Einstein-Sao PauloPub Date : 2024-07-26eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024AO0549
Lenises de Paula van der Steld, Mario de Seixas Rocha, Ana Marice Teixeira Ladeia, Humberto Lago Livramento, Gervásio Batista Campos, Francisco Carlos da Costa Darrieux, Oscar Campuzano, Ramon Brugada
{"title":"PRKAG2 syndrome, a rare hypertrophic cardiomyopathy: a Brazilian long-term follow-up with extracardiac disorders.","authors":"Lenises de Paula van der Steld, Mario de Seixas Rocha, Ana Marice Teixeira Ladeia, Humberto Lago Livramento, Gervásio Batista Campos, Francisco Carlos da Costa Darrieux, Oscar Campuzano, Ramon Brugada","doi":"10.31744/einstein_journal/2024AO0549","DOIUrl":"10.31744/einstein_journal/2024AO0549","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to provide a long-term follow-up of PRKAG2 syndrome and describe the new phenotypic aspects of the condition. PRKAG2 syndrome is a rare autosomal-dominant glycogen storage disease characterized by cardiac hypertrophy, ventricular pre-excitation, and conduction system disease. Fatal arrhythmias occur frequently.</p><p><strong>Methods: </strong>A family cohort of 66 participants was recruited. Clinical and genetic analyses were performed.</p><p><strong>Results: </strong>Median age of 36.97±17.28 years, with 69.9% being men. Nineteen subjects carried the deleterious variant p.K290I of the PRKAG2 gene. This group experienced many malignant events, including eight pacemaker implants, three sudden cardiac deaths, five aborted cardiac arrests, four strokes, four premature neonatal deaths, two spontaneous abortions, five forceps deliveries, and 12 cesarean procedures. Extracardiac involvement, such as in neurocognitive and psychiatric disorders, has been observed only in carriers of mutations. Palpitations, Syncope, atrial fibrillation, atrial flutter, sinus pauses, and bradycardia were strongly and significantly associated with major or severe adverse events (sudden cardiac death, aborted cardiac arrest, pacemaker use, stroke, and congestive heart failure). Early diagnosis and intervention through antiarrhythmic drugs, anticoagulation, pacemaker implantation, radiofrequency catheter ablation, and cesarean section surgery improved the symptoms and survival rates. Mutations carriers were advised to avoid pregnancy.</p><p><strong>Conclusion: </strong>This study identified that the p.K291I_PRKAG2 mutation is associated with poor prognosis, highlighting the need for early intervention. Further research may uncover the potential connections between intellectual disability, miscarriage, and neonatal death in individuals with this syndrome.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11239200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141856750","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":"Overview of global healthcare policies for patients with chronic kidney disease: an integrative literature review.","authors":"Letícia Borges Mendonça Soares, Alcimar Barbosa Soares, Janise Braga Barros Ferreira","doi":"10.31744/einstein_journal/2024RW0519","DOIUrl":"10.31744/einstein_journal/2024RW0519","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic kidney disease is a progressive and irreversible loss of kidney function and considerably affects the lives of patients and their families. Its high incidence necessitates efficient public policies for prevention and treatment. However, policies for chronic kidney disease education and awareness are scarce.</p><p><strong>Objective: </strong>To evaluate global public policies for the prevention and treatment of chronic kidney disease adopted in various regions, aiming to comprehend the differences between various models.</p><p><strong>Methods: </strong>This integrative review followed PRISMA recommendations and included papers published between 2016 and 2021 across several databases.</p><p><strong>Results: </strong>The 44 selected articles were categorized into three themes: structural and financial aspects of the organization of renal healthcare, access to renal healthcare or management of chronic kidney disease, and coping strategies for chronic kidney disease or kidney health. Critical analysis of the papers revealed global neglect of kidney disease in political agendas. Considerable policy variations exist between different countries and regions of the same country. Our research highlighted that free and universal health coverage, especially for the most vulnerable patients, is crucial for accessing treatment owing to the prohibitively high treatment costs.</p><p><strong>Conclusion: </strong>Social, economic, and ethnic inequalities strongly correlate with disease occurrence, primarily affecting minority groups who lack health support, especially for the prevention and treatment of chronic kidney disease.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11221832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753046","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}
Einstein-Sao PauloPub Date : 2024-07-19eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024RW0182
Caio de Almeida Lellis, Marco Alejandro Menacho Herbas, Ledismar José da Silva
{"title":"Psychiatric disorders after deep brain stimulation of the subthalamic nucleus in Parkinson's disease: a systematic review.","authors":"Caio de Almeida Lellis, Marco Alejandro Menacho Herbas, Ledismar José da Silva","doi":"10.31744/einstein_journal/2024RW0182","DOIUrl":"10.31744/einstein_journal/2024RW0182","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the psychiatric alterations resulting from deep brain stimulation of the subthalamic nucleus in the management of Parkinson's disease.</p><p><strong>Methods: </strong>Articles were searched using three databases: Public/Publisher MEDLINE, Virtual Health Library, and Cochrane Library.</p><p><strong>Results: </strong>Eleven studies were included in the analysis. Manic syndrome alone was reported in two of the 11 studies analyzed. Psychosis alone was not reported in any of them, but it was found in association with other psychiatric alterations in two studies, not including manic syndrome. In one case report, hypersexuality was associated with depression and self-alienation. Depressive disorder was the most frequent psychiatric disorder after deep brain stimulation of the subthalamic nucleus, according to five of the reviewed articles, encompassing 26 patients. In four of these articles, depression was associated with other psychiatric disorders, such as psychosis, suicidal ideation, hypersexuality, and anxiety. Hypomanic syndrome was reported in two cases.</p><p><strong>Conclusion: </strong>More common psychiatric disorders related to the neuroanatomy of the nucleus were observed, probably because of the microlesions caused by the implantation of deep brain stimulation and the regulation of the stimulation of the device. The most common disorders include depression, mania/hypomania, psychosis, anxiety, suicidal ideation, and hypersexuality.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11221831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753047","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}
Einstein-Sao PauloPub Date : 2024-07-08eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024AO0462
Beatriz Mokwa Dos Santos, Edward Araujo Júnior, Rita Maira Zanine
{"title":"Is the colposcopic lesion size a predictor of high-grade lesions in young patients?","authors":"Beatriz Mokwa Dos Santos, Edward Araujo Júnior, Rita Maira Zanine","doi":"10.31744/einstein_journal/2024AO0462","DOIUrl":"10.31744/einstein_journal/2024AO0462","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate whether severity changes with colposcopic lesion size, regardless of age.</p><p><strong>Methods: </strong>This retrospective comparative study reviewed the records of 428 women with altered cytopathology reports who were directed by primary health care. Only those women with colposcopic alterations were evaluated (n=411). Histopathological analyses were restricted to patients who underwent excisional treatment (n=345). According to their age, they were grouped into the following: <21, 21-24, 25-35, and >35 years, and also, ≤24 and ≥25 years. The cytopathological, colposcopic, and histopathological findings were grouped according to severity. Lesion size was subjectively assessed from the colposcopic drawing recorded in the chart and according to the number of quadrants of the total cervical surface affected by colposcopic alterations in the transformation zone. Statistical significance was set at p<0.05.</p><p><strong>Results: </strong>The evaluations suggested that the lesion size was directly related to the severity of the cytopathology, colposcopy, and histopathology reports for the age groups ≤24 or ≥25 years. We observed associations between lesion size and severity of the cytopathology (≤24 years, p=0.037) and histopathology (≥25 years, p=0.003) findings.</p><p><strong>Conclusion: </strong>The size of the lesion was directly related to the severity of the histopathological lesion in patients aged ≥25 years and cytopathological in patients aged ≤24 years.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11213560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141564746","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}
Einstein-Sao PauloPub Date : 2024-07-08eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024AO0707
Flavio Tocci Moreira, Tarso Augusto Duenhas Accorsi, Karine De Amicis, Karen Francine Köhler, Renata Albaladejo Morbeck, Eduardo Cordioli, Carlos Henrique Sartorato Pedrotti
{"title":"Multidrug stewardship and adherence to guidelines in >200,000 direct-to-consumer Telemedicine encounters.","authors":"Flavio Tocci Moreira, Tarso Augusto Duenhas Accorsi, Karine De Amicis, Karen Francine Köhler, Renata Albaladejo Morbeck, Eduardo Cordioli, Carlos Henrique Sartorato Pedrotti","doi":"10.31744/einstein_journal/2024AO0707","DOIUrl":"10.31744/einstein_journal/2024AO0707","url":null,"abstract":"<p><strong>Objective: </strong>The quality of care and safety for Telemedicine-discharged patients with suspected respiratory infections are closely related to low rates of prescriptions of unjustified and high-risk medications. This retrospective study aimed to assess adherence to the current COVID-19 guidelines in direct-to-consumer telemedicine encounters at a large center using multidrug stewardship protocols.</p><p><strong>Methods: </strong>A quarterly electronic survey utilizing medical records of individual physician care assessed various quality indicators. Physicians received ongoing adaptive feedback based on personal metrics, with Telemedicine Center recommendations derived from the 2020 Infectious Diseases Society of America guidelines. The study included all consecutive adults with new respiratory symptoms in the last 14 days who sought spontaneous Telemedicine consultations between March 2020 and August 2021. This study analyzed patients with suspected or confirmed COVID-19 and other airway infections.</p><p><strong>Results: </strong>Of the 221,128 evaluated patients, 42,042 (19%) had confirmed COVID-19; 104,021 (47%) were suspected to have COVID-19; and, 75,065 (33%) had other diagnoses. Patients with suspected or confirmed COVID-19 had a mean (+DP) age of 35±12 years. A total of 125,107 (85.65%) patients were managed at home, 2,552 (1.74%) were referred for non-urgent in-office reassessment, and 17,185 (11.7%) were referred to the emergency department for whom there was no further treatment recommendation. The antibiotic rate in confirmed or suspected COVID-19 cases was 0.46%/0.65% and that for non-evidence-based prescriptions was 0.01%/0.005%.</p><p><strong>Conclusion: </strong>Guideline training and Telemedicine consultation feedback may lead to lower antibiotic and antimicrobial prescriptions in suspected and confirmed COVID-19 cases. Multidrug stewardship protocols may improve guideline adherence and reinforce the quality of care and safety in Telemedicine encounters.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11213559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141564747","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}
Einstein-Sao PauloPub Date : 2024-07-01eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024AO0223
Pâmela Moraes Volz, Vanise Dos Santos Ferreira Viero, Elizabet Saes-Silva, Bianca Languer Vargas, Fernanda Oliveira Meller, Antônio Augusto Schäfer, Simone Dos Santos Paludo, Lauro Miranda Demenech, Lucas Neiva-Silva, Samuel Carvalho Dumith
{"title":"Adherence to social distancing measures in southern Brazil, 2020/2021: a cross-sectional study.","authors":"Pâmela Moraes Volz, Vanise Dos Santos Ferreira Viero, Elizabet Saes-Silva, Bianca Languer Vargas, Fernanda Oliveira Meller, Antônio Augusto Schäfer, Simone Dos Santos Paludo, Lauro Miranda Demenech, Lucas Neiva-Silva, Samuel Carvalho Dumith","doi":"10.31744/einstein_journal/2024AO0223","DOIUrl":"10.31744/einstein_journal/2024AO0223","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to analyze the frequency of adherence to social distancing and individual protection measures of adult and older populations in two cities in southern Brazil and to characterize the sociodemographic aspects of these individuals.</p><p><strong>Methods: </strong>This cross-sectional, population-based study was conducted in the cities of Rio Grande, RS, and Criciúma, SC, Brazil. The outcome measure was the frequency of adherence to social distancing measures. Fisher's exact test (5% significance) was used to calculate the differences in prevalence according to exposure variables.</p><p><strong>Results: </strong>Among the 2,170 participants over the age of 18, the prevalence of adherence to social distancing was 18.5%. Adherence was significantly higher among women; older adults; single, divorced, or widowed people with a low educational level; people of lower socioeconomic status; and people affected by multiple chronic diseases.</p><p><strong>Conclusion: </strong>Approximately one in five respondents adhered to measures of social distancing, and adherence was more prevalent among the risk groups.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11196087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493842","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}
Einstein-Sao PauloPub Date : 2024-07-01eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024RC0582
Giovanna Sawaya Torre, Bruna Bonaventura Failla, Felipe Soares Oliveira Portela, Marcelo Passos Teivelis, Nelson Wolosker, Rogerio Iquizli, Carlos Augusto Ventura Pinto, Marcelo Assis Rocha, Adriano Tachibana
{"title":"Dynamic computed tomography angiography for noninvasive diagnosis of bow Hunter's syndrome: a case report.","authors":"Giovanna Sawaya Torre, Bruna Bonaventura Failla, Felipe Soares Oliveira Portela, Marcelo Passos Teivelis, Nelson Wolosker, Rogerio Iquizli, Carlos Augusto Ventura Pinto, Marcelo Assis Rocha, Adriano Tachibana","doi":"10.31744/einstein_journal/2024RC0582","DOIUrl":"10.31744/einstein_journal/2024RC0582","url":null,"abstract":"<p><p>The focus of this case report is to technically describe a noninvasive diagnostic evaluation of bow Hunter's syndrome using a dynamic computed tomography angiography protocol and discuss its advantages. In addition, we aimed to exemplify the quality of the study by presenting images of a 3D-printed model generated to help plan the surgical treatment for the patient. The dynamic computed tomography angiography protocol consisted of a first image acquisition with the patient in the anatomic position of the head and neck. This was followed by a second acquisition with the head and neck rotated to the side that triggered the symptoms, with technical parameters similar to the first acquisition. The acquired images were used to print a 3D model to better depict the findings for the surgical team. The dynamic computed tomography angiography protocol developed in this study helped visualize the vertebrobasilar arterial anatomy, detect vertebral artery stenosis produced by head and neck rotation, depict the structure responsible for artery stenosis (e.g., bony structure or membranes), and study possible complications of the disease (e.g., posterior cerebral circulation infarction). Additionally, the 3D-printed model better illustrated the findings of stenosis, aiding in surgical planning. In conclusion, dynamic computed tomography angiography for the evaluation of bow Hunter's syndrome is a feasible noninvasive technique that can be used as an alternative to traditional diagnostic methods.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11196086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493843","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}
Einstein-Sao PauloPub Date : 2024-06-24eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024AO0575
Nicoly Marques de Castro, Fernando Moura, Aline Lury Hada, Diogo Garcia, Elivane da Silva Victor, Gustavo Schvartsman, Leonardo Carvalho, Milena Lourenço Coleta Fernandes, Rodrigo de Souza Martins, Elaine Ferreira da Silva, Sarah Silva Mello Batista Dos Santos, Letícia Taniwaki, Patrícia Taranto, Janaina Pontes, Juliana Rodrigues Beal, Ana Carolina Pereira Dutra, João Bosco de Oliveira Filho, Sérgio Eduardo Alonso Araujo, Pedro Luiz Serrano Usón Junior
{"title":"Prognostic value of programmed cell death ligand 1 (PD-L1) expression in patients with stage III non-small cell lung cancer under different treatment types: a retrospective study.","authors":"Nicoly Marques de Castro, Fernando Moura, Aline Lury Hada, Diogo Garcia, Elivane da Silva Victor, Gustavo Schvartsman, Leonardo Carvalho, Milena Lourenço Coleta Fernandes, Rodrigo de Souza Martins, Elaine Ferreira da Silva, Sarah Silva Mello Batista Dos Santos, Letícia Taniwaki, Patrícia Taranto, Janaina Pontes, Juliana Rodrigues Beal, Ana Carolina Pereira Dutra, João Bosco de Oliveira Filho, Sérgio Eduardo Alonso Araujo, Pedro Luiz Serrano Usón Junior","doi":"10.31744/einstein_journal/2024AO0575","DOIUrl":"10.31744/einstein_journal/2024AO0575","url":null,"abstract":"<p><strong>Objective: </strong>Currently programmed cell death protein 1 (PD-1) inhibitors in combination with other therapies are being evaluated to determine their efficacy in cancer treatment. However, the effect of PD-ligand (L) 1 expression on disease outcomes in stage III (EC III) non-small cell lung cancer is not completely understood. Therefore, this study aimed to assess the influence of PD-L1 expression on the outcomes of EC III non-small cell lung cancer.</p><p><strong>Methods: </strong>This study was conducted on patients diagnosed with EC III non-small cell lung cancer who underwent treatment at a tertiary care hospital. PD-L1 expression was determined using immunohistochemical staining, all patients expressed PD-L1. Survival was estimated using the Kaplan-Meier method. Relationships between variables were assessed using Cox proportional regression models.</p><p><strong>Results: </strong>A total of 49 patients (median age=69 years) with EC III non-small cell lung cancer and PD-L1 expression were evaluated. More than half of the patients were men, and most were regular smokers. The patients were treated with neoadjuvant chemotherapy, surgery, or sequential or combined chemotherapy and radiotherapy. The median progression-free survival of the entire cohort was 14.2 months, and the median overall survival was 20 months. There was no significant association between PD-L1 expression and disease progression, clinical characteristics, or overall survival.</p><p><strong>Conclusions: </strong>PD-L1 expression was not correlated with EC III non-small cell lung cancer outcomes. Whether these findings differ from the association with immune checkpoint inhibitors remains to be addressed in future studies.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11196088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141451892","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}
Einstein-Sao PauloPub Date : 2024-06-24eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024AO0450
Marcela Tengler Carvalho Takahashi, Joana Bisol Balardin, Paulo Rodrigo Bazán, Danielle de Sá Boasquevisque, Edson Amaro Junior, Adriana Bastos Conforto
{"title":"Effect of transcranial direct current stimulation in the initial weeks post-stroke: a pilot randomized study.","authors":"Marcela Tengler Carvalho Takahashi, Joana Bisol Balardin, Paulo Rodrigo Bazán, Danielle de Sá Boasquevisque, Edson Amaro Junior, Adriana Bastos Conforto","doi":"10.31744/einstein_journal/2024AO0450","DOIUrl":"10.31744/einstein_journal/2024AO0450","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed at assessing the alterations in upper limb motor impairment and connectivity between motor areas following the post-stroke delivery of cathodal transcranial direct current stimulation sessions.</p><p><strong>Methods: </strong>Modifications in the Fugl-Meyer Assessment scores, connectivity between the primary motor cortex of the unaffected and affected hemispheres, and between the primary motor and premotor cortices of the unaffected hemisphere were compared prior to and following six sessions of cathodal transcranial direct current stimulation application in 13 patients (active = 6; sham = 7); this modality targets the primary motor cortex of the unaffected hemisphere early after a stroke.</p><p><strong>Results: </strong>Clinically relevant distinctions in Fugl-Meyer Assessment scores (≥9 points) were observed more frequently in the Sham Group than in the Active Group. Between-group differences in the alterations in Fugl-Meyer Assessment scores were not statistically significant (Mann-Whitney test, p=0.133). ROI-to-ROI correlations between the primary motor cortices of the affected and unaffected hemispheres post-therapeutically increased in 5/6 and 2/7 participants in the Active and Sham Groups, respectively. Between-group differences in modifications in connectivity between the aforementioned areas were not statistically significant. Motor performance enhancements were more frequent in the Sham Group compared to the Active Group.</p><p><strong>Conclusion: </strong>The results of this hypothesis-generating investigation suggest that heightened connectivity may not translate into early clinical benefits following a stroke and will be crucial in designing larger cohort studies to explore mechanisms underlying the impacts of this intervention. ClinicalTrials.gov Identifier: NCT02455427.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11196089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141451891","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}
Einstein-Sao PauloPub Date : 2024-06-10eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024AO0433
Priscila Montesano Cunha Crispim, Julia Yaeko Kawagoe, Ana Cristina Rosseti, Fernando Gatti de Menezes
{"title":"Factors underlying the high occupational risk of healthcare personnel for COVID-19 infection.","authors":"Priscila Montesano Cunha Crispim, Julia Yaeko Kawagoe, Ana Cristina Rosseti, Fernando Gatti de Menezes","doi":"10.31744/einstein_journal/2024AO0433","DOIUrl":"10.31744/einstein_journal/2024AO0433","url":null,"abstract":"<p><p>Crispim et al. demonstrated the independent risk factors for acquiring COVID-19 among healthcare personnel. They also showed the importance of infection prevention training to avoid acquiring COVID-19 in this population.</p><p><strong>Objective: </strong>To verify the rate of COVID-19 infection among healthcare personnel at high and low risk of COVID-19 infection and identify the underlying risk factors.</p><p><strong>Methods: </strong>This cross-sectional study was conducted between December 1, 2020 and February 28, 2021. Associations were verified between the levels of risk (high or low) of occupational COVID-19 infection and participant characteristics using the World Health Organization risk assessment questionnaire and adjusted using logistic regression models in single and multiple approaches.</p><p><strong>Results: </strong>Of the 486 participants, 57.4% were classified as having a high occupational risk for SARS-CoV-2 infection, with a diagnosis rate of 12.1%. The factors identified in the multivariate analysis for high occupational risk were age up to 29 years (odds ratio [OR] = 2.7, 95% confidence interval [95%CI] = 1.63-4.47), monthly family income greater than eight times the basic salary (OR= 1.8, 95%CI= 1.07-3.16), and healthcare personnel who did not participate in initial training to work in the area of patients with COVID-19 infection (OR= 2.39, 95%CI= 1.53-3.75).</p><p><strong>Conclusion: </strong>Encouraging training for occupational infection prevention is very important to reduce the impact of infectious diseases on healthcare personnel, especially young health professionals. COVID-19 infection among healthcare personnel has impacted the workforce in hospitals. Knowledge of the risk factors for COVID-19 infection is important for disease prevention measures. Failure to train healthcare personnel is an important risk factor for acquiring COVID-19.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11155719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141312032","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}