Revista da Associacao Medica Brasileira (1992)最新文献

Objective: The aim of the study was to evaluate the cardiotoxic effects of pantoprazole in Wistar rats submitted to cardiac ischemia and reperfusion.

Methods: Cardiac ischemia and reperfusion was induced in rats through tourniquet of the left anterior descending coronary artery (10 min) followed by reperfusion (75 min). The incidences of ventricular arrhythmias, atrioventricular block, and lethality were evaluated by electrocardiogram analysis and compared between the control group (saline solution+cardiac ischemia and reperfusion) and the animals treated with pantoprazole 36 mg/kg (pantoprazole+cardiac ischemia and reperfusion), intravenously, immediately before cardiac ischemia (pantoprazole+cardiac ischemia and reperfusion) or before cardiac reperfusion (pantoprazole+cardiac reperfusion).

Results: There were no differences between the incidences of ventricular arrhythmias in the groups studied. Treatment with pantoprazole before cardiac ischemia and reperfusion increased the incidence of atrioventricular block and lethality and myocardial injuries compared to the saline solution+cardiac ischemia and reperfusion group, but treatment of animals with pantoprazole before cardiac reperfusion decreased these parameters and serum creatine kinase-MB levels.

Conclusion: Our results indicate that when pantoprazole is administered before cardiac ischemia and reperfusion, it promotes cardiotoxicity; however, when administered before cardiac reperfusion, it promotes cardioprotection in Wistar rats.

Objective: The aim of the study was to evaluate the effects of epidural and spinal anesthesia techniques on neonatal cerebral oxygenation during cesarean surgery using near-infrared spectroscopy.

Methods: Pregnant women aged 18-35 years, classified as American Society of Anesthesiologists (ASA) II, scheduled for elective cesarean surgery at >37 weeks of gestation, and their newborns were included. Two groups, one to receive spinal anesthesia (Group S) and the other epidural anesthesia (Group E), were determined. Appearance Pulse Grimace Acitivity Respiration (APGAR) scores, heart rates, and SpO2 values of the newborns were recorded, and umbilical venous blood gas was collected. Near-infrared spectroscopy and rSO2 (regional cerebral oxygen saturation) change percentage were measured.

Results: A total of 80 patients were statistically analyzed, with 40 patients in Group S and 40 patients in Group E. Neonatal SpO2 values at 2.5 min were found to be significantly lower in Group S, while in blood gas parameters, PaO2 values were significantly lower in Group S. Near-infrared spectroscopy values at 2.5 and 5 min were significantly lower in Group S, and rSO2 change percentages were significantly lower at 2.5 min in Group S. Maternal hypotension was observed to be significantly higher in Group S (52.5%) than in Group E (22.5%). The amount of ephedrine administered until delivery was higher in Group S, but this difference was not statistically significant between the two groups.

Conclusion: We found significantly lower near-infrared spectroscopy values at 2.5 and 5 min and rSO2 change percentage at 2.5 min in the spinal group. We believe that epidural anesthesia has minimally more positive effects on early neonatal cerebral oxygenation compared to spinal anesthesia.

Objective: The aim of this study was to investigate polymorphisms in the proprotein convertase subtilisin/kexin type 9 gene and compare disease severity in familial hypercholesterolemia participants with and without these polymorphisms.

Methods: Fifty patients were included in this observational, cross-sectional study of primary data collection between June 2014 and June 2015 at Clinics Hospital of Ribeirão Preto Medical School/University of São Paulo Inclusion criteria for the study included individuals with an low-density lipoprotein cholesterol level ≥190 mg/dL, based on Dutch make early diagnosis prevent early death criteria for familial hypercholesterolemia. Patients with kidney disease, liver failure, a triglyceride level ≥300 mg/dL, or hypothyroidism were excluded. Gene analysis was performed using the high-resolution melting method. deoxyribonucleic acid samples with detected changes were sequenced to identify polymorphisms. Lipid profile, body mass index, history of cardiovascular events, gender, and statin use were compared between participants with and without polymorphisms.

Results: Of the 50 patients, 14 carried proprotein convertase subtilisin/kexin type 9 polymorphisms. Familial hypercholesterolemia was not associated with these polymorphisms in this cohort. As gene expression was not assessed, no conclusions can be drawn regarding functional effects. Six patients (four in the polymorphism group and two in the non-polymorphism group) reported cardiovascular events. The significantly higher occurrence of these events in the polymorphism group suggests a possible association between the presence of proprotein convertase subtilisin/kexin type 9 polymorphisms and an increased cardiovascular risk.

Conclusion: Benign variants were identified in the proprotein convertase subtilisin/kexin type 9 gene, with no pathogenic alterations detected. Despite the significantly higher number of participants with a history of cardiovascular events in the polymorphism group, these data do not support a direct, causal association between these polymorphisms and an increased cardiovascular risk.

Objective: The aim of this study was to determine the association of unilateral multicystic dysplastic kidney in fetuses with genetic disorders, syndromic conditions, accompanying anatomical anomalies, and postnatal prognosis.

Methods: Cases diagnosed with multicystic dysplastic kidney and followed at the Perinatology Clinic of Samsun Ondokuz Mayıs University between January 2012 and June 2024 were retrospectively reviewed. Demographic, ultrasonographic, genetic, and postnatal outcomes were analyzed.

Results: Thirty-eight fetuses with multicystic dysplastic kidney were identified during intrauterine life. The diagnosis was made via antenatal ultrasonography in 97.2% of cases. Laterality was on the left side in 55.3% and on the right side in 44.7% of multicystic dysplastic kidney cases. The cohort consisted of 42.1% females and 57.9% males. Major extrarenal anomalies were present in 21.1% of fetuses with unilateral multicystic dysplastic kidney. Amniocentesis for karyotyping was performed in 23.7% of cases, all of which yielded normal karyotypes. Contralateral kidney anomalies were detected in 13.2% of cases, and ureterocele was observed in 15.8%. The most common postnatal anomalies were ureteropelvic junction obstruction and grade four-five vesicoureteral reflux. During a mean follow-up period of 7 years, no cases of hypertension or Wilms tumor were identified.

Conclusion: Prenatal diagnosis of multicystic dysplastic kidney is crucial for early detection of potential contralateral kidney anomalies and predicting postnatal outcomes. In cases of isolated multicystic dysplastic kidney, the likelihood of karyotypic abnormalities, malignancies, or hypertension is very low, and the postnatal prognosis is favorable.

Objective: This study was conducted to determine the effect of genital self-image on sexual function and satisfaction in married women.

Methods: The study included 353 married women in Central Anatolia. Data were collected using the Descriptive Information Form, the Female Genital Self-Image Scale, the Female Sexual Function Index-6, and the Golombok-Rust Inventory of Sexual Satisfaction.

Results: The participants' mean total scores were 20.36±4.03 on the Female Genital Self-Image Scale, 19.46±4.98 on the Female Sexual Function Index-6, and 55.84±16.79 on the Golombok-Rust Inventory of Sexual Satisfaction. The regression analysis indicated that Female Sexual Function Index-6, age, marriage duration, and total Golombok-Rust Inventory of Sexual Satisfaction scores collectively predicted Female Genital Self-Image Scale scores, accounting for 13.2% of variance and suggesting a modest yet meaningful effect.

Conclusion: Approaches that enhance genital self-image support women's sexual health, and it is essential for healthcare professionals to provide quality care by taking these factors into consideration.

Objective: The aim of this study was to explore the optimal method of induction of labor in women with gestational diabetes mellitus and its impact on delivery outcomes.

Methods: This retrospective cohort study was conducted among nulliparous women with gestational diabetes mellitus delivering at the First Affiliated Hospital of Fujian Medical University and the First People's Hospital of Yunnan Province from 2018 to 2023. Data were extracted from electronic medical records.

Results: A total of 600 patients who delivered met the inclusion criteria: the double-balloon group (Group B, n=198), the misoprostol vaginal insert group (Group M, n=200), and the Misoprostol combined with artificial membrane stripping group (Group MA, n=202). Group MA showed higher induction of labor success rates (93.5%) compared to Group M (86.0%) and Group B (81.5%, p=0.002). The time to labor onset was shortest in Group MA (32.5±6.5 h), followed by Group M (35.8±2.5 h) and Group B (45.8±4.5 h, p<0.001). Vaginal delivery time was also significantly shorter in Group MA (47.4±4.3 h) compared to Group M (49.1±7.4 h) and Group B (57.1±5.7 h, p<0.001). Chorioamnionitis rates were lower in Group MA (2.5%) and Group M (3.0%) compared to Group B (8.5%, p=0.007). No significant differences were observed between groups for cesarean rates, fetal distress, abnormal labor, or neonatal outcomes (p>0.05).

Conclusion: The combination of misoprostol vaginal insert and artificial membrane stripping effectively enhances cervical ripening and improves vaginal delivery success in gestational diabetes mellitus patients, providing a promising strategy for labor induction.

Objective: The prognosis of metastatic breast cancer has improved with new targeted therapies like cyclin-dependent kinase 4/6 inhibitors. Renin-angiotensin system inhibitors, such as direct renin inhibitors, angiotensin II receptor blockers and angiotensin-converting enzyme inhibitors are frequently used to manage hypertension and heart failure. However, recent research indicates that they may also provide potential benefits in cancer therapy. The combination of renin-angiotensin system inhibitors with cyclin-dependent kinase 4/6 inhibitors is an emerging area of interest in cancer research. Our hypotesis that, by inhibiting angiogenesis, renin-angiotensin system inhibitors may reduce tumor growth and improve the effectiveness of cyclin-dependent kinase 4/6 inhibitors by cutting off the supply of nutrients and oxygen to the tumor.

Methods: Metastatic breast cancer patients treated with cyclin-dependent kinase 4/6 inhibitors were enrolled and retrospectively divided according to angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker use: angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (+) and angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (-). Progression-free survival and overall survival were defined as primary and secondary endpoints. The effect of categorized data on progression-free survival and overall survival was determined by Cox regression analyses.

Results: Estimated median progression-free survival (HR 0.61, 95%CI 0.34-0.94; p = 0.041) and overall survival (HR 0.71, 95%CI 0.49-0.79; p: 0.01) were statistically significantly longer in the angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (+) group than in the angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (-) group.

Conclusion: Concomitant use of renin-angiotensin system inhibitors and cyclin-dependent kinase 4/6 inhibitors may have beneficial oncological effects in patients with breast cancer beyond their cardiovascular indications.

Objective: The aim of the study was to evaluate the quality and readability of ChatGPT responses to frequently asked questions by individuals with posture disorder. Providing reliable and evidence-based information about posture disorders is vital for individuals to be correctly informed.

Methods: The 10 most frequently asked questions about posture disorder were selected by two researchers from a list created by ChatGPT. The questions were transmitted to ChatGPT 4.0, and the initial responses were recorded without further follow-up questions. The quality of the responses was then assessed by five independent experts (three physiotherapists, one physical therapy and rehabilitation specialist, and one orthopedics and traumatology specialist) with a four-grade evaluation system. Readability levels were analyzed with the Flesch-Kincaid Grade Level through WordCalc software. Statistical analysis was performed using Statistical Package for the Social Sciences v29.0, and intraclass correlation coefficients were used to measure inter-rater reliability.

Results: Following a thorough evaluation of the 10 responses received, six were rated as "Excellent responses requiring no explanation," while a further four were designated as "Satisfactory responses requiring minimal explanation." The median quality score of the responses was high, indicating good alignment with current evidence-based practice. The average readability level of the responses was determined to be 8.4. Inter-rater reliability was good, with an intraclass correlation coefficients value of 0.756.

Conclusion: ChatGPT provides relatively coherent and generally readable answers to frequently asked questions about posture disorders, with most needing minimal explanation. While promising as a resource to meet the information needs of people with posture disorders, further improvements are needed to align it with personalized health needs.

Objective: Polycystic ovary syndrome is a common and important disease that affects ovarian functions in women of reproductive age. Disease-genetic variation associations between polymorphisms of the ADIPOQ gene rs1501299 and rs17300539, and polycystic ovary syndrome were studied in several populations previously and obtained divergent results; we have investigated this association in a case-control study for the first time in the studied population.

Methods: Forty-five polycystic ovary syndrome patients and 45 control participants were enrolled. Deoxyribonucleic acid of the participants was extracted from peripheral blood. Genotyping of subjects was made according to the real-time polymerase chain reaction method using custom primers. Allele and genotype frequencies, as well as clinical characteristics, were compared between the polycystic ovary syndrome and control groups using appropriate statistical methods.

Results: The mean testosterone level of the polycystic ovary syndrome group was significantly higher than the control group after multiple testing with Bonferroni correction (p<0.001). The mean progesterone level of the control group was significantly higher than the polycystic ovary syndrome group after multiple testing with Bonferroni correction (p<0.001). There were no significant differences between groups in terms of both allele and genotype frequencies (p>0.05). According to regression analysis, neither polymorphism had any effect on having polycystic ovary syndrome (p>0.05).

Conclusion: For the first time in a sample from the studied ethnicity, we conclude that both rs1501299 and rs17300539 polymorphisms are not associated with polycystic ovary syndrome. Testosterone and progesterone levels were significantly affected by polymorphisms.