Einstein-Sao Paulo最新文献

{"title":"Management of oral stomatitis associated with BRAFi-MEKi therapy using intralesional corticosteroid and local anesthetic: a case report.","authors":"Maria Cecilia Querido de Oliveira, Maria Cláudia Cuzzullin, Vallentine Louzada Miranda, Aline Paim de Abreu Paulo Gomes, Julio Cesar Marcassa, Pablo Augustin Vargas, Ana Luiza Oliveira Corrêa Roza, André Caroli Rocha, Alan Roger Santos-Silva, Ana Carolina Prado-Ribeiro, João Gabriel Silva Souza, Aljomar José Vechiato-Filho","doi":"10.31744/einstein_journal/2026RC2409","DOIUrl":"10.31744/einstein_journal/2026RC2409","url":null,"abstract":"<p><p>This case documents the clinical pattern of a fibrinopurulent ulcer with a hyperplastic lesion that developed after the initiation of two classes of targeted therapies acting on different components of the mitogen-activated protein kinase signaling pathway (BRAF inhibitors [BRAFi] and MEK inhibitors [MEKi]). A 66-year-old woman was diagnosed with choroidal melanoma in the right eye in 2012 and successfully treated by choroidal melanoma resection. Tumor recurrence was diagnosed 8 years later. Nivolumab and ipilimumab were prescribed, but this combination was replaced with dabrafenib-trametinib due to disease progression. A second orbital exenteration and adjuvant radiotherapy to the orbital cavity (total dose of 4,000 cGy) were performed during dabrafenib-trametinib therapy. A few months after initiating this combination, the patient reported oral discomfort and an ulcer on the dorsum of the tongue. An incisional biopsy showed only signs of inflammation. A second biopsy demonstrated the same histological pattern. Based on clinical and histopathological findings, the final diagnosis was stomatitis associated with BRAFi-MEKi therapy. An intralesional injection of triamcinolone solution combined with 2% mepivacaine was performed. One month later, 0.05% topical corticosteroid was prescribed, and the lesion completely healed after an additional month. This report describes a previously unreported clinical presentation of an oral adverse event associated with combined BRAFi-MEKi therapy. It highlights the importance of recognizing unusual oral toxicities related to targeted therapies, as well as the role of appropriate local management in controlling symptoms and allowing the continuation of oncologic treatment.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 spe3","pages":"eRC2409"},"PeriodicalIF":1.1,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13689969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921218","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":"Oral cavity as a reservoir of respiratory pathogens: microbial dynamics in patients receiving mechanical ventilation.","authors":"Gabrielle Luiza de Camargos Pessoa, Ana Maria Schroden Rodrigues da Cunha, Leticia Schroden Rodrigues da Cunha, Giovanna Schroden Rodrigues da Cunha, Vinicius Rangel Geraldo-Martins, Ruchele Dias Nogueira","doi":"10.31744/einstein_journal/2026AO2476","DOIUrl":"10.31744/einstein_journal/2026AO2476","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the prevalence, co-occurrence, and temporal dynamics of Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, and Pseudomonas aeruginosa in oral and tracheal samples from critically ill patients receiving mechanical ventilation.</p><p><strong>Methods: </strong>This observational analytical study included 21 adult patients receiving mechanical ventilation who were admitted to an intensive care unit. Oral and tracheal samples were collected within the first 24 h after intubation (Day 0) and again after 48 h (Day 2). Bacterial genomic deoxyribonucleic acid was extracted and analyzed using quantitative realtime polymerase chain reaction. Microbial detection was evaluated qualitatively based on the presence or absence of each microorganism and quantitatively using relative bacterial load analysis. Statistical analyses assessed correlations between oral and tracheal colonization patterns and temporal changes in bacterial load.</p><p><strong>Results: </strong>More than 43% of oral and tracheal samples tested positive for at least one investigated pathogen at both collection time points, indicating persistent microbial colonization during mechanical ventilation. Significant positive correlations for Staphylococcus aureus detection were observed between oral and tracheal samples on Day 0 (p=0.0028) and Day 2 (p=0.0021), suggesting a possible association between oral colonization and lower airway microbial presence. Streptococcus pneumoniae detected in initial oral samples showed a significant correlation with tracheal detection after 48 h (p=0.03). Quantitative analyses demonstrated no significant changes in bacterial load over time for most microorganisms. However, Klebsiella pneumoniae showed a significant increase in tracheal bacterial load between Day 0 and Day 2 (p=0.04), with higher tracheal loads than oral samples on Day 2 (p=0.01).</p><p><strong>Conclusion: </strong>The oral cavity may serve as an important reservoir of respiratory pathogens in patients receiving mechanical ventilation. The observed correlations between oral and tracheal colonization and pathogen-specific colonization patterns reinforce the relevance of oral health management in critical care settings. In particular, the increase in tracheal Klebsiella pneumoniae load suggests that lower airway proliferation may occur during mechanical ventilation independently of simultaneous increases in oral bacterial load.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 spe3","pages":"eAO2476"},"PeriodicalIF":1.1,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13689972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921167","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":"First-contact access from the perspective of users of primary health care: an evaluation in family and oral health teams.","authors":"Valmir Vanderlei Gomes Filho, Lorrayne Belotti, Ana Carolina Cintra Nunes Mafra, Anne da Silva Almeida, Rebeca Cardoso Pedra, Fernanda Campos de Almeida Carrer","doi":"10.31744/einstein_journal/2026AO2528","DOIUrl":"10.31744/einstein_journal/2026AO2528","url":null,"abstract":"<p><strong>Objective: </strong>In this study, we aimed to evaluate the primary health care attribute of first-contact access from the perspective of users of family and oral health teams in São Paulo, Brazil.</p><p><strong>Methods: </strong>A cross-sectional study was conducted at 12 basic health units between January and November 2021. The adult versions of the Primary Care Assessment Tool (PCATool-Brazil) and PCATool-Oral Health were used to assess first-contact access through its two components of utilization and accessibility.</p><p><strong>Results: </strong>In total, 537 individuals participated, including 129 users of oral health teams and 408 users of family health teams. In both groups, utilization scores were higher than accessibility scores. Among users of oral health teams, the mean scores were 8.08 for utilization and 4.37 for accessibility; among users of family health teams, the corresponding scores were 8.43 and 3.80. For oral and family health teams, high performance for utilization was observed in 85.37% and 87.53% of users, whereas low performance for accessibility was observed in 95.08% and 97.70% of users, respectively. Few differences in participant characteristics were observed among users of oral health teams, with higher utilization scores noted among those without private health insurance. Regarding users of family health teams, higher utilization scores were observed among older adults, retirees, or pensioners; beneficiaries of social programs; those without private health insurance; and those with hypertension and or diabetes. For accessibility, higher scores were observed among men, older adults, and retirees or pensioners.</p><p><strong>Conclusion: </strong>Overall, utilization was satisfactory and accessibility was unsatisfactory in both family and oral health teams. Primary health care services were recognized as a usual source of care, but organizational barriers to timely access remain, especially in oral health care. These findings highlight the need to strengthen accessibility in primary health care, particularly through organizational strategies aimed at improving timely access to care.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 spe3","pages":"eAO2528"},"PeriodicalIF":1.1,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13689953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841619","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":"Assessment of predictive factors for acute kidney injury after thrombectomy using AngioJet for iliofemoral deep vein thrombosis.","authors":"Veruska Castanheira Frade, Vinícius Bertoldi, Manoel Augusto Lobato Filho, Vitor Cervantes Gornati, Walter Campos Júnior, Nelson Wolosker, Igor Rafael Sincos","doi":"10.31744/einstein_journal/2026AO2438","DOIUrl":"10.31744/einstein_journal/2026AO2438","url":null,"abstract":"<p><strong>Objective: </strong>To identify the relationship between acute kidney injury (AKI) and the treatment of iliofemoral deep vein thrombosis in the acute phase using an AngioJet® device.</p><p><strong>Methods: </strong>This retrospective study included all 40 patients diagnosed with iliofemoral deep vein thrombosis who underwent treatment with AngioJet, conducted at the Vascular and Endovascular Clinic Service (Team Science) of Hospital Israelita Albert Einstein(HIAE), Hospital Edmundo Vasconcelos, Hospital São Camilo.</p><p><strong>Results: </strong>No significance difference was observed regarding sex (p=0.128), procedures with vs. without stent placement (p=0.138), body mass index (BMI) <25 vs. >25kg/m2 (p=0.4), and BMI <30 vs. >30kg/m2 (p=0.77). Independent factors associated with the development of AKI included hemoglobin <10mg/dL in the immediate postoperative period (p=0.0009), a 2-point decrease in hemoglobin level immediately after surgery (p=0.0088), history of previous major surgery (p=0.002), and glomerular filtration rate <60mL/min/1.73m² (p=0.02) in the first postoperative day.</p><p><strong>Conclusion: </strong>A relationship between the use of AngioJet and the development of AKI was noted. Independent risk factors for AKI were hemoglobin <10mg/dL in the immediate postoperative period, a 2-point decrease in hemoglobin level immediately after surgery, history of previous major surgery, and glomerular filtration rate <60mL/min/1.73m² in the first postoperative day.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 ","pages":"eAO2438"},"PeriodicalIF":1.1,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13682777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841553","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":"Quality of referral letters in oral medicine: a two-year study in a Brazilian public dental specialty center.","authors":"Beatriz Pontim Pistolato, Lorena Gasques Contin, Hugo Sobrinho Bueno, Fernando de Souza Buzo, Saygo Tomo, Luciana Estevam Simonato","doi":"10.31744/einstein_journal/2026AO2330","DOIUrl":"10.31744/einstein_journal/2026AO2330","url":null,"abstract":"<p><strong>Objective: </strong>In the Brazilian public health system, referral letters, issued by general dentists and physicians who perform initial clinical assessments, is the main source of information in arriving at a final diagnosis. However, the consistency and completeness of the referral letters remain poorly explored. Therefore, we assessed the quality of referral letters received by an oral medicine service at a dental specialty center over a 2-year period (2023-2024) and characterized the diagnostic profile of referred cases.</p><p><strong>Methods: </strong>This census-based retrospective cross-sectional study analyzed 430 referral letters using 8 predefined criteria (0-8 points) on lesion characteristics, clinical history, and diagnostic hypothesis. The referral letters were classified as poor (0-1), regular (2-3), good (4-6), or excellent (7-8).</p><p><strong>Results: </strong>All referrals were from public services; 47.0% were issued in 2023 and 53.0% in 2024. Referrals to dentists accounted for 97.2% of the referrals. Most letters were rated as regular (60.5%) or good (23.0%), while 15.6% were classified as poor and only 0.9% as excellent. Frequently reported descriptors included lesion location (84.2%) and primary morphology (76.5%). Clinically relevant details such as symptomatology (22.8%), time of evolution (16.0%), lesion size (3.5%), and limits (2.3%) were mostly absent. Diagnoses included benign lesions (71.9%), potentially malignant disorders (10.7%), normality variations (6.3%), and malignant lesions (3.7%); 7.4% of the referrals had no diagnosis. Referral quality scores differed significantly across diagnostic categories (p=0.0076), with lower scores observed in cases without a final diagnosis.</p><p><strong>Conclusions: </strong>Despite the predominance of benign lesions, more than one in every seven referrals, which were often incompletely documented, involved potentially malignant disorders or malignant lesions. Strengthening referral documentation through targeted training and standardized electronic templates may improve screening accuracy, support the earlier detection of oral lesions, and reduce diagnostic delays within the Brazilian unified health system.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 spe3","pages":"eAO2330"},"PeriodicalIF":1.1,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13689975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841627","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":"Donor-recipient risk assessment in extended criteria liver transplantation: a comparative analysis of prognostic scores.","authors":"Isadora Chen Rabello da Motta, Giovana Garcia Rossi, Fernanda Marques, Amanda Pinter Carvalheiro da Silva Boteon, Yuri Longatto Boteon","doi":"10.31744/einstein_journal/2026AO2500","DOIUrl":"10.31744/einstein_journal/2026AO2500","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the association between the use of extended criteria donors and post-transplant outcomes in a Brazilian liver transplantation center and to compare the prognostic performance of established severity scores.</p><p><strong>Methods: </strong>We conducted a retrospective observational study of liver transplantation performed between 2016 and 2020. Patient and graft survivals were assessed at 3, 12, 36, and 60 months. Extended criteria donor status was defined according to the Eurotransplant criteria. The predictive values of the Donor-Model for End-Stage Liver Disease, Donor Risk Index, and Balance of Risk scores were analyzed using categorical and continuous models.</p><p><strong>Results: </strong>Among 414 transplants, 62% (n=258) involved extended criteria donor grafts. One- and five-year patient survival rates were 89.5% and 82.5%, respectively, with no significant difference between extended criteria donor and non-extended criteria donor groups (log-rank p=0.074). The extended criteria donor classification was not independently associated with mortality. The Balance of Risk score was the only prognostic model significantly associated with mortality and graft loss. Each one-point increase in the Balance of Risk was associated with a 7.3% increase in mortality risk (hazard ratio [HR]=1.073; 95% confidence interval [95%CI], 1.016-1.133; p=0.012) and a 17.4% increase in graft loss risk (HR=1.174; 95%CI=1.073-1.284; p<0.001).</p><p><strong>Conclusion: </strong>In this cohort, extended criteria donor status alone did not predict inferior survival, whereas the Balance of Risk score demonstrated consistent prognostic discrimination. These findings support the use of integrated donor-recipient risk assessment to guide organ acceptance and allocation decisions in liver transplantation.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 ","pages":"eAO2500"},"PeriodicalIF":1.1,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13682792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841636","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":"Abdominal wall hernias in abdominal aneurysm cases: a cross-sectional imaging study.","authors":"Nathalia Cardoso Oliveira, Maria Fernanda Portugal, Matheus Toledo Nora, Paula Ribeiro do Prado Chadud, Luciana Helena Benetti, Camila de Freitas Corrêa, Adriano Tachibana, Ricardo Aun, Sergio Quilici Belczak","doi":"10.31744/einstein_journal/2026AO2405","DOIUrl":"10.31744/einstein_journal/2026AO2405","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to assess the prevalence of abdominal and hiatal hernias in patients with aortic, visceral, and renal aneurysms in a quaternary hospital.</p><p><strong>Methods: </strong>Computed tomography angiography reports from 2,597 patients with intra-abdominal aneurysms, collected between January 2005 and July 2021 at a private hospital in São Paulo, Brazil, were analyzed. The variables of interest were analyzed descriptively, and inferential statistics (chi-square test and Student's t-test) were applied to explore relationships between sex, age, number of vessels with aneurysms, and number of hernias identified by computed tomography angiography.</p><p><strong>Results: </strong>Of 2,597 patients with abdominal aneurysms, 837 (32.23%) presented with at least one hernia. Among them, 416 patients (16.03%) had abdominal wall hernias, while 421 (16.20%) had hiatal hernias. Patients with hernias were significantly older (72.2±12.0 years; p<0.001) than patients without hernias (68.2±14.0 years); there were no significant age differences between sexes (p=0.714). Hiatal hernias had a high prevalence (50.3%) among both aortic and visceral aneurysms, particularly amnong those with hepatic artery (42.91%) and celiac trunk aneurysms (41.82%).</p><p><strong>Conclusion: </strong>A high coexistence of abdominal and hiatal hernias was observed among patients with intra-abdominal aneurysms. These findings highlight a statistical association and should not be interpreted as indicating a causal relationship or as a risk-stratification tool in the absence of prospective, controlled studies.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 ","pages":"eAO2405"},"PeriodicalIF":1.1,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13682778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841542","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":"Disparities in disease profiles among Afro-Brazilians and public healthcare patients with prostate cancer: real-world data from Brazil.","authors":"Ana Luiza Spina Nagy, Yuri Greb Vazquez, Yasmin Giovani de Sousa, Natalia Yamazaki Centrone, Uelson Donizeti Rocioli Junior, Francisco Tustumi, Fernando Moura, Fernando Maluf, Pedro Luiz Serrano Usón Junior","doi":"10.31744/einstein_journal/2026AO2267","DOIUrl":"10.31744/einstein_journal/2026AO2267","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate disparities in patients with prostate cancer treated at private or public health systems in Brazil.</p><p><strong>Methods: </strong>Anonymized retrospective and prospective data were collected from the medical records of patients over 18 years old diagnosed with prostate cancer between 2017 and 2024.</p><p><strong>Results: </strong>A descriptive analysis of 2,387 patients treated at private or public hospitals revealed that more than half were younger than 75 years old. Regarding race, 58% of patients reported their ethnicity: 75.41% identified as white, 13.84% mixed-race, 7.35% Black, 3.32% Asian, and 0.07% Indigenous. Public hospital patients had a 2.5-fold higher risk of metastasis at diagnosis (p<0.01) and longer hospital stays (p<0.01) when compared to private service patients. Black (odds ratio [OR]=2.27) and mixed-race (OR=1.89) patients had a higher risk of metastasis at diagnosis than white patients. Furthermore, Black (OR=0.04), mixed-race (OR=0.26), and Asian (OR=0.14) patients, and those >75 years old (OR=0.42) had lower chances of undergoing advanced surgery techniques such as robotic surgery. Patients older than 75 years had significantly worse overall survival (p<0.01).</p><p><strong>Conclusion: </strong>The results of this study highlight significant disparities in patients with prostate cancer. Black and mixed-race patients, as well as those from the public healthcare system, faced a higher risk of metastasis at diagnosis and lower chances of accessing advanced technologies. Additionally, advanced age was associated with shorter overall survival and longer hospitalization. These findings underscore the need for targeted interventions to reduce treatment access inequalities and improve clinical outcomes, particularly in vulnerable populations.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 ","pages":"eAO2267"},"PeriodicalIF":1.1,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13682784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841583","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":"Quality of life and caregiver burden among caregivers of children with autism spectrum disorder and neurotypical children: a cross-sectional study.","authors":"João Victor Soares Rodrigues, Wilton Mitsunari Takeshita, Rafael Arakaki Garcia, Alessandra Marcondes Aranega, Rafael Scaf de Molon, Letícia Helena Theodoro","doi":"10.31744/einstein_journal/2026AO2383","DOIUrl":"10.31744/einstein_journal/2026AO2383","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to compare quality of life and caregiver burden between caregivers and guardians of children with autism spectrum disorder and those of neurotypical children.</p><p><strong>Methods: </strong>A total of 124 caregivers participated and were assigned to two groups: autism spectrum disorder (ASD; n=62) and neurotypical (NT; n=62). Participants were recruited from a specialized multiprofessional dental care institution. Data were collected using a sociodemographic questionnaire, the WHOQOL-BREF, and the Zarit Burden Interview. Data were tabulated and analyzed using a 5% significance level.</p><p><strong>Results: </strong>The mean age of the children was 9.45 years in the ASD Group and 8.29 years in the NT Group. The proportion of boys was higher in the ASD Group than in the NT Group (p<0.001). Regarding functional independence, 69.4% of children with ASD depended on caregivers for activities of daily living, whereas 67.7% of neurotypical children were independent (p<0.001). For oral hygiene, 64.4% of children with ASD required caregiver assistance, whereas 82.3% of neurotypical children performed oral hygiene independently (p<0.001). Overall quality of life did not differ significantly between groups. However, specific items in the physical and psychological domains differed significantly between groups (Q3: p=0.021; Q4: p=0.001; Q26: p=0.003). By contrast, caregiver burden was significantly higher among caregivers of children with autism spectrum disorder than among caregivers of NT children, as reflected by higher total and domain scores (p<0.001).</p><p><strong>Conclusion: </strong>Although caregivers in both groups reported moderate quality of life, those caring for children with autism spectrum disorder experienced substantially greater caregiver burden. These findings support the need for targeted strategies to reduce caregiver stress and improve well-being in families of children with autism spectrum disorder.Brazilian Registry of Clinical Trials: RBR-4cvz58n and U1111-1299-9942.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 spe3","pages":"eAO2383"},"PeriodicalIF":1.1,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13689955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841612","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":"Insights from long-term follow-up of patients treated with oral immunotherapy for cow's milk allergy.","authors":"Lais Ferreira Lopes Brum, Nayara Maria Furquim Nasser, Glauce Hiromi Yonamine, Thais Costa Lima de Moura, Mayra de Barros Dorna, Antonio Carlos Pastorino, Beni Morgenstern, Ana Paula Moschione Castro","doi":"10.31744/einstein_journal/2026AO2168","DOIUrl":"10.31744/einstein_journal/2026AO2168","url":null,"abstract":"<p><strong>Objective: </strong>To describe the long-term outcomes of patients undergoing oral immunotherapy for cow's milk allergy in a pediatric allergy clinic, focusing on treatment efficacy and adverse reactions over 5 years of follow-up.</p><p><strong>Methods: </strong>This retrospective cohort study reviewed medical records of patients aged 5-18 years who underwent cow's milk oral immunotherapy at Instituto da Criança, São Paulo. All patients initiated treatment between 2013 and 2019 and completed at least 5 years of maintenance follow-up. Evaluated outcomes included treatment adherence, adverse reactions, anaphylaxis, and eosinophilic esophagitis. Data were analyzed descriptively, and statistical tests were applied.</p><p><strong>Results: </strong>Thirty patients entered the maintenance phase (median age, 8.2 years). Most had allergic comorbidities and a history of anaphylaxis. Four patients discontinued treatment within the first trimester: two due to anaphylaxis and two due to eosinophilic esophagitis. Adverse reactions were predominantly mild and decreased significantly over time (p=0.01). Severe reactions accounted for 17% of events, including 22 episodes of anaphylaxis. Eosinophilic esophagitis was diagnosed in 33% of patients and occurred more frequently among those initiating treatment after 12 years of age.</p><p><strong>Conclusion: </strong>Long-term oral immunotherapy increased tolerance and enabled regular milk ingestion in most patients. Older age at treatment initiation was associated with a higher incidence of eosinophilic esophagitis. Careful patient selection and structured monitoring during and after treatment are essential for early identification of severe reactions and eosinophilic esophagitis. Larger studies with longer follow-up are needed to optimize protocols and improve safety strategies.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 ","pages":"eAO2168"},"PeriodicalIF":1.1,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13682786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841581","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}