Artigos e Materiais de Revistas Científicas - FM/Outros

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A coleção de Artigos e Materiais de Revistas Científicas engloba artigos originais, artigos de revisão, artigos de atualização, artigos técnicos, relatos de experiências, resenhas, ensaios, editoriais, cartas ao editor, debates, notas científicas e técnicas, depoimentos, entrevistas e pontos de vista. Consideram-se como artigos científicos originais os trabalhos redigidos para divulgação de informações e resultados sobre determinada pesquisa científica, publicados em periódico científico após avaliação por outros pesquisadores.

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Autolesiones no suicidas en estudiantes de medicina: frecuencia y factores asociados
(2023) BARRIOS, Iván; MELGAREJO, Osvaldo; AMARILLA, Diego; ZÁRATE, Karen; CASTALDELLI-MAIA, João Mauricio; VENTRIGLIO, Antonio; GARCÍA, Deysi; CAYCHO-RODRÍGUEZ, Tomás; TORALES, Julio
ABSTRACT Introduction: the mental health of medical students has been extensively researched, showing that they are part of a group vulnerable to the development of mental disorders. Aim: the aim of this research was to determine the frequency of NSSI and its associated factors in medical students in Paraguay. Methodology: this was a descriptive and cross-sectional study. An online survey was launched to assess depression, anxiety, and self-harm, the PHQ-2, the GAD-7 and SHQ scales were used, respectively. Results: we received responses from 330 medical students. Of the participants, 71.2 % were female. 46.4% of the participants were identified as having depression (PHQ-2 ≥ 3) and 37.3 % as having anxiety (GAD-7 ≥10). The frequency of NSSI was 27 % (n = 89). The main factors associated with NSSI were a previous diagnosis of a mental disorder (which increased the likelihood of NSSI by 3.76 times) and/ or a history of physical or sexual abuse (with a 3.75-fold increase). Conclusion: this research found the presence of NSSI in almost 3 out of 10 of the medical students surveyed. The main factors associated with self-injurious behavior were a previous diagnosis of a mental disorder and/or a history of physical or sexual abuse.
CORRELATION BETWEEN CYPHOSE AND LORDOSE WITH THE FOOT SUPPORT OF ADOLESCENTS WITH IDIOPATHIC SCOLIOSIS
(2023) MOURÃO, MAX MULLER BEZERRA; BARSOTTI, CARLOS EDUARDO GONÇALVES; TOSTES, GUSTAVO ALVES; TORINI, ALEXANDRE PENNA; ANDRADE, RODRIGO MANTELATTO; RIBEIRO, ANA PAULA
ABSTRACT Objective: To verify the correlation between the thoracic and lumbar Cobb angle and the type of foot, and the parameters of plantar support during gait in adolescents with idiopathic scoliosis. Material and Methods: Sixty adolescents with idiopathic scoliosis (AIS) were divided into three groups: normal foot (n=20), cavus foot (n=20), and flat foot (n=20). The Cobb angles of thoracic kyphosis and lumbar lordosis were evaluated by radiographic examination. The plantar arch was recorded the podoscope and calculated by the ratio between the midfoot and the total foot area. The adolescents performed the march on a 20-meter track, with their feet resting on the pressure platform, totaling an average of 12 steps of the foot (right and left). The variables evaluated were: contact area, peak pressure, and maximum force on the four regions of the feet: hindfoot (medial and lateral), midfoot, and forefoot. Results: There was a positive correlation between the Cobb angle of lumbar lordosis and the arch plantar cavus (r=0.40; p=0.048) and flat (0.25; p=0.004), with no significant correlations for the Cobb angle thoracic (p>0.005). The pressure peak strongly correlated with the cavus plantar arch (r=0.92, p=0.001) in the lateral hindfoot and forefoot region, while the flat foot with the midfoot region. Conclusion: The Cobb lumbar lordosis angle positively correlates with the plantar arch height and the plantar support pattern during gait in adolescents with idiopathic scoliosis. Level of Evidence II; Observational and Cross-Sectional Study.
Qualidade de vida e sobrecarga de mães de crianças com microcefalia
(2023) SANTOS, Daniel Batista Conceição dos; CARDOSO, Luana da Conceição Costa; TORALES, Andréia Poschi Barbosa; REIS II, Francisco Prado; OLIVEIRA, Cristiane Costa da Cunha; LIMA, Sonia Oliveira
Abstract Introduction: Due to congenital infection, children with microcephaly have great limitations due to this condition. These limitations make the child need more health and home care. Generally, the mother becomes the main caretaker for this child, this role can lead to overload feelings that affect their quality of life. Objective: To analyze the role overload and the quality of life of mothers or primary caregiver of children with microcephaly related to congenital infection. Method: Cross-sectional, correlational study carried out with 105 participants from the state of Sergipe, Brazil, during the period from October 2017 to April 2018, through the application of questionnaires: sociodemographic, WHOQOL-Bref, and caregiver burden. For statistical analysis, ANOVA, t-test, and Pearson (r) tests were used. Results: All of the participants were females, 39 % were classified with severe role overload and 30.5% with intense role overload. The total average of this caregiver burden (49.47) presents a moderate to severe classification. There was a strong correlation (p<0.0001) between the levels of their role overload and the domains of their quality of life, where the greatest damage was in the environmental (36.57) and physical (38.53) aspects. A significant and inversely proportional correlation (r=-0.547, p<0.0001) was observed between the quality of life and the caregiver burden. Conclusion: Mothers suffer severe and intense caregiver overload that has a negative influence on their quality of life. Nursing can contribute to the creation and implementation of specific lines of care for these women emphasizing the promotion of physical and mental health to improve their quality of life.
Simulação in situ e suas diferentes aplicações na área da saúde: uma revisão integrativa
(2023) SANTOS, Marcos Maciel Candido Justino dos; LIMA, Sara Fiterman; VIEIRA, Carine Freitas Galvão; SLULLITEL, Alexandre; SANTOS, Elaine Cristina Negri; PEREIRA JÚNIOR, Gerson Alves
Abstract Introduction: The in situ simulation (ISS) consists of a training technique that takes place in the real workplace as a relevant method to promote environmental fidelity in the simulated scenario. Objective: To verify the use of the ISS in the world, to understand its applicability in healthcare. Method: This is an integrative review, which used the following guiding question: How has in situ simulation been used by health professionals? Searches were carried out in the PubMed, SciELO, LILACS and Web of Science databases, with different combinations of the following descriptors: in situ simulation, health and medicine (in Portuguese, English and Spanish) and the Boolean operators AND and OR using a temporal filter from 2012 to 2021. A total of 358 articles were found and the inclusion and exclusion criteria were applied, following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), and also with an independent peer review, using Rayyan, leaving 190 articles for this review. Results: The results showed that the United States has the absolute majority of productions (97/51%), followed by Canada, but with a large numerical difference (18/9.5%). Most of the works are written in English (184/96.8%), are quasi-experimental studies (97/51%), and have multidisciplinary teams as the target audience (155/81.6%). The articles have 11,315 participants and 2,268 simulation interventions. The main ISS scenarios were the urgent and emergency sectors (114/60%), followed by the ICU (17/9%), delivery room (16/8.42%) and surgical center (13/6.84%). The most frequently studied topics were CPR (27/14.21%), COVID-19 (21/11%), childbirth complications (13/6.8%) and trauma (11/5.8%). Discussion: The pointed-out advantages include the opportunity for professional updating with the acquisition of knowledge, skills and competencies, in an environment close to the real thing and at low cost, as it does not depend on expensive simulation centers. Conclusion: In situ simulation has been used by health professionals worldwide, as a health education strategy, with good results for learning and training at different moments of professional training, with improved care and low cost. There is still much to expand in relation to the use of ISS, especially in Brazil, in the publication of studies and experience reports on this approach.
A visão de gerentes de atenção básica à saúde sobre suas atribuições
(2023) SILVA, Luciano Bairros da; SOUSA, Marcos Henrique Oliveira; ÍñIGUEZ-RUEDA, Lupicinio
Abstract The article aimed to understand the development of the attributions of the primary care manager from the perspective of these same professionals, in the capital Maceió, Alagoas, Brazil. It is a qualitative research, which interviewed eight managers of Basic Health Units and treated by means of content analysis. The results identified that the managers as routine manage the flow of care and the attendance record of the team members, but present limitations to manage the teamwork and the physical structure. At the institutional level, they mediate the relationship of the team's professionals with the administrative headquarters, but show little participation in the establishment of intersectoral actions. They value the relationship with the community, however, they report little social participation at the Unit level. They show little knowledge about health policies and information systems. It is considered that, for a positive impact on access and quality to the health of the population, it is necessary: to guarantee the governability of managers over material resources and personnel management; the monitoring of health goals with the collaborative participation of the community; the appropriation and promotion of health work networks; and an in-service training program that helps local management.
Epidemiologic case investigation on the zoonotic transmission of Methicillin-resistant Staphylococcus pseudintermedius among dogs and their owners
(2023) GUIMARAES, Luciana; TEIXEIRA, Izabel Mello; SILVA, Isabella Thomaz da; ANTUNES, Milena; PESSET, Camilla; FONSECA, Carolina; SANTOS, Ana Luiza; CORTES, Marina Farrel; PENNA, Bruno
Dogs often carry methicillin-resistant Staphylococci asymptomatically. These bacteria are frequently linked to conditions such as canine pyoderma and otitis. Close interaction between dogs and humans can facilitate the exchange of resistant strains, particularly Methicillin-resistant Staphylococcus pseudintermedius (MRSP). This represents a public health issue, since these strains, in addition to occasionally causing infections in humans, can also serve as a source of resistance and virulence genes for strains of greater importance in human medicine, such as Staphylococcus aureus. Furthermore, MRSP strains are often multidrug resistant, which ends up compromising the treatment of infections. This study aimed to assess the potential transmission of Staphylococcus pseudintermedius among dogs and their owners. We examined a total of one hundred canine samples collected from cases of pyoderma and otitis to detect the presence of staphylococci. Simultaneously, we conducted evaluations on all dog owners. Staphylococci strains were identified using MALDI-TOF MS and PCR targeting the nuc gene. Methicillin resistance screening was also performed by detecting the mecA gene using PCR. Among the sampled dogs, 64 carried S. pseudintermedius. Nine were identified as MRSP. In six instances, dogs and their owners exhibited S. pseudintermedius. These samples underwent genome sequencing and were screened for antimicrobial resistance genes, SCCmec typing, MLST characterization, and Single Nucleotide Polymorphisms (SNP) analyses. The results of the phylogenetic analysis revealed that in three cases, dogs and owners had closely related isolates, suggesting interspecies transmission. Two of these cases involved MRSP and one MSSP. Moreover, in the two MRSP cases, the same SCCmec type (type V) was detected. Additionally, the sequence type was consistent across all three cases involving dogs and owners (MSSP ST2277, MRSP ST2282, and ST2286). These findings strongly indicate a transmission event. Since Staphylococcus pseudintermedius is primarily isolated from canine samples, it is plausible that dogs may have acted as a potential source. In the remaining three cases, despite identifying the same species in both samples, they had notable phylogenetic differences. (c) 2023 The Author(s).
How Cool is That? The Effects of Menthol Mouth Rinsing on Exercise Capacity and Performance: A Systematic Review and Meta-analysis
(2024) GAVEL, Erica H.; BARRETO, Gabriel; HAWKE, Kierstyn V.; STELLINGWERFF, Trent; JAMES, Lewis J.; SAUNDERS, Bryan; LOGAN-SPRENGER, Heather M.
Background Menthol (MEN) mouth rinsing (MR) has gained considerable interest in the athletic population for exercise performance; however, the overall magnitude of effect is unknown. Objective The aim of this systematic review and meta-analysis was to determine the efficacy of menthol MEN MR and the impact it has on exercise capacity and performance. Methods Three databases were searched with articles screened according to the inclusion/exclusion criteria. Three-level meta-analyses were used to investigate the overall efficacy of MEN MR and the impact it has on exercise capacity and performance. Meta-regressions were then performed with 1) mean VO2(peak), 2) MEN swilling duration; 3) the MEN concentration of MR solution, 4) the number of executed swills throughout a single experiment, 5) the use of flavoured sweetened, non-caloric, or non-flavoured neutral solutions as controls, 6) mean environmental temperature at the time of exercise tests, and 7) exercise type as fixed factors to evaluate their influence on the effects of MEN MR. Results Ten MEN MR studies included sufficient information pertaining to MEN MR and exercise performance and capacity. MR with MEN resulted in no significant change in capacity and performance (SMD = 0.12; 95% CI - 0.08, 0.31; p = 0.23, n = 1, tau(2)1 < 0.0001, tau(2)2 = < 0.0001, I-2 = 0%). No significant influence was detected in meta-regressions for VO2(peak), (estimate: 0.03; df = 8; 95% CI - 0.03, 0.09; p = 0.27), swilling duration (5 vs. 10 s: 0.00; df = 16; 95% CI - 0.41, 0.41; p = 1.0), MEN concentration (low [0.01%] vs. high [0.1%]: - 0.08; df = 15; 95% CI - 0.49, 0.32; p = 0.67), number of swills (estimate: 0.02; df = 13; 95% CI - 0.05, 0.09; p = 0.56), the use of flavoured sweetener or non-caloric as control (non-flavoured vs. flavoured: 0.12; df = 16; 95% CI - 0.30, 0.55; p = 0.55) or mean room temperature during exercise tests (estimate: 0.01; df = 16; 95% CI - 0.02, 0.04; p = 0.62). Conclusion MEN MR did not significantly improve overall exercise capacity and performance, though those involved in endurance exercise may see benefits.
Participating as a research team during the COVID-19 pandemic benefits mental health of undergraduate medical students in Brazil
(2023) CALDERARO, Debora Cerqueira; TEODORO, Maycoln Leoni Martins; BASUALTO, Samuel; BORGES, Aline Rizzo; LOPES, Joao Vitor Ziroldo; ARAUJO, Nafice Costa; MARIZ, Henrique de Ataide; VALADARES, Lilian David de Azevedo; RIBEIRO, Sandra Lucia Euzebio; KAHLOW, Barbara Stadler; GOMES, Kirla Wagner Poti; MUNHOZ, Gabriela Araujo; FERREIRA, Gilda Aparecida; KAKEHASI, Adriana Maria; PILEGGI, Gecilmara Salviato; BICA, Blanca; BRITO, Danielle Christinne Soares Egypto; GOMIDES, Ana Paula Monteiro; KLUMB, Evandro Mendes; PAIVA, Eduardo Dos Santos; PROVENZA, Jose Roberto; REIS-NETO, Edgard; SOUZA, Viviane Angelina de; VALIM, Valeria; PINHEIRO, Marcelo de Medeiros
During the COVID-19 pandemic, undergraduate medical students (UMS) exposed to isolation, social distancing and complete or partial face-to-face educational activities interruption may present increased stress, depression and anxiety. This study was undertaken to evaluate if, during isolation, UMS involved in online group activities as investigators of a research project (volunteer group) would present better mental health than their colleagues, not involved in that research (control group). A Web-based survey, via the Google Forms platform, including details on demographic data, life habits, previous health conditions, worries with the COVID-19 pandemic, sleep pattern modifications and depression, anxiety and mental stress, using the DASS-21 (Depression, Anxiety and Stress Scale) was implemented from 20 July to 31 August 2020. Statistical analysis was performed using the SPSS version 20.0. A p-value <0.05 was significant. A total of 684 UMS were included, 228 as a volunteer group and 456 as a control group. Mean age was 23.15 (3.16) years. The groups were paired for age, gender, ethnicity, life habits and previous health conditions. Older age, male gender, participation in the research project, unchanged sleep pattern during the pandemic, lack of fear from getting the COVID-19 and lack of previous health conditions were associated with lower DASS21 scores (better mental health). Participating as investigators of a research project foreseeing frequent interaction with patients, colleagues and professors (other investigators) lead to better mental health during the COVID-19 quarantine in Brazil.
Management of Pain after Photorefractive Keratectomy A Report by the American Academy of Ophthalmology
(2023) STEIGLEMAN, Walter Allan; ROSE-NUSSBAUMER, Jennifer; AL-MOHTASEB, Zaina; SANTHIAGO, Marcony R.; LIN, Charlies C.; PANTANELLI, Seth M.; KIM, Stephen J.; SCHALLHORN, Julie M.
Objective: To evaluate current best practices for postoperative photorefractive keratectomy (PRK) pain control.Methods: Literature searches in the PubMed database were last conducted in October 2021 and were restricted to publications in English. This search identified 219 citations, of which 84 were reviewed in full text for their relevance to the scope of this assessment. Fifty-one articles met the criteria for inclusion; 16 studies were rated level I, 33 studies were rated level II, and 2 studies were rated level III.Results: Systemic opioid and nonsteroidal anti-inflammatory drugs (NSAIDs); topical NSAIDs; postoperative cold patches; bandage soft contact lenses (BCLs), notably senofilcon A contact lenses; and topical anesthetics were demonstrated to offer significantly better pain control than comparison treatments. Some other commonly reported pain mitigation interventions such as systemic gabapentinoids, chilled intraoperative balanced salt solution (BSS) irrigation, cycloplegia, and specific surface ablation technique strategies offered limited improvement in pain control over control treatments.Conclusions: Systemic NSAIDs and opioid medications, topical NSAIDs, cold patches, BCLs, and topical an-esthetics have been shown to provide improved pain control over alternative strategies and allow PRK-associated pain to be more tolerable for patients. Ophthalmology 2023;130:87-98 2022 by the American Academy of Ophthalmology
Severe mpox in patients with advanced AIDS: long-term disease and fatal outcome
(2023) FARIAS, Luis Arthur Brasil Gadelha; HOLANDA, Pablo Eliack Linhares de; SILVA, Ana Danielle Tavares da; CAVALCANTE, Karene Ferreira; JUCA, Marina Catunda Pinheiro; NETO, Lauro Vieira Perdigao; DAMASCENO, Lisandra Serra
Herein, we report two cases of severe mpox in patients with advanced acquired immunodeficiency syndrome from Brazil who developed atypical lesions and prolonged illness, one of whom had a fatal outcome. Both patients experienced serious complications involving the perianal and genital regions and prolonged disease with persistent viremia.
Challenges and potential solutions for physician suicide risk factors in the COVID-19 era: psychiatric comorbidities, judicialization of medicine, and burnout
(2023) DUARTE, Dante; EL-HAGRASSY, Mirret M.; COUTO, Tiago; GURGEL, Wagner; MINUZZI, Luciano; SAPERSON, Karen; CORREA, Humberto
Introduction: Suicide among physicians constitutes a public health problem that deserves more consideration. A recently performed meta-analysis and systematic review evaluated suicide mortality in physicians by gender and investigated several related risk factors. It showed that the post-1980 suicide mortality was 46% higher in female physicians than among women in the general population, while the risk in male physicians was 33% lower than among men in general, despite an overall contraction in physician mortality rates in both genders.Methods: This narrative review was conducted by searching and analyzing articles/databases that were relevant to addressing questions raised by a prior meta-analysis and how they might be affected by COVID-19. This process included unstructured searches on Pubmed for physician suicide, burnout, judicialization of medicine, healthcare organizations, and COVID-19, and Google searches for relevant databases and medical society, expert, and media commentaries on these topics. We focus on three factors critical to addressing physician suicides: epidemiological data limitations, psychiatric comorbidities, and professional overload. Results: We found relevant articles on suicide reporting, physician mental health, the effects of healthcare judicialization, and organizational involvement on physician and patient health, and how COVID-19 may impact such factors. This review addresses information sources, underreporting/misreporting of physician suicide rates, inadequate diagnosis and management of psychiatric comorbidities and the chronic effects on physicians' work capacity, and, finally, judicialization of medicine and organizational failures increasing physician burnout. We discuss these factors in general and in relation to the COVID-19 pandemic.Conclusions: We present an overview of the above factors, discuss possible solutions, and specifically address how COVID-19 may impact such factors.
Whole grain products in Brazil: the need for regulation to ensure nutritional benefits and prevent the misuse of marketing strategies
(2023) ANDRADE, Giovanna Calixto; MAIS, Lais Amaral; RICARDO, Camila Zancheta; DURAN, Ana Clara; MARTINS, Ana Paula Bortoletto
OBJECTIVE: This study aims to evaluate the use of ""whole grains"" claims in food products marketed in Brazil and evaluate the nutrient profile of these products. METHODS: Data from 775 grain-based packaged foods collected in Brazil from April to July 2017 were analyzed. Based on the INFORMAS protocol for food labeling, the prevalence of packaged foods with ""whole grains"" claims was estimated. Information on the list of ingredients was analyzed to evaluate the presence and amount of whole or refined grains in six food groups. The nutrient profiles of the products with and without ""whole grains"" claims were compared using the Pan American Health Organization (PAHO) nutrient profile model. RESULTS: The packages of about 19% of the evaluated products showed ""whole grains"" claims in their front panel. Of these, 35% lacked any whole grains among their top three ingredients. Breakfast cereals, granola bars, bread, cakes and other bakery products, cookies, and pasta had higher amounts of refined flour than whole grain ingredients in their compositions. We found 66% of products with ""whole grains"" claims were high in nutrients of concern according to PAHO's criteria. CONCLUSION: Our results showed that over a third of the products in Brazil with ""whole grains"" claims lacked whole grains as one of their main ingredients. Most had a high content of nutrients associated with noncommunicable chronic disease risk factors, indicating the overestimation of their health benefits.
Acceptability and feasibility of a parent-mediated social-communication therapy for young autistic children in Brazil: A qualitative implementation study of Paediatric Autism Communication Therapy
(2024) GODOY, Priscilla Brandi Gomes; MCWILLIAMS, Lorna; SILVEIRA, Leticia Rodrigues da; BIASAO, Mirian de Cesaro Revers; ALARCAO, Fernanda Speggiorin Pereira; SEDA, Leonardo; CAMPOLI, Renata Generoso; LIANG, Holan; DIVAN, Gauri; LEADBITTER, Kathy; GREEN, Jonathan; SHEPHARD, Elizabeth
Effective support for autistic individuals is lacking in Brazil. Few centres offer services and those that do are limited in therapeutic options and geographical location. Paediatric Autism Communication Therapy is a low-intensity, evidence-based parent-mediated social-communication intervention that may be useful for this scenario. This implementation study aimed to assess the acceptability and feasibility of Paediatric Autism Communication Therapy for young autistic children (aged 2-10 years) in Brazil. Parents (n = 18) of 2- to 10-year-old autistic children and clinicians (n = 20) who work with autistic children in Brazil were interviewed and the data analysed using thematic analysis to explore their perceptions concerning the acceptability and feasibility of Paediatric Autism Communication Therapy. In addition, Paediatric Autism Communication Therapy was delivered to a case series of 15 further parent-child dyads; these parents were interviewed at the end of the therapy, and the data were analysed using thematic analysis. All parents and clinicians had favourable opinions about the acceptability, feasibility and perceived effectiveness of a parent-mediated intervention conducted mainly in the home. However, they also highlighted obstacles concerning the implementation of Paediatric Autism Communication Therapy in Brazil, especially related to engaging Brazilian parents in a parent-mediated model of therapy. Based on these data, minor adaptations were made to the original Paediatric Autism Communication Therapy protocol to facilitate the implementation of the intervention in Brazil. Lay abstract Parents of autistic children and health professionals who work with autistic children in Brazil had positive views about introducing Paediatric Autism Communication Therapy as a therapy for autistic children in Brazil. The parents and clinicians also mentioned some difficulties about using Paediatric Autism Communication Therapy in Brazil. We made adaptations to Paediatric Autism Communication Therapy to address these difficulties. Paediatric Autism Communication Therapy is a therapy to support the development of social and communication skills for autistic children aged 2-10 years. The therapy is conducted with the autistic child's parent. Paediatric Autism Communication Therapy has not been used in Brazil before. There are few therapy options available for autistic children in Brazil and we believed that Paediatric Autism Communication Therapy may be useful. We asked three groups of people in Brazil about their views of Paediatric Autism Communication Therapy, after explaining how the therapy works. Group 1 included 18 parents of autistic children aged 2-10 years. Group 2 included 20 health professionals such as psychologists who work with autistic children. Group 3 included 15 parents of autistic children aged 2-7 years who received the Paediatric Autism Communication Therapy. We learned that parents and clinicians felt that Paediatric Autism Communication Therapy would be a beneficial therapy for autistic children in Brazil. We also found out about the challenges of using Paediatric Autism Communication Therapy in Brazil. We used these findings to make small cultural adaptations to Paediatric Autism Communication Therapy to make it more suitable for Brazil.
High prevalence of olfactory impairment among leprosy patients: A cross-sectional study
(2023) KONDO, Rogerio Nabor; ARAUJO, Milene Cripa Pizatto de; RAMOS, Paulo Muller; MIOT, Helio Amante; FORNAZIERI, Marco Aurelio
BackgroundThe effect of leprosy on the sense of smell is not yet fully established. Studies that have relied only on patients' perceptions may have under- or over-estimated the change in smell perception. A validated and psychophysical method is necessary to avoid these errors in assessment. ObjectivesThis study aimed to validate the existence of olfactory involvement in leprosy patients. MethodsA cross-sectional, controlled study was conducted, in which individuals with leprosy (exposed individuals) and individuals without leprosy (control patients) were recruited. For each exposed individual, we selected two control patients. A total of 108 patients (72 control patients and 36 exposed individuals) with no history of infection with the new coronavirus (COVID-19) took the University of Pennsylvania Smell Identification Test (UPSIT). ResultsMost exposed individuals had olfactory dysfunction [n = 33, 91.7% (CI 95%: 77.5%-98.3%)] when compared with the control patients [n = 28, 38.9% (CI 95%: 27.6%-51.1%)], but only two (5.6%) had olfactory complaints. The olfactory function was significantly worse among exposed individuals [UPSIT leprosy = 25.2 (CI 95%: 23.1-27.3) when compared with the UPSIT control patients = 34.1 (CI 95%: 33.0-35.3); p<0.001]. The risk of olfactory loss was higher among the exposed individuals [OR: 19.5 (CI 95%: 5.18-105.70; p < 0.001)]. ConclusionsOlfactory dysfunction was highly prevalent among exposed individuals, although they had little or no self-knowledge of the disorder. The results show that it is important to assess the sense of smell in exposed individuals. Author summaryLeprosy is one of the oldest neurocutaneous diseases in the world. However, it has been neglected by the general population, doctors, and scientists. Transmitted by Mycobacterium leprae and Mycobacterium lepromatosis, leprosy is met with stigma and prejudice. Some patients with leprosy (exposed individuals) keep their diagnosis a secret, fearing a negative impact on their social lives. The disease is characterized by white or red skin lesions associated with local numbness. Few studies have evaluated smell among exposed individuals, but they have not used the University of Pennsylvania Smell Identification Test (UPSIT), which is a validated psychophysical method. The present study found a high prevalence of olfactory impairment (91.7%) among exposed individuals, accompanied by low self-knowledge of the disorder (5.6%). It is thus important to assess the sense of smell in infected individuals, as this sensorineural assessment has not been performed as a routine for patients.
A Multicenter Assessment of Interreader Reliability of LI-RADS Version 2018 for MRI and CT
(2023) HONG, Cheng William; CHERNYAK, Victoria; CHOI, Jin-Young; LEE, Sonia; POTU, Chetan; DELGADO, Timoteo; WOLFSON, Tanya; GAMST, Anthony; BIRNBAUM, Jason; KAMPALATH, Rony; LALL, Chandana; LEE, James T.; OWEN, Joseph W.; AGUIRRE, Diego A.; MENDIRATTA-LALA, Mishal; DAVENPORT, Matthew S.; MASCH, William; ROUDENKO, Alexandra; LEWIS, Sara C.; KIERANS, Andrea Siobhan; HECHT, Elizabeth M.; BASHIR, Mustafa R.; BRANCATELLI, Giuseppe; DOUEK, Michael L.; OHLIGER, Michael A.; TANG, An; CERNY, Milena; FUNG, Alice; COSTA, Eduardo A.; CORWIN, Michael T.; MCGAHAN, John P.; KALB, Bobby; ELSAYES, Khaled M.; SURABHI, Venkateswar R.; BLAIR, Katherine; MARKS, Robert M.; HORVAT, Natally; BEST, Shaun; ASH, Ryan; GANESAN, Karthik; KAGAY, Christopher R.; KAMBADAKONE, Avinash; WANG, Jin; CRUITE, Irene; BIJAN, Bijan; GOODWIN, Mark; CUNHA, Guilherme Moura; TAMAYO-MURILLO, Dorathy; FOWLER, Kathryn J.; SIRLIN, Claude B.
Background: Various limitations have impacted research evaluating reader agreement for Liver Imaging Reporting and Data System (LI-RADS). Purpose: To assess reader agreement of LI-RADS in an international multicenter multireader setting using scrollable images. Materials and Methods: This retrospective study used deidentified clinical multiphase CT and MRI and reports with at least one untreated observation from six institutions and three countries; only qualifying examinations were submitted. Examination dates were October 2017 to August 2018 at the coordinating center. One untreated observation per examination was randomly selected using observation identifiers, and its clinically assigned features were extracted from the report. The corresponding LI-RADS version 2018 category was computed as a rescored clinical read. Each examination was randomly assigned to two of 43 research readers who independently scored the observation. Agreement for an ordinal modified four-category LI-RADS scale (LR-1, definitely benign; LR2, probably benign; LR-3, intermediate probability of malignancy; LR-4, probably hepatocellular carcinoma [HCC]; LR-5, definitely HCC; LR-M, probably malignant but not HCC specific; and LR-TIV, tumor in vein) was computed using intraclass correlation coefficients (ICCs). Agreement was also computed for dichotomized malignancy (LR-4, LR-5, LR-M, and LR-TIV), LR-5, and LR-M. Agreement was compared between research-versus-research reads and research-versus-clinical reads. Results: The study population consisted of 484 patients (mean age, 62 years +/- 10 [SD]; 156 women; 93 CT examinations, 391 MRI examinations). ICCs for ordinal LI-RADS, dichotomized malignancy, LR-5, and LR-M were 0.68 (95% CI: 0.61, 0.73), 0.63 (95% CI: 0.55, 0.70), 0.58 (95% CI: 0.50, 0.66), and 0.46 (95% CI: 0.31, 0.61) respectively. Research-versus-research reader agreement was higher than research-versus-clinical agreement for modified four-category LI-RADS (ICC, 0.68 vs 0.62, respectively; P =.03) and for dichotomized malignancy (ICC, 0.63 vs 0.53, respectively; P =.005), but not for LR-5 (P =.14) or LR-M (P =.94). Conclusion: There was moderate agreement for LI-RADS version 2018 overall. For some comparisons, research-versus-research reader agreement was higher than research-versus-clinical reader agreement, indicating differences between the clinical and research environments that warrant further study.
Total energy expenditure assessed by 24-h whole-room indirect calorimeter in patients with colorectal cancer: baseline findings from the PRIMe study
(2023) FORD, Katherine L.; PICHARD, Claude; SAWYER, Michael B.; TROTTIER, Claire F.; DISI, Ilana Roitman; PURCELL, Sarah A.; GHOSH, Sunita; SIERVO, Mario; DEUTZ, Nicolaas E. P.; PRADO, Carla M.
Background: Total energy expenditure (TEE) determines energy requirements, but objective data in patients with cancer are limited. Objectives: We aimed to characterize TEE, investigate its predictors, and compare TEE with cancer-specific predicted energy requirements. Methods: This cross-sectional analysis included patients with stages II-IV colorectal cancer from the Protein Recommendation to Increase Muscle (PRIMe) trial. TEE was assessed by 24-h stay in a whole-room indirect calorimeter before dietary intervention and compared with cancer-specific predicted energy requirements (25-30 kcal/kg). Generalized linear models, paired-samples t tests, and Pearson correlation were applied. Results: Thirty-one patients (56 & PLUSMN; 10 y; body mass index [BMI]: 27.9 & PLUSMN; 5.5 kg/m2; 68% male) were included. Absolute TEE was higher in males (mean difference: 391 kcal/d; 95% CI: 167, 616 kcal/d; P < 0.001), patients with colon cancer (mean difference: 279 kcal/d; 95% CI: 73, 485 kcal/d; P = 0.010), and patients with obesity (mean difference: 393 kcal/d; 95% CI: 182, 604 kcal/d; P < 0.001). Appendicular lean soft tissue (fl: 46.72; 95% CI: 34.27, 59.17; P < 0.001) and tumor location (colon-fl: 139.69; 95% CI: 19.44, 259.95; P = 0.023) independently predicted TEE when adjusted for sex. Error between measured TEE and energy requirements predicted by 25 kcal/kg (mean difference: 241 kcal/d; 95% CI: 76, 405 kcal/d; P = 0.010) or 30 kcal/kg (mean difference: 367 kcal/d; 95% CI: 163, 571 kcal/d; P < 0.001) was higher for patients with obesity, and proportional error was observed (25 kcal/kg: r = -0.587; P < 0.001; and 30 kcal/kg: r = -0.751; P < 0.001). TEE (mean difference: 25 kcal/kg; 95% CI: 24, 27 kcal/kg) was below predicted requirements using 30 kcal/kg (-430 & PLUSMN; 322 kcal/d; P < 0.001). Conclusions: This is the largest study to assess TEE of patients with cancer using whole-room indirect calorimeter and highlights the need for improved assessment of energy requirements in this population. Energy requirements predicted using 30 kcal/kg overestimated TEE by 1.44 times in a controlled sedentary environment and TEE was outside of the predicted requirement range for most. Special considerations are warranted when determining TEE of patients with colorectal cancer, such as BMI, body composition, and tumor location. This is a baseline cross-sectional analysis from a clinical trial registered at clinicaltrials.gov as NCT02788955 (https://clinicaltrials.gov/ct2/show/NC T02788955).
Cardiovascular autonomic dysfunction in ""Long COVID"": pathophysiology, heart rate variability, and inflammatory markers
(2023) MARQUES, Karina Carvalho; QUARESMA, Juarez Antonio Simoes; FALCAO, Luiz Fabio Magno
Long COVID is characterized by persistent signs and symptoms that continue or develop for more than 4 weeks after acute COVID-19 infection. Patients with Long COVID experience a cardiovascular autonomic imbalance known as dysautonomia. However, the underlying autonomic pathophysiological mechanisms behind this remain unclear. Current hypotheses include neurotropism, cytokine storms, and inflammatory persistence. Certain immunological factors indicate autoimmune dysfunction, which can be used to identify patients at a higher risk of Long COVID. Heart rate variability can indicate autonomic imbalances in individuals suffering from Long COVID, and measurement is a non-invasive and low-cost method for assessing cardiovascular autonomic modulation. Additionally, biochemical inflammatory markers are used for diagnosing and monitoring Long COVID. These inflammatory markers can be used to improve the understanding of the mechanisms driving the inflammatory response and its effects on the sympathetic and parasympathetic pathways of the autonomic nervous system. Autonomic imbalances in patients with Long COVID may result in lower heart rate variability, impaired vagal activity, and substantial sympathovagal imbalance. New research on this subject must be encouraged to enhance the understanding of the long-term risks that cardiovascular autonomic imbalances can cause in individuals with Long COVID.
Influenceofbloodphenylalaninelevelvariationsonthedevelopmentofexecutivefunctionsandsocialcognitioninchildrenwithphenylketonuria
(2023) DUARTE, Cristiane Mendes de Almeida; PIAZZON, Flavia Balbo; ROCCO, Isadora Salvador; MELLO, Claudia Berlim de
Toinvestigatetheperformanceof27childrenwithphenylketonuria(PKU) intestsofExecutiveFunctions( EF) andSocialCognition(SC), andtheirassociationswithmetaboliccontrolinferredbyphenylalanine( Phe) levels. Methods: ThePKUgroupwasdichotomizedaccordingtobaselinePhe-levelsinto;""classicalPKU""( n= 14), withPhe-levelsabove1200mmol/L(> 20mg/dL); and""mildPKU""(n= 13) withPhebetween360and1200mmol/L(6-20mg/dL). TheneuropsychologicalassessmentfocusedontheEFandSCsubtestsoftheNEPSYIIbatteryandintellectualperformance. Childrenwerecomparedtoagematchedhealthyparticipants. Results: ParticipantswithPKUpresentedsignificantlylowerIntellectualQuotient(IQ) comparedtocontrols( p= 0.001). RegardingEFanalysisadjustedbyageandIQ, significantdifferencesbetweengroupswereobservedonlyintheexecutiveattentionsubtests( p= 0.029). TheSCsetofvariableswassignificantlydifferentbetweengroups( p= 0.003), asintheaffectiverecognitiontask(p< 0.001). InthePKUgroup, therelativevariationofPhe-achieved32.1 +/- 21.0%. RelativePhe-variationwascorrelatedonlywithmeasuresofWorkingMemory(p< 0.001), VerbalFluency( p= 0.004), InhibitoryControl(p= 0.035) andTheoryofMind(p= 0.003). Conclusions: PhonologicalVerbalFluency, WorkingMemory, InhibitoryControl, andTheoryofMindwereshowntobemostvulnerablewhenthereisnonidealmetaboliccontrol. VariationsinthelevelofPhemayhaveaselectivenegativeeffectonExecutiveFunctionsandSocialCogni- tion, butnotonintellectualperformance.
The Risk of Reinfection or Primary Hepatitis E Virus Infection at a Liver Transplant Center in Brazil: An Observational Cohort Study
(2024) ZICKER, Michelle; PINHO, Joao R. R.; WELTER, Eliane A. R.; GUARDIA, Bianca D.; SILVA, Paulo G. T. M. da; SILVEIRA, Leonardo B. da; CAMARGO, Luis F. A.
The hepatitis E virus is a major etiological agent of chronic hepatitis in immunosuppressed individuals. Seroprevalence in the liver transplantation setting varies according to the seroprevalence of the general population in different countries. This was a prospective cohort study of liver transplant recipients in southeastern Brazil. Recipients were systematically followed for one year, with the objective of determining the prevalence, incidence, and natural history of HEV infection in this population. We included 107 liver transplant recipients and 83 deceased donors. Positivity for anti-HEV IgG was detected in 10.2% of the recipients and in 9.7% of the donors. None of the patients tested positive for HEV RNA at baseline or during follow-up. There were no episodes of reactivation or seroconversion, even in cases of serological donor-recipient mismatch or in recipients with acute hepatitis. Acute and chronic HEV infections seem to be rare events in the region studied. That could be attributable to social, economic, and environmental factors. Our data indicate that, among liver transplant recipients, hepatitis E should be investigated only when there are elevated levels of transaminases with no defined cause, as part of the differential diagnosis of seronegative hepatitis after transplantation.
Rehabilitation Interventions in Head and Neck Cancer
(2024) CHENG, Jessica T.; EMOS, Marc Ramos; LEITE, Victor; CAPOZZI, Lauren; WOODROW, Lindsey E.; GUTIERREZ, Carolina; NGO-HUANG, An; KRAUSE, Kate J.; PARKE, Sara C.; LANGELIER, David Michael
Objective: The aim of the study is to identify and appraise current evidence for rehabilitation interventions in head and neck cancer. Design: A previously published scoping review spanning 1990 through April 2017 was updated through January 11, 2023 and narrowed to include only interventional studies (Arch Phys Med Rehabil. 2019;100(12):2381-2388). Included studies had a majority head and neck cancer population and rehabilitation-specific interventions. Pairs of authors extracted data and evaluated study quality using the PEDro tool. Results were organized by intervention type. Results: Of 1338 unique citations, 83 studies with 87 citations met inclusion criteria. The median study sample size was 49 (range = 9-399). The most common interventions focused on swallow (16 studies), jaw (11), or both (6), followed by whole-body exercise (14) and voice (10). Most interventions took place in the outpatient setting (77) and were restorative in intent (65 articles). The overall study quality was fair (median PEDro score 5, range 0-8); none were of excellent quality (PEDro >9). Conclusions: Most head and neck cancer rehabilitation interventions have focused on restorative swallow and jaw exercises and whole-body exercise to address dysphagia, trismus, and deconditioning. More high-quality evidence for head and neck cancer rehabilitation interventions that address a wider range of impairments and activity and social participation limitations during various cancer care phases is urgently needed to reduce head and neck cancer-associated morbidity.

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