Revista da Associacao Medica Brasileira (1992)最新文献

Objective: The aim of this study was to investigate the long-term effects of tenofovir alafenamide, tenofovir disoproxil fumarate, and entecavir on fibrotic burden and to compare the virological clearance and biochemical improvement times achieved with these drugs.

Methods: The study was designed with treatment-naive, hepatitis B e-antigen-negative chronic hepatitis B patients who started tenofovir alafenamide, tenofovir disoproxil fumarate, or entecavir at a tertiary care hospital. The aspartate aminotransferase-to-platelet ratio index and the fibrosis index based on four factors were used to determine the fibrotic burden.

Results: Age, gender, baseline aspartate aminotransferase-to-platelet ratio index and fibrosis index based on four factors values, and fibrosis grades obtained by the biopsy of patients treated with tenofovir alafenamide (n=45), tenofovir disoproxil fumarate (n=65), and entecavir (n=56) were similar (p>0.05 for all). Significant fibrosis regression was observed during the 5-year antiviral therapy period in the tenofovir alafenamide, tenofovir disoproxil fumarate, and entecavir groups.

Conclusion: Significant regression in aspartate aminotransferase-to-platelet ratio index and fibrosis index based on four factors was observed during tenofovir alafenamide, tenofovir disoproxil fumarate, and entecavir therapy within the first 2 years, and this regression remained stable up to the 5th year. None of the three drugs showed superiority over each other in terms of the pattern of fibrosis regression reflected by aspartate aminotransferase-to-platelet ratio index and fibrosis index based on four factors, average virological response time, and biochemical improvement time.

Objective: The coronavirus disease pandemic has significantly impacted maternal and neonatal health outcomes.

Methods: This retrospective study compared the health outcomes of 1,556 pregnant women and their newborns who gave birth before and during the pandemic at a tertiary university hospital. Demographic and clinical data were collected from hospital medical records. The primary outcome was the association between coronavirus disease and neonatal intensive care unit admission rates, while the secondary outcomes included birth weight, gestational age at delivery, 5th-min APGAR scores, and maternal complications.

Results: During the pandemic, screening test rates (58.9 vs. 33.2%, p<0.001), gestational diabetes mellitus prevalence (9.8 vs. 4.2%, p<0.001), and neonatal intensive care unit admission rates (8 vs. 4.4%, p=0.003) were significantly higher than those in the pre-pandemic period. Preterm birth rates were lower during the pandemic (12.5 vs. 25.1%, p<0.001). Logistic regression analysis revealed that infants born during the pandemic had a significantly higher likelihood of neonatal intensive care unit admission (OR 1.910, 95%CI 1.237-2.949, p=0.004).

Conclusion: These findings highlight the need for health systems to be prepared and resilient to public health crises, ensuring uninterrupted health services for pregnant women and newborns.

Objective: Primary hyperparathyroidism is considered the third most common endocrine disorder. Moreover, persistently elevated levels of parathyroid hormone occur in up to 30% of patients undergoing parathyroidectomy. The aim of this study was to determine the prevalence of persistently elevated parathyroid hormone levels after parathyroidectomy and analyze its associated factors.

Methods: An anonymized medical record query was conducted, filtering patients who underwent parathyroidectomy at a tertiary hospital center in Southern Brazil from 2010 to 2019. Clinical, laboratory, and sociodemographic data were collected. The analyzed period ranged from 3 months prior to surgery and up to 18 months after surgery.

Results: A total of 261 patients with an average age of 56 (45-65) years and a body mass index of 25.53 (22.19-28.86) kg/m2 were included. Patients with normal parathyroid hormone levels after 18 months of surgery were compared to those with high parathyroid hormone levels in the same period. The latter had lower levels of median parathyroid hormone, minimum achieved parathyroid hormone, and higher values of vitamin D. The two groups showed no difference in terms of age, body mass index, parathyroid hormone before parathyroidectomy, calcium before and after parathyroidectomy, and glomerular filtration rate. The multivariate linear regression model showed a negative association between body mass index, glomerular filtration rate, and total calcium after parathyroidectomy with parathyroid hormone variation. Patients with reduced glomerular filtration rate had higher levels of parathyroid hormone before parathyroidectomy, with no significant difference after the procedure between glomerular filtration rate groups.

Conclusion: Persistently elevated levels of parathyroid hormone occurred in more than half of the patients subjected to parathyroidectomy. The observed variation in parathyroid hormone was significantly higher in patients with reduced glomerular filtration rate.

Objective: To identify risk factors for hyperglycemia and evaluate the impact on outcomes among pediatric patients with acute lymphoblastic leukemia undergoing chemotherapy.

Methods: We conducted a retrospective cohort study involving 188 pediatric patients treated for acute lymphoblastic leukemia at a Brazilian cancer referral center between 2004 and 2017. Hyperglycemia was assessed during the induction and consolidation phases of chemotherapy. Associations with patient and disease characteristics were examined through multivariate analysis. Outcomes analyzed included severe infections, relapse, and mortality.

Results: Hyperglycemia occurred in 43.6% of patients, predominantly during the induction phase. Pubertal status at diagnosis, younger age, and high relapse risk classification were independently associated with increased hyperglycemia risk. Puberty conferred a nearly 8-fold increased risk. However, hyperglycemia was not associated with increased risk of infections, relapse, or mortality. Higher mortality was observed among patients with overweight/obesity and those with pancreatitis or recurrent infections.

Conclusion: Hyperglycemia was a frequent early adverse event in pediatric acute lymphoblastic leukemia treatment, particularly among pubertal patients and those at high relapse risk. Despite its high incidence, hyperglycemia was not associated with worse clinical outcomes in this cohort. These findings underscore the importance of early identification and monitoring, particularly during high-risk treatment phases.

Objective: The relationship between sleep quality in pregnancy, which is associated with adverse pregnancy outcomes, and healthy life behaviors is unclear. The aim of the study was to investigate the relationship between healthy life behaviors and sleep quality during pregnancy.

Methods: This study was conducted as a descriptive and correlational study. This study included 282 pregnant women. The study "Healthy Lifestyle Behaviors in Pregnancy Scale" was used to determine women's healthy lifestyle behaviors and "Pittsburgh Sleep Quality Index" was used to evaluate sleep problems. In this study, PATH analysis was used to test the model (p<0.050).

Results: The mean age of the participants was 27.43±5.54 years, and the mean gestational age was 24.32±10.4 weeks. Healthy Lifestyle Behaviors in Pregnancy Scale total mean score was 109.62±16.46, and Pittsburgh Sleep Quality Index total mean score was 6.90±3.37. According to the results of path analysis, there was no statistically significant relationship between Pittsburgh Sleep Quality Index and Healthy Lifestyle Behaviors in Pregnancy Scale total and sub-dimension scores (p>0.050).

Conclusion: The results of this study suggest that there is no association between healthy lifestyle behaviors and sleep quality during pregnancy, but poor sleep quality is common during pregnancy. Therefore, studies investigating the longitudinal associations of sleep with objectively measured lifestyle behaviors during pregnancy are recommended.

Objective: The receptors and cell membrane channels found in breast cancer in high numbers have been promising for drugs in the past and in the future. In addition, analyses of proliferation indices play an essential role in predicting the success of these treatments.

Methods: Gamma-aminobutyric acid type A receptor subunit π and minichromosome maintenance-3 expressions were studied by immunohistochemical staining from tissue samples obtained by trucut biopsy from epidermal growth factor receptor 2-negative breast cancer patients who received neoadjuvant chemotherapy.

Results: The study included 101 patients. Almost 96.0% of the breast tumor tissues expressed gamma-aminobutyric acid type A receptor subunit π. The median value for gamma-aminobutyric acid type A receptor subunit π was calculated as 30% (19 patients) and the median for minichromosome maintenance-3 as 80% (13 patients). When neoadjuvant chemotherapy response was evaluated, pathological complete response was achieved in 23.8% of patients (n=24). Pathological complete response was achieved in 16.4% of patients for hormone receptor positivity and in 38.2% of patients for triple-negative breast cancer. When the factors predicting pathological complete response were evaluated with univariate analysis, age (p=0.044), molecular subtype (p=0.017), menopausal status (p=0.032), Ki-67 increase (p<0.001), estrogen receptor decrease (p<0.006), progesterone receptor decrease (p<0.002), and grade (p<0.001) predicted treatment response. There was no relationship between gamma-aminobutyric acid type A receptor subunit π (p=0.945) and minichromosome maintenance-3 (p=0.985) and treatment response.

Conclusion: Our study found that gamma-aminobutyric acid type A receptor subunit π is highly expressed in breast cancer cells but absent in normal breast tissue, making it a potential therapeutic target. Additionally, we determined that minichromosome maintenance-3 is not a reliable proliferation index or predictor of treatment response.