Revista da Associacao Medica Brasileira最新文献

{"title":"Perception of newly graduated physicians toward ethical education in medical schools: a Brazilian cross-sectional nationwide study.","authors":"Gustavo Rosa Gameiro,&nbsp;Giovana Rosa Gameiro,&nbsp;Bruno Alonso Miotto,&nbsp;Aline Gil Alves Guilloux,&nbsp;Alex Jones Flores Cassenote,&nbsp;Mario César Scheffer","doi":"10.1590/1806-9282.20230108","DOIUrl":"https://doi.org/10.1590/1806-9282.20230108","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to evaluate fresh medical graduates' perceptions regarding the general aspects of ethics teaching in Brazilian medical schools.</p><p><strong>Methods: </strong>A structured questionnaire was applied to 4,601 participants among the 16,323 physicians who registered in one of the 27 Regional Medical Councils of Brazil in 2015. Answers to four questions regarding general aspects of ethics education in medical school were analyzed. Sampling procedures involved two stratification variables: legal nature (public vs. private) of medical schools and monthly household income higher than 10 minimum wages.</p><p><strong>Results: </strong>A large percentage of the participants had witnessed unethical behaviors during contact with patients (62.0%), toward coworkers (51.5%), and in relationships with patients' families (34.4%) over the course of their medical training. Even though most of the responders (72.0%) totally agreed that patient-physician relationship and humanities education were part of their medical school curriculum, important topics such as conflicts of interest and end-of-life education were not satisfactorily addressed in the participants' medical training. Statistically significant differences were found between the answers of public and private school graduates.</p><p><strong>Conclusion: </strong>Despite great efforts to improve medical ethics education, our findings suggest the persistence of deficits and inadequacies in the ethics training currently given in medical schools in Brazil. Further modifications in ethics training must be made to address the deficiencies shown in this study. This process should be accompanied by continuous evaluation.</p>","PeriodicalId":21234,"journal":{"name":"Revista da Associacao Medica Brasileira","volume":"69 6","pages":"e20230108"},"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/e0/f8/1806-9282-ramb-69-06-e20230108.PMC10241081.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9652501","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":"The use of esketamine in the treatment of patients with oral antidepressant-resistant depression: systematic review and meta-analysis.","authors":"Idevaldo Floriano,&nbsp;Antônio Silvinato,&nbsp;Wanderley Marques Bernardo","doi":"10.1590/1806-9282.2023D696","DOIUrl":"https://doi.org/10.1590/1806-9282.2023D696","url":null,"abstract":"<p><p>The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field to standardize how to conduct, and to assist in the reasoning and decision-making of doctors. The information provided by this project must be critically evaluated by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical condition of each patient. Guideline conclusion: April 2023. Societies: Brazilian Medical Association.</p>","PeriodicalId":21234,"journal":{"name":"Revista da Associacao Medica Brasileira","volume":"69 6","pages":"e2023D696"},"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/30/26/1806-9282-ramb-69-06-e2023D696.PMC10305833.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9729737","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":"Hereditary thrombophilia and low -molecular -weight heparin in women: useful determinants, including thyroid dysfunction, incorporating the management of treatment and outcomes of the entity.","authors":"Stefan Dugalic,&nbsp;Milica Petronijevic,&nbsp;Demet Sengul,&nbsp;Dzenana A Detanac,&nbsp;Ilker Sengul,&nbsp;Eduardo Carvalho de Arruda Veiga,&nbsp;Tamara Stanisavljevic,&nbsp;Maja Macura,&nbsp;Jovana Todorovic,&nbsp;Miroslava Gojnic","doi":"10.1590/1806-9282.20221445","DOIUrl":"https://doi.org/10.1590/1806-9282.20221445","url":null,"abstract":"<p><strong>Objective: </strong>Our study purposed to examine the complex relationship between low-molecular-weight heparin therapy, multiple pregnancy determinants, and adverse pregnancy outcomes during the third trimester in women with inherited thrombophilia.</p><p><strong>Methods: </strong>Patients were selected from a prospective cohort of 358 pregnant patients recruited between 2016 and 2018 at the Clinic for Obstetrics and Gynecology, University Clinical Centre of Serbia, Belgrade.</p><p><strong>Results: </strong>Gestational age at delivery (β=-0.081, p=0.014), resistance index of the umbilical artery (β=0.601, p=0.039), and D-dimer (β=0.245, p<0.001) between 36th and 38th weeks of gestation presented the direct predictors for adverse pregnancy outcomes. The model fit was examined using the root mean square error of approximation 0.00 (95%CI 0.00-0.18), the goodness-of-fit index was 0.998, and the adjusted goodness-of-fit index was 0.966.</p><p><strong>Conclusion: </strong>There is a need for the introduction of more precise protocols for the assessment of hereditary thrombophilias and the need for the introduction of low-molecular-weight heparin.</p>","PeriodicalId":21234,"journal":{"name":"Revista da Associacao Medica Brasileira","volume":"69 2","pages":"335-340"},"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/f8/5d/1806-9282-ramb-69-02-0335.PMC9983488.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9136752","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":"Effects of maternal anxiety on fetal and maternal circulation.","authors":"Tiago Ferreira Jorge,&nbsp;Roseli Mieko Yamamoto Nomura","doi":"10.1590/1806-9282.20221011","DOIUrl":"https://doi.org/10.1590/1806-9282.20221011","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to evaluate the association between maternal anxiety in the third trimester and changes in fetal and maternal circulation assessed by Doppler velocimetry.</p><p><strong>Methods: </strong>This is a prospective, cross-sectional study. The inclusion criteria were good health, a singleton pregnancy, maternal age between 18 and 40 years, and gestational age between 34 and 40 weeks. Doppler measurements included mean uterine artery pulsatility index, fetal middle cerebral artery pulsatility index, peak of systolic velocity, umbilical artery, and umbilical vein. The Beck Anxiety Inventory questionnaire, validated for the Brazilian population, with 21 self-reported items, was applied.</p><p><strong>Results: </strong>The study included 34 pregnant women, and 6 (17.7%) presented a total Beck Anxiety Inventory score showing moderate or severe maternal anxiety. The mean maternal age was 28.1 years (SD 5.7 years); the mean gestational age at interview was 36.5 weeks (SD 1.8 weeks), and the mean Beck Anxiety Inventory total score was 12.3 (SD 9.8). The group with moderate or severe anxiety, compared to the group with minimal or mild anxiety, presented an association with lower maternal age (median 21.5 vs. 29.5 years, p=0.019), lower fetal umbilical vein blood flow (median 189.4 vs. 249.5 mL/min, p=0.047), and lower umbilical vein-corrected blood flow (median 68.5 vs. 84.9 mL/kg/min, p=0.038).</p><p><strong>Conclusion: </strong>Maternal anxiety may affect fetal circulation patterns in late pregnancy and is associated with reduced blood flow in the fetal umbilical vein. The underlying physiopathology needs further investigation.</p>","PeriodicalId":21234,"journal":{"name":"Revista da Associacao Medica Brasileira","volume":"69 3","pages":"410-414"},"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/12/10/1806-9282-ramb-69-03-0410.PMC10004293.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9138701","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":"\"The road to hell is paved with good intentions\" - the cognitive bias of immobility in in-patients at risk of falling.","authors":"Cassiano Teixeira","doi":"10.1590/1806-9282.20221310","DOIUrl":"https://doi.org/10.1590/1806-9282.20221310","url":null,"abstract":"Patient falls are one of the most common adverse events reported in hospitals1. Although preventable hospital falls have been decreasing over the past years, approximately 1 in 10 falls results in serious injury2. Besides, inpatient falls can result in significant physical and economic burdens to the patients (increased injury and mortality rates and decreased quality of life) and to medical organizations (increased length of stay, medical care costs, and litigation)1,2. Consistent concerns aimed at reducing this problem have led hospitals to adopt very heterogeneous guidelines for fall prevention3. These guidelines usually include (1) identification of patients who are at high risk of falling and (2) decisions to which attitude of fall prevention strategies to use to reduce fall risk1,2. However, this approach may had led to a confused “correct approach” to fall prevention in specific settings, since the lack of clarity of prevention guidelines may add to the cognitive burden of patient care and potentially increases in-hospital patient risk. First, the use of fall risk prediction tools is widespread, but their value in hospital fall prevention interventions is questionable4. In this context, it is important to distinguish between fall risk assessments and fall prediction or screening tools. Risk assessments usually consist of a checklist of risk factors for falls but do not provide a score or value for the patient’s fall risk1. The lack of evidence supporting the use of predictive tools led National Institute for Health and Care Excellence and the Agency for Healthcare Research and Quality to recommend a caution in the routine use of fall prediction tools1. Despite this, fall risk screening tools are frequently used to identify patients for intervention and are recommended and required by Healthcare International Quality Agencies5. Second, falls in hospitals are different from falls in general, community-dwelling adult populations3. Inconsistencies in risk factors for falls have been identified between hospitalized and nonhospitalized older adult populations1. The hospitalized patients are in unfamiliar environments and routines; present pain; are commonly under the influence of psychotropic drugs, anesthetics, or opioid analgesics; are connected to drains, tubes, or venous catheters; and have a loss of locus of control in performance of personal activities and a physical dependency on staff. In this context, a recent meta-analysis identifies 11 risk factors for falls in hospitalized patients with cancer, including age, history of falls, opiates, benzodiazepines, steroids, antipsychotics, sedatives, radiation therapy, chemotherapy, the use of an assistive device, and length of hospitalization6. Another problem is that the trials have not preferentially evaluated hospitalized patients1,3. When evaluated only hospitalized patients, there were no significant reduction of risk of falls and combined clinic-level quality improvement strategies, patie","PeriodicalId":21234,"journal":{"name":"Revista da Associacao Medica Brasileira","volume":"69 3","pages":"365-366"},"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/74/71/1806-9282-ramb-69-03-0365.PMC10004290.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9162070","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":"Association between antibiotic prophylaxis and adverse perinatal outcomes in premature rupture of membranes.","authors":"Thaísa de Souza Lima,&nbsp;Flávia Mariane Pagani,&nbsp;Carolina Bianchini Borges,&nbsp;Caetano Galvão Petrini,&nbsp;Marina Carvalho Paschoini,&nbsp;Edward Araújo Júnior,&nbsp;Alberto Borges Peixoto","doi":"10.1590/1806-9282.20211299","DOIUrl":"https://doi.org/10.1590/1806-9282.20211299","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to evaluate the association between antibiotic prophylaxis and adverse perinatal outcomes in premature rupture of membranes.</p><p><strong>Methods: </strong>This retrospective cohort included pregnant women with premature rupture of membranes (between 24 and 33+6 weeks) who used or did not use prophylactic antibiotics. Pearson's chi-square (χ²) test, Student's t-test, and binary logistic regression were used for statistical analysis.</p><p><strong>Results: </strong>A significant effect was observed in patients with premature rupture of membranes using prophylactic antibiotics regarding amniotic fluid index (p=0.007), deepest vertical pocket (p=0.049), duration of antibiotic therapy (p≤0.001), C-reactive protein level upon admission (p≤0.001), leukocyte count upon admission (p=0.007), and length of stay in neonatal intensive care (p=0.047). A significant association was observed between the abovementioned patients and surfactant use during the neonatal period (p=0.04). A higher prevalence of surfactant use was noted in these patients (20.0 vs. 8.7%; p=0.04).</p><p><strong>Conclusion: </strong>No association was found between antibiotic prophylaxis and the presence of adverse perinatal outcomes in pregnant women with premature rupture of membranes between 24 and 33+6 weeks of gestation.</p>","PeriodicalId":21234,"journal":{"name":"Revista da Associacao Medica Brasileira","volume":"69 1","pages":"24-29"},"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/3d/0f/1806-9282-ramb-69-01-0024.PMC9937626.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9325142","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":"The effect of positron emission tomography/computed tomography in axillary surgery approach after neoadjuvant treatment in breast cancer.","authors":"Ecem Memişoğlu,&nbsp;Ramazan Sarı","doi":"10.1590/1806-9282.20220097","DOIUrl":"https://doi.org/10.1590/1806-9282.20220097","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to determine the role of positron emission tomography/computed tomography in the decision to perform axillary surgery by comparing positron emission tomography/computed tomography findings with pathology consistency after neoadjuvant chemotherapy.</p><p><strong>Methods: </strong>Patients who were diagnosed for T1-4, cN1/2 breast cancer receiving neoadjuvant chemotherapy in our clinic between January 2016 and February 2021 were evaluated. Clinical and radiological responses, axillary surgery, and histopathological results after neoadjuvant chemotherapy were evaluated.</p><p><strong>Results: </strong>Axillary involvement was not detected in positron emission tomography/computed tomography after neoadjuvant chemotherapy in 140 (60.6%) of 231 node-positive patients. In total, 88 (62.8%) of these patients underwent sentinel lymph node biopsy, and axillary lymph node dissection was performed in 29 (33%) of these patients upon detection of 1 or 2 positive lymph nodes. The other 52 (37.1%) patients underwent direct axillary lymph node dissection, and no metastatic lymph nodes were detected in 33 (63.4%) patients. No metastatic lymph node was found pathologically in a total of 92 patients without involvement in positron emission tomography/computed tomography, and the negative predictive value was calculated as 65.7%. Axillary lymph node dissection was performed in 91 (39.4%) patients with axillary involvement in positron emission tomography/computed tomography after neoadjuvant chemotherapy. Metastatic lymph nodes were found pathologically in 83 of these patients, and the positive predictive value was calculated as 91.2%.</p><p><strong>Conclusion: </strong>Positron emission tomography/computed tomography was found to be useful in the evaluation of clinical response, but it was not sufficient enough to predict a complete pathological response. When planning axillary surgery, axillary lymph node dissection should not be decided only with a positive positron emission tomography/computed tomography. Other radiological images should also be evaluated, and a positive sentinel lymph node biopsy should be the determinant of axillary lymph node dissection.</p>","PeriodicalId":21234,"journal":{"name":"Revista da Associacao Medica Brasileira","volume":"69 1","pages":"37-43"},"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/78/6d/1806-9282-ramb-69-01-0037.PMC9937613.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9325143","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":"Comparison of pain levels developed during intramuscular injections to laterofemoral and ventrogluteal regions in children: a randomized controlled study.","authors":"Serap Balci,&nbsp;Birsen Bilgen Sivri","doi":"10.1590/1806-9282.20220770","DOIUrl":"https://doi.org/10.1590/1806-9282.20220770","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to compare the levels of pain developed during intramuscular injections to the laterofemoral and ventrogluteal regions in children.</p><p><strong>Methods: </strong>The study population consisted of all children aged between 7 and 12 years who presented to the pediatric emergency clinic of a hospital. The sample consisted of 62 children who met the inclusion criteria and agreed to participate in the study, and the children were randomly assigned to each group (laterofemoral n=31, ventrogluteal n=31). \"Buzzy\" and \"deep breathing\" were applied to children in both groups to relieve pain during the procedure. The data were obtained using an Information Form, a visual analog scale, and the Facial Pain Scale-Revised.</p><p><strong>Results: </strong>It was determined that the children in the ventrogluteal group during the intramuscular injections had lower visual analog scale and faces pain scale-revised scores immediately after the procedure compared with the vastus lateralis group, that is, they experienced less pain, and the difference between the two groups was significant (p<0.001).</p><p><strong>Conclusion: </strong>In children, it is recommended to choose the less painful ventrogluteal region for intramuscular injection and to inform health professionals about it.</p>","PeriodicalId":21234,"journal":{"name":"Revista da Associacao Medica Brasileira","volume":"69 1","pages":"85-89"},"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/7f/bd/1806-9282-ramb-69-01-0085.PMC9937611.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9325145","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 candesartan treatment on echocardiographic indices of cardiac remodeling in post-myocardial infarction patients.","authors":"Hüseyin Tezcan,&nbsp;Abdullah Tunçez,&nbsp;Kenan Demir,&nbsp;Bulent Behlül Altunkeser,&nbsp;Nazif Aygül,&nbsp;Muhammed Ulvi Yalcin,&nbsp;Muhammed Salih Ates,&nbsp;Canan Aydoğan,&nbsp;Onur Can Polat,&nbsp;Aslıhan Merve Toprak","doi":"10.1590/1806-9282.20220720","DOIUrl":"https://doi.org/10.1590/1806-9282.20220720","url":null,"abstract":"<p><strong>Objective: </strong>Myocardial infarction has unfavorable effect on structural and functional properties of the myocardium, referred to as cardiac remodeling. Left ventricular mass, left ventricular mass index, and relative wall thickness are important predictors of cardiac remodeling. In this study, we investigated the effect of candesartan treatment in comparison with zofenopril treatment on echocardiographic indices of cardiac remodeling in post myocardial infarction patients.</p><p><strong>Material and methods: </strong>In this prospective study, patients who underwent successful percutaneous coronary intervention were randomly assigned to a candesartan or zofenopril treatment. After randomization, echocardiographic indices of cardiac remodeling including left ventricular mass, left ventricular mass index, and relative wall thickness were evaluated before the start of treatment along with 1- and 6-month follow-ups.</p><p><strong>Results: </strong>According to our study, candesartan group showed significant reduction of estimated left ventricular mass and left ventricular mass index at 6-month follow-up visit compared to baseline values (199.53±38.51 g vs. 212.69±40.82 g; 99.05 g/m2 (90.00-116.5) vs. 106.0 g/m2 (96.0∼123.00), p<0.05, respectively). This trend was also observed in zofenopril group during the 6-month period (201.22±40.07 g vs. 207.52±41.61 g; 101.0 g/m2 (92.25-111.75.0) vs. 104.50 g/m2 (95.0∼116.75), p<0.05, respectively). Although both classes of drugs had favorable effects on post-myocardial infarction cardiac remodeling, the absolute benefit was more prominent in candesartan group as compared to zofenopril group (p<0.05).</p><p><strong>Conclusion: </strong>Our results suggest that candesartan treatment following myocardial infarction may potentially be useful in terms of improving post-myocardial infarction cardiac remodeling.</p>","PeriodicalId":21234,"journal":{"name":"Revista da Associacao Medica Brasileira","volume":"69 1","pages":"78-84"},"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/26/69/1806-9282-ramb-69-01-0078.PMC9937609.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9325146","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":"Immunoadsorption therapy in refractory heart failure patients with dilated cardiomyopathy: a potential therapeutic option.","authors":"Yuksel Cavusoglu,&nbsp;Senan Tahmazov,&nbsp;Selda Murat,&nbsp;Olga Meltem Akay","doi":"10.1590/1806-9282.20220784","DOIUrl":"https://doi.org/10.1590/1806-9282.20220784","url":null,"abstract":"SUMMARY OBJECTIVE: Removal of cardiac autoantibodies by immunoadsorption might confer clinical improvement in dilated cardiomyopathy. In this pilot study, we investigated the efficacy and safety of immunoadsorption therapy in refractory heart failure patients with dilated cardiomyopathy. METHODS: This study consisted of 9 heart failure patients with dilated cardiomyopathy, NYHA III-IV, left ventricular ejection fraction <30%, unresponsive to heart failure therapy, and with cardiac autoantibodies. Patients underwent immunoadsorption therapy for five consecutive days using a tryptophan column. Changes in cardiac function (left ventricular ejection fraction, left ventricular end-diastolic diameter, left ventricular end-systolic diameter), exercise capacity (6-minute walk distance), neurohormonal (N-terminal pro-brain natriuretic peptide), proinflammatory (high-sensitive C-reactive protein), and myocardial (cardiac troponin-I), biochemical, and hematological variables were obtained at baseline and after 3 and 6 months of immunoadsorption therapy. RESULTS: Mean left ventricular ejection fraction and 6-minute walk distance significantly increased at 3 months (from 23.27±5.09 to 32.1±1.7%, p=0.01 for left ventricular ejection fraction and from 353±118 to 434±159 m, p=0.04 for 6-minute walk distance) and further increased at 6 months after immunoadsorption therapy (to 34.5±7.7%, p=0.02 for ejection fraction and to 441±136 m, p=0.04 for 6-minute walk distance). NT-proBNP level reduced from 1161(392.8–3034) to 385(116.1–656.5) ng/L (p=0.04), and high-sensitive C-reactive protein decreased from 9.74±0.96 to 4.3±5.8 mg/L (p=0.04) at 6 months. Left ventricular end-diastolic diameter (66.1±5.8 vs. 64.7±8.9 mm) and left ventricular end-systolic diameter (56.1±8.6 vs. 52.3±10.8 mm) tended to decrease but did not reach statistical significance. No significant worsening was observed in creatinine, cardiac troponin-I, and hemoglobin levels after the immunoadsorption procedure. CONCLUSION: In dilated cardiomyopathy patients with refractory heart failure, immunoadsorption may be considered a potentially useful therapeutic option to improve a patient's clinical status.","PeriodicalId":21234,"journal":{"name":"Revista da Associacao Medica Brasileira","volume":"69 1","pages":"90-96"},"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/ee/ec/1806-9282-ramb-69-01-0090.PMC9937600.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9325148","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}