Sao Paulo Medical Journal最新文献

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.

Background: The Surprise Question (SQ), "Would I be surprised if this patient were to die in the next 12 months?", identifies patients at high risk of death who might benefit from palliative care (PC). However, little is known about its application in oncohematology.

Objectives: To evaluate the performance of the SQ among inpatients with hematologic malignancies.

Design and setting: A prospective cohort study was conducted between September and December 2021, including patients admitted to the Hematology Ward of the University Hospital in Salvador, Brazil.

Methods: Physicians answered the SQ (not surprised (SQ+) or surprised (SQ-)). Mortality data were assessed after one year.

Results: Eighty-one patients were included (56% SQ+ and 44% SQ-). At study closure, 36 patients (44%) had died. Median survival was 10.8 months (95%CI = 9.7-11.8) for SQ- and 5.6 months (95%CI = 4.1-7.1) for SQ+. Sensitivity was 86.1%, specificity 68.9%, positive predictive value 68.8%, negative predictive value 86.1%, and accuracy 76.5%. At the time of the interview, only 15 (18.5%) patients had consulted a PC specialist. By the study's end, 48% had been referred to PC. These patients had poorer performance status (82% vs. 40%, P < 0.001) and more advance care planning records (87% vs. 14%, P < 0.001).

Conclusions: Despite the prognostic uncertainty of hematologic malignancies, the SQ effectively estimates mortality and serves as a valuable tool for early PC integration in oncohematology.

Background: Heart failure with reduced ejection fraction (HFrEF) represents a compelling cause of hospital morbidity and mortality in Brazil. There is low adherence to guideline-directed medical therapy (GDMT), which in turn, can result in higher morbidity and mortality.

Objectives: The present study aims to evaluate adherence to GDMT in patients with HFrEF in a Brazilian University hospital service.

Design and settings: Observational, cross-sectional, single-center study conducted at the Hospital Universitário Professor Edgard Santos (HUPES), Salvador, BA, Brazil.

Methods: The study was conducted with convenience sampling at the cardiology outpatient clinic of a university hospital service. Patients with left ventricular ejection fraction (LVEF) < 40% who had reverse remodeling were excluded.

Results: 289 patients were included, with mean age 63 years, 54.7% were male, 56,4% mixed-race and 27,7% had Chagasic cardiomyopathy. 93.1% were prescribed ACEi, ARB or ARNi, 95.8% betablockers, 69.2% spironolactone and 8% the combination hydralazine/isosorbide-dinitrate. 71,7% were using enalapril, losartan or ARNi above 50% of GDMT target doses; 81,2% were using beta-blockers and 100% were using spironolactone. Only 21,2% were prescribed GDMT target doses of enalapril, losartan or ARNi and 52,3% of beta-blockers. 98,5% of spironolactone prescriptions reached GDMT target doses.

Conclusions: We found high frequencies of prescription of GDMT for HFrEF, considering the therapeutic goals recommended by cardiology guidelines, but, prescription of target doses were low in ACEi, ARB or ARNi and beta-blockers.

Background: Oxygen is widely used to treat hypoxemia.

Objective: To determine the frequency of inappropriate oxygen administration in patients admitted to Internal Medicine (IM) wards and intensive care units (ICU).

Design and setting: Single-center prospective, observational study in a tertiary university hospital in Ankara, Türkiye.

Methods: Patients who were hospitalized in the IM wards and ICU and were receiving oxygen were recruited. Every 6 hours, the oxygenation parameters were noted, and the averages over the first 24 hours of oxygen usage were recorded. Inappropriate usage was defined as oxygen flow rates > 6 L/min in the nasal cannula and < 5 L/min and > 10 L/min in the simple face mask, application of the simple face mask in chronic obstructive lung disease (COPD) exacerbation, SpO2 > 98% in general, or SpO2 > 92% in COPD exacerbation.

Results: Of the 397 patients, 20% in the IM wards and 50% of 124 in the ICU received oxygen. The oxygen method used was nasal cannula in 51%, simple face mask in 21%, and high-flow nasal cannula in 4% of the patients. Among the simple face mask applications, 46% were < 5 L/min and 5% were > 10 L/min. Among the 62% of patients with COPD exacerbations, the SpO2 was > 92%.

Conclusion: The frequency of oxygen use was 20% among patients hospitalized in IM wards and 50% among patients in the ICU. Almost half of the simple face mask applications were inappropriate.

Background: Scapular dyskinesis (SD) is a condition associated with impaired scapular movement caused by cervical, shoulder, and postural abnormalities.

Objective: The aim of this study was to determine the frequency of SD in patients with ankylosing spondylitis (AS).

Design and setting: A cross-sectional study was conducted at Ondokuz Mayıs University, Samsun, Turkey.

Methods: One hundred patients with AS but without shoulder involvement (74 males and 26 females) and 50 healthy controls (35 males and 15 females) were included in the study. The patients were divided into two groups: patients with and without SD. SD was assessed using the Scapular Dyskinesis Test and Lateral Scapular Slide Test. Disease activity, spinal mobility, and chest expansion were also measured. The severity of enthesitis was evaluated using the Spondyloarthritis Research Consortium of Canada index.

Results: There were significant differences between the two groups of patients with AS, those with SD, and those without SD in terms of age, chest expansion, and the Bath Ankylosing Spondylitis Metrology Index (BASMI) scores (P < 0.05). The groups differed significantly in terms of hip, thoracic, and lumbar involvement (P < 0.05). The BASMI score was a significant variable affecting SD (P < 0.05). No cases of SD were observed in the control group.

Conclusion: While there were no significant differences in disease activity and enthesitis scores between patients with and without SD, differences were detected in mobility parameters. Since shoulder examinations of the patients were normal, it can be inferred that SD occurred because of the involvement of the scapulothoracic joints and thoracic spine.

Background: Healthcare-associated infections (HAIs) have a significant impact on patient care worldwide and have serious implications for the Brazilian healthcare system.

Objectives: This study aimed to describe the trends in HAIs in adult intensive care units (ICUs) using data from a national point-prevalence survey.

Design and setting: A point-prevalence study was conducted in 2019 across adult intensive ICUs in large acute care hospitals in Brazil.

Methods: A matched case-control study was performed to assess the risk factors associated with the development of infection.

Results: A total of 386 patients from 15 hospitals were studied, of whom 102 (26.4%; 102/386) were infected, and 76.5% had at least one ICU-acquired infection. In clinical-surgical ICUs (CSU), the prevalence of infections acquired in the unit was 77.9%, whereas in Coronary ICUs (COU), it was 68.7%. There was a predominance of pneumonia (51.0%), mainly caused by Gram-negative non-fermenters, and bloodstream infections (34.4%), predominantly caused by coagulase-negative Staphylococcus (CoNS). In the risk factor analysis, cancer and general antimicrobial use were independently associated.

Conclusion: This study found a high burden of HAIs in adult ICUs in Brazil, mainly associated with the high use of antibiotics for infections and a worse prognosis.

Background: Exposure to multiple risk factors related to metabolic changes can negatively affect the health status of older individuals.

Objective: To investigate the clustering of factors related to metabolic changes in older individuals.

Design and setting: This was a cross-sectional study involving 287 older individuals (≥ 60 years old) enrolled in the Family Health Strategy in the municipality of Ibicuí, state of Bahia.

Methods: Factors associated with metabolic changes were abdominal obesity, self-reported diabetes, high blood pressure, sedentary behavior, and physical inactivity. Clustering was defined by an observed-to-expected prevalence (O/E) ratio greater than 1.20. The association between these factors was analyzed using multiple logistic regression.

Results: A total of seven clusters were identified with a predominance of diabetes, hypertension, sedentary behavior, and abdominal obesity (O/E = 2.28). Older adults were more likely to present with physical inactivity, diabetes, blood pressure, and sedentary behavior simultaneously (Odds Ratio [OR] = 7.78; 95% confidence interval [CI] = 1.25-48.42). Negative health perception was associated with the combination of high blood pressure, sedentary behavior, and abdominal obesity (OR = 0.23; 95%CI = 0.25-0.92); female sex with the cluster of physical inactivity and abdominal obesity (OR = 0.12; 95%CI = 0.04-0.35); and the occurrence of physical inactivity without the presence of other factors (OR = 3.87; 95%CI = 1.66-8.99).

Conclusions: The combination of risk factors related to metabolic changes represents a greater probability of health problems than individual factors. Therefore, investigating the association between these factors will help in planning targeted interventions.

Background: Ankylosing spondylitis (AS) is a sustained inflammatory pathology that manifests as increasing rigidity and a continuous decline in spinal flexibility, leading to increasing lumbar pain during rest.

Objectives: This study primarily aimed to evaluate depression assessments using the Beck Depression Inventory (BDI) and delineate depressive symptomatology in patients diagnosed with AS compared to those without this condition.

Design and setting: A comparative study was conducted in Medical Centers in Málaga, Spain.

Methods: A cohort of 102 participants, with a mean age of 46,80 ± 10,54 years, was divided into two sets: 51 individuals diagnosed with AS (cases) and another 51 without AS (controls), each harmonized across variables such as body mass index, age, and sex. Demographic variables were systematically gathered from each participant, and the BDI responses were accurately recorded and subsequently analyzed for comparison.

Results: Of the total sample, the sex distribution was 29.4% male and 70.6% female. BDI scores were higher for the AS group (19.25 ± 15.5) than for the control group (5.33 ± 7). Notably, there were clear statistical differences (P < 0.01) in the BDI categories, with elevated levels observed in participants with AS.

Conclusion: Individuals with AS experienced higher levels of depression than those without AS. Furthermore, there were sex differences within the case group, with a higher percentage of women than men at any level of depression. Notably, there was a moderate inverse correlation between the number of years since diagnosis and depression level.