Artigos e Materiais de Revistas Científicas - ODS/03

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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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Data-driven, cross-disciplinary collaboration: lessons learned at the largest academic health center in Latin America during the COVID-19 pandemic
(2024) RITTO, Ana Paula; ARAUJO, Adriana Ladeira de; CARVALHO, Carlos Roberto Ribeiro de; SOUZA, Heraldo Possolo De; FAVARETTO, Patricia Manga e Silva; SABOYA, Vivian Renata Boldrim; GARCIA, Michelle Louvaes; KULIKOWSKI, Leslie Domenici; KALLAS, Esper Georges; PEREIRA, Antonio Jose Rodrigues; COBELLO JUNIOR, Vilson; SILVA, Katia Regina; ABDALLA, Eidi Raquel Franco; SEGURADO, Aluisio Augusto Cotrim; SABINO, Ester Cerdeira; RIBEIRO JUNIOR, Ulysses; FRANCISCO, Rossana Pulcineli Vieira; MIETHKE-MORAIS, Anna; LEVIN, Anna Sara Shafferman; SAWAMURA, Marcio Valente Yamada; FERREIRA, Juliana Carvalho; SILVA, Clovis Artur; MAUAD, Thais; GOUVEIA, Nelson da Cruz; LETAIF, Leila Suemi Harima; BEGO, Marco Antonio; BATTISTELLA, Linamara Rizzo; DUARTE, Alberto Jose da Silva; SEELAENDER, Marilia Cerqueira Leite; MARCHINI, Julio; FORLENZA, Orestes Vicente; ROCHA, Vanderson Geraldo; MENDES-CORREA, Maria Cassia; COSTA, Silvia Figueiredo; CERRI, Giovanni Guido; BONFA, Eloisa Silva Dutra de Oliveira; CHAMMAS, Roger; BARROS FILHO, Tarcisio Eloy Pessoa de; BUSATTO FILHO, Geraldo
Introduction The COVID-19 pandemic has prompted global research efforts to reduce infection impact, highlighting the potential of cross-disciplinary collaboration to enhance research quality and efficiency.Methods At the FMUSP-HC academic health system, we implemented innovative flow management routines for collecting, organizing and analyzing demographic data, COVID-related data and biological materials from over 4,500 patients with confirmed SARS-CoV-2 infection hospitalized from 2020 to 2022. This strategy was mainly planned in three areas: organizing a database with data from the hospitalizations; setting-up a multidisciplinary taskforce to conduct follow-up assessments after discharge; and organizing a biobank. Additionally, a COVID-19 curated collection was created within the institutional digital library of academic papers to map the research output.Results Over the course of the experience, the possible benefits and challenges of this type of research support approach were identified and discussed, leading to a set of recommended strategies to enhance collaboration within the research institution. Demographic and clinical data from COVID-19 hospitalizations were compiled in a database including adults and a minority of children and adolescents with laboratory confirmed COVID-19, covering 2020-2022, with approximately 350 fields per patient. To date, this database has been used in 16 published studies. Additionally, we assessed 700 adults 6 to 11 months after hospitalization through comprehensive, multidisciplinary in-person evaluations; this database, comprising around 2000 fields per subject, was used in 15 publications. Furthermore, thousands of blood samples collected during the acute phase and follow-up assessments remain stored for future investigations. To date, more than 3,700 aliquots have been used in ongoing research investigating various aspects of COVID-19. Lastly, the mapping of the overall research output revealed that between 2020 and 2022 our academic system produced 1,394 scientific articles on COVID-19.Discussion Research is a crucial component of an effective epidemic response, and the preparation process should include a well-defined plan for organizing and sharing resources. The initiatives described in the present paper were successful in our aim to foster large-scale research in our institution. Although a single model may not be appropriate for all contexts, cross-disciplinary collaboration and open data sharing should make health research systems more efficient to generate the best evidence.
Combined transcatheter aortic valve replacement and left atrial appendage occlusion in patients ineligible for oral anticoagulation: A case series
(2022) FREIRE, A. F. D.; FILIPPINI, F. B.; BIGNOTO, T. C.; BRITO, P. H. F. de; NICZ, P. F. G.; MELO, P. H. M. C. D.; SILVA, R. C. e; QUEIROGA, M.; RIBEIRO, H. B.; PROCóPIO, A. G. M.; BEZERRA, C. G.; GRUBE, E.; ABIZAID, A.; FILHO, R. K.; BRITO JR., F. S. de
Patients presenting with aortic stenosis and atrial fibrillation (AF) undergoing transcatheter aortic valve replacement (TAVR) are commonly at increased risk for stroke and bleeding complications. Concomitant left atrial appendage occlusion (LAAO) after TAVR may be an alternative to oral anticoagulation (OAC). Between 2018 and 2022, 7 consecutive patients who were ineligible for OAC underwent simultaneous TAVR and LAAO. The mean age was 84.9 ± 4.9 years. The mean CHA2DS2-VASc, HAS-BLED, and STS predicted risk of mortality scores were 5.9 ± 0.7, 3.9 ± 1.1, and 8.8 ± 3.4%, respectively. The median follow-up time was 23 (1 to 27) months. All procedures achieved technical success and no adverse events were observed during follow-up. This case series shows that concomitant TAVR and LAAO is feasible and safe among patients with severe aortic stenosis and AF who are deemed ineligible for OAC. Learning objectives: Atrial fibrillation is the most common arrhythmia in the transcatheter aortic valve replacement (TAVR) population. In those who experience major or life-threatening bleeding, mortality is doubled. We report a case series of 7 concomitant left atrial appendage occlusions (LAAO) after TAVR in patients ineligible for oral anticoagulation. All procedures achieved technical success and no adverse events were observed. The simultaneous approach with TAVR and LAAO was feasible and safe in this case series.
Delayed left main coronary obstruction following transfemoral inovare transcatheter aortic valve replacement: A challenging case
(2022) KANHOUCHE, G.; CIVIDANES, F. R.; SAMPAIO, R. O.; SILVA, J. C. A. da; MACHADO, R. D.; WERNECK, M.; ACCORSI, T. A. D.; MORALES, K. R. D. P.; ABIZAID, A. C.; BRITO, F. S. D. Jr.; TARASOUTCHI, F.; PALMA, J. H.; RIBEIRO, H. B.
Coronary obstruction is an uncommon and severe complication after a transcatheter aortic valve replacement (TAVR), that occurs during the procedure in the vast majority of patients. In the present case even in the absence of classic risk factors, an acute coronary syndrome occurred one day after TAVR. Selective angiography revealed a severe left main ostium obstruction by the bulky native leaflet calcification. This is the first case of delayed presentation of coronary obstruction with a transfemoral balloon-expandable valve using the Inovare bioprosthesis (Braile Biomedica, Brazil). In addition, after drug-eluting stent placement in the left main coronary, intravascular ultrasound revealed severe stent underexpansion, so that a second layer of a bare-metal stent and high-pressure balloon post-dilatation was necessary to improve the final result. The patient was discharged after 7 days, and at the 6-month follow-up remained asymptomatic.
Comparison of Quality of Life in Breast Cancer Survivors with and without Persistent Depressive Symptoms: A 12-Month Follow-Up Study
(2023) RIBEIRO, F. E.; TEBAR, W. R.; FERRARI, G.; PALMA, M. R.; FREGONESI, C. E.; CALDEIRA, D. T.; SILVA, G. C. R.; VANDERLEI, L. C. M.; BERETTA, V. S.; CHRISTOFARO, D. G. D.
Although breast cancer treatments reduce mortality, their adverse effects can increase depression which impacts one’s quality of life (QoL). Physical activity (PA) seems to improve the QoL of breast cancer survivors (BCS). However, an unanswered question is the influence of PA on the QoL in BCS with depressive symptoms. Thus, we analyzed the influence of PA on the QoL in BCS with persistent depressive symptoms during 12 months of follow-up. The sample included 70 female BCS. Depression and QoL domains (i.e., functional capacity, physical limitations, body pain, general health status, vitality, social and emotional aspects, and mental health) were assessed at baseline and follow-up periods by the Hospital Anxiety and Depression Scale and SF-36, respectively. Habitual PA was assessed by Baecke’s questionnaire. Our results indicate a prevalence of 17.1% of depressive symptoms. Non-depressives BCS improved their physical limitations and general health status domains over time, but there were no observed differences in depressive BCS. BCS with persistent depressive symptoms (baseline and follow-up) showed worse QoL scores than non-depressives in all domains, regardless of confounding factors. When adjusted for PA, the difference between BCS depressives and non-depressives lost its significance in the functional capacity domain. In conclusion, habitual PA practice positively influenced the functional capacity domain of the QoL in BCS.
Application of thermography to estimate respiratory rate in the emergency room: The journal Temperature toolbox
(2023) ALDRED, A.; RIBEIRO, J. A. S.; BEZERRA, P. M. S.; ANTUNES, A. C. M.; GOULART, A. C.; DESUó, I. C.; GOMES, G.
Among the vital signs collected during hospital triage, respiratory rate is an important parameter associated with physiological, pathophysiological, and emotional changes. In recent years, the importance of its verification in emergency centers due to the severe acute respiratory syndrome 2 (SARS2) pandemic has become very clear, although it is still one of the least evaluated and collected vital signs. In this context, infrared imaging has been shown to be a reliable estimator of respiratory rate, with the advantage of not requiring physical contact with patients. The objective of this study was to evaluate the potential of analyzing a sequence of thermal images as an estimator of respiratory rate in the clinical routine of an emergency room. We used an infrared thermal camera (T540, Flir Systems) to obtain the respiratory rate data of 136 patients, based on nostrils’ temperature fluctuation, during the peak of the COVID-19 pandemic in Brazil and compared it with the chest incursion count method, commonly employed in the emergency screening procedures. We found a good agreement between both methods, with Bland-Altman limits of agreement ranging from −4 to 4 min−1, no proportional bias (R2 = 0.021, p = 0.095), and a strong correlation between them (r = 0.95, p < 0.001). Our results suggest that infrared thermography has potential to be a good estimator of respiratory rate in the routine of an emergency room.
Effect of Menstrual Cycle Phase on Fuel Oxidation Post HIT in Women Reproductive Age: A Pilot Study
(2023) FRIENTES, C. S.; MARQUEZI, M. L.; APARECIDO, J. M. L.; CASCAPERA, M. S.; ROGERI, P. S.; LANCHA JUNIOR, A. H.
Women of childbearing age have variations in substrate oxidation rates that can lead to overweight, type II diabetes, and other conditions that may be associated with metabolic inflexibility and the variations in estrogen concentrations observed during the monthly ovarian cycle. Purpose: This study aimed to verify and compare the influence of eight treadmill high-intensity interval training (HIT) sessions on carbohydrate and lipid oxidation rates (CHOox and LIPox, respectively) and intensities of ventilatory anaerobic thresholds (VATs) of women in different phases of the monthly ovarian cycle. Methods: Eleven irregularly active women performed incremental treadmill exercise testing followed by submaximal work-rate running for 45 min to determine VATs, VO2peak, peak velocity (Vpeak), and substrate oxidation rates, before and after a training period, in different phases of their monthly ovarian cycle (follicular phase group, FL, n = 6; luteal phase group, LT, n = 5). The training period consisted of eight HIT sessions, composed each one of eight sets of 60 s running at 100%Vpeak interspersed by 75 s recovery every 48 h. Results: Our results showed no significant differences in VATs intensities between groups. The comparison between groups showed significant differences in relative energy derived from CHO pre- and post-training of −61.42% and −59.26%, respectively, and LIP pre- and post-training of 27.46% and 34.41%, respectively. The relative energy derived from CHO after the training period was 18.89% and 25.50% higher for FL and LT, respectively; consequently, the relative energy derived from LIPox after the training period was 8,45% and 3.46% lower for FL and LT, respectively. Over the training period, Vpeak was ~13.5 km/h, which produced the relative intensities of ~89%VO2peak e ~93%HRpeak for both groups. Conclusion: The monthly ovarian cycle phases promote significant changes in substrate oxidation rates leading to a decrease in CHOox. High-intensity interval training can minimize the differences observed and constitute an alternative intervention.
Glycemic Variability and Fluctuations in Cognitive Status in Adults With Type 1 Diabetes (GluCog): Observational Study Using Ecological Momentary Assessment of Cognition
(2023) FONSECA, L. M.; STRONG, R. W.; SINGH, S.; BULGER, J. D.; CLEVELAND, M.; GRINSPOON, E.; JANESS, K.; JUNG, L.; MILLER, K.; PASSELL, E.; RESSLER, K.; SLIWINSKI, M. J.; VERDEJO, A.; WEINSTOCK, R. S.; GERMINE, L.; CHAYTOR, N. S.
Background: Individuals with type 1 diabetes represent a population with important vulnerabilities to dynamic physiological, behavioral, and psychological interactions, as well as cognitive processes. Ecological momentary assessment (EMA), a methodological approach used to study intraindividual variation over time, has only recently been used to deliver cognitive assessments in daily life, and many methodological questions remain. The Glycemic Variability and Fluctuations in Cognitive Status in Adults with Type 1 Diabetes (GluCog) study uses EMA to deliver cognitive and self-report measures while simultaneously collecting passive interstitial glucose in adults with type 1 diabetes. Objective: We aimed to report the results of an EMA optimization pilot and how these data were used to refine the study design of the GluCog study. An optimization pilot was designed to determine whether low-frequency EMA (3 EMAs per day) over more days or high-frequency EMA (6 EMAs per day) for fewer days would result in a better EMA completion rate and capture more hypoglycemia episodes. The secondary aim was to reduce the number of cognitive EMA tasks from 6 to 3. Methods: Baseline cognitive tasks and psychological questionnaires were completed by all the participants (N=20), followed by EMA delivery of brief cognitive and self-report measures for 15 days while wearing a blinded continuous glucose monitor. These data were coded for the presence of hypoglycemia (<70 mg/dL) within 60 minutes of each EMA. The participants were randomized into group A (n=10 for group A and B; starting with 3 EMAs per day for 10 days and then switching to 6 EMAs per day for an additional 5 days) or group B (N=10; starting with 6 EMAs per day for 5 days and then switching to 3 EMAs per day for an additional 10 days). Results: A paired samples 2-tailed t test found no significant difference in the completion rate between the 2 schedules (t17=1.16; P=.26; Cohen dz=0.27), with both schedules producing >80% EMA completion. However, more hypoglycemia episodes were captured during the schedule with the 3 EMAs per day than during the schedule with 6 EMAs per day. Conclusions: The results from this EMA optimization pilot guided key design decisions regarding the EMA frequency and study duration for the main GluCog study. The present report responds to the urgent need for systematic and detailed information on EMA study designs, particularly those using cognitive assessments coupled with physiological measures. Given the complexity of EMA studies, choosing the right instruments and assessment schedules is an important aspect of study design and subsequent data interpretation. ©Luciana Mascarenhas Fonseca, Roger W Strong, Shifali Singh, Jane D Bulger, Michael Cleveland, Elizabeth Grinspoon, Kamille Janess, Lanee Jung, Kellee Miller, Eliza Passell, Kerry Ressler, Martin John Sliwinski, Alandra Verdejo, Ruth S Weinstock, Laura Germine, Naomi S Chaytor.
Response letter: Neuropsychiatric presentation of Covid-19-related encephalitis: Case report
(2022) PORTO, F. H. de Gobbi; ORSINI, M.
Covid-19-related encephalitis is a heterogeneous syndrome characterized by a combination of clinical, laboratory, and imaging features related to inflammation of the brain, where the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is presumably the causative agent. We reported a case of Covid-19-related encephalitis presenting with neuropsychiatric symptoms, including intense agitation. Reverse-transcriptase polymerase-chain-reaction in cerebrospinal fluid was positive for SARS-CoV-2. Our case expands the literature about neurologic manifestations of Covid-19 and emphasizes the possibility of prominent behavioral symptoms as the initial manifestation.
Age of onset and cumulative risk of mental disorders: a cross-national analysis of population surveys from 29 countries
(2023) MCGRATH, J. J.; AL-HAMZAWI, A.; ALONSO, J.; ALTWAIJRI, Y.; ANDRADE, L. H.; BROMET, E. J.; BRUFFAERTS, R.; ALMEIDA, J. M. C. de; CHARDOUL, S.; CHIU, W. T.; DEGENHARDT, L.; DEMLER, O. V.; FERRY, F.; GUREJE, O.; HARO, J. M.; KARAM, E. G.; KARAM, G.; KHALED, S. M.; KOVESS-MASFETY, V.; MAGNO, M.; MEDINA-MORA, M. E.; MOSKALEWICZ, J.; NAVARRO-MATEU, F.; NISHI, D.; PLANA-RIPOLL, O.; POSADA-VILLA, J.; RAPSEY, C.; SAMPSON, N. A.; STAGNARO, J. C.; STEIN, D. J.; HAVE, M. ten; TORRES, Y.; VLADESCU, C.; WOODRUFF, P. W.; ZARKOV, Z.; KESSLER, R. C.; AGUILAR-GAXIOLA, S.; ALTWAIJRI, Y. A.; ATWOLI, L.; BENJET, C.; BUNTING, B.; CALDAS-DE-ALMEIDA, J. M.; CARDOSO, G.; CíA, A. H.; GIROLAMO, G. De; HARRIS, M. G.; HINKOV, H.; HU, C.-Y.; JONGE, P. De; KARAM, A. N.; KAZDIN, A. E.; KAWAKAMI, N.; KESSLER, R. C.; KIEJNA, A.; MCGRATH, J. J.; PIAZZA, M.; SCOTT, K. M.; STEIN, D. J.; VIANA, M. C.; VIGO, D. V.; WILLIAMS, D. R.; WOODRUFF, P.; WOJTYNIAK, B.; XAVIER, M.; ZASLAVSKY, A. M.
Background: Information on the frequency and timing of mental disorder onsets across the lifespan is of fundamental importance for public health planning. Broad, cross-national estimates of this information from coordinated general population surveys were last updated in 2007. We aimed to provide updated and improved estimates of age-of-onset distributions, lifetime prevalence, and morbid risk. Methods: In this cross-national analysis, we analysed data from respondents aged 18 years or older to the World Mental Health surveys, a coordinated series of cross-sectional, face-to-face community epidemiological surveys administered between 2001 and 2022. In the surveys, the WHO Composite International Diagnostic Interview, a fully structured psychiatric diagnostic interview, was used to assess age of onset, lifetime prevalence, and morbid risk of 13 DSM-IV mental disorders until age 75 years across surveys by sex. We did not assess ethnicity. The surveys were geographically clustered and weighted to adjust for selection probability, and standard errors of incidence rates and cumulative incidence curves were calculated using the jackknife repeated replications simulation method, taking weighting and geographical clustering of data into account. Findings: We included 156 331 respondents from 32 surveys in 29 countries, including 12 low-income and middle-income countries and 17 high-income countries, and including 85 308 (54·5%) female respondents and 71 023 (45·4%) male respondents. The lifetime prevalence of any mental disorder was 28·6% (95% CI 27·9–29·2) for male respondents and 29·8% (29·2–30·3) for female respondents. Morbid risk of any mental disorder by age 75 years was 46·4% (44·9–47·8) for male respondents and 53·1% (51·9–54·3) for female respondents. Conditional probabilities of first onset peaked at approximately age 15 years, with a median age of onset of 19 years (IQR 14–32) for male respondents and 20 years (12–36) for female respondents. The two most prevalent disorders were alcohol use disorder and major depressive disorder for male respondents and major depressive disorder and specific phobia for female respondents. Interpretation: By age 75 years, approximately half the population can expect to develop one or more of the 13 mental disorders considered in this Article. These disorders typically first emerge in childhood, adolescence, or young adulthood. Services should have the capacity to detect and treat common mental disorders promptly and to optimise care that suits people at these crucial parts of the life course. Funding: None.
Educational interventions on preventing pressure injuries targeted at nurses: systematic review and meta-analysis
(2023) KITAMURA, J. C.; NICOLOSI, J. T.; PAGGIARO, A. O.; CARVALHO, V. F. de
Background: Although preventable, pressure injuries are commonly observed in the hospital setting and are estimated to be the third most costly condition, after cancer and cardiovascular disease. Aim: Nurses play a crucial role in the prevention and management of pressure injuries, however, published evidence on the effectiveness of educational interventions, directed specifically at nurses in the hospital environment, is scarce. Method: The authors retrieved published studies on the subject from selected databases (Pubmed/Medline, Embase, Web of Science and the Cochrane Library) in a number of languages (Portuguese, English, French and Spanish). The search yielded randomised controlled trials, as well as quasi-experimental and comparative studies. Findings: In total, 11 studies were selected. The outcomes analysed, following some type of educational intervention, included the attitudes and knowledge of the nursing professionals, as well as the incidence of pressure injuries. Conclusion: The present study demonstrated that different educational strategies can help prevent pressure injuries in the hospital environment.
Infrared Imaging of the Brain-Eyelid Thermal Tunnel: A Promising Method for Measuring Body Temperature in Afebrile Children
(2023) MENECK, F. De; SANTANA, V.; BRIOSCHI, G. C.; HADDAD, D. S.; NEVES, E. B.; FRANCO, M. D. C.; BRIOSCHI, M. L.
(1) Infrared thermography of the inner canthus of the eye has emerged as a promising tool for temperature screening and fever diagnosis. Its non-invasive nature lends itself well to mass screening in diverse settings such as schools, public transport, and healthcare facilities. Swift and accurate temperature assessment plays a pivotal role in the early identification of potential fever cases, facilitating timely isolation, testing, and treatment, thereby mitigating the risk of disease transmission. Nonetheless, the reliability of this approach in the pediatric population, especially when compared to conventional thermometry methods, remains unexplored. This preliminary study aimed to evaluate the concordance between the temperature of the inner canthus of the eye (Tic,eye), referred to as the brain-eyelid thermal tunnel (BTT°), with axillary and tympanic methods in afebrile children. (2) Methods: A cohort of 36 children, matched in a 1:1 ratio for gender and age, underwent comprehensive assessments encompassing anthropometric data, blood pressure evaluations, axillary (Tax) and tympanic (Tty) temperature measurements, as well as BTT° infrared thermography. (3) Results: The findings revealed a high level of concordance among the tympanic, axillary, and BTT° measurement methods. Bland–Altman plots showed that the bias was minimal, and no statistically significant differences were observed when comparing BTT° with axillary (p = 0.136) and tympanic (p = 0.268) measurements. Passing–Bablok regression scatter plots further confirmed the agreement, aligning the fitted regression line closely with the identity line for both axillary versus BTT° and tympanic (Tty) versus BTT° comparisons. (4) Conclusions: This study holds significant implications for public health, especially in the context of infectious disease outbreaks such as COVID-19. BTT° infrared thermography of the inner canthus of the eye (Tic,eye) reliably measures body temperature in afebrile children in controlled settings; nevertheless, its practical application necessitates the adaptation of biothermodynamic parameters to accommodate diverse environmental conditions.
Lower urinary tract dysfunction in uncommon neurological diseases, Part II: A report of the Neuro-urology Promotion Committee of the International Continence Society
(2023) SINHA, S.; WACHTER, S. De; WELK, B.; SAKAKIBARA, R.; VRIJENS, D. M. J.; KONSTANTINIDIS, C.; RAPIDI, C.-A.; MONTEIRO, L. M.; GOMES, C. M.; DRAKE, M. J.; HAMID, R.
This is the second manuscript from the Neuro-urology Promotion Committee of the International Continence Society (ICS) discussing uncommon neuro-urological conditions that are not well described in urological literature. Readers are referred to the first document for a more detailed understanding of how neurological disease might affect lower urinary tract function ( https://doi.org/10.1016/j.cont.2022.100022). Eleven conditions are covered. This includes five genetic conditions — Duchene muscular dystrophy, mitochondrial encephalopathy, Down's syndrome, adrenoleukodystrophy and Ochoa's syndrome. Three infection-associated conditions are covered including central nervous system tuberculosis, schistosomal myeloradiculopathy and post-polio syndrome. Three other conditions covered are myasthenia gravis, syringomyelia and the vegetative state. Key aspects and specific recommendations related to clinical practice are summarized in tables. Knowledge of unusual neurological conditions that can affect the lower urinary tract is important for ensuring a timely and precise diagnosis. This document from the ICS, along with Part I published earlier, can serve as a reference for clinicians presented with unusual forms of neurogenic lower urinary tract dysfunction.
Xanthomicrol: Effective therapy for cancer treatment
(2023) POORMOLAIE, N.; MOHAMMADI, M.; MIR, A.; ASADI, M.; KARAROUDI, A. N.; VAHEDIAN, V.; RASHIDI, M.; MAROUFI, N. F.
Cancer treatment is one of the main challenges of global health. For decades, researchers have been trying to find anti-cancer compounds with minimal side effects. In recent years, flavonoids, as a group of polyphenolic compounds, have attracted the attention of researchers due to their beneficial effects on health. Xanthomicrol is one of the flavonoids that has the ability to inhibit growth, proliferation, survival and cell invasion and ultimately tumor progression. Xanthomicrol, as active anti-cancer compounds, can be effective in the prevention and treatment of cancer. Therefore, the use of flavonoids can be suggested as a treatment along with other medicinal agents. It is obvious that additional investigations in cellular levels and animal models are still needed. In this review article, the effects of xanthomicrol on various cancers have been reviewed.
An Unusual Presentation of Tuberculosis in a Crohn's Disease Patient Treated With Anti-TNF
(2022) BARROS, L. L.; CARLOS, A. de Sousa; AZEVEDO, M. F. C. D.
In view of the increase in the therapeutic arsenal available for the treatment of inflammatory bowel disease in recent years, concerns about safety and side effects of immunosuppressive therapies have been increasingly common in clinical practice. The combination of thiopurines and anti-tumor necrosis factor agents exposes patients to greater risks of serious and opportunistic infection such as tuberculosis (TB). Here we report a case of a 38-year-old female with an 8-year history of a fistulizing ileocolonic and perianal Crohn's disease that developed TB on the tongue and disseminated during treatment with adalimumab and azathioprine. TB remains a global public health problem characterized by high morbidity and mortality worldwide. The reported case draws attention to an extremely unusual presentation of TB involving the tongue. TB should be included in the differential diagnosis of oral lesions in patients with inflammatory bowel disease, especially in endemic areas.
The Impact of the COVID-19 Pandemic on the Mental Health of Teachers and Its Possible Risk Factors: A Systematic Review
(2023) SANTIAGO, I. S. D.; SANTOS, E. P. dos; SILVA, J. A. da; CAVALCANTE, Y. de Sousa; JúNIOR, J. Gonçalves; COSTA, A. R. de Souza; CâNDIDO, E. L.
(1) Objective: The objective was to analyze the development of psychiatric pathologies/burnout syndrome and their possible risk factors in teachers in the context of the COVID-19 pandemic. (2) Methods: A qualitative systematic review was carried out, according to the PRISMA protocol, in the PubMed, Scopus, and Web of Science databases using a combination of the following descriptors [MeSH]: “mental health”, “mental disorders’’, “covid-19” and “school teachers’’. Articles selected were written in English, Portuguese and Spanish, published between November 2019 and December 2022. (3) Results: The most common psychiatric pathologies were generalized anxiety disorders and depression. Burnout syndrome was also quite prevalent. Of the 776 articles identified, 42 were selected after applying the eligibility criteria. Although there is variability among the analyzed studies, the risk factors most correlated with increased morbidity in teachers were: (i) being female; (ii) age below the fifth decade of life; (iii) pre-existence of chronic or psychiatric illnesses before the pandemic; (iv) difficulty in adapting to the distance education model; (v) family/work conflicts; (vi) negative symptoms caused by the pandemic. (4) Conclusions: Therefore, the COVID-19 impact on mental health appears to be more common in female teachers in their fifth decade of life and with pre-existing psychiatric comorbidities. However, prospective studies are needed to better map this situation.
Diabetic Foot Assessment and Care: Barriers and Facilitators in a Cross-Sectional Study in Bangalore, India
(2023) SUDHA, B. G.; UMADEVI, V.; SHIVARAM, J. M.; BELEHALLI, P.; SHEKAR, M. A.; CHALUVANARAYANA, H. C.; SIKKANDAR, M. Y.; BRIOSCHI, M. L.
(1) Background: This cross-sectional study aims to highlight the assessment and foot care practices in an advanced clinical setting, the clinical characteristics of the patients, and to understand the barriers and facilitators for effective foot care from the perspectives of healthcare practices, resources, and patients’ socioeconomic and cultural practices, and other aspects in terms of new technologies for effective foot care such as infrared thermography. (2) Methods: Clinical test data from 158 diabetic patients and a questionnaire to assess the foot care education retention rate were collected at the Karnataka Institute of Endocrinology and Research (KIER) facility. (3) Results: Diabetic foot ulcers (DFUs) were found in 6% of the examined individuals. Male patients were more likely to have diabetes complications, with an odds ratio (OR) of 1.18 (CI = 0.49–2.84). Other diabetes problems raised the likelihood of DFUs by OR 5 (CI = 1.40–17.77). The constraints include socioeconomic position, employment conditions, religious customs, time and cost, and medication non-adherence. The attitude of podiatrists and nurses, diabetic foot education, and awareness protocols and amenities at the facility were all facilitators. (4) Conclusions: Most diabetic foot complications might be avoided with foot care education, regular foot assessments as the standard of treatment, and self-care as a preventive/therapeutic strategy.
Recommendations and optimal approaches to robotic-assisted partial nephrectomy: A consensus of Brazilian experts
(2023) FARIA, E. F.; MOSCHOVAS, M. C.; VAZ, C.; POMPEO, A.; SANTOS, A.; STIEVANO, A.; BERGER, A.; CARNEIRO, A.; DOURADO, A.; COLOMBO, J. R.; PASSEROTTI, C.; ANDREONI, C.; FRAGA, C.; GUGLIELMETTI, G.; LEMOS, G.; GUIMARãES, G.; NOGUEIRA, L.; ROCHA, M.; MELO, P.; ARANTES, P.; ROMANELLI, P.; TOURINHO, R.; NISHIMOTO, R.; MACHADO, R.; REIS, R.; FROTA, R.; GUIDA, R.; DUBEUX, V.; GUALBERTO, R.; TOBIAS-MACHADO, M.
Objective: Robotic-assisted partial nephrectomy (RAPN) is established as the gold standard approach to treating small renal masses. However, numerous technical challenges and concepts related to this approach are still under discussion and are not consensus among surgeons from different centers. We performed an online questionnaire with multiple topics about RAPN and selected high-volume surgeons from referral centers in Brazil to achieve a consensus. Methods: We implemented an online consensus of 29 experts selected based on surgical expertise and competence in analyzing the published literature. Based on the collected literature and current Guidelines (NCCN, AUA, and EAU) we created a questionnaire with 131 questions and administered it to all participants. The statements and the Delphi technique design were combined in a single round of questions. The answers were reviewed, 70% of concordance was considered a consensus, and a final manuscript with recommendations was developed. Results: We divided our results into 25 subtopics that included all questions and discussions of the questionnaire, including preoperative settings, surgical technique, pathological analysis, technology use, and challenging cases. Some areas had limited data in the literature, and these potential limitations were addressed and discussed on each topic. Conclusion: RAPN is the standard surgical treatment for renal masses in the centers of robotic surgery. Among the important topics of this study, we recommend always performing the first RAPN cases with proctors’ assistance, conducting preoperative planning using good-quality imaging exams, minimizing the amount of renal parenchyma removed, and achieving appropriate hemostatic suture while reducing renal parenchyma ischemia.
Synergistic Effects of the Association of BR2 Peptide with 2-Aminoethyl Dihydrogen Phosphate on Triple-Negative Breast Cancer Cells
(2023) CABRAL, L. G. de Sousa; OLIVEIRA, C. S. de; ALVES, R. C. B.; OLIVEIRA, V. X. Jr.; POYET, J.-L.; MARIA, D. A.
Background: Breast cancer is one of the most common diseases among women worldwide. The triple negative subtype is the most aggressive, with low tumor-free survival and the worst clinical evolution, requiring the development of more effective and targeted therapies. The present study investigated the in vitro pharmacological effects of the association of BR2 peptide with 2-aminoethyl dihydrogen phosphate (2-AEH2P) on MDA-MB-231 and 4T1 triple-negative breast cancer cells. Methods: The physical-chemical analysis of the peptide was performed using the Heliquest software, the cell viability was assessed using the MTT colorimeter method and the predictive pharmacological effect was evaluated using the Synergy Finder software. Results: The results showed the BR2 tumor penetration peptide and the 2-AEH2P+BR2 association significantly increased cytotoxicity in the MDA MB-231 and 4T1 tumor lines, without compromising the viability of the normal fibroblastic cells. The results also showed that depending on the time and concentration, a synergistic effect was observed for the association with tumor cells, with a therapeutic window between 0.8 and 50µm for MDA-MB-231 tumor cells in 48h. Conclusion: The results demonstrated in vivo antitumor and antiproliferative efficiency for MDA-MB-231 and 4T1 tumor cells with low toxicity for normal fibroblast cells, with MDA MB-231 cells being more sensitive to treatments.
Profile of Maternal Mortality of COVID-19 in Ceará, in the Period of 2020
(2023) FRANCELINO, S. M. A.; BEZERRA, I. M. P.; ALVES, S. A. A.; LEITãO, F. N. C.; MORAIS, M. J. de Deus; RAMOS, J. L. S.; ROCHA, J. B. F. da; ANTUNES, T. P. C.; SMIDERLE, F. R. N.; ABREU, L. C. de
The aim of this paper is to describe the profile of maternal mortality of COVID-19 in the state of Ceará, Brazil, in the period 2020. Ecological, exploratory, cross-sectional study, with secondary data from the Influenza Epidemiological Surveillance Information System, were made available by the Obstetric Observatory Brazilian COVID-19. A total of 485 pregnant and postpartum women were included, and the analysis considered the notifications from the year 2020. The variables of interest and the outcome (death/cure by COVID-19) were analyzed in a descriptive way. Most pregnant and postpartum women were between 20 and 35 years old, brown/white skin color and residing in an urban area. The proportion of deaths was 5.8% in the year 2020. In that period, the rates of hospitalization in the ward increased by 95.5%, 12.6% of hospitalization in the Unit of Intensive Care (ICU), and 7.2% needed invasive ventilatory support. Maternal mortality from COVID-19 suggests an emergency in terms of the development of health actions and policies due to the aggravation and risks due to this disease.
Mercury Exposure in Women of Reproductive Age in Rondônia State, Amazon Region, Brazil
(2023) BELLO, T. C. S.; BURALLI, R. J.; CUNHA, M. P. L.; DóREA, J. G.; DIAZ-QUIJANO, F. A.; GUIMARãES, J. R. D.; MARQUES, R. C.
Environmental contamination by mercury (Hg) is a problem of global scale that affects human health. This study’s aim was to evaluate Hg exposure among women of reproductive age residing in the Madeira River basin, in the State of Rondônia, Brazilian Amazon. This longitudinal cohort study used linear regression models to assess the effects on Hg levels of breastfeeding duration at 6 months, and of breastfeeding duration and number of new children at 2-year and 5-year. Breastfeeding duration was significantly associated with maternal Hg levels in all regression models (6 months, 2 years and 5 years) and no significant association was observed between the number of children and the change in maternal Hg levels in the 2-year and 5-year models. This longitudinal cohort study evaluated Hg levels and contributing factors among pregnant women from different communities (riverine, rural, mining and urban) in Rondônia, Amazon Region, for 5 years. A well-coordinated and designed national biomonitoring program is urgently needed to better understand the current situation of Hg levels in Brazil and the Amazon.

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