutral position. During this activity, 66.7% (n = 6) of caregivers presented with trunk and neck asymmetry, 66.7% (n = 6) did not provide support for the upper limbs, and 55.6% (n = 5) did not maintain their knees flexed at 90o.

Conclusions: Children with CZS and their caregivers present with inadequate postures during ADLs in the home environment, which may represent health risks.