Revista da Associacao Medica Brasileira (1992)最新文献

Objective: The aim of this study was to evaluate the correlation between changes in the inferior vena cava collapsibility index and subclavian vein collapsibility index in patients undergoing passive leg raising tests in the intensive care unit, considering that respiratory changes affecting the inferior vena cava may similarly affect the subclavian vein.

Methods: This single-center observational study was conducted on patients aged between 18 and 85 years who underwent passive leg raising in the intensive care unit. When the patient was 45° above the bed, the inferior vena cava and subclavian vein were displayed using ultrasonography; subclavian vein collapsibility index and inferior vena cava collapsibility index values were calculated. After the initial values were recorded, passive leg raising was performed, and the initial measurements were repeated. The CI values measured after passive leg raising were subtracted from those calculated before passive leg raising to determine the changes (Δ) in inferior vena cava and subclavian vein collapsibility indices.

Results: The study was conducted with a total of 64 patients. The mean±standard deviation values for ΔIVC-CI% and ΔSCV-CI% variables were found as 8.97±8.89 and 10.31±10.81, respectively. There were no statistically significant differences in values of ΔIVC-CI% and ΔSCV-CI% (p=0.297). In the Bland-Altman plot, because there were only two values exceeding the +1.96 SD and -1.96 SD limits, it can be said that the agreement between ΔIVC-CI% and ΔSCV-CI% was adequate.

Conclusion: ΔSCV-CI% values are compatible and correlated with ΔIVC-CI% values. Inferior vena cava and subclavian vein responded similarly to fluid changes during passive leg raising.

Objective: This study evaluates the efficacy of magnetic resonance imaging-based radiomics in predicting treatment responses in hepatocellular carcinoma patients undergoing transarterial radioembolization.

Methods: Pre-treatment magnetic resonance imaging scans from 65 hepatocellular carcinoma patients were analyzed. Radiomic features were extracted from axial T1-weighted and T2-weighted sequences using a standardized workflow involving image preprocessing, segmentation, and feature extraction. Multivariate logistic regression models combining radiomic and clinical features were developed to predict treatment outcomes. The performance of the models was evaluated using the area under the curve metric.

Results: The study included 65 patients with a median age of 64 years; 44.6% showed a complete response, while 55.4% showed a non-complete response. The median radiomics score in the T1-weighted portal phase was -0.49 for non-complete responders and -0.07 for complete responders (p<0.001). In the T2-weighted sequence, the median radiomics score was -0.76 for non-complete responders and 1.1 for complete responders (p<0.001). Tumor size ≥5 cm was a significant predictor of non-complete response in univariate analysis (p=0.027) but not in multivariate analysis after adding radiomics scores. The area under the curve for the radiomics signature in predicting non-complete response was 0.754 for T1-weighted and 0.850 for T2-weighted sequences.

Conclusion: Magnetic resonance imaging-based radiomics enhances the prediction of treatment responses in hepatocellular carcinoma patients undergoing transarterial radioembolization. Integrating radiomic features with clinical parameters significantly improves predictive accuracy.

Background: Inflammatory bowel diseases such as Crohn's disease and ulcerative colitis are influenced by environmental and immunological factors and may differ according to the patient's sex.

Objective: The objective was to study the differences in the clinical profile of a Brazilian sample of inflammatory bowel disease patients according to sex.

Methods: Retrospective study with chart review of 158 inflammatory bowel disease patients (43 with Crohn's disease and 115 with ulcerative colitis) from a single university hospital in southern Brazil.

Results: The Crohn's disease sample showed a female/male ratio of 2.1, and the sample of ulcerative colitis showed a ratio of 1.5. The only significant difference found in the clinical profile was an increased constipation rate in female patients with ulcerative colitis. No other differences in epidemiological, symptom profile, or treatment could be detected.

Conclusions: More females with inflammatory bowel diseases sought healthcare facilities compared to males. The only notable difference was a higher incidence of constipation symptoms among females; all other aspects were similar between the sexes.

Objective: This study was conducted as a randomized controlled trial to investigate the effect of breathing exercises on fatigue in patients diagnosed with tuberculosis.

Methods: The tuberculosis patients included in the study were divided into two groups: intervention (26) and control (28) by a program established after the power analysis. After the researcher informed the patients in the intervention group about breathing exercises, including diaphragmatic and pursed lip breathing, they were taught, and the first exercise was practiced. Then, the patients in this group did breathing exercises once a day in the morning, 3 days a week, for a total of 4 weeks, with the researcher using the online interview method. The data were collected using a questionnaire and the Piper Fatigue Scale. The total score of the Piper Fatigue Scale ranges from 0 to 10, and the higher the score, the higher the fatigue level. The Piper Fatigue Scale was repeated at the end of the fourth week in both groups.

Results: Patients in the intervention group (88.5%) and control group (85.7%) reported that they were tired after the diagnosis of tuberculosis. The Piper Fatigue Scale total mean score of the intervention group was 8.29±1.19 before the intervention and dropped to 6.83±1.02 at the fourth week (p<0.05), whereas the Piper Fatigue Scale total mean score of the control group was 7.88±1.09 before the intervention and 7.93±1.02 at the fourth week (p>0.05).

Conclusion: Breathing exercises done by tuberculosis patients were found to lower their levels of fatigue. Accordingly, it is recommended to benefit from breathing exercises, which are effective, inexpensive, and easy to apply in the management of fatigue.

Clinical trial registration number: The study was registered with clinicaltrial.gov NCT05202431.

Objective: BACKGROUND: There are limited data on the use of Mulligan's mobilization with movement technique in patients who underwent surgery for distal radius fracture. AIMS: This study aimed to evaluate the effectiveness of adding Mulligan's mobilization with movement to the conventional exercise program for those who underwent open reduction and volar plate application due to distal radius fracture.

Methods: This randomized controlled, single-blind study was conducted with 53 patients who had been operated on for distal radius fracture. The patients were divided into two groups, the mobilization with movement group and the control group. Patients in the mobilization with movement group were mobilized using Mulligan's mobilization with movement technique in addition to the rehabilitation program used in the control group. The degree of volar inclination and radial inclination were recorded. Radial height was measured in millimeters. Ulnar variance was recorded. Perimeter was measured using the Figure of Eight method. The range of motion of the joint was measured by goniometry. Hand grip strength was measured with Jamar® hand dynamometer, and pinch grip was measured with a pinch meter. The Patient-Rated Wrist Evaluation questionnaire was used to assess functionality.

Results: There is no statistically significant difference identified between the groups (p>0.05). The intra-group changes in the data of the groups were found to be statistically significant in visual analog scale, range of motion, pinch grip, hand grip, and Patient-Rated Wrist Evaluation parameters (p<0.05). There was a statistically significant difference between the mobilization with movement group and the control group for pronation value and hand grip strength value in measurements (p<0.05).

Conclusions: XThe mobilization with movement had no additive effect on parameters other than hand grip strength and pronation.

Objective: The aim of the study was to provide a golden opportunity to access sexual function in women who act as leaders in companies through the use of an instrument validated for this purpose (the Female Sexual Function Index). The number of women in leadership positions has been gradually increasing, which shows the need for women to prepare themselves to reorganize the different aspects of life, including social, family, and personal factors as well as sexuality.

Methods: This is a cross-sectional study involving female executives employed in private companies who answered the Female Sexual Function Index. A convenience sample was made up of 50 women in leadership positions who had been employed for at least 1 year and were aged between 35 and 50 years in childbearing age.

Results: The mean total Female Sexual Function Index score of the evaluated sample was 22.6+7.6, characterizing sexual dysfunction, and the domain that was less negatively impacted was pain. It was also observed that all Female Sexual Function Index domains were worse in women between 41 and 50 years old (p<0.05), except desire.

Conclusion: The total Female Sexual Function Index score of female company leaders was below the cutoff point for adequate sexual function. According to the results of this study and the applied methodology, professional success may not be associated with the quality of sexual life.

Objective: In addition to oxygen support, bronchodilator therapy constitutes the most essential treatment step in patients with chronic obstructive pulmonary disease. Our study aimed to compare the effectiveness of nebulizer treatments in patients who presented to the emergency department with acute exacerbation of chronic obstructive pulmonary disease.

Methods: Our study included 60 Group E chronic obstructive pulmonary disease patients admitted to the emergency department due to acute exacerbation of chronic obstructive pulmonary disease between June and September 2023 (NCT: 06178068). Patients were randomized as follows: Group 1: jet nebulizer treatment; Group 2: dry air nebulizer treatment; and Group 3: classic nebulizer treatment.

Results: While an increase in forced vital capacity (FVC) and forced expiratory volume 1 (FEV1) levels was observed in Group 1 patients (in the order of p=0.009 and 0.007), a decrease in residual volume (RV) and total lung capacity (TLC) levels was observed (p=0.02 and 0.05, respectively). At the same time, an increase in FEV1 levels was observed in Group 2 and 3 patients (p=0.04 and 0.04, respectively). A decrease was observed in RV and TLC levels (p=0.02, 0.05, 0.02, and 0.04, respectively). When comparing the respiratory function test parameters at the beginning and on the fifth day of treatment, FEV1 and peak expiratory flow 25/75 (PEF25/75) levels were higher in Group 1 patients than in Group 2 and 3 patients (p=0.01 and 0.02, respectively).

Conclusion: In chronic obstructive pulmonary disease patients, jet nebulizer treatment is more effective regarding bronchodilator activity than other nebulizer treatments. However, dry air nebulizer treatment may be preferred in chronic obstructive pulmonary disease patients because it is easily applicable and sterilizable.