Sao Paulo Medical Journal最新文献

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.

Background: Preventable cardiovascular diseases are among the leading causes of death in individuals aged < 70 years in Brazil.

Objective: This study assessed the level of patient activation among individuals with cardiovascular disease in Brazilian community pharmacies.

Design and setting: This cross-sectional study included 348 Brazilian participants diagnosed with hypercholesterolemia and/or hypertension.

Methods: The Patient Activation Measure (PAM-13) questionnaire was used. In addition, sociodemographic and clinical variables were collected, including coronary risk evaluation and quality of life assessment. Student's t-test was used to compare baseline quantitative variables between groups, and the chi-square test was used to assess associations for categorical variables. Pearson's correlation was used to examine the relationships among the quality of life, clinical variables, sociodemographic data, and activation levels.

Result: Participants had an average age of 59.0 ± 16.7 years and a low to moderate risk. The mean patient activation level was 2.8 out of 4, with high self-care responsibility and treatment adherence but lower confidence in maintaining lifestyle changes. Factors linked to lower activity included low physical activity (P < 0.001), multiple chronic conditions (P = 0.003), smoking (P = 0.016), age > 65 years (P = 0.033), low quality of life (P < 0.001), and high CVR (P < 0.001).

Conclusion: Patient activation in cardiovascular care in the Brazilian population is positively affected by lifestyle factors, particularly physical activity. Intervention strategies that promote lifestyle changes can enhance patient activity and improve health outcomes in this population.

Background: Delirium is a common and serious complication among elderly patients in intensive care units (ICUs), and is often associated with increased morbidity and mortality rates. The choice of sedoanalgesic may influence the incidence of delirium; however, the evidence remains unclear, particularly in the elderly population.

Objectives: To evaluate the association between the use of different sedoanalgesics and the incidence of delirium in elderly ICU patients, based on data from randomized clinical trials.

Design and setting: This systematic review was conducted using data from randomized clinical trials performed in various ICU settings.

Methods: A systematic search of the MEDLINE, Embase, and CENTRAL databases was performed in January 2024. The review included randomized clinical trials involving patients aged 60 years or older that examined the relationship between sedoanalgesics (midazolam, fentanyl, propofol, ketamine, and dexmedetomidine) and delirium incidence. Studies involving COVID-19 patients and non-randomized studies were excluded.

Results: A total of 1,331 patients from six studies were included. The mean age of the patients ranged from 71 to 74.7 years. Four studies compared dexmedetomidine with propofol; two found no significant difference in delirium incidence, whereas two suggested a lower incidence with dexmedetomidine. The remaining studies compared propofol with ketamine and dexmedetomidine with midazolam and showed no significant differences in the incidence of delirium.

Conclusions: Dexmedetomidine may be associated with a lower incidence of delirium than propofol or midazolam in elderly ICU patients. However, further research is needed to confirm these findings and explore the factors contributing to delirium in this population.

Systematic review registration: Registered with PROSPERO, CRD42024575693, available at https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=575693.

Background: This study investigated factors that may determine longevity in older adults, aiming to prolong their life expectancy and improve projections from before the coronavirus disease 2019 pandemic.

Objective: To identify risk factors for mortality in older Brazilian adults.

Design and setting: A prospective cohort study, part of the Estudo Longitudinal de Saúde do Idoso de Alcobaça.

Methods: This study included 332 older adults of both sexes who were followed up for over five years (2015-2020). Vital status was determined via telephone follow-up, information provided by family members, and death certificates. To identify the sociodemographic, health, functional, and behavioral factors associated with mortality risk among older adults, Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

Results: The risk factors for mortality among older adults included the number of people living with them (HR = 1.22; 95%CI = 1.07-1.38) and the number of prescribed drugs (HR = 1.15; 95%CI = 1.00-1.32). Factors associated with a lower risk of mortality were greater time spent in physical activity (HR = 0.99; 95%CI = 0.90-0.99) and greater hip circumference (HR = 0.95; 95%CI = 0.31-0.99).

Conclusions: Sociodemographic, health, functional, and behavioral factors are determinants of mortality risk among older adults. Regular screening of the older adult population should be conducted to assess their general health status, allowing for more appropriate interventions to increase their quality of life and improve aging.

Background and objectives: Acute pain following laparoscopic cholecystectomy is most intense in the first 24 h. The use of shorter-acting opioids for pain management may contribute to increased postoperative morbidity. The combination of methadone and ketamine has been associated with lower postoperative pain scores and less opioid use. We aimed to determine whether the combination of ketamine and methadone improves the quality of recovery.

Methods: This prospective cohort study included patients undergoing laparoscopic cholecystectomy. Patients who received either methadone alone or a combination of methadone and ketamine (0.3 mg/kg) were followed up for 24 h after surgery. The primary outcome was the quality of recovery, measured using the quality of recovery-40 (QoR-40) questionnaire. Secondary outcomes included postoperative pain intensity, opioid consumption, and the incidence of nausea and vomiting.

Results: The QoR-40 scores were higher in patients who received methadone and ketamine than in those who received methadone alone [197 (194.7-198) versus 195 (189-197), P = 0.01]. Postoperative pain scores, the incidence of postoperative nausea and vomiting, and postoperative opioid use were similar between the groups. The combination of methadone and ketamine was not associated with lower incidence of moderate-to-severe pain in propensity score analysis.

Conclusions: Although the combination of methadone and ketamine showed a slight increase in QoR40 scores at 24 h postoperatively, the observed difference between the groups was not clinically significant. Moreover, the absence of a reduction in postoperative pain intensity and similar perioperative opioid consumption between the groups further support the hypothesis that small, isolated doses of ketamine may not be effective in improving recovery quality compared with methadone alone.

Introduction: Essential hypertension is an important health condition responsible for conditions such as heart attack, stroke, and kidney disease. Traditional risk factors and their control are important for reducing mortality. Inflammation caused by organ damage plays a role in the undesirable outcomes of hypertension. Biomarkers, such as the systemic immune-inflammatory index (SII), are predictors, but their relationship with risk factors is poorly understood.

Objective: To evaluate the correlation between the SII and risk factors in patients with hypertension.

Methods: This cross-sectional study was conducted in 2020 in Bahia with hypertensive patients from an outpatient clinic. We collected demographic and clinical data such as age, body mass index, and the following biomarkers: low-density lipoprotein level, glomerular filtration rate, interleukin 6 level, C-reactive protein level, neutrophil/lymphocyte ratio (NLR), hemogram, creatinine level, urea level, ferritin level, and vitamin D level.

Results: A total of 61 patients, most of them black women, participated in the study. The prevalence of type 2 diabetes was 19%, and there was no prevalence of stroke or heart attacks. According to the Framingham risk index, a large part of the sample presented high and very high risks. The bivariate analysis between SII and NLR was positive. Multivariate analysis showed that age, renal function, and NLR were positively correlated with the SII. The patients' Framingham risk did not correlate with the SII.

Conclusions: Inflammation is important for vascular damage in arterial hypertension caused by increased oxidative stress. We evaluated SII and NLR as indices of correlation with risk factors. The SII is a lowcost tool that can be used to screen for chronic conditions, such as hypertension. In summary, higher SII was positively associated with older age and worse renal function in patients with high-risk hypertension.

Background: The atherogenic index of plasma (AIP), derived from the logarithmic transformation of the triglyceride to high-density lipoprotein cholesterol ratio, is frequently used to predict cardiovascular events.

Objective: This study aimed to investigate the association between AIP and 1-month mortality in patients with acute ischemic stroke (AIS).

Design and setting: Retrospective study was conducted in Türkiye.

Methods: In total, 530 AIS patients were enrolled in this study. Clinical, demographic, and laboratory characteristics were recorded within 24 hours of admission. One-month mortality outcomes were analyzed in relation to the AIP of the patients.

Results: Of the 530 patients, 140 patients did not survive during the follow-up period. The mean AIP was 0.50 ± 0.33 in survivors and 0.11 ± 0.27 in the mortality group (P = 0.001). In the receiver operating characteristic analysis, the AIP value of 0.291 had a sensitivity of 74.4%, specificity of 76.4%, positive predictive value of 75.92%, and negative predictive value of 74.9% for mortality. The AIP value above 0.291 had an AUC (area under curve) of 0.829 (95% CI [confidence interval] 0.78-0.88, P = 0.0001). In Cox regression analysis, AIP values below 0.291 (HR 3.962; 95% CI 2.643-5.937) were identified as an independent predictor of mortality. Higher mortality rates were observed in patients with cryptogenic stroke and AIP below 0.291 after stratification by stroke TOAST (P = 0.003).

Conclusions: Lower AIP is an independent predictor of short-term mortality in AIS patients, surpassing the sensitivity of traditional lipid parameters. This study provides a valuable prognostic tool for clinicians, offering a non-invasive and cost-effective test for a condition associated with substantial mortality and morbidity.

Background: Short and practical questionnaires and tests that assess premenstrual symptoms and premenstrual syndrome (PMS) are required.

Objectives: This study aimed to investigate the cross-cultural adaptation, validity, and reliability of the Premenstrual Syndrome Impact Questionnaire (PMS-IQ) in Turkish women with PMS.

Design and setting: The reliability and validity of the questionnaire were evaluated in Tokat, Türkiye.

Methods: A convenience sample of 146 individuals diagnosed with PMS was used to assess the reliability and validity of the Turkish version of the PMS-IQ. Test-retest analyses were performed in a subset of 96 individuals one week after the initial assessment. Construct validity was evaluated through convergent validity analysis using the Premenstrual Syndrome Scale (PMSS) and the Premenstrual Symptoms Impact Survey (PMSIS), and divergent validity analysis with the Big Five Inventory-10 (BFI-10).

Results: Cronbach's α values for the total score and subscales ranged from 0.861 to 0.917, whereas the test-retest reliability values ranged from 0.755 to 0.847. Factor analysis indicated that the scale had a three-factor structure. The total PMS-IQ score was significantly correlated with both the PMSS (r = 0.718) and PMSIS (r = 0.774), but showed no significant correlation with the BFI-10 (r = 0.113). No floor or ceiling effects were observed for the total or subscale scores of the PMS-IQ.

Conclusions: The Turkish version of the PMS-IQ demonstrated reliability and validity for evaluating individuals with PMS.

Clinical trial registration: This study is registered at ClinicalTrials.gov (identifier: NCT05725447).