Sao Paulo Medical Journal最新文献

Background: Interventions capable of modulating the heat shock response (HSR), such as physical exercise and heat therapy (HT), are potential therapeutic strategies for the prevention and treatment of diabetes.

Objective: This study aims to evaluate the effects of resistance training (RT) and HT on HbA1c levels, metabolic and inflammatory profiles, gut microbiota, and HSR in patients with type 2 diabetes mellitus (T2DM).

Design and setting: A randomized, double-blind, parallel clinical trial will be conducted for 12 weeks in southern Brazil.

Methods: Participants with T2DM will be randomized into control (any intervention), RT, or HT groups. In the RT group, participants will perform supervised exercise, and the HT group will undergo whole-body heat treatment in an environmental chamber initially set at 55.0°C, both on three non-consecutive days of the week (60 min). Blood samples will be collected before and after 12 weeks of treatment. Heat shock response, body composition and physical fitness, glycemic control, lipid profile, gut microbiota composition and diversity, inflammatory markers, and flow-mediated dilation will be evaluated.

Conclusion: Since the HSR response is decreased in individuals with diabetes, we believe that improving the HSR may be important in preventing chronic complications associated with T2DM. This randomized clinical trial will determine the efficacy of HT compared to RT in improving HSR when combined with conventional therapy in individuals with T2DM. Multiple HT and RT effects may contribute to a lower mortality risk in these individuals.

Clinical trial registration: Unique Identifier NCT05847075. https://clinicaltrials.gov/study/NCT05847075.

Background: Peripheral nerves may be affected in subclinical hypothyroidism (SH).

Objectives: This study aimed to investigate the presence of common entrapment mononeuropathies in patients with SH.

Design and setting: A prospective case-control study conducted between September 2022 and November 2023 at Adana City Training and Research Hospital, Adana, Türkiye.

Methods: SH patients without neurological complaints and healthy individuals over the age of 18 were included. Serum levels of free T3, free T4, thyroid-stimulating hormone (TSH), thyroid peroxidase (TPO) antibody, and creatine kinase (CK) were measured. All participants underwent nerve conduction studies of the upper and lower extremities.

Results: Thirty patients with SH and 40 healthy individuals were included in the study. The percentage reduction in compound muscle action potential (CMAP) amplitude across the knee segment was 2.8 ± 3.5% in healthy individuals and 6.7 ± 6.6% in SH patients (P = 0.017). Apart from this significant difference, other nerve conduction study findings did not differ between the two groups. A positive correlation was observed between CK levels and the percentage reduction in peroneal nerve CMAP amplitude across the knee segment (P = 0.021, r = 0.421). Additionally, there was a positive correlation between TPO antibody levels and F-wave latency in both the median and ulnar nerves (P = 0.028 r = 0.400/P = 0.005 r = 0.501). Electrodiagnostic evaluations revealed carpal tunnel syndrome (CTS) in four patients, peroneal neuropathy at the fibular head (PNFH) in four patients, and ulnar neuropathy at the elbow (UNE) in one patient.

Conclusion: This study suggests that patients with SH may develop subclinical CTS and PNFH, but not UNE. Accordingly, it highlights the importance of avoiding risk factors that may contribute to the development of CTS and PNFH. Serum CK and TPO antibody levels may be useful in monitoring subclinical neuropathy in SH.

Background: The incidence of skin cancer is increasing globally. However, it is largely preventable through early detection. Therefore, raising public awareness through education is essential.

Objective: This study aimed to evaluate the effect of a planned visual education program-based on the Health Belief Model-on university students' attitudes and beliefs regarding skin cancer.

Design and setting: This cluster-randomized controlled trial was conducted in two departments at a university in Manisa, Türkiye.

Methods: The study was conducted with 116 university students, divided equally into an intervention group (n = 58) and a control group (n = 58). Data were collected using the Student Information Form and the Health Belief Model Scale in Skin Cancer.

Results: Following the visual education program based on the Health Belief Model, significant differences were observed between the intervention and control groups in perceived severity, perceived susceptibility, perceived barriers, perceived benefits, and self-efficacy scores. While the intervention group showed significant improvements across these domains, no significant difference was found in perceived severity scores.

Conclusion: The findings indicate that planned visual education based on the Health Belief Model positively influenced students' attitudes and beliefs regarding skin cancer.

Clinical trial registration: The research was recorded at https://clinicaltrials.gov/study/NCT05788939.

Background: Selenium is essential to human health. There are few reports on the analysis of selenium intake in the Brazilian population; however, data have shown that Brazilian are in the deficient range of consumption.

Objectives: This study aimed to identify the major foods that contribute to dietary selenium and determine the socioeconomic and lifestyle factors associated with selenium intake.

Design and setting: This cross-sectional study used baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Methods: Selenium consumption was evaluated using a food frequency questionnaire (FFQ) developed and validated for the ELSA-Brasil. To determine the contribution of selenium consumption, each food item was divided by the total selenium intake of the population. Associations between selenium intake (mg/day, dependent variable) and sociodemographic and lifestyle factors (predictors) were tested using multiple linear regression analyses.

Results: The sample comprised 14,780 participants, most of whom were adults (78.5%). Individuals with income ≥ 3 minimum wages were mostly concentrated in the 5th quintile of selenium consumption; positive and significant correlations were found between selenium intake and female sex, age ≥ 60 years, income ≥ 3 minimum wages, higher or postgraduate education, alcohol consumption, and moderate physical activity level. Nuts and fish contributed the most to dietary selenium.

Conclusion: Nuts, meat, and fish contributed the most to the dietary intake of selenium, and selenium intake was associated with sociodemographic and lifestyle factors among the evaluated individuals.

Background: No study has reported about the prevalence and factors associated with dynapenic abdominal obesity in patients with pre-dialysis chronic kidney disease (CKD).

Objective: Evaluation of the prevalence of dynapenic abdominal obesity and its relationship with sociodemographic, lifestyle, clinical, and nutritional variables in patients with CKD not dependent on dialysis.

Design and setting: A cross-sectional study was conducted at the Nutrition and Nephropathy Outpatient Clinic (public service) in Bahia, Brazil.

Methods: This cross-sectional study was conducted on 102 patients of both sexes, aged ≥ 20 years. Dynapenic abdominal obesity (DAO) was defined as the simultaneous presence of dynapenia (handgrip strength less than the first tertile of the sample itself, according to sex and age) and increased waist circumference. Differences between groups with and without DAO were assessed using the Student's Mann-Whitney t-test, Pearson's chi-square test, or Fisher's exact test. Associations were tested using bivariate and multivariate models with Poisson regression to calculate the prevalence ratio and 95% confidence intervals (PR; 95% CI).

Results: The mean age of the patients was 58.7 (standard deviation = 11.69); 50.5% were male, 51.6% were elderly, 41.8% had diabetes, 5.5% were smokers, 58.2% were abdominally obese, and 38.5% were dynapenic. DAO was identified in 18.7% of participants and was associated with diabetes mellitus (PR = 2.8; 95% CI = 1.12-6.99) and smoking (PR = 3.22; 95% CI = 1.16-8.96).

Conclusion: Non-dialysis dependent patients with CKD showed a significant prevalence of DAO associated with smoking and diabetes mellitus.

Background: Evidence on frailty prevalence in Brazilian patients with kidney transplant (KT) is scarce.

Objectives: To estimate frailty prevalence in pre-KT patients and its association with functional, cognitive, and laboratory anomalies.

Design and setting: Cross-sectional descriptive study included adult KT candidates assessed within 24 hours before KT, at two medical centers in Northeast Brazil.

Methods: Frailty was classified as non-frail (scores 0-1), intermediate frail (score 2), or frail (scores 3-5), using Fried et al. criteria. Patients were divided into: Non-frail (0-1) and Frail (≥ 2) groups. Katz and Lawton's scales assessed the dependence on basic (ADLs) and instrumental (IADLs) activities of daily living, respectively. Montreal Cognitive Assessment was used to evaluate cognition. Laboratory tests were performed during pre-KT evaluation.

Results: Among 82 patients, most were male (80.5%), mixed-race (76.8%), and 48.8 ± 14.9-years-old. The Frail group (63.4%) comprised 34.1% intermediate frail, and 29.3% frail individuals. This group had a higher prevalence of hypertension (90.4% vs. 70%, P = 0.018), rheumatological diseases (15.4% vs. 0%, P = 0.024), cognitive impairment (71.0% vs. 40.7%, P = 0.020), dependence on ADLs (32% vs. 0%, P < 0.001) and IADLs (82% vs. 56.7%, P = 0.014), lower hemoglobin (11.9 ± 2.7 g/dL vs. 13.4 ± 1.8 g/d, P = 0.005), and lower creatinine levels (7.1 mg/dL, IQR 6-10 vs. 9.1 mg/dL, IQR 7-11, P = 0.044).

Conclusions: Pretransplant frailty was prevalent and associated with functional disability, cognitive impairment, and biomarkers indicating sarcopenia. Early frailty assessment and identification of modifiable factors are essential.

Background: Cardiovascular disease (CVD) and stroke are among the leading causes of death worldwide.

Objective: This article presents a review of the application of artificial intelligence in identifying biomarkers for CVD and stroke.

Design and setting: Narrative review conducted by a research group at the Universidade Federal de São Paulo, São Paulo, Brazil.

Methods: A literature search was conducted to identify the main applications of artificial intelligence in ophthalmology, using the keywords "artificial intelligence," "prediction," "biomarker," "cardiovascular disease," "retina," and "stroke," covering the period from January 1, 2018, to July 3, 2023. The Medical Literature Analysis and Retrieval System Online (MEDLINE, via PubMed) and the Latin American and Caribbean Literature in Health Sciences (Literatura Latino-Americana e do Caribe em Ciências da Saúde, LILACS, via the Virtual Health Library) were used to identify relevant articles.

Results: A total of 30 references were retrieved, of which 14 were considered eligible for intensive review and critical analysis.

Conclusions: Artificial intelligence has proven effective in identifying non-invasive biomarkers through the analysis of patients' retinal examinations. These findings contribute to a better understanding of the pathophysiology of CVD and stroke.

Background: Cardiovascular diseases, especially ischemic heart disease and stroke, are the main causes of mortality in older people.

Objectives: To estimate the prevalence of stroke in older people in Brazil, we investigated its associations with sociodemographic factors, health-related behaviors, chronic diseases, body mass index and self-rated health and determined the frequency of limitations related to disease and care practices.

Design and setting: This population-based, cross-sectional study used data from the 2019 Brazilian National Health Survey.

Methods: This study included older people aged ≥ 60 years (n = 22,728) who answered the question, "Has any doctor ever given you a diagnosis of stroke?" Adjusted odds ratios were estimated using logistic regression.

Results: The prevalence of stroke was 5.6% (95% confidence interval = 5.1-6.1) and was higher in men, individuals aged ≥ 70 years, those with a lower income, those without health insurance, ex-smokers, physically inactive individuals, those with excess weight/obesity, those who rated their own health as fair/poor/very poor and those who reported hypertension, diabetes, kidney failure, depression and heart disease. The most adopted care practices were follow-ups by a healthcare provider (60.8%), medication use (59.3%) and diet (47.2%). Only 17.0% of patients underwent physiotherapy, and 53.7% reported limitations in habitual activities.

Conclusions: Subgroups of people more affected by stroke were identified, which included older individuals, those with lower socioeconomic status, ex-smokers and those with neuroendocrine and cardiovascular comorbidities. Less than 20% of patients underwent physiotherapy, which underscores the need to expand multidisciplinary care in the health network.

Background: There are several randomized controlled trials (RCTs) in the literature on musculoskeletal rehabilitation that compare different types of exercise; however, the comparison is not relevant because the groups generally perform different physical efforts, and the researchers are not aware of this, nor do they control for the confounding variables.

Objectives: To discuss the methods of comparison of different types of exercises in musculoskeletal rehabilitation.

Design and settings: Short communication developed at the Universidade Federal de São Carlos (UFSCar), São Carlos (SP), Brazil.

Methods: A narrative review of the motion cadence, time-under-tension, actual duration of an exercise session, and total physical effort was conducted.

Results: To compare the different types of exercise, it is crucial that the parameters of the proposed exercises are the same between the groups, i.e., the exercise intensity, total physical effort, and actual duration of the exercise session.

Conclusion: It is correct to compare different types of exercise, however, in the field of musculoskeletal rehabilitation, RCTs adequately controlled for these variables are lacking.