N. Yaşar, B. Badak, M. Salış, F. Kar, Setenay Öner
{"title":"Can supplementation of tryptophan in parenteral nutrition increase melatonin and alleviate inflammatory response?","authors":"N. Yaşar, B. Badak, M. Salış, F. Kar, Setenay Öner","doi":"10.1590/1806-9282.20230826","DOIUrl":"https://doi.org/10.1590/1806-9282.20230826","url":null,"abstract":"SUMMARY OBJECTIVE: Endogenous melatonin is produced from tryptophan which is an essential amino acid. Besides its role in the regulation of sleep patterns, melatonin has anti-inflammatory effects. In this case-control study, we aimed to compare tryptophan and melatonin levels and their relationship with the inflammatory response, specifically serum interleukin-1, interleukin-6, and c-reactive protein levels following major abdominal surgery in patients with food restriction and who receive parenteral nutritional therapy. METHODS: We enrolled 40 patients between the ages of 18 and 65 years in the study. We collected blood and urine samples 48 h before the operation and on postoperative days 1, 3, and 5. RESULTS AND CONCLUSION: The tryptophan levels in the experimental group were higher than in the control group but failed to reach any statistical difference. Melatonin levels were increased in both groups following the surgery compared with preoperative levels. The increase in the experimental group was statistically different 3 days after the surgery. The difference in the level of interleukin-1 between the control and the experimental groups was greatest on postoperative day 3. On postoperative day 3, the interleukin-6 level in the treatment group was slightly higher than in the control group. We did not find any difference in the levels of c-reactive protein between the groups. As a result, the levels of tryptophan and melatonin were increased in the parenteral nutrition group, irrespective of the postoperative inflammatory response.","PeriodicalId":447105,"journal":{"name":"Revista da Associação Médica Brasileira","volume":"40 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140673091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Gul, Duygu Tozcu, A. Tekcan, Mustafa Capraz, Hatice Dortok Demir
{"title":"Serum adiponectin and peroxisome proliferator-activated receptors-γ levels in obese patients with and without prediabetes","authors":"M. Gul, Duygu Tozcu, A. Tekcan, Mustafa Capraz, Hatice Dortok Demir","doi":"10.1590/1806-9282.20231000","DOIUrl":"https://doi.org/10.1590/1806-9282.20231000","url":null,"abstract":"SUMMARY OBJECTIVE: Obesity is an increasingly prevalent global health problem, which is generally caused by the increase in body fat mass above normal and observed in all societies. If the blood glucose level is higher than normal but not high enough to diagnose diabetes, this condition is defined as prediabetes. Adiponectin increases fatty acid oxidation and insulin sensitivity and is closely associated with obesity. One of the nuclear receptor superfamily member peroxisome proliferator-activated receptors is shown to have an important role in various metabolic reactions. This study aimed to investigate the serum levels of adiponectin and peroxisome proliferator-activated receptors-gamma parameters, which are closely related to adipose tissue, energy metabolism, and insulin sensitivity, in obese patients with and without prediabetes. METHODS: For this purpose, 52 obese patients with prediabetes, 48 obese patients with non-prediabetes, and 76 healthy individuals were included in this study. Serum adiponectin and peroxisome proliferator-activated receptors-γ levels were analyzed by ELISA. RESULTS: Serum adiponectin levels were significantly higher in obese patients with prediabetes (18.15±15.99) compared with the control group (15.17±15.67; p=0.42). No significant difference was observed in both adiponectin and peroxisome proliferator-activated receptors-γ levels in the obese patients with the non-prediabetes group compared with the control group. However, no significant difference was observed in the obese patients with prediabetes group and obese patients with non-prediabetes group. CONCLUSION: Our results suggest that adiponectin may serve as an indicator of prediabetes. This implies that examining adiponectin levels in individuals diagnosed with prediabetes may enhance our understanding of the metabolic processes closely linked to prediabetes and related conditions.","PeriodicalId":447105,"journal":{"name":"Revista da Associação Médica Brasileira","volume":"65 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140675660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ela Erten, Umut Kara, F. Şimşek, Muharrem Öztaş, M. A. Süzer, Hasan Kamburoğlu, M. Burak Eskin, S. Şenkal, A. Çoşar
{"title":"Modified thoracoabdominal nerves block through perichondrial approach for laparoscopic cholecystectomy","authors":"Ela Erten, Umut Kara, F. Şimşek, Muharrem Öztaş, M. A. Süzer, Hasan Kamburoğlu, M. Burak Eskin, S. Şenkal, A. Çoşar","doi":"10.1590/1806-9282.20230962","DOIUrl":"https://doi.org/10.1590/1806-9282.20230962","url":null,"abstract":"SUMMARY OBJECTIVE: A new block, namely, modified thoracoabdominal nerves block through perichondrial approach, is administered below the costal cartilage. We sought to compare the analgesic efficacy of the modified thoracoabdominal nerves block through perichondrial approach block with local anesthetic infiltration at the port sites in an adult population who underwent laparoscopic cholecystectomy. METHODS: Patients who will undergo laparoscopic cholecystectomy were randomized to receive bilateral ultrasound-guided modified thoracoabdominal nerves block through perichondrial approach blocks or local anesthetic infiltration at the port insertion sites. The primary outcome was the total amount of tramadol used in the first 12 h postoperatively. The secondary outcomes were total IV tramadol consumption for the first postoperative 24 h and visual analog scale scores. RESULTS: The modified thoracoabdominal nerves block through perichondrial approach group had significantly less tramadol use in the first 12 h postoperatively (p<0.001). The modified thoracoabdominal nerves block through perichondrial approach group's visual analog scale scores at rest (static) and with movement (dynamic) were significantly lower compared with the port infiltration group (p<0.05). CONCLUSION: Patients who received modified thoracoabdominal nerves block through perichondrial approach block had significantly less analgesic consumption and better pain scores than those who received port-site injections after laparoscopic cholecystectomy.","PeriodicalId":447105,"journal":{"name":"Revista da Associação Médica Brasileira","volume":"62 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140675568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Evangely, the subcategorization has been announced in the 2023 Bethesda system for reporting thyroid cytopathology: let bygones be bygones in thyroidology!","authors":"I. Sengul, D. Sengul","doi":"10.1590/1806-9282.20231511","DOIUrl":"https://doi.org/10.1590/1806-9282.20231511","url":null,"abstract":"","PeriodicalId":447105,"journal":{"name":"Revista da Associação Médica Brasileira","volume":"32 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140677431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. D. Trabulus, M. Nazlı, E. Arslan, Ozlem Mermut, Fatih Dal, Bülent Akçe, R. U. Gursu, E. C. K. Talu, Jacqueline Nur Adira Couteau
{"title":"Predictors of recurrence in breast cancer patients with pathological partial response","authors":"F. D. Trabulus, M. Nazlı, E. Arslan, Ozlem Mermut, Fatih Dal, Bülent Akçe, R. U. Gursu, E. C. K. Talu, Jacqueline Nur Adira Couteau","doi":"10.1590/1806-9282.20231215","DOIUrl":"https://doi.org/10.1590/1806-9282.20231215","url":null,"abstract":"SUMMARY OBJECTIVE: Patients with residual disease after neoadjuvant chemotherapy have a relative risk of developing recurrence. This study investigates the risk factors for recurrence in locally advanced breast cancer patients with residual disease and evaluates survival analysis. METHODS: This is a retrospective, single-center study. Breast cancer patients who failed to achieve a pathological complete response after neoadjuvant chemotherapy were included. Demographic, clinicopathological, and treatment characteristics were evaluated to identify predictive factors of recurrence and survival analysis. RESULTS: We included 205 patients in this study. After a median of 31 months of follow-up, 10 patients died, and 20 developed distant metastasis. Disease-free survival and disease-specific survival were 73.8% and 83.1%, respectively. Lymphovascular invasion and non-luminal subtype were independent predictors of locoregional recurrence. In situ carcinoma, lymphovascular invasion, ypTIII stage, and non-luminal molecular subtypes were independent predictors of disease-free survival. The only independent factor affecting disease-specific survival was cNII–III. The number of involved lymph nodes was an independent predictor of disease-free survival in patients without complete axillary response. CONCLUSION: Factors affecting disease-specific survival and disease-free survival were cNII–III and the number of involved lymph nodes, respectively. Patients with non-luminal, large residual tumors with in situ carcinoma, lymphovascular invasion, clinically positive axilla, and residual nodal involvement have a high relative risk for recurrence and may benefit from additional treatments.","PeriodicalId":447105,"journal":{"name":"Revista da Associação Médica Brasileira","volume":"122 42","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140677719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Effect of obesity on mood regulation and eating attitudes in mental disorders","authors":"H. Baykan, Sinan Altunöz, Merve Şahin Can","doi":"10.1590/1806-9282.20231055","DOIUrl":"https://doi.org/10.1590/1806-9282.20231055","url":null,"abstract":"SUMMARY OBJECTIVE: The precise relationship between obesity and eating habits, attitudes, and emotion regulation is still ambiguous. The purpose of this study was to investigate possible correlations among body mass index, challenges related to managing emotions, and attitudes toward eating among adult participants with known psychiatric diagnoses. METHODS: The body mass indices of participants were calculated, and data on eating styles were collected using the Dutch Eating Behavior Questionnaire. The level of difficulty in managing emotions was evaluated using the Difficulties in Emotion Regulation Scale. RESULTS: The research findings indicated a meaningful positive association. An observation was made between body mass index and results from the Eating Attitude Test-40, as well as the restrained eating subdimension of the Dutch Eating Behavior Questionnaire. Conversely, a meaningful reverse relationship was identified between the scores of the \"strategies\" subdimension of the Difficulties in Emotion Regulation Scale. No meaningful differences in eating attitudes and emotion regulation were found between non-obese and obese patients. CONCLUSION: While a partial and meaningful correlation was observed among body mass index, eating attitudes, and emotion regulation difficulties, it is suggested that factors such as patients’ age, disease duration, current body mass index, and the simultaneous presence of depression and anxiety should be considered.","PeriodicalId":447105,"journal":{"name":"Revista da Associação Médica Brasileira","volume":"1 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140674559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Roman, F. Jalůvka, I. Sengul, D. Sengul, T. Jonszta, Pavel Hurník, Anton Pelikán, Václav Procházka
{"title":"The cystic adventitial disease of the popliteal artery: from imaging to histopathology","authors":"J. Roman, F. Jalůvka, I. Sengul, D. Sengul, T. Jonszta, Pavel Hurník, Anton Pelikán, Václav Procházka","doi":"10.1590/1806-9282.20231482","DOIUrl":"https://doi.org/10.1590/1806-9282.20231482","url":null,"abstract":"Cystic adventitial disease (CAD) is a rare non-atherosclerotic vascular disease, presenting with claudication symptoms usually in young males without any risk factors. Even though many cases have been described, the precise cause of this disease remains unknown. The incidence of CAD is 1:1200 calf claudication cases 1 . The disease causes myxomatous cystic tumor growth in the adventitial layer of a blood vessel, effectively causing external compression of the lumen and slowing down the blood flow. It mostly involves arteries, typically in (but not limited to) the popliteal region. However, it can also affect veins. Even though this disease can only be observed in asymptomatic patients, the only definitive treatment relies on surgical removal or marsupialization of the cyst. The following vignette case describes the clinical factors, treatment, and response of an adult who presented with a CAD of the popliteal artery. A 41-year-old white male, treated only for Klinefelter syndrome with testosterone substitution, presented with 14 days of claudication pain in the right calf. He reported pain, which occurred after a walking distance of 50–100 m and was accompanied by cold and pins-and-needles sensations in the affected area, without any limitation to movement or sensitivity. However, no similar problems had been experienced before-hand, and on examination, a colder right leg below the knee was revealed, with no palpable pulse in the popliteal area or more distally, with a positive Homans sign. The rest","PeriodicalId":447105,"journal":{"name":"Revista da Associação Médica Brasileira","volume":"45 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140672588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anna Karolinna Ribeiro Souza, Rhaissa Siqueira Sandes, Raquel Fernandes Vanderlei Vasco, Edoarda Vasco de Albuquerque Albuquerque
{"title":"Quality of sleep and excessive daytime sleepiness among medical students in a Brazilian private university","authors":"Anna Karolinna Ribeiro Souza, Rhaissa Siqueira Sandes, Raquel Fernandes Vanderlei Vasco, Edoarda Vasco de Albuquerque Albuquerque","doi":"10.1590/1806-9282.20231141","DOIUrl":"https://doi.org/10.1590/1806-9282.20231141","url":null,"abstract":"SUMMARY OBJECTIVE: The aim of this study was to assess medical students’ quality of sleep and excessive daytime sleepiness in different graduation cycles. METHODS: A cross-sectional study was carried out at a private university in Maceió, Brazil, from August 2021 to March 2022. The sample was composed of medical students aged 18 years and above from years 1–2 (basic cycle), 3–4 (clinical cycle), and 5–6 (internship) of Medical School who were invited to answer two validated questionnaires: the Pittsburgh Sleeping Quality Index and the Epworth Sleepiness Scale. RESULTS: A total of 179 students participated; most of them were female (78.2%), aged 19–25 years (73.7%), and with a body mass index<25 kg/m 2 (73.7%), with smaller participation from students from the basic cycle (21.2%). Analyzing the Pittsburgh Sleeping Quality Index, 55.9% of the students were classified as having poor sleep quality, with no difference in sleep category between gender, age, body mass index, and graduation cycle. Students with a body mass index of ≥25 kg/m 2 had longer sleep latency (p=0.016) and shorter sleep duration (p=0.027). The Epworth Sleepiness Scale assessment showed that 44.1% of the students exhibit daytime sleepiness. Women had more daytime sleepiness than men (p=0.017), with no difference between age, body mass index, and graduation cycle. CONCLUSION: About half of the medical students experience poor sleep quality and daytime sleepiness, regardless of the graduation cycle. This should trigger a targeted institutional intervention to promote better mental and physical health, as well as sleep hygiene, to reduce future health issues.","PeriodicalId":447105,"journal":{"name":"Revista da Associação Médica Brasileira","volume":"19 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140674761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Gram-stained smear in the diagnosis of acute urethritis: is it coming to an end?","authors":"M. Sarıer, Esin Kasap","doi":"10.1590/1806-9282.20231532","DOIUrl":"https://doi.org/10.1590/1806-9282.20231532","url":null,"abstract":"Acute urethritis is the most common infection of the male genital tract. Approximately 89 million new cases of non-gonococcal urethritis (NGU) and 62 million new cases of gonococcal ure-thritis (GU) are reported globally every year, and these numbers continue to increase 1 . Acute urethritis is most commonly caused by sexually transmitted pathogens. The three cardinal symptoms are urethral discharge, dysuria, and itching. The traditional diagnostic method for acute urethritis is a Gram-stained smear (GSS) of urethral discharge. GSS is widely used because it is of low cost and is easy to perform. Not only does GSS diagnose acute urethritis but it also allows the dichotomization of cases as GU caused by Neisseria gonorrhoeae with the detection of gram-negative diplococci or NGU in their absence 2 . However, GSS is a test susceptible to inter-and intra-observer errors. In the classical approach, the treatment of acute urethritis is managed through GSS. GSS inevitably leads the clinician to empirical treatment, especially in cases of NGU, as the specific identification of NGU pathogens by conventional methods is a long process. However, treatment failure occurs in up to 20% of NGU patients who receive empirical treatment based on the results of GSS 3 . Moreover, empirical treatment practices also contribute to the development of resistant strains. Antibiotic resistance in N. gonorrhoeae and Mycoplasma genitalium is a serious public health problem 4 , and M. genitalium alone is responsible for 41% of recurrent urethritis cases 5 . The","PeriodicalId":447105,"journal":{"name":"Revista da Associação Médica Brasileira","volume":"10 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140673552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lorrany da Silva Avanci, Thiago Guedes Pinto, Daniel Vitor de Souza, L. Mennitti, D. Ribeiro, L. Pisani
{"title":"Janus kinase-signal transducer and activator of transcription signaling pathway in the ocular cells of rat fetuses exposed to maternal saturated fat ingestion","authors":"Lorrany da Silva Avanci, Thiago Guedes Pinto, Daniel Vitor de Souza, L. Mennitti, D. Ribeiro, L. Pisani","doi":"10.1590/1806-9282.20231167","DOIUrl":"https://doi.org/10.1590/1806-9282.20231167","url":null,"abstract":"SUMMARY OBJECTIVE: The aim of this study was to analyze possible alterations (morphological and inflammatory) in the ocular cells of fetuses from mothers with insulin resistance exposed to saturated fatty acids through the period of pregnancy. METHODS: Wistar female rats were induced to develop insulin resistance before pregnancy. Fetuses' skulls were collected on the 20th day of intrauterine life. The rats were separated on the first day of management into two groups according to the diet applied: control group (C): diet containing soybean oil as a source of fat; and saturated fatty acid group (S): diet containing butter as a source of fat. RESULTS: Histological and immunohistochemical analyses have been conducted. The immunohistochemical analyses of interleukin 6, suppressor of cytokine signaling, 3 and signal transducer and activator of transcription 3 did not demonstrate alterations in the expression of proteins in the fetuses of mothers fed with a saturated fatty diet. Moreover, no histopathological changes were noticed between groups. CONCLUSION: The saturated fatty diet does not induce tissue changes or activate the Janus kinase/signal transducer and activator of transcription signaling pathway during eye development in the fetuses of mothers with insulin resistance.","PeriodicalId":447105,"journal":{"name":"Revista da Associação Médica Brasileira","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140677814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}