Einstein-Sao Paulo最新文献

{"title":"Stiff-person syndrome manifesting as unilateral extrinsic ocular musculature paresis.","authors":"Iago Resende Carvalho, Diogo Fernandes Dos Santos","doi":"10.31744/einstein_journal/2025AI0881","DOIUrl":"10.31744/einstein_journal/2025AI0881","url":null,"abstract":"","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAI0881"},"PeriodicalIF":1.1,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561499","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":"Perception of the multidisciplinary team and the patient's family companion regarding their presence during emergency room care.","authors":"Juanna Elisa Oliveira, Rafael da Silva Giannasi Severini, Gabriella Trevisan Padilha, Amélia Gorete Afonso da Costa Reis, Sylvia Costa Lima Farhat, Cláudio Schvartsman","doi":"10.31744/einstein_journal/2025AO0871","DOIUrl":"10.31744/einstein_journal/2025AO0871","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the perceptions of family companions and the professional team regarding the presence of a family member during emergency and urgent care at a tertiary pediatric hospital.</p><p><strong>Methods: </strong>This exploratory, descriptive cross-sectional study was conducted at a tertiary pediatric hospital that mandated the presence of companions in the emergency room during emergency care and/or procedures. The researcher conducted interviews after emergency care and administered questionnaires to the participants.</p><p><strong>Results: </strong>Ninety-five emergency room visits were selected, resulting in 92 interviews with companions and 148 interviews with multidisciplinary team members. Of the companions, 71% were unaware of the legislation regarding their presence. Despite their lack of knowledge, 90.2% insisted on accompanying the patient. Of the multidisciplinary team members, 37% were unaware that the patient could be accompanied to the emergency room, and 2% reported not allowing a companion in the emergency room. Nevertheless, 87% of the team agreed that the companion comforted the patient during care in the emergency room.</p><p><strong>Conclusion: </strong>Results from both companions and health professionals perceive the companion's presence during emergency room care as positive, making it necessary to implement care protocols that supports a companion's presence during pediatric care.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAO0871"},"PeriodicalIF":1.1,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561498","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":"Reply to \"comment on: Lessons from the pandemic and the value of a structured system of ultrasonographic findings in the diagnosis of COVID-19 pulmonary manifestations\".","authors":"Vítor Carminatti Romano, Natália Tavares de Melo Barros Lima, Victor Arantes Jabour, Guilherme Ciconelli Del Guerra, Paulo Rogério Barboza Silvério, Rodrigo Gobbo Garcia, Yoshino Tamaki Sameshima, Miguel José Francisco Neto, Marcos Roberto Gomes de Queiroz","doi":"10.31744/einstein_journal/2025CE1697","DOIUrl":"10.31744/einstein_journal/2025CE1697","url":null,"abstract":"","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eCE1697"},"PeriodicalIF":1.1,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327235","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":"Treatment of hypercalcemia related to polymethylmethacrylate injection: report of three cases.","authors":"Lívia Reis de Miranda, Eduardo de Paiva Luciano, Eduarda Andrea Silva Rizzo, Marissol Fernandes Oliveira, Sheila Cavalca Cortelli, Walnei Fernandes Barbosa","doi":"10.31744/einstein_journal/2025RC1377","DOIUrl":"10.31744/einstein_journal/2025RC1377","url":null,"abstract":"<p><p>Polymethylmethacrylate is a microsphere-based plastic used in aesthetic procedures. However, it can cause granuloma formation and severe hypercalcemia, often accompanied by renal impairment, which is a significant concern. Despite increasing reports, there is no standardized treatment approach for polymethylmethacrylate-induced hypercalcemia, and its incidence remains underreported. In this study, we present three cases of polymethylmethacrylate users who developed severe hypercalcemia that was resistant to conventional treatments, resulting in deteriorating renal function. These patients achieved symptom control with cinacalcet, a medication primarily used to treat secondary hyperparathyroidism, severe primary hyperparathyroidism, and parathyroid cancer.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eRC1377"},"PeriodicalIF":1.1,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327236","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":"Prevalence of tonsillar human papillomavirus infection in low-risk individuals without cancer.","authors":"Jéssica Boscariol da Silva, Aline Oliveira Silva, Luciana Reis Rosa Sacoman, Leandro Luongo Matos, Ronaldo Frizzarini, Raquel Ajub Moyses, José Eduardo Levi","doi":"10.31744/einstein_journal/2025AO1715","DOIUrl":"10.31744/einstein_journal/2025AO1715","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to determine the prevalence of human papillomavirus (HPV) 16 infection in the tonsils of patients without cancer and to analyze the associated risk factors in a low-risk population in Brazil.</p><p><strong>Methods: </strong>The study included 113 adult patients who underwent surgery for non-neoplastic conditions. The participants completed an interview-based questionnaire on lifestyle habits, including the use of tobacco and alcohol, and a questionnaire on sexual behavior. Overall, 226 freshly frozen tonsil samples were subjected to DNA extraction, conventional polymerase chain reaction using the PGMY09/11 primer for β-globin, and quantitative polymerase chain reaction for HPV16 detection.</p><p><strong>Results: </strong>In this cohort, 47 patients (41.6%) were women between 18 and 58 years of age (mean age, 28.5 years), and 66 (58.4%) were men between 18 and 68 years of age (mean age, 34 years). A total of 81 (71.7%) and 46 (40.7%) patients answered questionnaires on lifestyle habits and sexual behavior, respectively. All samples successfully amplified the β-globin gene fragment but tested negative for HPV DNA. This outcome precluded an investigation of the association between risk factors such as sexual behavior and HPV infection. External validation using oropharyngeal squamous cell carcinoma specimens confirmed the reliability of the laboratory procedures to detect HPV DNA, showing a 10% prevalence of HPV infection in the comparator population.</p><p><strong>Conclusion: </strong>The findings of this study suggest that the actual prevalence of HPV16 tonsillar infection in the general population without cancer may be lower than that previously reported in Brazil.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAO1715"},"PeriodicalIF":1.1,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12212012/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327234","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 evaluation of technical notes issued by NATJUS on healthcare judicialization.","authors":"Lucas Reis Correia, Luís Gustavo Nascimento de Paula, Julio Trecenti, Bruno Daleffi da Silva","doi":"10.31744/einstein_journal/2025GS0766","DOIUrl":"10.31744/einstein_journal/2025GS0766","url":null,"abstract":"<p><strong>Introduction: </strong>Technical Support Centers of the Judiciary (NATJUST), provide health technology assessments to judges in health-related litigations against both public and private healthcare systems. These centers provide technical notes, that can assist Brazilian Courts in making provisional rulings and determining patient access to health services during legal proceedings.</p><p><strong>Objective: </strong>This study aimed to evaluate the impact of NATJUS technical notes on preliminary injunctions in lawsuits against the Brazilian Unified Health System. Specifically, we analyzed the alignment between judicial decisions and technical notes recommendations, assessed lawsuit costs, and examined NATJUS-generated savings for Brazilian Unified Health System. Furthermore, we examined the technical notes issued by Hospital Israelita Albert Einstein, which manages the national NATJUS.</p><p><strong>Methods: </strong>We constructed a database of lawsuits with and without NATJUS technical notes. Using random forest models, we predicted the potential outcomes of preliminary injunctions where technical notes were available. Savings were estimated by examining the relationship between preliminary injunctions and case values, then compared with potential injunctions incorporating technical notes recommendations.</p><p><strong>Results: </strong>The technical notes recommendations and judges' decisions were aligned in 76% of the cases, with median savings from lawsuits amounting to BRL10,120. The estimated impact of NATJUS technical notes for Brazilian Unified Health System indicated median savings of BRL1,312.74 per case per year. Between 2020 and 2022, NATJUS resulted in total savings of BRL111.4 million. Focusing on Hospital Israelita Albert Einstein NATJUS, the cost savings for Brazilian Unified Health System amounted to BRL27 million, which indicates a return on investment of BRL1.66 per BRL1 invested in the project.</p><p><strong>Conclusion: </strong>Our findings indicate the economic importance of technical notes in shaping preliminary injunctions, not only elevating decision quality but also fostering evidence-based judicial processes.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eGS0766"},"PeriodicalIF":1.1,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327201","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":"Mucocutaneous disease: a child with extrapulmonary manifestation of mycoplasma infection.","authors":"Kelly Regina Pereira da Silva, Rafaela Sardini Covello Giaccio, Bárbara Martins de Aquino, Marina Abellan Van Moorsel, Fernanda Mazziero Pires, Carolina Maria Hélène, Selma Maria Furman Hélène","doi":"10.31744/einstein_journal/2025RC1138","DOIUrl":"10.31744/einstein_journal/2025RC1138","url":null,"abstract":"<p><p>Mycoplasma-induced rash and mucositis is a distinctive subset of reactive infectious mucocutaneous eruption identified in 2015 to differentiate it from other mucocutaneous disorders such as Stevens-Johnson syndrome, erythema multiforme major, and toxic epidermal necrolysis. Although its pathophysiology is not completely understood, Mycoplasma-induced rash and mucositis is characterized by polyclonal B cell proliferation, production of antibodies against Mycoplasma pneumoniae, subsequent immune complex deposition, and keratinocyte apoptosis. Clinical manifestations include scattered cutaneous lesions and severe mucositis, which predominantly affect children and young males. In this report, we present the case of a 4-year-old boy with characteristic Mycoplasma-induced rash and mucositis symptoms, including erythematous annular lesions, mucosal involvement, and positive serologies for Mycoplasma pneumoniae and herpes simplex. The diagnostic challenges, treatment modalities, and differential diagnosis of erythema multiforme major are discussed. Our case underscores the importance of recognizing Mycoplasma-induced rash and mucositis as a distinct entity, facilitating accurate diagnosis and tailoring management strategies to optimize patient outcomes.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eRC1138"},"PeriodicalIF":1.1,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327202","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":"Predatory Journals.","authors":"Jacyr Pasternak","doi":"10.31744/einstein_journal/2025ED1663","DOIUrl":"10.31744/einstein_journal/2025ED1663","url":null,"abstract":"","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eED01663"},"PeriodicalIF":1.1,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327203","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 extubation failure on the duration of mechanical ventilation in the pediatric population.","authors":"Thamires de Carvalho Silvério, Cristiane do Prado, Milena Siciliano Nascimento","doi":"10.31744/einstein_journal/2025AO0705","DOIUrl":"10.31744/einstein_journal/2025AO0705","url":null,"abstract":"<p><strong>Background: </strong>The study demonstrated that extubation failure prolonged the total duration of mechanical ventilation to twice that observed in patients with successful extubation. These findings emphasize the critical need for daily patient assessment guided by well-defined clinical criteria to ensure mechanical ventilation is discontinued precisely when the patient is clinically prepared-neither prematurely nor unnecessarily delayed. ■ In patients who experienced extubation failure, the total ventilation time was twice as long as that of patients with successful extubation. ■ The incidence of extubation failure was 5.2%, which is relatively low compared to other studies. ■ The study revealed no significant association between the presence of pre-existing illnesses and extubation outcomes. ■ Results indicated that the primary cause of extubation failure was upper airway obstruction, accounting for 67% of cases requiring reintubation.</p><p><strong>Objective: </strong>To compare the epidemiological profiles of patients who experienced extubation failure with those who achieved success and to evaluate the impact of extubation failure on total mechanical ventilation duration.</p><p><strong>Methods: </strong>An observational study with both retrospective and prospective components was conducted on patients admitted to the Pediatric Intensive Care Unit of a private hospital. This study included patients who underwent mechanical ventilation and were extubated between January 2017 and December 2022. Patients were classified into extubation Success or Failure Groups, with failure defined as requiring a return to invasive mechanical ventilation within 48hs post-extubation. Epidemiological factors, including age, pre-existing illnesses, and time on invasive mechanical ventilation, were analyzed.</p><p><strong>Results: </strong>A total of 173 patients were included, of which 9 (5.2%) required reintubation within 48hs. The total duration of mechanical ventilation differed significantly between the Success Group (3 days [1.8; 6.6]) and the Failure Group (6.5 days [5.6; 9.3]), p=0.004. Upper airway obstruction was identified as the primary cause of extubation failure.</p><p><strong>Conclusion: </strong>This study demonstrated that extubation failure doubled the total duration of mechanical ventilation compared to successful extubation. These findings highlight the importance of daily patient assessment with clearly defined clinical criteria to ensure mechanical ventilation is discontinued precisely when the patient is ready-neither prematurely nor excessively delayed.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAO0705"},"PeriodicalIF":1.1,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12094675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081381","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":"A pilot study on feasibility and hypothesis exploration: reducing on-scene length of stay of the emergency teams via ambulance dispatch teleconsultation for prehospital examination.","authors":"Tarso Augusto Duenhas Accorsi, João Carlos Barbosa, Ricardo Galesso Cardoso, José Leão de Souza Junior, Karine De Amicis, Renata Albaladejo Morbeck, José Paulo Ladeira, Eduardo Cordioli, Carlos Henrique Sartorato Pedrotti","doi":"10.31744/einstein_journal/2025AO1469","DOIUrl":"10.31744/einstein_journal/2025AO1469","url":null,"abstract":"<p><strong>Background: </strong>This pilot study showed that teleconsultation during ambulance dispatch considerably reduced the emergency team's on-scene evaluation time, underscoring the potential of telemedicine in prehospital care. ■ Teleconsultation reduced on-scene time from 36.8 to 20.6 min (p=0.019). ■ Video-based prearrival anamnesis improved team efficiency. ■ Interventions and clinical profiles were similar across the groups. ■ Study supports broader telemedicine adoption in emergency care.</p><p><strong>Objective: </strong>Ambulance transport time is an important metric in prehospital care. Limited studies have explored strategies to decrease on-scene time. We examined the effect of collecting telemedicine-based medical data during ambulance dispatch on the on-scene evaluation time of the prehospital team.</p><p><strong>Methods: </strong>This randomized, single-center, open-label study included individuals aged >18 years who independently sought hospital emergency services and requested on-site emergency care. Individuals with primary trauma emergencies occurring outside the home, cardiac arrest cases, and situations in which video communication was unfeasible were excluded.</p><p><strong>Results: </strong>Twenty patients were randomized to receive telemedicine assessment during ambulance dispatch or standard care with physician phone support. Both groups were comparable in age (53.2 ± 26.1 versus 63.4 ± 24.2 years, p=0.380), sex (50% versus 70% female, p=0.360), initial vital signs, and medical history. The main reasons for patients calls were falls from standing height (30%), followed by cardiovascular symptoms (20%), and acute neurological events (15%). Teleconsultation via a mobile application was successfully conducted in all cases. Furthermore, in situ interventions, including venous access, oxygen therapy, orthopedic immobilization, hypotension stabilization, and symptomatic treatment, were similar between the groups. The Telemedicine Group demonstrated a significantly shorter on-scene evaluation time (20.45 ± 6 min) than the Standard Group (36.80 ± 20.4 min, p = 0.019).</p><p><strong>Conclusion: </strong>Conducting checklist-based anamnesis teleconsultation during ambulance dispatch considerably decreased the on-scene evaluation time of the emergency team. Further research with larger cohorts and different settings is required to better examine telemedicine's potential in this context.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAO1469"},"PeriodicalIF":1.1,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12094677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081379","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}