Revista da Associacao Medica Brasileira (1992)最新文献

Objective: The aim of this research was to determine the effect of music on nonstress testing and pregnant women's satisfaction.

Methods: The research, which was designed as a randomized controlled experimental study, was conducted between September 2021 and September 2022 at a training and research university hospital in the north of Turkey. The population of the research consisted of pregnant women who were requested to take a nonstress test, and the sample consisted of 111 pregnant women (music group: 56 and control group: 55). The pregnant women in the music group listened to classical music during the nonstress test, while no intervention was applied to those in the control group. Data were collected with a Descriptive Information Form, a Nonstress Test Form, and the Visual Analog Scale to evaluate satisfaction. Mann-Whitney U and chi-square test statistics were used for the statistical analysis of the data.

Results: The mean basal fetal heart rate and count of fetal movements, the presence of acceleration, and the nonstress test results of the pregnant women in the music group were statistically significantly higher than those of the control group (p<0.05). Besides, a statistically significant difference was found between the groups in terms of mean satisfaction scores (p<0.05).

Conclusion: Listening to music during nonstress tests increases pregnant women's reactive nonstress test rates and satisfaction.

Objective: Despite the availability of treatment and vaccines for chronic hepatitis B infection, it remains a public health problem. The use of nucleos(t)ide antiviral agents is effective in preventing complications such as cirrhosis and hepatocellular carcinoma, but despite the reduction, the risk persists. The objective of this study was to assess alterations in aspartate aminotransferase to platelet ratio index and Fibrosis-4 scores and examine the effectiveness of risk estimates for HCC in chronic hepatitis B scores in predicting the risk of hepatocellular carcinoma among chronic hepatitis B patients undergoing prolonged antiviral treatment.

Methods: This is a retrospective 10-year follow-up study that included chronic hepatitis B patients who received antiviral treatment. The alterations in aspartate aminotransferase to platelet ratio index and Fibrosis-4 scores were examined for the first, fifth, and tenth years. In addition, the expected long-term risk of hepatocellular carcinoma, if antiviral treatment was not initiated, was calculated using the risk estimates for HCC in chronic hepatitis B scores before treatment, and the incidence of hepatocellular carcinoma despite long-term antiviral treatment was compared with these values.

Results: The study included a total of 218 chronic hepatitis B patients. A noteworthy decline in aspartate aminotransferase to platelet ratio index and Fibrosis-4 scores was noted across all fibrosis groups, irrespective of the initial degree of fibrosis, during the first year of antiviral treatment. Following the calculation using risk estimates for HCC in chronic hepatitis B scores, one case was observed compared to the expected 15.04 cases of hepatocellular carcinoma.

Conclusion: We showed that both aspartate aminotransferase to platelet ratio index and Fibrosis-4 scores significantly decreased until the fifth year of antiviral treatment, with a prominent decline occurring in the first year. This study demonstrates that the impact of antiviral treatment on fibrosis can be monitored using noninvasive fibrosis scores.

Objective: The study aimed to evaluate the effects of musical-animated toys and audiobooks on the fear and pain in the tracheostomy care of children in the palliative care clinic.

Methods: The study design was a single-center, single-arm, crossover-controlled study. The sample consisted of 16 children who were 3-6 years old. Musical-animated toys and audiobooks were used to divert the children's attention during tracheostomy care. The children whose control data were collected on the first day were shown musical-animated toys on the second day and listened to an audiobook a week later. The children were video-recorded during the interventions.

Results: The children who received musical-animated toy and audiobook interventions during and after tracheostomy care expressed less pain than those in the control group, and their fear levels were less during the care.

Conclusion: Audiobook and musical-animated toy interventions were effective in reducing children's procedure-related fear and pain during tracheostomy care in the pediatric palliative care clinic.

Objective: Tumor necrosis factor alpha inhibitors are frequently used in the treatment of axial spondyloarthritis. While tumor necrosis factor alpha is associated with some malignancies, studies on its effects on thyroid functions and thyroid nodules are limited. This study aimed to assess the effect of tumor necrosis factor alpha inhibitors treatments on the evaluation of thyroid nodules and thyroid function tests in axial spondyloarthritis patients.

Methods: A total of 106 patients with axial spondyloarthritis, 48 receiving nonsteroidal antiinflammatory drugs and 58 receiving tumor necrosis factor alpha inhibitors, were included in the study. All cases were screened by ultrasound for the presence of nodules, European Thyroid Association - Thyroid Imaging Reporting and Data System classification category, thyroid volume, and thyroid function tests.

Results: The prevalence of patients with multiple nodules in the tumor necrosis factor alpha inhibitors treatment group was significantly higher compared to the nonsteroidal antiinflammatory drug group (68.2 vs. 38.1%, p=0.033). Furthermore, the prevalence of nodules measuring ≥1 cm in the tumor necrosis factor alpha inhibitors treatment group was higher compared to the only nonsteroidal antiinflammatory drug treatment group (56 vs. 19.05%, p=0.011). In the tumor necrosis factor alpha inhibitors treatment group, the proportion of patients with nodules requiring fine-needle aspiration cytology was higher compared to the nonsteroidal antiinflammatory drug group (34.5 vs. 16.7%, p=0.038). No significant difference was found between thyroid-stimulating hormone and free thyroxine values before and during treatment in both groups (p>0.005).

Conclusion: The number of nodules requiring fine-needle aspiration cytology according to the European Thyroid Association - Thyroid Imaging Reporting and Data System classification seems higher in nonsteroidal antiinflammatory drugs users than Tumor necrosis factor-alpha inhibitor users. Therefore, it may be rational to examine the thyroid gland while administering Tumor necrosis factor-alpha inhibitor treatment in axial spondyloarthritis patients.

Objective: This study aimed to investigate the association between the atherogenic index of plasma and insulin resistance, while also evaluating atherogenic index of plasma's prognostic value in inflammation by examining its correlation with platelet/lymphocyte ratio and neutrophil/lymphocyte ratio.

Methods: Data collection involved accessing records from January 2022 to December 2022, with analyses including calculation of atherogenic index of plasma and homeostatic model assessment index.

Results: Data from 510 patients (mean age: 48.90±18.71 years; 69.4% female) showed a mean atherogenic index of plasma of 0.40±0.28, with 69% at high risk. Significant positive correlations were found between atherogenic index of plasma and age, lymphocyte, neutrophil, C-reactive protein, glucose, insulin, and homeostatic model assessment-insulin resistance, while the correlation with platelet/lymphocyte ratio was significantly negative.

Conclusion: Atherogenic index of plasma presents as a promising predictor for insulin resistance, demonstrating robust associations with inflammation, thus offering valuable clinical insights and potential for early risk assessment and management strategies.

Objective: This study aimed to evaluate kinesiophobia levels in patients with osteoporosis compared to healthy controls and investigate the associations with pain, depression, anxiety, fear of falling, and quality of life.

Methods: The study involved 60 postmenopausal osteoporosis patients and 60 healthy controls aged 50 years and above. Kinesiophobia was assessed using the Tampa Scale for Kinesiophobia, while quality of life, psychological symptoms, and fear of falling were evaluated using the Quality of Life Questionnaire of the European Foundation for Osteoporosis, Hospital Anxiety and Depression Scale, and Tinetti Falls Efficacy Scale.

Results: Kinesiophobia levels were significantly higher in the osteoporosis group compared to controls (p<0.05). Positive correlations were observed between kinesiophobia and Falls Efficacy Scale (r=0.278, p=0.002), as well as with Quality of Life Questionnaire of the European Foundation for Osteoporosis physical function scores (r=0.185, p=0.043). No significant relationship was found between kinesiophobia and depression or anxiety scores.

Conclusion: Kinesiophobia is notably higher in osteoporosis patients compared to healthy individuals, correlating with an increased fear of falling and reduced physical function. Early identification and management of kinesiophobia are essential to prevent reduced physical activity and associated risks, such as decreased bone mineral density and higher fracture risk.

Objective: Acute appendicitis is the most common cause of acute abdomen. It is important to differentiate between complicated and uncomplicated appendicitis before surgery in the emergency department. Recently, immature granulocytes have become one of the biomarkers used as predictors of inflammation. The aim of this study was to determine whether immature granulocyte levels are a biomarker that can predict whether acute appendicitis is complicated or not in patients admitted to the emergency department.

Methods: Patients aged 18 years and older who presented to the emergency department between May 1, 2023, and April 30, 2024, and were diagnosed with appendicitis were included in the study. Patients with a histopathologic diagnosis of acute appendicitis were divided into two groups: acute simple appendicitis (n=149) and acute complicated appendicitis (n=103). Demographic characteristics, imaging results, and laboratory results were recorded.

Results: White blood cell, neutrophil count and percentage, lymphocyte count and percentage, immature granulocyte count and percentage, direct bilirubin, C-reactive protein, and procalcitonin values were found to be significantly higher in the complicated appendicitis group than in the uncomplicated group (p-values; 0.001, <0.001, <0.001, <0.001, 0.001, <0.001, <0.001, <0.001, <0.001, 0.016, <0.001, and 0.001, respectively). The immature granulocyte percentage was 92% specific for the diagnosis of complicated appendicitis at a cut-off value of 0.6.

Conclusion: The immature granulocyte percentage may be useful as a predictive biomarker in the diagnosis of complicated acute appendicitis with a specificity of 92%. Additionally, the immature granulocyte percentage has a higher discrimination power than the immature granulocyte count, C-reactive protein, and procalcitonin.

Objective: This study aimed to evaluate the prognostic significance of the cardiac electrophysiological balance index in predicting the recurrence of atrial fibrillation following radiofrequency ablation.

Methods: Patients with paroxysmal atrial fibrillation undergoing radiofrequency ablation were enrolled from July 2021 to March 2023 and categorized into recurrence and non-recurrence groups based on postoperative atrial fibrillation recurrence during a 6- to 12-month follow-up. Clinical and electrocardiogram data at admission were collected, and cardiac electrophysiological balance index was calculated. Multivariate logistic regression analysis identified independent factors contributing to atrial fibrillation recurrence. Receiver operating characteristic curves assessed predictive values.

Results: Among 127 subjects, 36 experienced postoperative recurrence (22 paroxysmal atrial fibrillation, 10 atrial flutter, and 4 atrial tachycardia). Significant differences in hypersensitive C-reactive protein levels, QT, QRS, and cardiac electrophysiological balance index were observed between recurrent and non-recurrent groups. Multivariate analysis revealed cardiac electrophysiological balance index as an independent risk factor for recurrence (OR 1.766, 95%CI 1.415-2.204, p<0.001). Receiver operating characteristic curve analysis showed cardiac electrophysiological balance index's predictive value with an area under the curve of 0.865 (95%CI 0.807-0.923, p<0.001), and a cutoff value of 4.3 demonstrated a sensitivity of 87.67% and a specificity of 71.23%.

Conclusions: The cardiac electrophysiological balance index emerges as a non-invasive tool with substantial predictive value for estimating the likelihood of paroxysmal AF recurrence post-ablation.

Objective: The objective of this study was to describe the process of cross-cultural adaptation of the Breastfeeding Self-Efficacy Scale-Short Form among Fathers for use in Brazil.

Methods: This is a cross-cultural adaptation study that began with the translation from the original English into Portuguese, followed by back translation. A committee of experts evaluated the semantic, idiomatic, experiential, and conceptual equivalences. The pre-test of the Brazilian version of the Breastfeeding Self-Efficacy Scale-Short Form among Fathers was conducted with 10 fathers whose children were in the breastfeeding period. To assess the psychometric properties, a cross-sectional study was carried out involving 131 fathers with children in the breastfeeding phase. Factor analysis with principal component extraction and item response theory were used in data analysis.

Results: The Brazilian version of the Breastfeeding Self-Efficacy Scale-Short Form among Fathers presented an overall Cronbach α of 0.852. Very closely distributed factors explained 55.6% of the total variance in the principal component analysis. The item response theory showed that all questions have discriminatory characteristics.

Conclusion: The cross-cultural adaptation process was carried out within validated international parameters and represents a potential instrument for promoting maternal and child health in Brazil.

Objective: The objective of this study was to describe and critically appraise the conclusions of randomized clinical trials assessing monoclonal antibodies sponsored by the pharmaceutical industry.

Methods: This is a meta-research study on conclusions' characteristics of randomized clinical trials with monoclonal antibodies as interventions sponsored by the pharmaceutical industry.

Results: A total of 82 publications were considered. Notably, 79.3% (65/82) of the trials were fully funded by the pharmaceutical industry, and sponsors had data and publishing rights in 70.7% (58/82). Among the fully sponsored studies, 78.5% (51/65) presented conclusions with a drug-favorable direction of the effect, and 30.8% (20/65) made some recommendations for clinical practice, of which 95% (19/20) were favorable to the drug. In relation to the partially funded studies, drug-favorable direction of effect was present in 68.8% (11/16) of conclusions, and 18.8% (3/16) recommended the drug for the practice, in which 66.7% (2/3) favored the drug. Positive direction of effect was more present in trials in which the sponsor owned data and publication (81.0%; 47/58), compared to trials where the funder did not (63.3%; 14/22). Only 13.4% (11/82) of included studies recognize the uncertainty in the estimates in the conclusions, and 37.4% (31/82) had a statement regarding the need for future studies.

Conclusions: Most of the included randomized clinical trials on monoclonal antibodies funded by the industry concluded a drug-favorable direction of effect. Recommendations for practice were common, while recognition of uncertainty and statements regarding the need for future studies were less frequently present in the conclusion.