Revista da Associacao Medica Brasileira (1992)最新文献

Objective: Placenta accreta spectrum (PAS) is defined as the attachment of the placenta to the uterine wall in varying degrees. However, the studies have explored that the underlying molecular mechanisms of the PAS are very limited. Sirtuins 1 (SIRT1) is associated with placental development by controlling trophoblast cell invasion and remodeling of spiral arteries. We aimed to determine the expression level of SIRT1 in placentas, and maternal and umbilical cord serum of patients with PAS.

Methods: In total, 30 individuals in control, 20 patients in the placenta previa group, and 30 patients in the PAS group were included in this study. The expression levels of SIRT1 in the placentas were determined by Western blot and immunohistochemistry. Serum levels of SIRT1 in maternal and umbilical cord blood were determined by ELISA.

Results: SIRT1 was significantly lower in placentas of the PAS. However, maternal and umbilical cord serum samples were not significantly different between groups.

Conclusion: SIRT1 may play an important role in the pathogenesis of the PAS.

Objective: This study was conducted to determine the relationship between personality traits and premenstrual syndrome in university students.

Method: This cross-sectional study was conducted with 616 female university students between February and June 2020.

Results: The Premenstrual Syndrome Scale score was determined as a mean of 125.40±25.41. According to linear regression analysis, extrovert/introvert personality traits, emotional balance/neuroticism, and consistent/inconsistent personality traits were statistically significant predictive factors of premenstrual syndrome.

Conclusion: The results of this study demonstrated that two-thirds of the students had premenstrual syndrome and personality traits affected premenstrual syndrome. It is recommended that attention should be paid to personality traits when coping with premenstrual syndrome.

Aim: The aim of the study was to determine the respiratory muscle strength of stroke patients and compare them with healthy individuals.

Method: The study was conducted with 171 patients who had a stroke between 2017 and 2021 and 32 healthy controls. Respiratory muscle strength and inspiratory and expiratory mouth pressure (MIP and MEP) were measured using the portable MicroRPM device (Micro Medical, Basingstoke, UK).

Results: The stroke group exhibited significantly lower values in both MIP for men (p<0.001) and women (p=0.013) and maximal expiratory pressure for men (p<0.001) and women (p=0.042), compared with the healthy control group. Notably, there was a significant difference in the MIPmen (p=0.026) and MEPmen (p=0.026) values when comparing the reference values, which were calculated based on age and sex, with those of the healthy group. The baseline values calculated according to age for stroke patients were as follows: MIPmen 31.68%, MIPwomen 63.58%, MEPmen 22.54%, and MEPwomen 42.30%.

Conclusion: This study highlights the significant respiratory muscle weakness experienced by stroke patients, with gender-specific differences. It highlights the importance of incorporating respiratory assessments and interventions into stroke rehabilitation protocols to improve the overall health and well-being of stroke patients.

Objective: Neonatal sepsis is a serious disease that needs timely and immediate medical attention. So far, there is no specific prognostic biomarkers or model for dependable predict outcomes in neonatal sepsis. The aim of this study was to establish a predictive model based on readily available laboratory data to assess 30-day mortality in neonatal sepsis.

Methods: Neonates with sepsis were recruited between January 2019 and December 2022. The admission information was obtained from the medical record retrospectively. Univariate or multivariate analysis was utilized to identify independent risk factors. The receiver operating characteristic curve was drawn to check the performance of the predictive model.

Results: A total of 195 patients were recruited. There was a big difference between the two groups in the levels of hemoglobin and prothrombin time. Multivariate analysis confirmed that hemoglobin>133 g/L (hazard ratio: 0.351, p=0.042) and prothrombin time >16.6 s (hazard ratio: 4.140, p=0.005) were independent risk markers of 30-day mortality. Based on these results, a predictive model with the highest area under the curve (0.756) was built.

Conclusion: We established a predictive model that can objectively and accurately predict individualized risk of 30-day mortality. The predictive model should help clinicians to improve individual treatment, make clinical decisions, and guide follow-up management strategies.

Objective: The aim of this study was to evaluate the effectiveness of cognitive behavioral therapy in the treatment of vasomotor, sexual dysfunction, and recurrent depression in postmenopausal women.

Methods: This prospective, open study evaluated 112 postmenopausal women with vasomotor symptoms. Sexual dysfunction has cultural, social, biological, and emotional issues and divided into two groups: G1, without depression (n=65) and G2, with recurrent depression (n=47). The subjects underwent 12 sessions of in-person cognitive behavioral therapy and 12 sessions of home-based activity over a period of 6 months. They were evaluated at 3 months following the completion of therapy. Depression, memory, and attention-related functions, as well as climactic symptoms, were assessed using a questionnaire.

Results: In the depression questionnaire, the G1 group had a lower initial score than the G2 group (p<0.01). Following 6 months of therapy, both groups had similar improved scores. In the depression questionnaire, the women in group G1 had higher baseline values. In the assessment of vasomotor symptoms, the values in both groups were similar and showed an improvement in vasomotor symptoms after 24 weeks of treatment, but these effects disappeared after the follow-up of 48 weeks in the G2 group. Both groups improved the sexual dysfunction after 24 weeks.

Conclusion: Cognitive behavioral therapy may be effective in reducing vasomotor symptoms and ameliorate the sexual dysfunction and recurrent depression in postmenopausal women after 24 weeks of treatment.

Objective: The aim of this study was to determine the effect of compression stockings on complaints, well-being, and sleep quality in pregnant women with restless legs syndrome.

Methods: This randomized placebo-controlled study was conducted on 63 pregnant women (placebo group [PG]=31; experimental group [EG]=32) at the Perinatology Outpatient Clinic of a Health Research and Application Centre in Turkey. Pregnant women in the experimental group wore compression stockings when they got up in the morning for 3 weeks and took them off at bedtime. Placebo group women wore a placebo stocking. Data were collected using the restless legs syndrome Severity Rating Scale, the Pittsburgh Sleep Quality Index, the World Health Organization-5 Well-Being Index, and the Application Satisfaction Form on the 22nd day of the first interview. Statistical significance was accepted as p<0.05.

Results: Post-test mean scores of both the experimental group and placebo group in the restless legs syndrome Severity Rating Scale (post-test:;8.87±5.27, 12.19±5.60; pre-test:;21.28±5.63, 21.0±5.61; p<0.05), the Pittsburgh Sleep Quality Index (post-test:;5.34±3.28, 6.12±3.12; pre-test:;10.15±4.23, 9.61±4.59; p<0.05), and Well-Being Index (post-test:;18.06±4.59, 19.00±4.47; pre-test:;12.71±5.85, 15.09±5.62; p<0.05) showed recovery according to the pre-tests. However, the post-test restless legs syndrome Severity Rating Scale of the experimental group was lower than that of the placebo group (p<0.05). The effect of their application started in 3.93±1.74 days on average in the experimental group, while it started in 5.09±1.55 days in the placebo group (p<0.05).

Conclusion: Both applications reduced the severity of restless legs syndrome in pregnant women and increased sleep quality and well-being. However, compression stockings were more effective in reducing restless legs syndrome severity. Nurses can use compression and placebo stockings in the care of pregnant women with restless legs syndrome.

Clinical trial registration number: NCT05795868.

Objective: This study examines the relationship between two frailty screening tools and 90-day all-cause mortality in geriatric inpatients.

Methods: The study included patients aged ≥60 years who were admitted to the geriatrics unit of a university hospital between June 2021 and August 2022 and whose mortality status and duration of hospitalization data were obtained from the Health Ministry System. During hospitalization, the patients were screened using two different frailty scales: the Simpler Modified Fried Frailty Scale (sMFS) and the Clinical Frailty Scale (CFS). Patients scoring ≥5 on the CFS and ≥3 on the sMFS were considered frail.

Results: A total of 84 participants with a mean age of 78.3±7.6 years were included in this study, of which 36.9% were male. Of the total, 60.7% and 89.3% were considered frail according to the CFS and sMFS, respectively, and the prevalence of all-cause mortality within 90 days was 19%. A univariate analysis using the Kaplan-Meier survival method revealed CFS scores to be statistically significantly related to 90-day all-cause mortality (p<0.001), while sMFS scores were not found to be statistically significant (p=0.849). Furthermore, a statistically significant relationship was identified between CFS score and all-cause mortality in multivariate analysis with Cox regression analysis [(p<0.001), hazard ratio (HR): 3.078; (95% confidence interval: 1.746-5.425)].

Conclusion: An evaluation of frailty in hospitalized older adults using two different scales revealed the CFS to be superior to the sMFS in predicting all-cause mortality within 90 days.

Objective: Back to the sources, postoperative nausea and vomiting, hypo- and hypertension, heart rate alterations, and hypoxemia due to laryngospasm might be considered perioperative complications.

Methods: This cross-sectional study was conducted at an Education and Research Hospital between January 2018 and June 2023. The study included a total of 437 cases of thyroid surgery. The demographic data such as age, sex, co-morbidities of the instances, hypotension, hypertension, bradycardia, hypoxemia, and postoperative nausea and vomiting, as well as laboratory data were obtained and analyzed.

Results: Of 437 cases, 334 (76%) were females and 103 (24%) were males, with a mean age of 51.83±11.91 years and 55.32±11.87 years, respectively. No statistical significance was realized between the complications, co-morbid diseases, and age. Notably, no liaison between the complications after awakening from the anesthesia and preoperative laboratory parameters was discerned. However, a high but no significant relationship was revealed between the platelet-to-lymphocyte ratio (P/L) in cases with hypoxemia and hypotension. Finally, no significance between laboratory values, bradycardia, hypertension, and postoperative nausea and vomiting was distinguished.

Conclusion: We postulate that the so-called inflammatory biomarkers measured at the time of preoperative examination in the blood count concept selectively do not enrich for anticipating complications that arise in the perioperative echelon.

Objective: This study aims to investigate the predictive value of hemogram parameters in early preterm delivery (32 gestational weeks and below) among pregnant women who have undergone cervical cerclage, based on cervical changes determined before the cerclage procedure.

Methods: Between 2010 and 2020, a total of 161 patients underwent cervical cerclage. The participants were divided into three groups. Group 1 (n=92) consisted of pregnant women who underwent prophylactic cerclage. Group 2 (n=31) included those with cervical shortening (<5 mm) and/or dilation (≤3 cm). Group 3 (n=38) comprised pregnant women with cervical dilation >3 cm. Each group was further divided based on delivery weeks, with a cutoff at 32 weeks. Demographic parameters and laboratory parameters were assessed.

Results: In Group 1, all hemogram parameters showed no significant differences between deliveries below and above 32 weeks. In Group 2, the neutrophil-to-lymphocyte ratio value before cerclage was higher in the early preterm delivery group (p=0.002), with a cutoff value of 4.75 in receiver operating characteristic analysis. In Group 3, the white blood cell value before cerclage was higher in the early preterm delivery group (p=0.005), with a cutoff value of 13.05×103/μL in receiver operating characteristic analysis.

Conclusion: The use of hemogram parameters to predict early preterm delivery in pregnant women undergoing prophylactic cerclage is not appropriate. However, neutrophil-to-lymphocyte ratio value can predict early preterm delivery when cervical dilation is 3 cm or less and/or cervical shortening is 5 mm or less. When cervical dilation exceeds 3 cm, the white blood cell value is more appropriate for predicting early preterm delivery.