Einstein-Sao Paulo最新文献

{"title":"COVID-19 pandemic-driven evolution of Klebsiella pneumoniae: rising resistance, genetic diversity, and virulence in a Brazilian tertiary hospital.","authors":"Romário Oliveira de Sales, Laura Leaden, Paula Célia Mariko Koga, André Mario Doi, Letícia Busato Migliorini, Alexandra do Rosario Toniolo, Fernando Gatti de Menezes, Marines Dalla Valle Martino, Patricia Severino","doi":"10.31744/einstein_journal/2026AO1627","DOIUrl":"10.31744/einstein_journal/2026AO1627","url":null,"abstract":"<p><strong>Objective: </strong>Coronavirus disease 2019 (COVID-19) caused increased intensive care unit admissions, invasive procedures, and antimicrobial use, potentially worsening bacterial infections and multidrug resistance. Retrospective studies have found that Klebsiella pneumoniae co-infections in COVID-19 patients were significant and possibly linked to mechanical ventilation and central catheter placement. In the present study, we assessed the genetic diversity and antimicrobial resistance of K. pneumoniae isolates collected before and during the pandemic to evaluate the effect of the pandemic on these factors.</p><p><strong>Methods: </strong>Antimicrobial resistance profiling, whole-genome sequencing, and phylogenetic analyses were used to examine resistance patterns, genetic diversity, and mobile genetic elements.</p><p><strong>Results: </strong>From January 2018 to January 2021, 263 K. pneumoniae isolates were identified from infection sites. Carbapenem-resistant isolates increased from 32.5% in 2019 to 60.3% in 2020, remaining stable until January 2021. Nevertheless, healthcare-associated infections did not increase significantly, highlighting the effectiveness of infection control programs. Whole-genome sequencing showed that 54% of carbapenem-resistant isolates carried plasmids resembling pKPC_FCF3SP (IncN) and pKpQIL-like (IncFII) plasmids; however, the number of pKpQIL-like plasmid carriers declined during the pandemic likely due to patient transfer carrying isolates with distinct mobilome. Simultaneously, the number of plasmid-negative isolates increased by 25%. Carbapenem-resistant isolates showed multidrug resistance, particularly to cephalosporins and fluoroquinolones; however, aminoglycosides remained effective. Genetic analysis identified ten aminoglycoside resistance genes, with aac(6')-Ib-D181Y associated with improved substrate recognition, being the most prevalent. Virulence factors included four integrative conjugative elements, with the integrative conjugative element K. pneumoniae ICEKp4 found only in pandemic period isolates. The O4 and O2 antigens predominated, whereas O3b appeared exclusively during the pandemic.</p><p><strong>Conclusion: </strong>The COVID-19 pandemic has contributed to a rise in carbapenem-resistant K. pneumoniae , underscoring the need for ongoing surveillance. Molecular shifts reflect the adaptation of the pathogen to evolving clinical settings.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 ","pages":"eAO1627"},"PeriodicalIF":0.9,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13128235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infographic: towards evidence-based simulation training.","authors":"Thomaz Bittencourt Couto, Alessandra Mazzo, Brena Carvalho Pinto de Melo, Mariana Santos Alecrim Molina, Priscilla Cerullo Hashimoto, Joyce Kelly Barreto Silva, Desiree Gonçalves, Dario Cecilio-Fernandes","doi":"10.31744/einstein_journal/2026CE2393","DOIUrl":"10.31744/einstein_journal/2026CE2393","url":null,"abstract":"","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 ","pages":"eCE2393"},"PeriodicalIF":0.9,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13128241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective study of the behavior of totally implantable catheters in female oncology patients with mammary hypertrophy.","authors":"Maria Fernanda Cassino Portugal, Bruno Jeronimo Ponte, Carolina Carvalho Jansen Sorbello, Thulio Fernandes de Souza, Amanda Indig Pinheiro, Andressa Cristina Sposato Louzada, Dafne Braga Diamante Leiderman, Cynthia de Almeida Mendes, Nelson Wolosker","doi":"10.31744/einstein_journal/2026AO1922","DOIUrl":"10.31744/einstein_journal/2026AO1922","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the change in the position of totally implantable venous access devices in patients with mammary hypertrophy compared to patients without this condition, in both supine and upright positions.</p><p><strong>Methods: </strong>This was a prospective study involving 116 female patients who underwent implantation of totally implantable venous access devices in the internal jugular vein with reservoir placement in the infraclavicular region of the chest wall. Patients with mammary hypertrophy were compared to a Control Group of patients with normotrophic breasts. Mammary hypertrophy was defined on the basis of the Sacchini index. The catheter tip was placed at the cavoatrial junction. The distances between the tip of the catheter and carina were compared intraoperatively and postoperatively. Measurements were performed using a radiopaque ruler intraoperatively under fluoroscopy and postoperatively with posteroanterior chest radiography in the upright position.</p><p><strong>Results: </strong>Of the 116 female patients, 53 (46.7%) had mammary hypertrophy, and 63 constituted the Control Group (53.3%). Displacement of the catheter tip in the cranial direction correlated with the previous presence of a peripherally inserted central catheter on the same side as the totally implantable venous access device (p=0.042). In contrast, caudal displacement correlated with non-deforming surgery on the chest wall (p=0.002). Patients with mammary hypertrophy did not show a higher incidence of catheter tip displacement than those with normotrophic breasts (p=0.182).</p><p><strong>Conclusion: </strong>Mammary hypertrophy, assessed using the Sacchini index, did not significantly correlate with catheter tip displacement.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 ","pages":"eAO1922"},"PeriodicalIF":0.9,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13128251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility, outcomes, and cost analysis of robotic head and neck surgery in the Public Health System.","authors":"Marco Aurélio Vamondes Kulcsar, Christiana Maria Ribeiro Salles Vanni, Leandro Luongo de Matos, Lenine Garcia Brandão, Luiz Paulo Kowalski, Claudio Roberto Cernea, Dhara Giovanna Santin de Souza","doi":"10.31744/einstein_journal/2026AO1666","DOIUrl":"10.31744/einstein_journal/2026AO1666","url":null,"abstract":"<p><strong>Objective: </strong>To assess the feasibility and benefits of transoral robotic surgery in the public healthcare system and to conduct a cost analysis of its implementation.</p><p><strong>Methods: </strong>This prospective, nonrandomized, observational cohort study was conducted over 24 months and included patients with T1-T2 oropharyngeal and supraglottic laryngeal tumors.</p><p><strong>Results: </strong>Thirty patients were included. The mean surgery duration was 204 min, and the mean hospital stay was 2.1 days. Postoperative complications included one case of bleeding and one case of aspiration. The estimated 5-year survival rate was 77%. Cost analysis revealed a higher initial cost for robotic surgery compared with conventional approaches; however, reduced postoperative complications mitigated the overall expenses.</p><p><strong>Conclusion: </strong>Transoral robotic surgery is a feasible and safe option within the public healthcare system. It enables highly complex procedures with faster postoperative recovery, lower morbidity, and survival outcomes comparable to conventional approaches.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 ","pages":"eAO1666"},"PeriodicalIF":0.9,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13128234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measurement properties of the Sexual Risk Behaviors Scale (SRBS) in university students in Brazil.","authors":"Jainé Dalmolin, Guilherme Tavares de Arruda, Erisvan Vieira da Silva, Caroline Arboite de Fraga, Amanda Dos Santos Candido, Hedioneia Maria Foletto Pivetta, Melissa Medeiros Braz","doi":"10.31744/einstein_journal/2026AO1714","DOIUrl":"10.31744/einstein_journal/2026AO1714","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to translate and evaluate the measurement properties of the Sexual Risk Behaviors Scale into Brazilian Portuguese for use in university students.</p><p><strong>Methods: </strong>Content validity was assessed by experts and Brazilian adults. Structural validity was assessed using a confirmatory factor analysis. Internal consistency and test-retest reliability were assessed using McDonald's Omega and intraclass correlation coefficient (ICC), respectively. Measurement invariance between females and males was evaluated using multigroup confirmatory factor analysis. The measurement error and floor and ceiling effects were also evaluated.</p><p><strong>Results: </strong>The experts and Brazilian adults suggested that the five-item Sexual Risk Behaviors Scale was more relevant, comprehensive, and comprehensible. In total (n=633; 22.8±2.0 years), 362 (57.2%) women and 271 (42.8%) men participated in the study. Structural validity indicated a one-factor structure as the best-fitting model, and the internal consistency was sufficient (McDonald's Omega=0.723). There was measurement invariance between females and males. The test-retest reliability was found to be sufficient (ICC=0.873). Moreover, no systematic error were observed. There was a floor effect across the entire sample.</p><p><strong>Conclusion: </strong>The Sexual Risk Behaviors Scale is valid and reliable for assessing sexual risk behaviors in university students in Brazil.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 ","pages":"eAO1714"},"PeriodicalIF":0.9,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13128242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional and demographic disparities in low-risk hospital deliveries in Brazil's Public Health System.","authors":"Marina Martins Siqueira, Gustavo Yano Callado, Lucas Hernandes Corrêa, Gabriely Rangel Pereira, Eduardo Félix Martins Santana","doi":"10.31744/einstein_journal/2026GS1911","DOIUrl":"10.31744/einstein_journal/2026GS1911","url":null,"abstract":"<p><strong>Objective: </strong>To compare the volume, public funding, and in-hospital outcomes of vaginal deliveries and cesarean sections within the Brazilian Public Health System (SUS - Sistema Único de Saúde ) across regions and maternal age groups.</p><p><strong>Methods: </strong>This retrospective, cross-sectional study presents a population-based analysis of low-risk vaginal and cesarean hospital deliveries within the SUS from 2009 to 2023 using publicly available data from the SUS Hospital Information System. Trends in delivery mode distribution were assessed using the chi-square test, whereas in-hospital mortality rates, length-of-stay, and average public financing were compared between the groups using the Mann-Whitney test.</p><p><strong>Results: </strong>Over the study period, vaginal deliveries decreased by 39%, whereas cesarean sections increased by 3%, leading to a rising proportion of cesarean births within the SUS despite an overall decline in total deliveries in Brazil. The cesarean section rate increased from 32.4% in 2009 to 44.6% in 2023, and regional disparities were observed. Despite the SUS promoting vaginal delivery for low-risk pregnancies, cesarean section rates increased across all states except Roraima. In-hospital mortality rates were numerically higher for cesarean sections, particularly among women aged ≥40 years, although statistical significance was not observed. Cesarean sections were also associated with a longer length-of-stay and higher public funding.</p><p><strong>Conclusion: </strong>Despite policies favoring vaginal births, rising cesarean section rates in the SUS reveal persistent structural, cultural, and logistical challenges. Higher public funding and longer hospital stays add to the healthcare burden. Strengthening primary care, expanding Normal Birth Centers, and optimizing cesarean section use are crucial for balanced and accessible maternity care across Brazil.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 ","pages":"eGS1911"},"PeriodicalIF":0.9,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13128224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidermolysis bullosa and global challenges in translational research for rare diseases.","authors":"Priscila Keiko Matsumoto Martin, Laurent Ketlen Leão Viana, Mel Dominici Sanfins","doi":"10.31744/einstein_journal/2026Suppl_2ED0001","DOIUrl":"10.31744/einstein_journal/2026Suppl_2ED0001","url":null,"abstract":"","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 suppl 2","pages":"eED0001"},"PeriodicalIF":0.9,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13128228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of peripheral muscle strength on extubation success after cardiac surgery.","authors":"Júlio Adriano Leal de Bittencourt Carvalho, Maria Beatriz Sampaio Santana, André Luiz Lisboa Cordeiro","doi":"10.31744/einstein_journal/2026AO1455","DOIUrl":"10.31744/einstein_journal/2026AO1455","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effects of peripheral muscle strength on extubation success after cardiac surgery.</p><p><strong>Methods: </strong>In this prospective cohort study, peripheral muscle strength and Rapid Shallow Breathing Index were assessed at 30 and 10 minutes during a spontaneous breathing trial. Patients were extubated and monitored for 48 hours to verify the success or failure of extubation, and preoperative variables were compared.</p><p><strong>Results: </strong>A total of 66 patients were evaluated, 55 (83%) of whom were classified as successful and 11 (17%) as weaning failures. The Medical Research Council score 30 minutes before the spontaneous breathing trial demonstrated a cut-off value of 44, with a sensitivity of 77%, specificity of 84%, area under the curve of 0.864, and 95% confidence interval (95%CI) 0.69-1.00. The Medical Research Council score 10 minutes before the spontaneous breathing trial showed a cut-off value of 49, with a sensitivity of 55%, specificity of 80%, area under the curve of 0.845, and 95%CI= 0.77-1.00. The Rapid Shallow Breathing Index assessed 10 minutes before the spontaneous breathing trial had a cut-off value of 45, with a sensitivity of 30%, specificity of 70%, area under the curve of 0.476, and 95%CI= 0.22-0.71.</p><p><strong>Conclusion: </strong>Peripheral muscle strength may be a useful predictor of extubation success in patients undergoing cardiac surgery.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 ","pages":"eAO1455"},"PeriodicalIF":0.9,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13128246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Topical tranexamic acid powder for bleeding control in dentistry: a scoping review.","authors":"Beatriz Rezende Bergo, Letícia Mendes Nunes, Camila Vassallo de Andrade, Paula Cristina Costa, Francisca Daniele Moreira Jardilino, Amanda Leal Rocha","doi":"10.31744/einstein_journal/2026RW1859","DOIUrl":"10.31744/einstein_journal/2026RW1859","url":null,"abstract":"<p><strong>Objective: </strong>This scoping review evaluated the efficacy of topical tranexamic acid powder, prepared from crushed tablets, for bleeding prevention during minor oral surgical procedures.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted in accordance with PRISMA-ScR guidelines across MEDLINE/PubMed, Elsevier, Embase, BVSalud, Web of Science, and Periódicos CAPES. Studies investigating topical tranexamic acid in powder form for minor dental procedures were included. Reviews, in vitro or animal studies, and investigations focusing on systemic, injectable, or mouthwash formulations of tranexamic acid were excluded. Methodological quality was assessed using the Newcastle-Ottawa Scale and Joanna Briggs Institute critical appraisal checklists.</p><p><strong>Results: </strong>Ten studies met the inclusion criteria, including clinical trials, retrospective and prospective studies, case reports, and one letter to the editor. Tranexamic acid powder was applied directly to surgical sites or prepared as a paste or saline suspension, with doses ranging from 250 to 500mg. Most participants were receiving anticoagulant therapy or had underlying bleeding disorders, highlighting the need for effective local hemostatic approaches. All included studies reported successful bleeding control with topical tranexamic acid, frequently combined with additional local hemostatic measures such as sutures or gelatin sponges.</p><p><strong>Conclusion: </strong>Topical tranexamic acid powder shows promise as an adjunctive measure for bleeding control in minor oral surgery, particularly in individuals at increased risk of hemorrhage. However, further studies are needed to clarify the isolated efficacy of tranexamic acid powder in dental bleeding management.Open Science Framework: https://osf.io/n5mbp.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 ","pages":"eRW1859"},"PeriodicalIF":0.9,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13128248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilizing Artificial Intelligence to create narrative literature reviews.","authors":"Auro Del Giglio, Mateus Uérlei Pereira da Costa","doi":"10.31744/einstein_journal/2026RW1165","DOIUrl":"10.31744/einstein_journal/2026RW1165","url":null,"abstract":"<p><p>This study explores the potential impact of Artificial Intelligence on narrative literature reviews in academic research. The literature review process involves finding, analyzing, and synthesizing relevant literature and is crucial for situating new research within existing knowledge. The integration of Artificial Intelligence tools, specifically Large Language Models such as the Generative Pre-Trained Transformer series, can significantly improve the efficiency and effectiveness of this process. This paper outlines the steps involved in conducting a literature review and examines how Artificial Intelligence tools can aid in identifying research gaps, organizing and analyzing retrieved articles, and writing the review. In the literature review process, we provide examples of both free and commercially available Artificial Intelligence software to demonstrate their potential applications.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 ","pages":"eRW1165"},"PeriodicalIF":0.9,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13128250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}