Revista da Associacao Medica Brasileira (1992)最新文献

Objective: The aim of the study was to evaluate the incidence of early-onset neonatal sepsis and other perinatal adverse outcomes associated with not screening for group B beta-hemolytic Streptococcus.

Methods: A retrospective cohort study was conducted by searching electronic medical records from 2018 to 2022. Group B beta-hemolytic Streptococcus culture was performed after routine collection of vaginal and anal swabs from pregnant women at any time of pregnancy..

Results: A total of 968 pregnant women were included; 69.3% (675/968) were screened for group B beta-hemolytic Streptococcus, and 30.3% were not screened for group B beta-hemolytic Streptococcus. Of the pregnant women who were screened, 30.5% (206/675) had positive cultures and 69.5% (469/675) had negative cultures for group B beta-hemolytic Streptococcus. Pregnant women who underwent group B beta-hemolytic Streptococcus screening had a lower prevalence of preterm birth (p<0.0001), neonatal intensive care unit (NICU) admission (p=0.001), and neonatal death within 48 h (p=0.002). Group B beta-hemolytic Streptococcus screening was an independent predictor of preterm birth (p<0.0001). The best model for neonatal death in the first 48 h included group B beta-hemolytic Streptococcus screening (p=0.035) and NICU admission (p=0.016). Antibiotic use (p=0.040), preterm birth (p<0.0001), premature rupture of ovular membranes (p=0.047), premature delivery (p<0.0001), and chorioamnionitis (p=0.001) were associated with an increased risk of early-onset neonatal sepsis.

Conclusions: Screening for group B beta-hemolytic Streptococcus was not significantly associated with early-onset neonatal sepsis, but it was an independent predictor of preterm birth.

Objective: Mediastinal neoplasms are relatively rare tumors that require surgical or non-surgical treatment, and they harbor a wide variety of cell types. The aim of this study was to evaluate the surgical outcomes and prognosis of patients who underwent surgery for mediastinal masses.

Methods: The age, gender, symptoms, comorbid factors, radiological findings, preoperative diagnostic steps, surgical procedure, mortality, complications, length of hospital stay, histopathological diagnosis, and survival of 118 patients with mediastinal masses operated on for diagnosis and treatment between January 2013 and December 2018 were retrospectively analyzed.

Results: When the mediastinal masses were evaluated according to compartments, the most common mass was found in the anterior mediastinum (n=72, 61%). While 83.3% of malignant lesions were located in the anterior mediastinum, no malignant lesion was detected in the posterior mediastinum. There was a significant correlation between the compartment where the mass was located and its malignancy. A significant increase in the malignancy rate was observed among male patients. The likelihood of malignancy increased with increasing tumor size (p=0.002). Complications were shown to significantly extend the length of hospitalization (p=0.018). Overall survival was found to be at an average of 71.46±2.1 months. The 5-year survival rate was found to be 88.1%. There was a significant difference in survival between genders, in favor of the female sex (p=0.02).

Conclusion: Considering the low morbidity and mortality rates of mediastinal masses, surgical intervention should be performed promptly for the diagnosis and treatment of mediastinal masses. With videothoracoscopy, adequate biopsies can be obtained from unresectable masses and complete excision of benign lesions can be achieved safely.

Objective: The aim of this study was to determine the knowledge and attitudes of pregnant women about endocrine disruptors.

Methods: This cross-sectional and descriptive study was conducted with 313 pregnant women who visited the obstetrics clinic of a state hospital. Data were collected through face-to-face interviews using a Personal Information Form and the Endocrine Disruptors Attitude Scale. Data analysis was performed using SPSS 25.0, with a significance level of p<0.05.

Results: The average age of the pregnant women was 28.52±4.52 years. It was found that 62% of the pregnant women had more than 8 years of education, only 20.8% had prior knowledge about endocrine disruptors, and 30.7% of these obtained more information from social and visual media. Pregnant women scored an average of 76.26±9.33 on the Endocrine Disruptors Attitude Scale and were found to have a moderate protective attitude toward endocrine disruptors. It was determined that women who did not consume alcohol during pregnancy and were previously knowledgeable about endocrine disruptors scored significantly higher on the Endocrine Disruptors Attitude Scale (p<0.05).

Conclusion: In this study, it was determined that the attitudes of pregnant women toward endocrine disruptors were generally at a moderate level, and that the level of knowledge about endocrine disruptors during pregnancy could have an effect on the attitude.

Objective: Studies reporting the outcomes of patients after surgical repair of uterine isthmoceles usually have small patient populations. Therefore, the aim of the study was to contribute to the literature by reporting the outcomes of surgical repair of uterine isthmoceles in Turkish women.

Methods: This retrospective study included 41 patients who underwent surgical repair for symptomatic uterine isthmoceles. The patients were divided into two groups: those who underwent vaginal operative hysteroscopy and those who underwent abdominal laparoscopy and laparotomy.

Results: Surgical repair was performed vaginally in 29 patients (70.7%) using operative hysteroscopy and abdominally (laparotomy and laparoscopy) in 12 patients (29.3%). The isthomocele sac size, mean operative time, and median hospital stay were significantly shorter in the hysteroscopically repaired group (p<0.01, p=0.03, and p<0.01, respectively). Six months after surgery, the rate of persistent isthmocele sac was higher in the hysteroscopically repaired group (p<0.01). The myometrial thickness in the area of the repaired isthmocele sac was thicker in the abdominally repaired group (p<0.01). Among the 12 patients who desired pregnancy and underwent surgical repair, 58.3% (n=7) conceived spontaneously. Of these pregnancies, 71.4% were intrauterine and 28.6% were cesarean scar.

Conclusion: Hysteroscopic repair of uterine isthmoceles is advantageous, as it contributes to a shorter operative time and shorter hospital stay. However, complete removal of the isthmocele sac via the abdominal route appears to be more beneficial in terms of live birth rates in future pregnancies. Therefore, we recommend laparoscopic or laparotomic isthmocele repair in patients with fertility desires.

Background: Prolonged hospitalization increases the risk of adverse events and resource overuse. In dual public-private systems like Brazil's, it is unclear how much hospital length of stay reflects clinical needs versus systemic delays.

Objective: The aim of the study was to quantify clinical and non-clinical contributions to length of stay in medical inpatients and compare patterns between public (Unified Health System [SUS]) and privately insured patients.

Methods: We conducted a prospective multicenter cohort study including 5,423 adults admitted via the emergency department to internal medicine wards in three Brazilian hospitals (2009-2022). Physicians recorded daily whether ongoing hospitalization was clinically necessary or due to delays (e.g., tests, specialist input, administrative or social issues). Statistical analyses included multivariate models adjusted for comorbidities and frailty.

Results: The mean length of stay was 11.8±5.2 days, but only 38% (4.5±2.6 days) were clinically justified. The remainder resulted from non-clinical delays, particularly in diagnostics (2.9±3.1 days) and specialist input (1.9±1.5 days). SUS patients had longer stays than those privately insured (13.2 vs. 10.1 days; p<0.001), despite similar clinical complexity. These differences remained significant after adjustment. SUS patients were more likely to stay ≥12 days (OR 1.76), wait ≥3 days for tests (OR 1.89), and ≥2 days for specialist evaluations (OR 1.67).

Conclusion: Most hospital days were not due to clinical needs. Diagnostic and specialist delays, especially in the public system, were key contributors to prolonged length of stay, highlighting structural inefficiencies and the need for system-wide reforms.

Background: Postoperative care after McKeown esophagectomy remains challenging. The aim of this study was to evaluate retrograde gastric decompression and feeding as an alternative to nasogastric decompression and nasogastric-jejunal feeding.

Methods: This retrospective study analyzed 142 esophageal cancer patients undergoing McKeown esophagectomy (between June 2020 and August 2022): retrograde gastric decompression and feeding (n=74) vs. nasogastric-jejunal (n=68). Outcomes included operative parameters, complications, and recovery metrics.

Results: Retrograde gastric decompression and feeding required longer operative time (183.0±41.7 vs. 169.4±32.6 min, p=0.031) but showed comparable blood loss, R0 resection rates (95.9 vs. 97.1%), and lymph node yield. Gastric tube retention was shorter with retrograde gastric decompression and feeding (3.2±1.6 vs. 3.6±1.4 days). Complication rates (anastomotic leak: 10.8 vs. 10.3%; respiratory: 16.2 vs. 16.2%) and in-hospital mortality (1.4 vs. 1.5%) were similar. Tube-related complications trended lower with retrograde gastric decompression and feeding (5.4 vs. 10.3%, p=0.276).

Conclusion: Retrograde gastric decompression and feeding is a safe, effective method for enteral nutrition and decompression post-esophagectomy.

Objective: The aim of this study was to estimate the prevalence of electronic cigarette use and to explore the perceptions and beliefs of university students regarding their use.

Methods: This is a cross-sectional study involving 437 students from higher education institutions of Guanambi, Bahia. A questionnaire based on five previous studies on electronic cigarette perceptions among students was applied, consisting of 25 questions addressing student characteristics, knowledge, and experimentation with electronic cigarettes. Bivariate analyses were performed to assess the relationship between electronic cigarette use, age, perceptions, and beliefs, using the chi-square test.

Results: The prevalence of electronic cigarette use was 39.2%, with no statistically significant difference between genders. The age of initiation was related to the places of use, predominantly parties and socialization environments. Individuals who used electronic cigarettes believed that they were more socially acceptable than conventional cigarettes and viewed them as a tool for smoking cessation.

Conclusion: The results indicate a significant prevalence of electronic cigarette use among university students, with varied perceptions of its risks and benefits.