Einstein-Sao Paulo最新文献

{"title":"Müllerian-type clear cell adenocarcinoma of the urethra: a case report.","authors":"Júlia Costa Linhares, Andressa Caroline Martins de Souza, Renata Namie Yoshioka Kimura, Paulo Eduardo Dietrich Jaworski, Ana Paula Martins Sebastião, Samya Hamad Mehanna","doi":"10.31744/einstein_journal/2026RC1169","DOIUrl":"10.31744/einstein_journal/2026RC1169","url":null,"abstract":"<p><p>Primary urethral carcinoma is a rare malignancy, particularly in women, that often presents at an advanced stage with nonspecific symptoms. Among the histological subtypes, clear cell adenocarcinoma is exceptionally uncommon, with approximately only 250 cases reported in the English literature, posing diagnostic and management challenges. We report a case of Müllerian-type clear cell adenocarcinoma of the urethra in a 58-year-old woman. Imaging studies excluded gynecological origins, suggesting derivation from a Müllerian duct remnant or metaplasia. Histologically, the tumor displayed the classic features of clear cell carcinoma, which were supported by positive PAX8 and napsin A immunostaining. Primary urethral adenocarcinoma appears to have poor prognosis in women. Current management relies on a multimodal approach that combines surgery, chemotherapy, and radiotherapy and has shown promising outcomes in recent studies. This case highlights the importance of considering clear cell adenocarcinomas in the differential diagnosis of urethral tumors.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 ","pages":"eRC1169"},"PeriodicalIF":0.9,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13128244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692787","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":"For more Mangomoments in health care!","authors":"Alexsandro Tartaglia, Marcos Antônio Almeida Matos, Mary Gomes Silva, Felipe Reis","doi":"10.31744/einstein_journal/2026CE1486","DOIUrl":"10.31744/einstein_journal/2026CE1486","url":null,"abstract":"","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 ","pages":"eCE1486"},"PeriodicalIF":0.9,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13128227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692819","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":"Severe bleeding diathesis after dental extractions: a complex case of coagulation disturbances in a patient with multiple myeloma.","authors":"Fernanda de Paula Eduardo, Leticia Mello Bezinelli, Vitor Abreu de Goes, Mariana Henriques Ferreira, Marcella Ferreira Gobbi, Livia Goron Bergamin, José Mauro Kutner, Luciana Corrêa, Jose Luiz Bonamigo-Filho","doi":"10.31744/einstein_journal/2026RC1902","DOIUrl":"https://doi.org/10.31744/einstein_journal/2026RC1902","url":null,"abstract":"<p><p>This case report describes a male patient diagnosed with multiple myeloma who experienced significant bleeding from both the maxillary and mandibular dental sockets following dental extraction, lasting several days. Laboratory tests revealed prolonged prothrombin time and thrombin time, accompanied by reduced factor VII levels. Initial management with intravenous vitamin K and fresh frozen plasma failed to achieve hemostasis. Despite the risk of thrombosis, low-dose tranexamic acid was initiated, resulting in effective hemorrhage control and improved healing of the alveolar sockets. This case illustrates the complex hemostatic imbalance between pro- and anticoagulant factors in a patient with multiple myeloma. It also underscores the diagnostic and therapeutic challenges associated with managing bleeding in patients with a high risk of thrombosis.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 spe3","pages":"eRC1902"},"PeriodicalIF":0.9,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147515753","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":"Assessment of medullary response through cellular immaturity parameters in patients undergoing hematopoietic stem cell transplantation.","authors":"Bruno Gabriel Nardini Fogo, Iracema Esteves, Nelson Hamerschlak, Carolina Bonet Bub, Rosana Moreira Cosentino Penteado, Andréa Aparecida Rocco Vilarinho, João Carlos de Campos Guerra","doi":"10.31744/einstein_journal/2026AO1805","DOIUrl":"https://doi.org/10.31744/einstein_journal/2026AO1805","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate relative immature platelet fraction (IPF%), absolute immature platelet fraction (A-IPF), and relative immature reticulocyte fraction (IRF%) as biomarkers of bone marrow recovery after hematopoietic stem cell transplantation and to assess their potential role in reducing prophylactic platelet transfusions.</p><p><strong>Methods: </strong>Sixty hematopoietic stem cell transplantation recipients (mean age, 50 years) were analyzed, and sex-specific reference ranges for IPF%, A-IPF, and IRF% were established. The predictive performance for platelet engraftment and transfusion requirements was assessed using receiver operating characteristic curve analysis, logistic regression, Fine-Gray competing risks models, Cox regression, and negative binomial modeling.</p><p><strong>Results: </strong>Only A-IPF differed significantly between groups. An A-IPF threshold greater than 1,450 predicted platelet engraftments within two days with a sensitivity of 82.1% and a specificity of 80.0%. Logistic regression demonstrated a 2.3-fold increase in the likelihood of platelet engraftment for every 1,000-unit increase in A-IPF, and Fine-Gray analysis confirmed a higher cumulative incidence of engraftment in the intermediate and high A-IPF strata (subdistribution hazard ratios, 2.71 and 3.58; p<0.001). All patients required platelet transfusions (149 events). Cox regression identified A-IPF as an independent risk factor for transfusion (hazard ratio, 1.0001; p=0.027), whereas platelet count showed a protective effect (hazard ratio, 0.959; p<0.001). Negative binomial modeling demonstrated that higher weekly mean A-IPF was associated with fewer subsequent transfusions.</p><p><strong>Conclusion: </strong>A-IPF is a robust biomarker for early platelet engraftment and a clinically relevant predictor of platelet transfusion requirements in patients undergoing hematopoietic stem cell transplantation.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 spe2","pages":"eAO1805"},"PeriodicalIF":0.9,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147515711","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":"Outcomes of multiple myeloma in patients with access to novel drugs.","authors":"Leonardo Javier Arcuri, Danielle Ovigli, Cinthya Corrêa da Silva, Fernando Moura, Ricardo Helman, Nelson Hamerschlak","doi":"10.31744/einstein_journal/2026AO1748","DOIUrl":"https://doi.org/10.31744/einstein_journal/2026AO1748","url":null,"abstract":"<p><strong>Objective: </strong>To report the outcomes of patients with multiple myeloma who had access to novel drugs in Brazil, and to establish a local benchmark.</p><p><strong>Methods: </strong>This prospective observational study was conducted at Hospital Israelita Albert Einstein in São Paulo, Brazil. We included all patients diagnosed with plasma cell disorders treated between 2019 and 2022.</p><p><strong>Results: </strong>We included 109 patients with a median follow-up of 3.7 years. The three-year overall and progression-free survival rates were 69% and 51%, respectively. Multivariate analysis identified age (HR = 1.60 for each additional 10 years, p=0.0025) and hemoglobin levels (HR = 1.25 for each point decrease, p=0.0038) as risk factors for mortality were identified in a model that fared better than the International Staging System. Our results indicate that basic clinical and laboratory data (age and hemoglobin level) also predict overall survival in modern patients with multiple myeloma with access to novel therapies, similar to the International Staging System.</p><p><strong>Conclusion: </strong>Simple clinical and laboratory data, which are rarely available to patients, can predict outcomes, particularly non-relapse mortality. Therefore, a less toxic treatment approach should be considered for high-risk patients.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 spe2","pages":"eAO1748"},"PeriodicalIF":0.9,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147515734","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":"Cost of hematopoietic cell transplantation for hematologic malignancies from a transplant center in a developing country.","authors":"Cinthya Corrêa da Silva, Leonardo Javier Arcuri, Daniel Tavares Malheiro, Vanessa Damazio Teich, Nelson Hamerschlak","doi":"10.31744/einstein_journal/2026AO1834","DOIUrl":"https://doi.org/10.31744/einstein_journal/2026AO1834","url":null,"abstract":"<p><strong>Objective: </strong>Hematopoietic cell transplantation is a resource-intensive procedure influenced by several cost drivers. The primary objective of this study was to compare the costs of matched-sibling (MSD), unrelated (URD), and haploidentical (Haplo) donor transplants and to identify patient- and transplant-related factors associated with higher costs.</p><p><strong>Methods: </strong>This observational, retrospective cohort study compared the costs among human leucocyte antigen (HLA)-matched MSD, HLA-matched URD, and Haplo transplants. Patients with hematologic malignancies who underwent their first allogeneic hematopoietic cell transplantation were included. Median cost analyses were performed using a parametric lognormal survival model at 1 year. Patients who did not complete the follow-up were censored. The median follow-up was 53 months, and a total of 177 patients were included (54 MSD, 43 Haplo, and 80 URD).</p><p><strong>Results: </strong>Crude 1-year costs were US$83,753 for MSD, lower than those of URD (US$122,811) and Haplo (US$148,461) (p=0.01). In the 1-year cost model, Haplo (p=0.02) and URD (p=0.01) were associated with higher costs than MSD. In multivariable analysis, Haplo (p=0.008) and URD (p=0.004) remained independently associated with higher costs. Haplo costs were not significantly different from URD costs (p=0.84).</p><p><strong>Conclusion: </strong>From a financial perspective, sibling transplantation remains the gold standard treatment.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 spe2","pages":"eAO1834"},"PeriodicalIF":0.9,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147515740","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":"Comment on: Transrectal prostate biopsy complications: a prospective single center study in a mid-income country.","authors":"Hüsnü Tokgöz, Özlem Tokgöz","doi":"10.31744/einstein_journal/2026CE2121","DOIUrl":"10.31744/einstein_journal/2026CE2121","url":null,"abstract":"","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 ","pages":"eCE2121"},"PeriodicalIF":0.9,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12977236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147357075","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":"Difficulties in diagnosing a pediatric patient with small intestinal bacterial overgrowth.","authors":"Luanna Campos Tuñas, Ana Clara Rigueti Toma, Ricardo Katsuya Toma, Eduardo Juan Troster","doi":"10.31744/einstein_journal/2026RC2117","DOIUrl":"10.31744/einstein_journal/2026RC2117","url":null,"abstract":"<p><p>A 3.5-year-old female presented with a 10-month history of abdominal pain and distension, accompanied by frequent belching and flatulence. No nausea, vomiting, or nighttime awakening due to pain was reported, and the patient's appetite remained intact. Growth and development were age-appropriate (weight: 16.2kg, height: 106cm). She was born at term without complications and had a normal neonatal screening. No comorbidities typically associated with small intestinal bacterial overgrowth (SIBO)-such as prior intensive care unit admission, immunodeficiency, food intolerance, Helicobacter pylori infection, anatomical abnormalities, prior abdominal surgeries, motility disorders, autoimmune conditions, or hepatic condition-were identified. Initial diagnostic hypotheses included more prevalent gastrointestinal disorders such as lactose intolerance, celiac disease, intestinal parasitosis, chronic constipation, and intestinal malformations (e.g., intestinal malrotation). SIBO was suspected following a thorough reassessment of the clinical history. The diagnosis was confirmed via a hydrogen breath test with lactulose, supported by radiological findings. Following treatment with metronidazole (30 mg/kg/day for 10 days), the patient demonstrated significant clinical resolution of the previously reported symptoms. A follow-up hydrogen breath test revealed no further evidence of bacterial overgrowth in the small intestine.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 ","pages":"eRC2117"},"PeriodicalIF":0.9,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12977240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147357063","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":"Guided and unguided neural organoids play complementary roles in studying neurodevelopment and neuroinflammation.","authors":"Raphaella Josino, Bruno Yukio Yokota-Moreno, Isabella de Sousa Nóbrega, André Luíz Teles E Silva, Melissa Bernardini Bachir Moysés, Guilherme Grecco Ferreira, Mariana Silva Branquinho, Elisa Varella Branco, Maria Rita Passos-Bueno, Andrea Laurato Sertié","doi":"10.31744/einstein_journal/2026AO1716","DOIUrl":"10.31744/einstein_journal/2026AO1716","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to compare guided dorsal forebrain neural organoids with unguided neural organoids, focusing on differences in structural organization, cellular composition, and functional properties.</p><p><strong>Methods: </strong>Using the same human induced pluripotent stem cell line, we applied two established differentiation protocols in parallel to generate guided and unguided neural organoids.</p><p><strong>Results: </strong>Guided neural organoids exhibited reproducible cytoarchitecture, relatively homogeneous morphology, and robust network activity, making them particularly well-suited for modeling specific aspects of cortical neurodevelopment and neurodevelopmental disorders. In contrast, unguided neural organoids displayed greater heterogeneity in morphology and cellular composition, including prominent development of astrocytes, microglia, and choroid plexus-like structures that respond to inflammatory stimuli, positioning them as valuable models for studying neuroinflammation during brain development.</p><p><strong>Conclusion: </strong>These findings emphasize the importance of selecting neural organoids protocols based on specific research questions, and suggest that the guided and unguided approaches can complement each other to provide insights into neurodevelopmental and neuroinflammatory processes.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 ","pages":"eAO1716"},"PeriodicalIF":0.9,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12977266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147357029","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":"Anesthetic practices and physiological foundations in fetal surgery: a literature review.","authors":"Marco Augusto Sperandeo Liguori, Ana Carolina Florentino Lobato, Gustavo Yano Callado, Cid Akihiko Ura Kusano, Eduardo Félix Martins Santana","doi":"10.31744/einstein_journal/2026RW1538","DOIUrl":"10.31744/einstein_journal/2026RW1538","url":null,"abstract":"<p><p>Fetal anesthesia plays a critical role in ensuring maternal and fetal safety and optimizing outcomes during fetal surgical interventions. Despite its importance, there is currently no consensus regarding optimal anesthetic strategies for these procedures. This narrative review explores the principal types of fetal surgery, including minimally invasive and fetoscopic procedures, open fetal surgery, and Ex Utero Intrapartum Treatment, with particular emphasis on the factors influencing anesthetic decision-making. A comprehensive literature search was conducted across SciELO, PubMed, and Google Scholar, including articles published in any language up to May 2024. This review aims to highlight current anesthetic techniques and relevant maternal-fetal physiological considerations. Although fetal surgery can be performed safely using different anesthetic modalities, anesthetic management should be individualized according to maternal and fetal conditions, patient preferences, and the expertise of the multidisciplinary team. The lack of standardized guidelines and the limited availability of high-quality evidence underscore the need for further research. Future studies should focus on protocol development, complication management, and the use of adjuvant therapies to enhance maternal and fetal outcomes.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 ","pages":"eRW1538"},"PeriodicalIF":0.9,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12977265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147357084","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}