Sao Paulo Medical Journal最新文献

Background: The coronavirus disease 2019 (COVID-19) pandemic has placed unprecedented strain on healthcare systems, particularly on critically ill patients requiring prolonged mechanical ventilation (MV). Percutaneous tracheostomy (PT) has emerged as a potential strategy to facilitate weaning, reduce intensive care unit (ICU) stay, and optimize resource use. However, the timing, safety, and outcomes of PT in COVID-19 patients remain debatable.

Objectives: This study aimed to describe the technical aspects of the procedure and evaluate the early safety of our technique to healthcare professionals, as well as the short-term factors affecting survival in 103 consecutive patients after tracheostomy.

Methods: We retrospectively analyzed patients with COVID-19 who underwent PT between March 2020 and June 2020 at Hospital Alemão Oswaldo Cruz, São Paulo. The factors considered for analysis included age, sex, timing of tracheostomy, proportion of affected lungs, comorbidities, fraction of inspired oxygen on MV, and availability of professional private equipment. Univariate analysis was performed for screening, and variables with P < 0.20 were included in the multivariate Cox proportional hazards regression model.

Results: Most patients were male, with a median age of 68 years. The most common comorbidities were hypertension (n = 55/52%), diabetes (n = 37/36%), and heart disease (n = 24/21%). Patients over 60 years old had reduced survival (hazard ratio [HR] = 3.35; P = 0.003), and those who underwent high nasal flow catheter (HR = 0.49; P = 0.02) and PT earlier (< 10 days) had better survival (HR = 0.37; P = 0.04).

Conclusion: Early PT in selected patients may reduce the duration of MV and lead to shorter ICU stays. The health system is overloaded by the scarcity of ventilators and beds for critically ill patients.

Background: Studies assessing the prevalence of mental disorders in the context of remote teaching in Brazil during the coronavirus disease (COVID-19) pandemic are scarce.

Objective: To estimate the prevalence of symptoms of anxiety and depression and their relationship with sociodemographic characteristics among university students during the COVID-19 pandemic.

Design and setting: This multicenter cross-sectional study was conducted at eight Brazilian public universities.

Methods: This study was conducted on students regularly enrolled in undergraduate courses. Data were collected between October 2021 and February 2022 using an online self-administered questionnaire that addressed sociodemographic and academic characteristics, lifestyle habits, and health conditions. Anxiety and depression symptoms were assessed using the Depression, Anxiety, and Stress Scale-21. The variables were analyzed descriptively using frequency distribution, proportion, 95% confidence interval (95% CI), and Pearson's chi-squared test.

Results: A total of 8,650 students participated, and most of them were women, white, heterosexual, cisgender, and unmarried, with a mean age of 23.9 (standard deviation: ± 6.34) years and living with family members. Symptoms of anxiety and depression were observed in 59.7% (95% CI: 58.7-60.7) and 63.0% (95% CI: 62.0-64.0) of the students, respectively. These symptoms were associated with sex, age, skin color, sexual orientation, gender identity, marital status, education of the head of the family, family income, decrease in income during the pandemic, and area of knowledge.

Conclusion: Most university students showed symptoms of anxiety and depression during the suspension of face-to-face activities in universities, indicating the need for institutional actions and public policies aimed at promoting their health and mental well-being.

Background: Pregnant women are at an increased risk of thromboembolism compared with non-pregnant women. Venous thrombosis is a manifestation of antiphospholipid syndrome (APS), an autoimmune thrombophilia associated with pregnancy morbidity.

Objectives: This study was designed to compare gestational outcomes of pregnant patients with deep venous thrombosis (DVT) and primary APS with outcomes of patients with DVT and negative results for antiphospholipid antibodies (aPLs).

Design and setting: This was a retrospective cohort study with data collected from patients with DVT who received prenatal care for autoimmunity and thrombophilia at Hospital Universitário Pedro Ernesto, Rio de Janeiro.

Methods: All patients with DVT were tested for aPLs. Those with positive results were tested again after 12 weeks and classified as having primary APS. Patients with systemic lupus erythematosus, superficial venous thrombosis without DVT, twin pregnancies, or fetuses with congenital malformations were excluded.

Results: This study included 171 patients (39 with APS, 132 with DVT and negative aPL results). Patients with primary APS and DVT had higher frequencies of miscarriages (P = 0.004) and stillbirths during previous pregnancies (P < 0.001). When obstetric outcomes were analyzed prospectively, APS patients had a lower birth weight (P = 0.001) and higher rates of oligohydramnios (P = 0.04), intrauterine growth restriction (P = 0.01), preeclampsia (P = 0.04), stillbirths (P = 0.02), and small-for-gestational-age newborns (P < 0.001) than patients with DVT and negative aPL results. The latter group had gestational outcomes similar to those of the general population.

Conclusions: Patients with primary APS have adverse obstetric outcomes despite appropriate treatment, whereas those with DVT and negative for aPLs have favorable results.

Background: Sense of mastery has been described in the literature as a psychological resource potentially associated with reduced caregiver burden. However, there are no validated instruments in the Brazilian context that allow the evaluation of the sense of mastery as a possible outcome of interventions aimed at supporting unpaid caregivers of people with dementia.

Objective: To validate the construct of the Brazilian version of the Pearlin Mastery Scale among unpaid caregivers of people living with dementia.

Design and setting: This methodological study was conducted with 100 unpaid caregivers of people living with dementia, cared for at home, and who resided in Brazil.

Methods: Evidence of validity was tested based on internal structure, reliability, and correlations with theoretically related constructs. Sociodemographic data on sense of mastery, burden, depressive symptoms, anxiety, and quality of life were collected.

Results: Difficulties involving burden (80%), depressive symptoms (70%), anxiety (65%), and low quality of life (62%) were reported. Satisfactory measures of adjustment were found in the factor analysis; however, by removing two inversely scored items, these measures improved, resulting in a Cronbach's alpha of 0.75. Significant correlations were found between sense of mastery and burden scores (ρ = -.56), symptoms of depression (ρ = -.57), anxiety (ρ = -.57), and quality of life (ρ = .64).

Conclusion: Evidence of validity was found for the Pearlin Mastery Scale Brazilian version based on the internal structure, reliability, and correlations with theoretically related constructs, indicating that it is a suitable instrument for use in Brazil.

Background: Lipid profiles are largely determined by genetic variants, and lipid metabolism plays a crucial role in Alzheimer's disease.

Objective: To investigate whether lipid profile variability in response to diverse statins could be affected by cholesterol metabolism-related genetic variants in Alzheimer's disease..

Design and setting: This prospective observational pharmacogenetic study was conducted at the Universidade Federal de São Paulo (Unifesp), Brazil.

Methods: Consecutive outpatients were prospectively followed for lipid profile variations over one year, estimated by the associations between statin therapy and the following variants: rs2695121 (NR1H2), rs3846662 (HMGCR), rs11669576 (LDLR8), rs5930 (LDLR10), rs5882 and rs708272 (CETP), rs7412 and rs429358 (APOE), and ACE insertion/deletion polymorphism.

Results: All polymorphisms in the 189 patients were in Hardy-Weinberg equilibrium. Statins resulted in lower total cholesterol and LDL cholesterol levels, whereas the effects on HDL cholesterol varied according to the statin used. Atorvastatin resulted in lower triglyceride level variations than simvastatin. APOE-ε4 carriers showed a better response to atorvastatin in elevating HDL-cholesterol than APOE-ε4 non-carriers. Carriers of the ACE insertion allele had cumulatively lower total cholesterol and LDL-cholesterol levels, regardless of statin therapy, but lower triglyceride levels when using atorvastatin. Carriers of rs11669576-G had lower total cholesterol and LDL-cholesterol levels when using simvastatin, and lower total cholesterol and triglycerides when using atorvastatin. Concerning CETP haplotypes, carriers of rs5882-A and rs708272-A benefitted the most from statins, which lowered total cholesterol and increased HDL-cholesterol levels, and from atorvastatin lowering triglycerides; however, the effects of atorvastatin lowering total cholesterol and LDL-cholesterol were more pronounced for carriers of rs5882-GG/rs708272-GG.

Conclusion: Lipid profile variations may be pharmacogenetically mediated in Alzheimer's disease, thus, confirming their high heritability.

Background: Inadequate diet is considered a major risk factor for chronic noncommunicable diseases and mortality. Among the ultra-processed foods, sweetened soft drinks are significant contributors to high-calorie diets and are associated with adverse health outcomes.

Objective: To estimate the association between soft drink consumption and the risk of cardiovascular events.

Design and setting: A cross-sectional study was conducted using data of adults aged ≥ 18 years from the 2013 National Health Survey.

Methods: The explanatory variable was the daily consumption of sugar-sweetened soft drinks. Cardiovascular risk (CVR) was calculated using the Framingham score. Multinomial logistic regression was used for the analyses. Two models were used: one adjusted for age and body mass index and the other for age and waist circumference. Both models were applied to the general population and stratified by race and educational attainment.

Results: The study sample consisted of 8,391 participants. Individuals with sugary soda consumption ≥ 0.4 cups/day were associated with a higher CVR, which escalated with increasing consumption of soft drinks.

Conclusions: CVR was observed across all consumption categories and difference in risk was based on the intake quantity.

Background: Burnout is a global problem, and resilience may support the well-being of healthcare workers (HCWs) in stressful conditions.

Objectives: This study aimed to evaluate the association between burnout and resilience among HCWs in intensive care units (ICU) during the coronavirus disease 2019 (COVID-19) pandemic.

Design and setting: A cross-sectional study was conducted in the ICU of four public hospitals in Fortaleza, Brazil.

Methods: A face-to-face survey was conducted among HCWs in the ICUs of four public hospitals in Fortaleza between January and August 2023. The participants completed questionnaires on burnout and resilience.

Results: A total of 194 professionals, including physichians (24%), nurses (29%), nursing technicians (25%), and physiotherapists (22%), completed questionnaires on burnout and resilience through face-toface interviews. Most professionals (62%) presented with overall burnout symptoms, and an inverse association was observed between resilience and burnout. However, 16 of the 44 (34%) HCWs with the highest resilience scores experienced burnout. Furthermore, younger age and higher workload were associated with a higher prevalence of burnout.

Conclusion: Determinants of burnout were identified among ICU staff members during the last year of the COVID-19 pandemic. Resilience helped HCWs cope with burnout. However, some of the most resilient HCWs presented with high levels of burnout. Efforts are necessary to implement resilience-building tools, yet public health policies to improve ICU organizational issues are more important and urgent for promoting sustainable well-being among professionals, particularly during challenges such as pandemics. Introducing resilience-building tools and implementing public health policies are necessary to improve ICU management and promote sustainable well-being among healthcare workers in high workload settings.

Background: Surgical treatment of hemorrhoidal disease has undergone numerous modifications in recent decades. Among the technical options, stapled hemorrhoidopexy is currently considered an optimal alternative because it provides a less painful recovery. However, many reports have associated this technique with higher recurrence rates than excisional techniques.

Objectives: This manuscript presents a technical modification that aims to provide more extensive mucosectomy with mechanical hemorrhoidopexy.

Design and setting: The present technical modification was developed and has been recently used in two hospitals in São Paulo (SP), Brazil.

Methods: To achieve this, we placed a circumferential submucosal suture at the 3 o'clock position in the clockwise direction. When the left lateral position (9 o'clock) was reached, a loop of 2-0 non-absorbable suture thread was passed around the continuous suture and retracted to the left. Subsequently, the original suture progressed towards the point on the right lateral side, where it was started.

Results: Specifically, the modification consists of establishing two traction points from the pursestring suture; thus, the rectal mucosa entering the stapler head will be more uniform, and the retrieved mucosal strip will present a greater height. These features may play a role in effectively reducing mucosal prolapse and alleviating the symptoms.

Conclusions: The proposed modification of the original operative technique is simple and aims to improve postoperative results by increasing the height of the mucosal specimen to be resected, thereby reducing long-term recurrence. In the future, this hypothesis will be tested in a randomized study comparing the mucosectomy height and postoperative outcomes of both technical options (classical and present).

Background: Percutaneous microelectrolysis (MEP) is a minimally invasive technique used for pain relief, inflammation control, and tissue repair. However, the optimal treatment protocol remains under debate.

Objective: To compare the effects of dry needling and MEP, with and without a treatment algorithm, on pain in individuals with active myofascial trigger points (MTrPs) in the upper trapezius muscle. Design and setting: Randomized controlled trial conducted at Maimónides University, Buenos Aires.

Methods: Eighty-eight participants with MTrPs in the upper trapezius muscle were enrolled. The presence of MTrPs was confirmed through physical examination and algometric measurement before intervention. Participants were randomly assigned to one of six groups: Sham, dynamic dry needling, static dry needling, dynamic MEP, static MEP, or algorithmic MEP. Active treatments were administered using 0.30 mm × 40 mm acupuncture needles. Pain was assessed using two tools: the Numerical Pain Rating Scale (NPRS) and the Pressure Pain Threshold (PPT). Both measures were recorded with participants at rest before the intervention and again at 10 min, 24 h, 48 h, and 7 days post-intervention.

Results: Significant post-intervention differences in NPRS scores were observed in all groups except dynamic dry needling when compared to Sham. The algorithmic MEP group achieved complete pain relief by day 7. In terms of PPT, the threshold values in the MEP groups were lower than those in the other groups.

Conclusions: All needling techniques demonstrated analgesic effects on myofascial trigger points, with the algorithm-enhanced MEP showing the most notable improvement in self-reported pain. However, MEP was not superior to other methods in improving pressure pain thresholds.

Clinical trials: NCT05478928.

Background: The High-Activity Arthroplasty Score (HAAS) is a reliable and valid self-administered questionnaire that was developed in British English and was designed to determine the level of physical activity in patients after lower limb arthroplasty (hip and/or knee). The Brazilian version (HAAS-Brazil) was developed after a cross-cultural adaptation in 2023.

Objective: To evaluate the psychometric properties of HAAS-Brazil in patients after hip arthroplasty.

Design and setting: A cross-sectional quantitative and qualitative study was conducted in an orthopedic outpatient setting.

Methods: Evidence for the validity of HAAS-Brazil was assessed via psychometric testing, which followed the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN).

Results: A total of 112 patients with a mean age of 56 years were included as participants; of these patients, 50.9% were female, with 44.6% being overweight and 85.7% being engaged in physical activity. HAAS-Brazil provided satisfactory evidence of content validity (CVC > 0.9), structural validity (AISP = 1; Hi > 0.3; VIMon = 0; VIIIO = 0), construct validity (ρ HOS-SP = 0.696; ρ SF-12 PSC = 0.554; ρ SF-1 MSC = 0.338), no ceiling or floor effect, acceptable internal consistency (Mokken ρ = 0.707; Cronbach α = 0.663), and good reliability (ICC(3,K) = 0.840 ; P < 0.001).

Conclusion: The HAAS-Brazil provided satisfactory validation evidence in patients who underwent hip arthroplasty.