Revista da Associacao Medica Brasileira (1992)最新文献

Objective: Thiols play an essential role in eliminating oxidative stress in cells. We aimed to evaluate the oxidative stress occurring during labor with thiol-disulfide balance.

Methods: A total of 97 healthy pregnant women in the 37th-41st gestational weeks who underwent delivery between June 2021 and August 2022 were included in the study. Elective cesarean section group 1 (n=33), vaginal deliveries group 2 (n=29), and cesarean section due to cephalopelvic disproportion group 3 (n=35) were determined. Blood samples were taken before delivery, and from the umbilical artery just after the fetus and placenta were delivered. Serum native thiol (μmol/L), total thiol (μmol/L), and disulfide (μmol/L) were measured. Disulfide/native thiol (%), disulfide/total thiol (%), and native thiol/total thiol (%) ratios were calculated.

Results: No significant difference was observed in thiol values in maternal blood (p>0.05). There was a significant difference between the groups in terms of native/total thiol (p=0.017), disulfide/total thiol (%) (p=0.018), and disulfide/native thiol (%) (p=0.018) in cord blood.

Conclusion: In the literature, evidence concerning the impact of the mode of delivery on the level of neonatal and maternal oxidative stress is inconsistent. It is not clear whether parturition accompanied by pain, as in spontaneous vaginal delivery, poses more oxidative stress than a planned operative delivery. Prospective studies in larger cohorts are needed to better understand the impact of oxidative stress on pregnant women and neonates.

Objective: Pelvic organ prolapse affects women's quality of life through symptoms such as vaginal laxity, urinary incontinence, defecation and sexual dysfunction, and pelvic pain. Given the challenges in managing recurrent cases, understanding risk factors and the effect of surgical choices on recurrence is vital for guiding clinical decisions. This study explores how uterine preservation influences postoperative recurrence and develops predictive models to aid in assessing recurrence risk.

Methods: A total of 87 patients diagnosed with pelvic organ prolapse who underwent laparoscopic sacral fixation were included. Patients were classified into two groups based on the occurrence of pelvic organ prolapse recurrence within 3 years post-surgery (recurrence: n=22; no recurrence: n=65). Follow-up over 3 years was recorded. Factors including age, body mass index, birth order, occupation, and uterus preservation during surgery were evaluated. The relationship between pelvic floor muscle strength and pelvic organ prolapse recurrence was also examined. Logistic regression analysis assessed the correlation between pelvic organ prolapse recurrence and levels of serum elastase inhibitor and osteopontin.

Results: In a follow-up of 87 patients with pelvic organ prolapse, 22 experienced recurrences within 3 years, marking a 25.29% recurrence rate. Multivariate analysis identified older age, higher parity, and sustained contraction of type II muscle fibers as independent risk factors for recurrence (all p<0.05). Lower systolic blood pressure in type I and II muscle fibers was associated with decreased serum elastase inhibitor and osteopontin levels, increasing pelvic organ prolapse recurrence risk. Logistic regression identified age, multiple deliveries, and low systolic pressure in type II muscle fibers as independent recurrence factors. The constructed nomogram risk prediction model, incorporating these factors, showed good discrimination ability with an area under the receiver operating characteristic curve of 0.891 (95%CI 0.871, 0.921), indicating accurate predictions and high net benefit.

Conclusion: Factors such as age, birth order, uterine preservation, and pelvic floor muscle strength impact postoperative pelvic organ prolapse recurrence. Older age, a higher number of deliveries, and reduced systolic pressure of class II muscle fibers are independent risk factors for pelvic organ prolapse recurrence after surgery.

Introduction: The term second victim arises when a healthcare professional experiences an adverse event that has an emotional impact and/or physical suffering for the healthcare professional. The experiences of the second victim can be measured using the Second Victim Experience and Support Tool, originally developed in English, translated and validated internationally in several languages. A revised version of the tool (Second Victim Experience and Support Tool-Revised) has been published since 2020.

Objective: The objective of this study was to translate and gather evidence of the validity of the Second Victim Experience and Support Tool-Revised Version into Brazilian Portuguese.

Methods: This is a methodological study that involved the necessary procedures for the translation and cross-cultural adaptation of the instrument, carefully following the stages of translation, back-translation, pre-testing, evaluation by a panel of experts, and a test on a large population for validity and reliability.

Results: A total of 146 health professionals took part in the study, with a greater predominance of doctors (38.4%) and physiotherapists (30.8%). Seven items were excluded, all with factor loadings of less than 0.50. The "institutional support" dimension had to be excluded due to its low factor loadings. The fit indices of the re-specified model were χ2/df=1.60, CFI=0.90, TLI=0.88, and RMSEA=0.07 (CI 0.06-0.08).

Conclusion: The adapted version of the instrument showed satisfactory psychometric properties when composed of 28 items distributed in eight dimensions, making it a valid and reliable instrument for assessing second victim experiences in different professions, suitable for dissemination in Brazil.

Introduction: Chronic kidney disease has presented frequencies that exceed the installed capacity of dialysis services, and data on prevalence are uncertain worldwide.

Objective: The objective of this study was to analyze the epidemiological profile of patients assisted in renal replacement therapy and details on the assistance provided.

Methods: Population-based cross-sectional study with information obtained from the Unified Health System database. The research location was the state of Paraíba, and the observation period was from January 1, 2009, to December 31, 2013, n = 64,676 documents, and the variables observed were: gender; age group, race, or color; place of residence; place where the therapy was performed; vascular access; modality if hemodialysisor peritoneal dialysis; registration on the kidney transplantation list; infection by hepatitis B, C, and HIV viruses; and costs.

Results: A higher prevalence of request for highly complex procedure was observed in males (56.8%) and white (39%). The cities with the highest prevalence of dialysis patients were João Pessoa, Campina Grande, Santa Rita, Sousa, Bayeux, and Patos. Most of the sample referred to patients undergoing hemodialysis as a renal replacement therapy modality, with 42.2% not having definitive arteriovenous fistula access. The renal replacement therapy expenses observed were increasing, and in 2009, they accounted for 2.89% of health spending, reaching 3.32% of state health spending in 2013.

Conclusion: Using secondary data from DATASUS to understand the population with chronic kidney disease and the assistance offered is possible.

Objective: The objective of this study was to evaluate the descriptive outcomes of 38 prenatally suspected clubfoot cases.

Methods: This is a retrospective cohort study conducted in Ankara Bilkent City Hospital's perinatology clinic. All consecutive cases with the diagnosis of fetal clubfoot between 2020 and 2023 were included. Multiple pregnancies and skeletal dysplasias were excluded from the study. Demographic features, prenatal ultrasound findings, prenatal screening test results, invasive diagnostic test results, clinical approaches, short-term and long-term postnatal outcomes, and treatment types of clubfoot were reported.

Results: There were a total of 38 prenatally diagnosed clubfoot cases noted during the study period. The mean gestational age at diagnosis was 15.3±1.4 weeks. Prenatal ultrasound screening noted bilateral clubfoot in 16 (42.1%) cases and unilateral clubfoot in 22 (57.8%) cases. Clubfoot was isolated in 7 (18.4%) cases, and additional anomalies were present in 31 (81.6%) cases. The gender of the fetuses was 26 (68.4%) males and 12 (31.6%) females. The prenatal noninvasive screening test was high risk in 7 (18.4%) patients and low risk in 16 (42.1%) patients. As a result of amniocentesis performed in 16 (42.1%) patients, abnormal karyotypes were detected in 2 patients (trisomy 18, 22q11.2 del). Six pregnancies were terminated before 24 weeks, and 27 pregnancies resulted in live birth at an average of 37.8±2.5 weeks. The diagnosis was correct in 84.2% of the cases, and 84.6% of the pregnancies resulted in live births.

Conclusion: The outcomes of congenital clubfoot are generally favorable, especially in isolated cases.