Einstein-Sao Paulo最新文献

{"title":"Effects of 3'-sialyllactose, saliva, and colostrum on Candida albicans biofilms.","authors":"Juliana Barbosa Faria, Marcela Beraldo Santiago, Paula Hueb Menezes de Oliveira, Vinicius Rangel Geraldo-Martins, Ruchele Dias Nogueira","doi":"10.31744/einstein_journal/2025AO0663","DOIUrl":"https://doi.org/10.31744/einstein_journal/2025AO0663","url":null,"abstract":"<p><strong>Background: </strong>Faria et al. evaluated the initial adhesion and biofilm formation of Candida albicans in vitro in the presence of saliva, human colostrum, and 3'-sialyllactose. Colostrum applied either before or after inoculation with saliva did not differ from that of the control biofilms (p<0.05). In contrast, colostrum applied during C. albicans inoculation resulted in a higher biomass than the control (p<0.05). Saliva without colostrum decreased the biofilm biomass (p<0.05), and the application of 3'- sialyllactose reduced biofilm formation regardless of the timing of application (p<0.05). Candidiasis can present as localized or systemic infections. Disseminated infections in newborns and adults can be life-threatening, with high mortality and morbidity rates (40-60%), and rank as the fourth most common type of nosocomial infection. Oral candidiasis is a local condition affecting 10-15% of children in their first months of life. Saliva and 3'-sialyllactose can disrupt the initial development of Candida albicans biofilm. The effect of colostrum needs to be elucidated because it may hinder initial adhesion but promote fungal proliferation after application.</p><p><strong>Objective: </strong>The aim of this study was to investigate the effects of saliva, human colostrum, and 3'-sialyllactose on the initial adhesion and biofilm formation of Candida albicans in vitro.</p><p><strong>Methods: </strong>Colostrum and saliva samples were collected from 30 postpartum mothers and newborns, respectively. An 18h culture of C. albicans was treated with colostrum, 3'-sialyllactose, saliva, or a combination of colostrum and saliva at three different time points: before, during, and 24h after C. albicans inoculation. Biofilm assays were conducted in sterile 96-well flat-bottom microtiter plates for 24h. Biofilms were fixed, washed, stained with crystal violet, and extracted. Absorbance was measured to evaluate biofilm biomass.</p><p><strong>Results: </strong>The combined application of colostrum and saliva before and after microbial inoculation did not differ from the control biofilms (p<0.05). In contrast, the combined application of colostrum and saliva during C. albicans application resulted in a higher biomass than the control (p<0.05). Saliva alone decreased the biofilm biomass (p<0.05), and the application of 3'-sialyllactose reduced biofilm formation regardless of the timing of application (p<0.05).</p><p><strong>Conclusion: </strong>Saliva contributed to the proliferation of biofilms, while colostrum did not prevent initial adhesion but influenced biofilm accumulation and development. In contrast, 3'-sialyllactose significantly decreased biofilm formation at all application times. These findings underscore the importance of colostrum as a potent oral antimicrobial biofluid.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAO0663"},"PeriodicalIF":1.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711624","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":"Silicone gel migration masquerading as metastatic breast cancer.","authors":"Felipe Magaldi de Carvalho, Leandro Jonata Carvalho Oliveira, Carlos Shimizu, Felipe de Galiza Barbosa, Leonardo de Abreu Testagrossa, Max Senna Mano","doi":"10.31744/einstein_journal/2025AI1493","DOIUrl":"https://doi.org/10.31744/einstein_journal/2025AI1493","url":null,"abstract":"","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAI1493"},"PeriodicalIF":1.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710217","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":"Spiritual care in the intensive care unit. Is it already a reality?: an integrative review.","authors":"Alessandre Carvalho Junior, Adriane Maria Netto de Oliveira, Camila Daiane Silva, Diéssica Roggia Piexak","doi":"10.31744/einstein_journal/2025RW1081","DOIUrl":"https://doi.org/10.31744/einstein_journal/2025RW1081","url":null,"abstract":"<p><strong>Introduction: </strong>Spirituality has emerged as a phenomenon of interest in various global contexts. The adoption of spirituality as a fundamental aspect of healthcare remains underexplored, especially in critical environments such as intensive care units.</p><p><strong>Objective: </strong>To identify strategies for incorporating spiritual care into adult intensive care environments through an integrative literature review.</p><p><strong>Methods: </strong>An integrative review was conducted using the Embase, Web of Science, Medline/PubMed, PsycINFO, LILACS, and Cochrane Central databases. Twenty-one studies published in English, Spanish, or Portuguese over the last 10 years were selected.</p><p><strong>Results: </strong>Different approaches to spirituality were identified, including training implementation, individual interviews, meetings, educational programs, and practices involving healthcare professionals.</p><p><strong>Conclusion: </strong>Spirituality in the intensive care environment has been a growing reality in recent years through efforts aimed at helping healthcare professionals integrate spirituality into the care provided in clinical practice. Individual interviews were the primary strategy for incorporating spiritual care in intensive care unit settings. Questionnaires were used to support these interviews, and the frequency and duration typically involved a single session, ranging from 15 to 60 min.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 spe1","pages":"eRW1081"},"PeriodicalIF":1.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710220","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":"Epidemiology with real-world data: deep endometriosis in women of reproductive age.","authors":"Nilson Abrão Szylit, Luciana Cristina Pasquini Raiza, Anucha Andrade Schindler Leal, Sérgio Podgaec","doi":"10.31744/einstein_journal/2025AO1259","DOIUrl":"https://doi.org/10.31744/einstein_journal/2025AO1259","url":null,"abstract":"<p><strong>Background: </strong>Szylit et al. conducted a descriptive prevalence study combined with a cross-sectional observational study in a public primary care clinic. Using real-world data, they determined the prevalence of endometriosis in women selected without prior screening for the condition, employing pelvic and transvaginal ultrasound. This study represents the first of its kind in Latin America. This study represents the first investigation into the prevalence of deep endometriosis within outpatient services. Utilizing real-world data, this study explores the prevalence of endometriosis. The prevalence of endometriosis among women of reproductive age is 6.4% (based on real-world data). The prevalence of endometriosis in women experiencing pelvic pain is 34.2%. Infertility is 6.5 times more common in women diagnosed with endometriosis. The presence of palpable posterior cul-de-sac nodules or a retroverted uterus suggests endometriosis.</p><p><strong>Objective: </strong>Endometriosis is characterized by the presence of glandular tissue or endometrial stroma outside the uterus. This study aimed to determine the prevalence of symptomatic deep endometriosis and the clinical factors associated with this condition in women of reproductive age.</p><p><strong>Methods: </strong>A descriptive prevalence study combined with a cross-sectional observational study was conducted between 2017 and 2021 at a public primary care outpatient clinic in Brazil. Women of reproductive age with at least one of the following symptoms were included in the study: deep dyspareunia, dysmenorrhea, chronic pelvic pain, intestinal or urinary symptoms during the menstrual cycle, or infertility. A sample size calculation indicated that an estimated sample of 269 patients was required for the study. Qualitative variables are described as absolute and relative frequencies, while quantitative variables are expressed as medians and quartiles. Factors associated with endometriosis were analyzed using logistic regression and multiple models.</p><p><strong>Results: </strong>Data from 1,445 patients were considered. Among these, 92 were diagnosed with deep endometriosis, resulting in a prevalence of 6.4% (95%CI= 5.2-7.7) and 34.2% among women with pelvic pain (95%CI= 28.8-40.1). Women with palpable posterior cul-de-sac nodules (0R= 3.58, 95%CI= 1.68-7.63, p = 0.001) or a retroverted uterus (0R= 2.36, 95%CI= 1.28-4.37, p = 0.006) were more likely to have endometriosis.</p><p><strong>Conclusion: </strong>Using real-world data, the prevalence of deep endometriosis was found to be 6.4% in women of reproductive age and 34.2% in those with pelvic pain. The primary clinical variables associated with endometriosis are palpable posterior cul-de-sac nodules and a retroverted uterus.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAO1259"},"PeriodicalIF":1.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711625","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":"Nodular vulvar lesions and its key differential diagnoses: a case report.","authors":"Juliana Jorge Romano, Fernanda Kesselring Tso, Yasmin Cristina Cesquim Noronha, Julizia Foloni May, Mariano Tamura Vieira Gomes, Sérgio Podgaec, Patricia Napoli Belfort-Mattos","doi":"10.31744/einstein_journal/2025RC0362","DOIUrl":"10.31744/einstein_journal/2025RC0362","url":null,"abstract":"<p><p>The etiologies of vulvar nodules range from infectious to neoplastic. Owing to the wide spectrum of vulvar diseases, clinical differentiation of the lesions is crucial for adequate diagnosis and management. A 46-year-old patient presented with a nodular lesion in the vulvar region that had been growing slowly for 10 years. Gynecological examination revealed the presence of a solid nodular lesion measuring approximately 3 cm in the middle third of the right labia majora without phlogistic signs or secretion discharge. The lesion was excised and an anatomopathological study revealed a nodular hidradenoma. Nodular hidradenoma is a rare benign neoplasm of the apocrine glands that mainly affects women between 30 and 60 years of age. Although generally asymptomatic, some symptoms have been described, such as itching, pain, ulceration, or secretory discharge. The diagnosis was made by an anatomopathological study, and treatment consisted of total excision of the lesion without the need to enlarge the margin. During the investigation, malignant lesions such as liposarcoma of the vulvar region and non-melanoma skin cancers were excluded. Differential diagnosis is important because it requires a more invasive approach and surgical margins. This report aimed to expand the knowledge of the diagnosis of vulvar hidradenoma to exclude the possibility of malignant neoplasia while caring for vulvar nodules, thereby allowing proper management of the case.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eRC0362"},"PeriodicalIF":1.1,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659113","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":"Aortic calcium score predicts early outcomes in aortoiliac revascularization.","authors":"Adalberto Batalha Megale, Nelson Wolosker, Vitoria Magliari Kalil, João Mário Nigro, Carolina Sciammarella Wakisaka, Bianca Oberhuber Dias, Marcelo Passos Teivelis, Marcelo Assis Rocha, Cynthia de Almeida Mendes","doi":"10.31744/einstein_journal/2025AO0527","DOIUrl":"10.31744/einstein_journal/2025AO0527","url":null,"abstract":"<p><strong>Background: </strong>Calcium scores were evaluated in the lower limbs of patients with clinical limb ischemia after aortoiliac revascularization. The aortic calcium score was related to the short-term outcomes of amputation and subsequent revascularization. Similarly, the calcium score in below-the-knee arteries was associated with revascularization and amputation at 12 months. ■ The calcium score can be calculated using computed tomography angiography. ■ The aortic calcium score was associated with amputation and subsequent revascularization within 30 days. ■ The calcium score in below-the-knee arteries was higher in the patients who underwent subsequent revascularization and amputation at 12 months.</p><p><strong>Objective: </strong>To evaluate the association between lower limb artery calcium scores in preoperative computed tomography angiography and outcomes of patients with critical limb ischemia who underwent revascularization procedures in the aortoiliac segment.</p><p><strong>Methods: </strong>We retrospectively reviewed 14 interventions performed on 11 patients. The calcium score was calculated in segments of the aorta, iliac, femoropopliteal, and below-the-knee arteries. The evaluated outcomes included amputation, patency, death, subsequent revascularization, and readmission. Major adverse limb events were defined as amputation, subsequent revascularization, or readmission. The patients were followed through a 12-month period.</p><p><strong>Results: </strong>Higher aortic calcium scores were associated with amputation within 30 days (5,767.6 versus 805.3; p=0.02). Amputation during the first year correlated with a higher below-the-knee arteries calcium score (672.4 versus 163.25; p=0.04). Subsequent revascularization within 30 days was associated with a higher aortic calcium score (3,686.8 versus 645.2; p=0.008), while below-the-knee arteries calcium scores were associated with revascularization within 30 days (155.5 versus 817; p=0.05) and 12 months (158.875 versus 679.4; p=0.019). Readmissions within 1 year were more prevalent with higher below-the-knee arteries calcium scores (882.4 versus 32; p=0.011). Major adverse limb events were related to below-the-knee arteries calcium scores at 30 days (158.875 versus 679.4; p=0.019) and 1 year (12.3 versus 910.1; p=0.002).</p><p><strong>Conclusion: </strong>Below-the-knee arteries calcium score is a predictor of long-term revascularization, amputation, readmission, and major adverse limb events. The aortic calcium score was associated with amputation and subsequent revascularization within the first 30 days.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAO0527"},"PeriodicalIF":1.1,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659027","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":"Validation of an ultra-high performance liquid chromatography/UV method to quantify busulfan in plasma: application to therapeutic drug monitoring.","authors":"Laura Ben Olivo, Gabriel Giron Corrêa, Bruna Bernar Dias, Janaína Aparecida Risczik Arruda Corrêa, Bruna Martins Schweinberger, Raiza Lima do Carmo, Liane Esteves Daudt, Teresa Dalla Costa, Bibiana Verlindo de Araujo","doi":"10.31744/einstein_journal/2025AO0964","DOIUrl":"10.31744/einstein_journal/2025AO0964","url":null,"abstract":"<p><strong>Background: </strong>Olivo et al. validated an in-house precise UHPLC/UV method for quantifying busulfan in human plasma for therapeutic monitoring. The method shows linearity (0.5-10 μg/mL) with a lower limit of quantification of 0.5 μg/mL, demonstrating accuracy and precision. It effectively supported therapeutic drug monitoring in a Brazilian public hospital by providing rapid and reliable results. ■ We validated the UHPLC/UV method for accurate busulfan quantification in plasma. ■ Inaccuracy and imprecision were below 15%, ensuring reliable therapeutic drug monitoring results. ■ This enables effective pharmacokinetic studies with rapid turnaround times in patient samples.</p><p><strong>Objective: </strong>This study aimed to validate a sensitive, accurate, and precise bioanalytical ultra-high-performance liquid chromatography coupled with ultraviolet (UHPLC/UV) method for the determination of busulfan in human plasma using 1,6-bis-(methanesulfonyloxy) hexane as an internal standard for therapeutic drug monitoring.</p><p><strong>Methods: </strong>Plasma samples were deproteinized with acetonitrile (1:2, v/v) and, after derivatization with sodium diethyl dithiocarbamate, submitted to liquid-liquid extraction with ethyl acetate and evaporation at 50ºC under a nitrogen stream. Analyses were performed on a Shimadzu® system using a C18 column and isocratic elution with methanol/water (70:30, v/v) at a flow rate of 0.4mL min-1 and detection at 277nm.</p><p><strong>Results: </strong>The retention times of busulfan and the IS were approximately 2.87 and 6.35 min, respectively. The plasma calibration curves were linear in the concentration range of 0.5-10 µg mL-1 with a coefficient of determination greater than 0.99. The lower limit of quantification was 0.5 µg mL-1. The inaccuracies and imprecisions of this method are less than 15%. The applicability of this method to pharmacokinetic studies was confirmed using patient samples obtained after 4 h of 3.2-5.4 mg kg-1 busulfan intermittent infusion.</p><p><strong>Conclusion: </strong>This method demonstrated the feasibility of quantifying samples within the target concentration range and quickly releasing results to allow for busulfan therapeutic monitoring.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAO0964"},"PeriodicalIF":1.1,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659127","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":"Cutaneous manifestations of diabetes mellitus: a narrative review.","authors":"Maria Carolina Mendes de Oliveira Abate, Priscila Maria Teixeira Aroucha, Diego Vanderlei Medeiros da Nóbrega, Iara Patrícia Moura Rocha, Sofia Duarte Soares, Anita Andrade Reis, Isabella Cristina Paliares, Fernando de Mello Almada Giuffrida, Sergio Atala Dib, André Fernandes Reis, Joao Roberto de Sa","doi":"10.31744/einstein_journal/2025RW1193","DOIUrl":"10.31744/einstein_journal/2025RW1193","url":null,"abstract":"<p><p>Diabetes mellitus is a highly prevalent human endocrine disorder. Skin lesions are reported in approximately one-third of all diabetes mellitus patients. The clinical presentation and frequency vary according to the subtype of diabetes mellitus, metabolic control, and clinical course, with certain skin diseases occurring before diagnosing hyperglycemia. In this regard, the correct definition of cutaneous manifestations associated with diabetes mellitus can help define the etiology of hyperglycemia as well as the need to optimize glycemic control. In this narrative review, the most common cutaneous diseases observed in diabetes mellitus are discussed, including pruritus, acanthosis nigricans, necrobiosis lipoidica, bullosis diabeticorum, scleroderma diabeticorum, granuloma annulare, diabetic dermopathy, skin reactions due to device use, diabetic foot ulcers, recurrent cutaneous infections in diabetes mellitus and other dermatoses associated with hyperglycemia. The epidemiology, pathophysiology, differential diagnosis, and treatment of this disease are discussed. Therefore, knowledge and recognition of the most common dermatological lesions in patients with diabetes mellitus are essential for both endocrinologists and primary care physicians.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eRW1193"},"PeriodicalIF":1.1,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659106","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":"Barriers to cardiac rehabilitation and their association with hospital readmission in patients with heart failure.","authors":"Ana Carla Soares Mota de Carvalho, Raphaela Vilar Groehs, Carolina Pereira, Vivian Lavor Soares, Tarsila Perez Mota, Sherry L Grace, Luciana Diniz Nagem Janot de Matos","doi":"10.31744/einstein_journal/2025AO0713","DOIUrl":"https://doi.org/10.31744/einstein_journal/2025AO0713","url":null,"abstract":"<p><strong>Background: </strong>High rehospitalization rates and limited access to cardiac rehabilitation characterize heart failure in South America. This study highlights the significant barriers faced by patients, including lack of energy, awareness, and accessibility. Despite these challenges, professional exercise supervision has reduced readmission rates by more than 50%, underscoring its importance. ■ Barriers to rehabilitation: high inactivity rates (88.4%) and significant barriers, such as fatigue and lack of awareness, hinder recovery. ■ Professional supervision: only 1% of patients were enrolled in formal cardiac rehabilitation; however, those who received professional supervision experienced lower readmission rates (14.6% versus 35.1%). ■ Systematic gaps: addressing systemic gaps, such as coverage and referral to rehabilitation programs, is critical for improving patient outcomes and reducing rehospitalization rates.</p><p><strong>Objective: </strong>This study assessed the barriers to cardiac rehabilitation in inpatients with heart failure, the use of formal exercise supervision, and its relationship to readmissions.</p><p><strong>Methods: </strong>This study was a prospective, observational design. The Cardiac Rehabilitation Barriers Scale, the Readiness Scale focusing on physical activity, and the International Physical Activity Questionnaire were administered before hospital discharge. Participants were followed up via telephone at 30- and 90-days post-discharge, during which the International Physical Activity Questionnaire was readministered, and formal exercise supervision and readmission rates were assessed.</p><p><strong>Results: </strong>Of the 95 patients who provided consent, 88.4% were inactive. A total of 85 (89.5%) were retained at the 30-day follow-up, and 86 (90.5%) patients at the 90-day follow-up; 2 patients died. The mean total Cardiac Rehabilitation Barriers Scale score was 2.3±6.5 (out of 5), with the highest item scores for lack of energy, prior exercise, lack of awareness, distance, and exercise-related pain/fatigue. Only one participant was enrolled in cardiac rehabilitation. Nearly half had engaged in professional exercise (n=48, 56.5% at 30 days and n=45, 52.3% at 90 days) at both follow-ups. At 30 days, 25.8% of the patients were readmitted, and 25.5% were readmitted at 90 days. Participants who received professional exercise supervision within 30 days had significantly fewer readmissions (n=7, 14.6%) than those who did not (n=13, 35.1%; p=0.03).</p><p><strong>Conclusion: </strong>Barriers to cardiac rehabilitation are high among patients with heart failure. Despite access to professional exercise training, most participants remain insufficiently active. Systematic referral for cardiac rehabilitation and advocacy for coverage could mitigate poor self-management and, ultimately, reduce high readmission rates.</p><p><strong>Registry of clinical trials: </strong>NCT03385837.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAO0713"},"PeriodicalIF":1.1,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658954","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":"Ideal time and self-reported time to ejaculate, frequent use of virtual pornography, and disorders of ejaculation among internet users in the Metropolitan Region of São Paulo, Brazil. Cross-sectional study.","authors":"Margareth de Mello Ferreira Dos Reis, Eduardo Augusto Corrêa Barros, Leonardo Monteiro, Cristiano Linck Pazeto, Willy Baccaglini, Sidney Glina","doi":"10.31744/einstein_journal/2025AO1282","DOIUrl":"10.31744/einstein_journal/2025AO1282","url":null,"abstract":"<p><strong>Background: </strong>Almost half (46%) of adult men living in São Paulo metropolis who responded an anonymous survey think they ejaculate earlier than it would be ideal. Only 10% watched virtual pornography frequently (every day or for several hours 2-4 days a week). No associations were found between ejaculation disorders and frequent use of virtual pornography. ■ About one in every 10 social network male users in São Paulo frequently use virtual pornography. ■ Over half of the respondents believed that the ideal time to ejaculate would be of 15 minutes or more. ■ Frequent use of virtual pornography was not associated with ejaculation disorders.</p><p><strong>Objective: </strong>To investigate the association between frequent use of virtual pornography, perceptions of the ideal time to ejaculate, and changes in ejaculation.</p><p><strong>Methods: </strong>Adult men living in São Paulo metropolis responded to an online anonymous survey between May 2019 and March 2020. The questions were about sociodemographics, sexual behavior, frequency and time of virtual pornography use, and responses to three instruments for assessing ejaculation disorders: self-reported estimated time from vaginal or anal penetration to ejaculation; self-assessment of what is a normal, premature, or delayed ejaculation, and the Premature Ejaculation Diagnostic Tool (PEDT).</p><p><strong>Results: </strong>Of 528 participants, 27.3% said the ideal time (for them and for the partner) to ejaculate during sex with a partner would be 6-15 minutes, and for 44.1%, longer than 15 minutes. However, 45.8% said they usually ejaculate earlier than the ideal time. Only 55 men (10.4%; 95% confidence interval, 95%CI= 7.9-13.3) participants were frequent users of virtual pornography (defined as the use during solitary masturbation for at least one hour/day every day or many hours/day two to four times/week). Frequent use of pornography was associated with not being heterosexual (odds ratio, OR= 1.81; 95%CI= 1.02-3.23), lower educational level (OR= 2.21; 95%CI= 1.12-4.32) and using virtual pornography during sexual intercourse (OR= 2.58; 95%CI= 1.21-5.48). No associations were observed between frequent virtual pornography use and ejaculation disorders.</p><p><strong>Conclusion: </strong>Approximately half of the men surveyed are not satisfied with the time they take to ejaculate and around 10% of them use virtual pornography frequently, although this is not associated with ejaculation dysfunction.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAO1282"},"PeriodicalIF":1.1,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574277","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}