Revista da Associacao Medica Brasileira最新文献

{"title":"Healthcare compliance: pioneer experience in a public hospital.","authors":"Fabio Roberto Cabar, Matheus Abelo de Oliveira, Maria Luiza Gorga","doi":"10.1590/1806-9282.20221160","DOIUrl":"https://doi.org/10.1590/1806-9282.20221160","url":null,"abstract":"INTRODUCTION The judicialization of health is an irreversible reality not only for professionals, but also for public or private institutions, with an exponential increase in actions against public entities, hospitals, and professionals. Such actions can result in indemnification for alleged malpractice, accountability for various illegal acts, in addition to requiring the right to treatments, hospitalizations, and surgeries. The Brazilian National Council of Justice published a report showing a 130% increase in cases involving health-related aspects between 2008 and 2017, compared to a 50% increase in cases in general1. A detailed analysis identified that medications, orthotics, prostheses and auxiliary means, examinations, procedures, and hospitalization beds are the main causes related to the search for judicial guardianship. On the contrary, actions with allegations of medical error represented a higher number than the demands for transplants, for example. Another very sensitive subject is hospital mortality related to the occurrence of preventable adverse events. In a survey by the Institute for Supplementary Health Studies, it was demonstrated that mortality from this cause could be prevented in almost 40% of cases. In addition, the prevention of serious adverse events could provide fence one million beds for hospitalizations for other causes every year2. In addition to the direct and indirect damages caused to patients and families, there is undeniable and enormous financial damage, with the consequent misuse of resources that could be used in the treatment of other patients. Some of the possible causes of this situation may be the lack of hierarchical definitions, tolerance for individualistic measures and practices, poverty in available information, and fear of punishment. Adjunct to these aspects, conducts known to be unethical or even illegal can be taken in professional practice, which should not be seen as mere individual inappropriate conduct, but as systemic problems in hospital institutions3. In this scenario, it is evident that measures need to be adopted to try to prevent or reduce harm, such as the establishment of a non-punitive culture of care security, so that failures are seen as real opportunities for improvement, and the training of health professionals to know and use measures to prevent these failures. It is essential to make professionals aware of the consequences of harmful attitudes, even when they are routine and apparently harmless. As a result, it is urgent to implement a compliance culture in health practices.","PeriodicalId":21234,"journal":{"name":"Revista da Associacao Medica Brasileira","volume":"69 2","pages":"203-206"},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/46/81/1806-9282-ramb-69-02-0203.PMC9983469.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9155014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of protection of enoxaparin against experimental ischemia/reperfusion injury in the rat ovary on in vitro fertilization outcomes.","authors":"Mehmet Suhha Bostancı,&nbsp;Ozcan Budak,&nbsp;Hüseyin Çakiroğlu,&nbsp;Osman Köse,&nbsp;Özkan Durmaz,&nbsp;Erdem Cokluk","doi":"10.1590/1806-9282.20220385","DOIUrl":"https://doi.org/10.1590/1806-9282.20220385","url":null,"abstract":"<p><strong>Objective: </strong>The study aimed to investigate the protection of enoxaparin (E) against experimental ischemic (I) and ischemic-reperfusion (I/R) injury in rat ovaries on in vitro fertilization outcomes.</p><p><strong>Methods: </strong>In total, 56 adult female Sprague-Dawley albino rats were randomly assigned to 6 groups of 8 animals each: Sham, Ischemia, I/R, Sham+E, I+E, and I/R+E. Ischemia groups were subjected to bilateral adnexal torsion for 3 h. In contrast, I/R and I/R+E groups received subsequent detorsion for 3 h. Enoxaparin (0.5 mg/kg s.c.) was administered 30 min prior to ischemia (I+platelet-rich plasma) or reperfusion (I/R+I+platelet-rich plasma). Ovaries were stimulated through intraperitoneal injection of 150-300 internal units IU/kg pregnant mare serum gonadotropin. Anti-Müllerian hormone levels were measured before and after surgery in all groups.</p><p><strong>Results: </strong>When the number of metaphase II oocytes was evaluated, statistically significant differences were observed between the I and I+E (p=0.001) and I/R and I/R+E (p=0.000) groups. When both I and I+E groups and I/R and I/R+E groups were compared, it was found that E application increased the number of fertilized oocytes. The number of embryos on the second day was higher in the I/R+E group than that in the I/R group. Statistically significant differences were found in the number of grade 1 embryos between the I/R and I/R+E groups (p=0.003). In comparing anti-Müllerian hormone values within the group, the highest decrease was observed in the I and I/R groups.</p><p><strong>Conclusion: </strong>Enoxaparin effectively minimizes ovarian damage and preserves ovarian reserve following ovarian torsion.</p>","PeriodicalId":21234,"journal":{"name":"Revista da Associacao Medica Brasileira","volume":"69 3","pages":"380-385"},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/93/06/1806-9282-ramb-69-03-0380.PMC10004281.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9192302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular disease risk prediction in scleroderma.","authors":"Aliye Çelikkol,&nbsp;Rıdvan Mercan,&nbsp;Savaş Güzel,&nbsp;Ahsen Yılmaz","doi":"10.1590/1806-9282.20220936","DOIUrl":"https://doi.org/10.1590/1806-9282.20220936","url":null,"abstract":"<p><strong>Objective: </strong>Cardiovascular disease risk prediction in scleroderma is important. In this study of scleroderma patients, the aim was to investigate the relationship between cardiac myosin-binding protein-C, sensitive troponin T, and trimethylamine N-oxide and cardiovascular disease risk with the Systematic COronary Risk Evaluation 2 model of the European Society of Cardiology.</p><p><strong>Methods: </strong>Systematic COronary Risk Evaluation 2 risk groups of 38 healthy controls and 52 women with scleroderma were evaluated. Cardiac myosin-binding protein-C, sensitive troponin T, and trimethylamine N-oxide levels were analyzed with commercial ELISA kits.</p><p><strong>Results: </strong>In scleroderma patients, cardiac myosin-binding protein-C and trimethylamine N-oxide levels were higher than healthy controls but sensitive troponin T was not (p<0.001, p<0.001, and p=0.274, respectively). Out of 52 patients, 36 (69.2%) were at low risk, and the other 16 (30.8%) patients were at high-moderate risk with the Systematic COronary Risk Evaluation 2 model. At the optimal cutoff values, trimethylamine N-oxide could discriminate high-moderate risk with sensitivity 76%, specificity 86% and cardiac myosin-binding protein-C with sensitivity 75%, specificity 83%. Patients with high trimethylamine N-oxide levels (≥10.28 ng/mL) could predict high-moderate- Systematic COronary Risk Evaluation 2 risk 15 times higher than those with low trimethylamine N-oxide (<10.28 ng/mL) levels (odds ratio [OR]: 15.00, 95%CI 3.585-62.765, p<0.001). Similarly, high cardiac myosin-binding protein-C (≥8.29 ng/mL) levels could predict significantly higher Systematic COronary Risk Evaluation 2 risk than low cardiac myosin-binding protein-C (<8.29 ng/mL) levels (OR: 11.00, 95%CI 2.786-43.430).</p><p><strong>Conclusion: </strong>Noninvasive cardiovascular disease risk prediction indicators in scleroderma, cardiac myosin-binding protein-C, and trimethylamine N-oxide could be recommended to distinguish between high-moderate risk and low risk with the Systematic COronary Risk Evaluation 2 model.</p>","PeriodicalId":21234,"journal":{"name":"Revista da Associacao Medica Brasileira","volume":"69 2","pages":"246-251"},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a5/61/1806-9282-ramb-69-02-0246.PMC9983472.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9434175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transjugular intrahepatic portosystemic shunt in decompensated cirrhotic patients in a tertiary hospital in southern Brazil.","authors":"Carolina Moro Titton,&nbsp;Marcio Torikachvili,&nbsp;Heloísa M C Rêgo,&nbsp;Eduardo F Medronha,&nbsp;Enio Ziemiecki Junior,&nbsp;Carolina Ribas,&nbsp;Carlos Germano Ceratti,&nbsp;Angelo Alves de Mattos,&nbsp;Cristiane Valle Tovo","doi":"10.1590/1806-9282.20220944","DOIUrl":"https://doi.org/10.1590/1806-9282.20220944","url":null,"abstract":"<p><strong>Objective: </strong>The aim of the present study was to evaluate the outcomes of cirrhotic patients undergoing transjugular intrahepatic portosystemic shunt.</p><p><strong>Methods: </strong>A retrospective longitudinal observational study was carried out evaluating 38 cirrhotic patients undergoing transjugular intrahepatic portosystemic shunt. The outcomes were evaluated in an outpatient follow-up period of 3 months. The assumed significance level was 5%.</p><p><strong>Results: </strong>The indications for transjugular intrahepatic portosystemic shunt were refractory ascites in 21 (55.3%), variceal hemorrhage in 13 (34.2%), and hydrothorax in 4 (10.5%) patients. There was development of hepatic encephalopathy in 10 (35.7%) patients after transjugular intrahepatic portosystemic shunt. From the 21 patients with refractory ascites, resolution was observed in 1 (3.1%) patient, and in 16 (50.0%) patients, there was ascites control. Regarding transjugular intrahepatic portosystemic shunt after variceal bleeding, 10 (76.9%) patients remained without new bleeding or hospitalizations in the follow-up period. The global survival in the follow-up period in patients with and without hepatic encephalopathy was 60 vs. 82%, respectively (p=0.032).</p><p><strong>Conclusion: </strong>Transjugular intrahepatic portosystemic shunt can be considered in decompensated cirrhotic patients; however, the development of hepatic encephalopathy which can shorten survival should be focused.</p>","PeriodicalId":21234,"journal":{"name":"Revista da Associacao Medica Brasileira","volume":"69 4","pages":"e20220944"},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fb/f5/1806-9282-ramb-69-04-e20220944.PMC10176653.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9450205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of appendiceal neoplasms in 1,423 appendectomy specimens: a 10-year retrospective cohort study from a single institution.","authors":"Ahmet Rencuzogullari,&nbsp;Cihan Atar,&nbsp;Ugur Topal,&nbsp;İbrahim Coğal,&nbsp;Ahmet Gokhan Saritas,&nbsp;Orcun Yalav,&nbsp;Kubilay Dalci,&nbsp;İsmail Cem Eray","doi":"10.1590/1806-9282.20220714","DOIUrl":"https://doi.org/10.1590/1806-9282.20220714","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to reveal the incidence, clinicopathological, and oncological outcomes of appendiceal neoplasms.</p><p><strong>Methods: </strong>This is a retrospective cohort study from a single institution. Patients with a pathological diagnosis of malignancy who underwent appendectomy between January 2011 and 2021 were included in the study, and groups were formed according to pathological type. Clinical, pathological, and oncological results were compared in these groups.</p><p><strong>Results: </strong>The incidence of neoplasia was 2.38% (n=34) in a cohort of 1,423 appendectomy cases. Of the cases, 56% (n=19) were female. The median age in the entire cohort was 55.5 (range: 13-106) years. In the cohort, the rate of neuroendocrine tumor mucinous cystadenoma adenocarcinoma, and low-grade appendiceal mucinous neoplasm, according to the American Joint Committee on Cancer classification of appendiceal neoplasms, was 32.3% (n=11), 26.4% (n=9), 26.4% (n=9), and 14.7% (n=5), respectively. Neuroendocrine tumor patients (median age: 35 years) were younger than the other groups (p=0.021). Secondary complementary surgery was performed in 66.7% (n=6) of adenocarcinoma patients and 27.3% (n=3) of neuroendocrine tumor patients. Right hemicolectomy was performed in all neuroendocrine tumor patients requiring secondary surgery, while right hemicolectomy was performed in three adenocarcinoma patients and cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in three adenocarcinoma patients. After a median follow-up of 44.4 months (95% confidence interval: 18.6-70.1), the mean survival rate was 55% in appendiceal adenocarcinoma patients compared to 100% in neuroendocrine tumor patients.</p><p><strong>Conclusion: </strong>Appendiceal neoplasms are rare but remain an important cause of mortality. Appendiceal adenocarcinomas are associated with poorer oncological outcomes compared to other neoplasms.</p>","PeriodicalId":21234,"journal":{"name":"Revista da Associacao Medica Brasileira","volume":"69 5","pages":"e20220714"},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f9/0b/1806-9282-ramb-69-05-e20220714.PMC10204856.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9524941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Colic and sleep outcomes of nonpharmacological intervention in infants with infantile colic: systematic review and metaanalysis.","authors":"Doğan Çağrı Tanrıverdi,&nbsp;Aysu Yıldız Karaahmet,&nbsp;Fatma Şule Bilgiç","doi":"10.1590/1806-9282.20230071","DOIUrl":"https://doi.org/10.1590/1806-9282.20230071","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to systematically review the colic and sleep outcomes of nonpharmacological intervention in infants with infantile colic and perform a meta-analysis of the available evidence.</p><p><strong>Methods: </strong>The literature review for this systematic review was conducted between December 2022 and January 2023 using five electronic databases, namely PubMed, CINAHL, Scopus, Web of Science, and ULAKBİM. Published articles were scanned using MeSH-based keywords. Only randomized controlled trials conducted in the past 5 years were included. The data were analyzed using the Review Manager computer program.</p><p><strong>Results: </strong>This meta-analysis included three studies involving a total of 386 infantile colic infants. After nonpharmacological treatment, it was found that infants with infantile colic reduced crying time (standardized mean difference: 0.61; 95%CI 0.29-0.92; Z=3.79; p=0.00002), improved sleep duration (standardized mean difference: 0.22; 95%CI -0.04 to 0.48; Z=1.64; p=0.10), and decreased crying intensity (mean difference: -17.24; 95%CI -20.11 to 14.37; Z=11.77; p<0.000001).</p><p><strong>Conclusion: </strong>According to the meta-analysis findings, it was determined that the risk of bias was low in the studies included and that nonpharmacological chiropractic, craniosacral, and acupuncture treatments applied to infantile colic infants in the three included studies reduced crying time and intensity and increased sleep duration.</p>","PeriodicalId":21234,"journal":{"name":"Revista da Associacao Medica Brasileira","volume":"69 5","pages":"e20230071"},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/65/18/1806-9282-ramb-69-05-e20230071.PMC10204857.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9577123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive carbohydrate restriction: a new proposal for the diet mentality in the era of low-carb diets.","authors":"Jônatas de Oliveira","doi":"10.1590/1806-9282.20230601","DOIUrl":"https://doi.org/10.1590/1806-9282.20230601","url":null,"abstract":"Dear Editor, Low-carb diets have been considered again for weight loss in trials, and their spread goes hand in hand with the increase in unsupervised practices, as seen in intermittent fasting strategies1. Even if the results of controlled studies indicate more consistent results, the discussions also reach the lay public, who will make food choices, considering information dissipated on the Internet and by health professionals2. Feinman et al. evaluated an online support forum with 86,000 members discussing lowcarb, “Active Low-Carber Forums3,” and recently investigated this practice among university students in Brazil. In 2018, 25% of students practiced low-carb4. However, analyses of this behavioral profile and how food choices are made still lack appropriate methodologies to understand the low-carb phenomenon. Considering all the information and the various types of low-carb diets1, how do these people plan their eating behaviors to ensure this restriction? In other words, eating attitudes (i.e., thoughts, beliefs, and feelings), specifically about the food source of this macronutrient, are elements of choice that determine consumption. Considering this problem, we adapted the cognitive restriction subscale of the Three Factor Eating Questionnaire, which assesses how willing, in terms of thoughts and behaviors, individuals are to restrict food in order to change shape and body weight5. The change was to identify this carbohydrate-directed diet mindset6. An example is question #3, “I do not eat some foods because they make me fat,” which was adapted to “I do not eat some foods (source of carbohydrates) because they make me fat.” Low-carb dieters showed more remarkable cognitive restraint and more significant cognitive restriction of carbohydrates compared to non-dieters. Nevertheless, the overall score for cognitive restraint on carbohydrates correlated positively with guilt for food cravings in low-carb dieters7. These findings indicate that unsupervised and popularly advertised diets will not always be aligned with healthy eating behavior, requiring further studies regarding diet mentality and other ways of thinking about food from an attitudinal point of view, which can be worked on in psychoeducational proposals and treatment programs.","PeriodicalId":21234,"journal":{"name":"Revista da Associacao Medica Brasileira","volume":"69 8","pages":"e20230601"},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/86/f9/1806-9282-ramb-69-08-e20230601.PMC10427171.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10103453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comments on \"Comparison of the outcomes of flexible ureteroscopy and mini-percutaneous nephrolithotomy for the treatment of kidney stones: a matched-pair analysis\".","authors":"André Pontes-Silva","doi":"10.1590/1806-9282.20221429","DOIUrl":"https://doi.org/10.1590/1806-9282.20221429","url":null,"abstract":"In the article entitled “Comparison of the outcomes of flexible ureteroscopy and mini-percutaneous nephrolithotomy for the treatment of kidney stones: a matched-pair analysis,” Rodrigues et al. 1 compared the outcomes of initial mini-percutaneous nephrolithotomy and flexible ureteroscopy. This study has scientific relevance; however, it did not answer an important question: does statistical significance (p<0.05) have clinical importance? A comparison of outcomes must consider the clinical relevance of the differences because the","PeriodicalId":21234,"journal":{"name":"Revista da Associacao Medica Brasileira","volume":"69 2","pages":"215"},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d1/9f/1806-9282-ramb-69-02-0215.PMC9983478.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9153989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endofibrosis as a cause of peripheral artery disease: a comprehensive review and proposal of two novel algorithms for diagnosis and treatment.","authors":"Tereza Mazurová,&nbsp;Ilker Sengul,&nbsp;Daniel Toman,&nbsp;Anton Pelikán,&nbsp;Demet Sengul,&nbsp;Miloslav Mazur,&nbsp;Petr Vávra,&nbsp;Václav Procházka","doi":"10.1590/1806-9282.20221374","DOIUrl":"https://doi.org/10.1590/1806-9282.20221374","url":null,"abstract":"INTRODUCTION Endofibrosis is a rare condition affecting blood vessels, occurring mainly among young healthy athletes. This condition arises as progressive stenosis of the iliac arteries, which attenuates the blood circulation of the limb, thus leading to pain during movement. Iliac artery compression was first described in 1984 among professional cyclists1. Some authors have reported that up to 10–20% of top athletes are affected2,3. Endofibrosis is one of the rare causes of peripheral artery disease, in which the exact prevalence is unknown, possessing no any accurate data. This comprehensive review is purposed to sum up the current knowledge of endofibrosis and ensure concise information about its etiology, and diagnostic and treatment modalities. In addition, two cases including imagery are purposed to be presented to illustrate the perioperative findings.","PeriodicalId":21234,"journal":{"name":"Revista da Associacao Medica Brasileira","volume":"69 2","pages":"352-356"},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a0/fd/1806-9282-ramb-69-02-0352.PMC9983487.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9153992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fetal thymus in growth-restricted fetuses due to placental insufficiency.","authors":"Marisa Akemi Takeno,&nbsp;Roseli Mieko Yamamoto Nomura","doi":"10.1590/1806-9282.20220975","DOIUrl":"https://doi.org/10.1590/1806-9282.20220975","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to assess fetal thymus size by ultrasound in growth-restricted fetuses due to placental insufficiency and compare to high-risk and low-risk pregnancy fetuses with normal placental function.</p><p><strong>Methods: </strong>This is a nested case-control study of pregnant women followed up at a university hospital (July 2012 to July 2013). In all, 30 pregnant women presenting small fetuses for gestational age (estimated fetal weight <p10) due to placental insufficiency (umbilical artery Doppler >p95) were compared to 30 high-risk and 30 low-risk pregnancies presenting normal Doppler indices. The thymus transverse diameter and perimeter were converted into zeta score according to the normal values for gestational age. Head circumference and femur length were used to calculate ratios.</p><p><strong>Results: </strong>Fetal thymus were significantly lower in pregnancies with placental insufficiency when compared to high-risk and low-risk pregnancies presenting, respectively, transverse diameter zeta score (-0.69±0.83 vs. 0.49±1.13 vs. 0.83±0.85, p<0.001) and P zeta score (-0.73±0.68 vs. 0.45±0.96 vs. 0.26±0.89, p<0.001). There was also a significant difference (p<0.05) in the ratios among the groups: pregnancies with placental insufficiency (TD/HC=0.10, P/FL=1.32, and P/HC=0.26), high-risk pregnancies (TD/HC=0.11, P/FL=1.40, and P/HC=0.30), and control group (DT/HC=0.11, P/FL=1.45, and P/HC=0.31).</p><p><strong>Conclusion: </strong>Fetal thymus size is reduced in growth-restricted fetuses due to placental insufficiency, suggesting fetal response as a consequence of the adverse environment.</p>","PeriodicalId":21234,"journal":{"name":"Revista da Associacao Medica Brasileira","volume":"69 1","pages":"136-141"},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/17/8e/1806-9282-ramb-69-01-0136.PMC9937593.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10834924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}