Sao Paulo Medical Journal最新文献

Background: Research on the economic burden of sedentary behavior and abdominal obesity on health expenses associated with cardiovascular diseases is scarce.

Objective: The objective of this study was to verify whether sedentary behavior, isolated and combined with abdominal obesity, influences the medication expenditure among adults with cardiovascular diseases.

Design and setting: This cross-sectional study was conducted in the city of President Prudente, State of São Paulo, Brazil in 2018.

Methods: The study included adults with cardiovascular diseases, aged 30-65 years, who were treated by the Brazilian National Health Services. Sedentary behavior was assessed using a questionnaire. Abdominal obesity was defined by waist circumference. Medication expenditures were verified using the medical records of each patient.

Results: The study included a total of 307 adults. Individuals classified in the group with risk factor obesity combined (median [IQ] USD$ 29.39 [45.77]) or isolated (median [IQ] USD$ 27.17 [59.76]) to sedentary behavior had higher medication expenditures than those belonging to the non-obese with low sedentary behavior group (median [IQ] USD$ 13.51 [31.42]) (P = 0.01). The group with combined obesity and sedentary behavior was 2.4 (95%CI = 1.00; 5.79) times more likely to be hypertensive.

Conclusion: Abdominal obesity was a determining factor for medication expenses, regardless of sedentary behavior, among adults with cardiovascular diseases.

Background: Specific types of violence such as intimate partner sexual violence and intimate partner homicide occur more frequently in rural areas.

Objective: This study aimed to systematically review the literature on the knowledge and attitudes of rural healthcare providers regarding cases of domestic violence against women.

Design and setting: Systematic review developed at Universidade Federal de Uberlândia.

Methods: We conducted an electronic search of six databases, which only included observational studies, regardless of the year, language, or country of publication, except for studies that used secondary data and were exclusively qualitative. Two reviewers performed the selection, data extraction, and risk of bias assessment using a specific Joanna Briggs Institute tool.

Results: Six studies met the inclusion criteria. All the studies had a low risk of bias. Approximately 38% of these professionals identified injuries caused by violence in patients. When asked about knowing the correct attitude to take in cases of confirmed violence, between 12% and 64% of rural healthcare providers answered positively; most of them would refer to specialized institutions and promote victim empowerment and counseling. The number of professionals with an educational background in the field ranged from 16% to 98%.

Conclusions: The evident disparity across studies shows that some professionals have suboptimal knowledge and require training to adopt the correct attitude when identifying female victims of domestic violence in clinical practice.

Systematic review registration: This systematic review was registered in the Open Science Framework Database under the registration http://doi.org/10.17605/OSF.IO/B7Q6S.

Background: Neck circumference (NC) is a useful anthropometric measure for predicting obstructive sleep apnea (OSA). Ethnicity and sex also influence obesity phenotypes. NC cut-offs for defining OSA have not been established for the Latin American population.

Objectives: To evaluate NC, waist circumference (WC), and body mass index (BMI) as predictors of OSA in the Colombian population and to determine optimal cut-off points.

Design and setting: Diagnostic tests were conducted at the Javeriana University, Bogota.

Methods: Adults from three cities in Colombia were included. NC, WC, and BMI were measured, and a polysomnogram provided the reference standard. The discrimination capacity and best cut-off points for diagnosing OSA were calculated.

Results: 964 patients were included (57.7% men; median age, 58 years) and 43.4% had OSA. The discrimination capacity of NC was similar for men and women (area under curve, AUC 0.63 versus 0.66, P = 0.39) but better for women under 60 years old (AUC 0.69 versus 0.57, P < 0.05). WC had better discrimination capacity for women (AUC 0.69 versus 0.57, P < 0.001). There were no significant differences in BMI. Optimal NC cut-off points were 36.5 cm for women (sensitivity [S]: 71.7%, specificity [E]: 55.3%) and 41 cm for men (S: 56%, E: 62%); and for WC, 97 cm for women (S: 65%, E: 69%) and 99 cm for men (S: 53%, E: 58%).

Conclusions: NC and WC have moderate discrimination capacities for diagnosing OSA. The cut-off values suggest differences between Latin- and North American as well as Asian populations.

Background: Neuroleptic malignant syndrome (NMS) is a neurologic emergency potentially fatal. This rare side effect is most commonly associated with first-generation antipsychotics and less frequently with atypical or second-generation antipsychotics. The diagnosis relies on both clinical and laboratory criteria, with other organic and psychiatric conditions being ruled out.

Case report: A 39-year-old female patient, who is institutionalized and completely dependent, has a medical history of recurrent urinary infections and colonization by carbapenem-resistant Klebsiella pneumoniae. Her regular medication regimen included sertraline, valproic acid, quetiapine, risperidone, lorazepam, diazepam, haloperidol, baclofen, and fentanyl. The patient began experiencing dyspnea. Upon physical examination, she exhibited hypotension and a diminished vesicular murmur at the right base during pulmonary auscultation. Initially, after hospitalization, she developed high febrile peaks associated with hemodynamic instability, prompting the initiation of antibiotic treatment. Despite this, her fever persisted without an increase in blood inflammatory parameters, and she developed purulent sputum, necessitating antibiotherapy escalation. The seventh day of hospitalization showed no improvement in symptoms, suggesting NNMS as a differential diagnosis. All antipsychotic and sedative drugs, as well as antibiotherapy, were discontinued, after which the patient showed significant clinical improvement.

Conclusion: Antipsychotic agents are commonly employed to manage behavioral changes linked to various disorders. However, their severe side effects necessitate a high degree of vigilance, the cessation of all medications, and the implementation of supportive care measures. A prompt and accurate diagnosis of NMS is crucial to alleviating the severe, prolonged morbidity and potential mortality associated with this syndrome.

Background: Among the complications related to chronic kidney disease (CKD), those of a neurological nature stand out, and for a better quality of life for patients, the diagnosis and treatment of these complications is fundamental.

Objectives: This study aimed to assess the effect of hemodialysis on intracranial pressure waveform (ICPw) in patients with chronic kidney disease undergoing hemodialysis and those who are not yet undergoing substitutive therapy.

Design and setting: An observational study was conducted in two stages at a kidney replacement therapy center in Brazil. The first was a longitudinal study and the second was a cross-sectional study.

Methods: Forty-two patients on hemodialysis were included in the first stage of the study. In the second stage, 226 participants were included. Of these, 186 were individuals with chronic kidney disease (who were not undergoing substitutive therapy), and 40 did not have the disease (control group). The participants' intracranial compliance was assessed using the non-invasive Brain4care method, and the results were compared between the groups.

Results: There was a significant difference between the hemodialysis and non-hemodialysis groups, with the former having better ICPw conditions.

Conclusions: Hemodialysis influenced the improvement in ICPw, probably due to the decrease in the patients' extra-and intracellular volumes. Furthermore, ICPw monitoring can be a new parameter to consider when defining the moment to start substitutive therapy.

Background: Exclusive breastfeeding is recommended for the first six months, and mother's age impact early weaning. Educational support and relevant information can increase breastfeeding rates.

Objective: To determine whether antenatal education enhances the maintenance, intention, and confidence in breastfeeding among adolescents.

Design and setting: A prospective cohort study involving primiparous adolescents who gave birth at the Woman's Hospital (CAISM), Universidade Estadual de Campinas, Brazil.

Methods: Adolescent mothers were categorized into two groups based on the location of prenatal care: those at the Woman's Hospital (WH) who received antenatal education, and at the Primary Care (PC) who did not receive antenatal education. All adolescents received breastfeeding orientation during their postpartum hospital stay. The groups were compared using the Student's t-test, Mann-Whitney U test, and chi-squared test. Log-binomial models were used to compare the groups at different time intervals.

Results: The study included 132 adolescents: 59 in the WH group and 73 in the PC group. Six months postpartum, adolescents in the WH group demonstrated higher engagement in breastfeeding (P < 0.005) and exclusive breastfeeding (P = 0.04) than PC group. PC group showed greater lack of confidence in breastfeeding (P = 0.02) and felt less prepared (P = 0.01). Notably, all WH adolescents reported a stronger desire to breastfeed after antenatal education.

Conclusion: Antenatal education significantly improves the maintenance, intention, and confidence of breastfeeding among adolescents. This education approach can be implemented across all healthcare levels and should be made accessible to all women throughout the pregnancy and postpartum period.

Background: To highlight the importance of clinical simulations and simulated laboratories for student training, especially in physical examination teaching.

Objective: To evaluate the gains obtained by medical students in their cognitive and practical performance of physical examinations (abdominal, cardiological, and pulmonary), as well as satisfaction and self-confidence in what they have learned, after concentrated practice developed in a skills and simulation laboratory.

Design and setting: A quantitative and quasi-experimental study in which 48 students were evaluated at the Faculdade de Odontologia de Bauru, São Paulo, Brazil.

Methods: A quantitative and descriptive study was conducted with regularly enrolled 2nd year medical students over 18 years of age who had content prior to data collection regarding anamnesis and physical examination remotely taught in a Moodle virtual learning environment. For data collection, the participants were subjected to a concentrated period of skill training (abdominal, cardiological, and pulmonary). Every day after the skill training session, they were subjected to a practical evaluation and completed a theoretical test before and after the practical activities. At the end of all activities, they answered the instrument to assess the simulated practices (self-confidence and satisfaction).

Results: Among the 49 students evaluated, positive and significant theoretical and practical gains were identified in all three components (abdominal, cardiological, and pulmonary) (P = 0.000), as well as in the general evaluation (Theoretical 1 and Theoretical 2) (P = 0.000), satisfaction, and self-confidence (P = 0.000).

Conclusion: Concentrated laboratory practice resulted in positive improvements in students' physical examination skills.

Background: The cardiopulmonary function of patients with obstructive sleep apnea (OSA) is significantly lower than that of patients with simple snoring and is significantly related to the severity of OSA. Currently, only a few studies have been conducted on cardiopulmonary exercise testing in overweight patients with OSA.

Objective: To analyze the correlation between cardiopulmonary exercise test (CPET) indices and the condition of overweight patients with OSA.

Design and setting: Retrospective study in Guangdong Provincial Hospital of Chinese Medicine.

Methods: This study included 73 hospitalized overweight patients. The patients were divided into no, mild, moderate, and severe OSA groups. Differences in the CPET indices among the four groups were compared. The correlation between the CPET indices and conditions was analyzed.

Results: No, mild, moderate, and severe OSA groups had 18 men and 5 women, 11 men and 3 women, 12 men and 2 women, and 21 men and 1 woman, respectively (P > 0.05). No significant difference was observed in resting pulmonary function among the four groups (P > 0.05). In the CPET, the anaerobic threshold, maximum oxygen uptake, and oxygen pulse were significantly lower in the severe OSA group than those in the normal OSA group (P < 0.05). Moreover, CPET indices negatively correlated with the apnea-hypopnea index.

Conclusion: Changes in CPET indices occurred earlier than changes in resting pulmonary function in patients with OSA. CPET might be a potential method for evaluating the severity of OSA combined with overweight status.

Background: Few food frequency questionnaires (FFQ) have been validated for pregnant women, particularly those in small- and medium-sized cities in different regions of Brazil.

Objectives: To validate and calibrate a semiquantitative FFQ for pregnant women.

Design and setting: The study was validated with a sample of 50 pregnant women (≥ 18 years) enrolled in Brazilian prenatal services.

Methods: An FFQ and a 24-hour recall were used to evaluate dietary intake. Dietary variables were tested for normality and log-converted when asymmetrical. Pearson's Correlation Coefficient was used to validate the questionnaire. Linear regression was applied to extract calibration factors. All variables underlying the consumption analysis were adjusted for energy.

Results: The mean age of the pregnant women was 26 years ± 6.2 years; 58% were in their first trimester, and 30% were identified as overweight/obese. The Pearson correlation analysis results indicated that the FFQ overestimated energy and nutrient intake, whose coefficients ranged from -0.15 (monounsaturated fat) to 0.50 (carbohydrate). Adjusting for energy reduced the mean values of intake coefficients, which now ranged from -0.33 (sodium) to 0.96 (folate). The calibration analysis results indicated variation in the coefficients from -0.23 (sodium) to 1.00 (folate). Calibration produced satisfactory coefficients for the FFQ compared with the reference standard for energy, macronutrients, monounsaturated fat, cholesterol, vitamins B12/C, folate, sodium, iron, and calcium.

Conclusions: After validating and calibrating tests, we observed that the FFQ was adequately accurate for assessing the food consumption of the pregnant women in this study.