Einstein-Sao Paulo最新文献

{"title":"Snakebites by Bothrops taeniatus: characteristics of snakebites involving a rare venomous snake in Brazil.","authors":"Paula Cristina Yukari Suzaki Fujii, Bruna Seffrin Soares, Eduarda Scoto Dias, Henrique Lira Borges, Daniel Emilio Dalledone Siqueira, Ramon Cavalcanti Ceschim","doi":"10.31744/einstein_journal/2025RC1430","DOIUrl":"10.31744/einstein_journal/2025RC1430","url":null,"abstract":"<p><p>Snakebites from the genus Bothrops account for up to 90% of venomous snakebites in Brazil. Among these species, Bothrops taeniatus is considered rare in Brazil, with only one reported case in the literature. Its venom has a strong hemorrhagic effect but lacks procoagulant activity, which can lead to significant variations in the neutralizing efficacy of anti-Bothrops serum. We describe the first case of severe envenomation by B. taeniatus with rapid recovery following the administration of anti-Bothrops serum in Brazil, and discuss the characteristics of B. taeniatus envenomation based on a literature review.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eRC1430"},"PeriodicalIF":0.9,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12671650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145558097","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":"Hemostasis, myocardial protection, and advanced monitoring in cardiovascular anesthesia: evidence-based practical insights.","authors":"Alfredo Olivera Orellana","doi":"10.31744/einstein_journal/2025CE1982","DOIUrl":"10.31744/einstein_journal/2025CE1982","url":null,"abstract":"","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eCE1982"},"PeriodicalIF":0.9,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12674824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145558066","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":"Stigma, quality of life, and return-to-work outcomes among organ and tissue transplant recipients in Brazil: a cross-sectional study.","authors":"Edson Arakaki, Érika Bevilaqua Rangel, Janine Schirmer, Bartira Aguiar Roza","doi":"10.31744/einstein_journal/2025AO1737","DOIUrl":"10.31744/einstein_journal/2025AO1737","url":null,"abstract":"<p><strong>Objective: </strong>Organ transplantation improves survival rates and quality of life; however, reintegration into the workforce remains a challenge. Therefore, this study examined the relationship among return-to-work, quality of life, and perceived stigma in Brazilian transplant recipients.</p><p><strong>Methods: </strong>This cross-sectional study assessed stigma, quality of life (using the Short Form-36), and employment status in 352 transplant recipients. Statistical analyses included Kaplan-Meier survival curves, regression models, and factor analysis to identify key return-to-work and stigma determinants.</p><p><strong>Results: </strong>The average return-to-work rate was 53.7%, with socioeconomic class, prior employment, and organ transplantation type positively influencing return-to-work. Stigma negatively impacted return-to-work and quality of life, especially Functional Capacity and Mental Health. Older age, racial disparities, and socioeconomic inequities were significant return-to-work barriers.</p><p><strong>Conclusion: </strong>Return-to-work was observed in 53.7% of transplant recipients, with rates declining over time. Higher return-to-work was associated with pre-transplant employment, higher socioeconomic status, and organ transplant type. Stigma negatively impacted both return-to-work and quality of life. Return-to-work disparities were evident in terms of age, race, and income. Pre-transplant employment has emerged as the strongest return-to-work predictor. Overcoming these structural barriers is essential for optimizing long-term outcomes and ensuring that transplant recipients fully reintegrate into their occupational lives.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAO1737"},"PeriodicalIF":0.9,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12671647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145558260","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":"Asymptomatic T prolymphocytic leukemia: case report and literature review.","authors":"Luiz Frederico Bezerra Honorato Junior, Elizabeth Xisto Souto, Roberta Maria da Silva Oliveira Safranauskas, Renata Kiyomi Kishimoto, Laiz Cameirao Bento, Marilia Sandoval Passaro, Rodrigo Seiti Kojima, Nydia Strachman Bacal, Barbara Ferreira Cordeiro Galvão, Luiz Gustavo Ferreira Cortês, Elvira Deolinda Rodrigues Pereira Velloso, Nelson Hamershlak","doi":"10.31744/einstein_journal/2025RC1899","DOIUrl":"10.31744/einstein_journal/2025RC1899","url":null,"abstract":"<p><p>T-cell prolymphocytic leukemia is a rare and aggressive mature T-cell malignancy that usually presents with marked lymphocytosis, hepatosplenomegaly, lymphadenopathy, and B symptoms. However, a minority of patients present with an indolent, asymptomatic form. Case Report: A 44-year-old man was diagnosed with asymptomatic T-cell prolymphocytic leukemia after routine blood tests revealed persistent lymphocytosis. Immunophenotyping revealed a mature CD4-/CD8+ T-cell population. Cytogenetic analysis showed 14q11.2 abnormalities with TCRAD rearrangement by fluorescent in situ hybridization. A monoclonal T-cell population was confirmed by flow cytometry and polymerase chain reaction, and a STAT5B mutation was identified by next-generation sequencing. The patient had no cytopenia or organ involvement and a watch-and-wait strategy was adopted. The pathogenesis of T-cell prolymphocytic leukemia involves recurrent genetic alterations, including TCL1A rearrangements and ATM mutations, which promote genomic instability. Despite their aggressive nature, up to 30% of cases initially follow an indolent course, allowing for observation rather than immediate treatment. Standard therapies include alemtuzumab-based regimens and hematopoietic stem cell transplantation, although relapse rates remain high. Conclusion: This case underscores the need to recognize indolent presentations of T-cell prolymphocytic leukemia that may be managed conservatively. Further research is required to identify prognostic markers and optimize therapeutic strategies.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eRC1899"},"PeriodicalIF":0.9,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12671651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145558012","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":"HPV-independent vulvar squamous cell carcinoma: a case report and review of the literature.","authors":"Raphael Federicci Haddad, Mari Hattori Ballantyne Wyper, Samuel Drumond Esperança, Gustavo Yano Callado, Karla Calaça Kabbach Prigenzi, Fernanda Kesselring Tso, Patricia Napoli Belfort-Mattos","doi":"10.31744/einstein_journal/2025RC1482","DOIUrl":"10.31744/einstein_journal/2025RC1482","url":null,"abstract":"<p><p>Vulvar cancer, a rare gynecological malignancy, accounts for 3-5% of cases and is most commonly squamous cell carcinoma. Prognosis is poorer in cancers unrelated to human papillomavirus (HPV), often associated with chronic inflammation. We report the case of a 42-year-old woman from São Paulo, Brazil, who presented with a vulvar lesion initially misdiagnosed as an ingrown hair. Despite treatment, the lesion progressed, and subsequent evaluation revealed invasive squamous cell carcinoma. Biopsy confirmed HPV-independent disease, with immunohistochemistry demonstrating aberrant p53 expression. Molecular analysis identified differentiated vulvar intraepithelial neoplasia, underscoring the distinct molecular pathways of HPV-related and HPV-independent carcinogenesis. This case emphasizes the importance of early diagnosis, comprehensive histopathological assessment, and further research to improve management and outcomes in HPV-independent vulvar cancer.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eRC1482"},"PeriodicalIF":0.9,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12539858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453324","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":"Perineural hematoma following lumbar injection presenting as a neurosurgical emergency.","authors":"Guilherme Pianowski Pajanoti, Matheus Neves Castanheira, Delio Eulalio Martins Filho, Michel Kanas, Marcelo Wajchenberg, Nelson Astur","doi":"10.31744/einstein_journal/2025RC1483","DOIUrl":"10.31744/einstein_journal/2025RC1483","url":null,"abstract":"<p><p>Lower back pain and sciatica account for approximately 40% of work-related absences, with management options ranging from conservative measures, such as rest and analgesia, to surgical intervention. Lumbar epidural steroid injections and facet joint blocks are frequently used for both diagnostic and therapeutic purposes. While most complications are minor (2.4%-9.6%), severe events, including infection, hematoma formation, and spinal cord infarction, have been reported. This case presents a perineural hematoma manifesting as acute radiculopathy, necessitating urgent surgical decompression. The patient was a 55-year-old woman with a 7-month history of low back pain radiating to her right leg, unresponsive to conservative treatments, who subsequently underwent facet and nerve root injections. Magnetic resonance imaging demonstrated lumbar degeneration with Modic changes and multilevel disc bulging. The procedure, performed under fluoroscopic guidance with contrast and therapeutic agents, was initially uneventful. However, on the third day post-injection, she developed acute left leg weakness and sensory impairment. Repeat magnetic resonance imaging showed an abnormal signal in the left L3-L4 foramen compressing the L3 nerve root, raising suspicion for a perineural hematoma. Urgent surgical decompression was performed, and pathological examination confirmed organizing hemorrhage. The patient's neurological symptoms improved rapidly, with complete recovery achieved within a month. The literature indicates that hematomas may arise from increased epidural pressure or direct needle injury, even in the absence of signs of bleeding. Practitioners should remain vigilant for post-injection hematomas, as delayed recognition can result in permanent neurological deficits. Magnetic resonance imaging is essential for timely diagnosis, and urgent decompression may optimize outcomes, given that earlier intervention is associated with better recovery.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eRC1483"},"PeriodicalIF":0.9,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12539834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453449","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":"Difficult clinical management of groove pancreatitis: a case report.","authors":"Matheus Marcelino Dias, Marcelo Bruno de Rezende, Rielly de Sousa E Silva, Vanderlei Segatelli, Adriano Tachibana","doi":"10.31744/einstein_journal/2025RC1216","DOIUrl":"10.31744/einstein_journal/2025RC1216","url":null,"abstract":"<p><p>Groove pancreatitis is a rare form of chronic pancreatitis that affects the anatomical area between the head of the pancreas, medial wall of the second part of the duodenum, and common bile duct, known as the groove area. We present the case of a 40-year-old female patient with recurrent acute abdominal pain, vomiting, inappetence, and weight loss over several months. Diagnostic imaging revealed obliteration of fat in the pancreaticoduodenal groove and densification of the adjacent adipose planes, along with an infiltrative and stenosing lesion in the duodenum. Despite negative biopsy results, the patient's symptoms persisted, leading to a multidisciplinary decision regarding surgical intervention. Initially, a less-invasive robotic gastroenteric anastomosis was performed; however, this did not yield the desired outcome. Consequently, after further episodes of pancreatic inflammation, a more extensive pancreaticoduodenectomy (Whipple procedure) was performed. The patient showed significant clinical improvement postoperatively, with no recurrence of symptoms. Groove pancreatitis poses a diagnostic challenge owing to its nonspecific clinical presentation and imaging findings. Although management typically involves dietary changes, medication, and endoscopic interventions, surgical intervention may be necessary in cases of recurrent symptoms or complications. This case highlights the importance of a multidisciplinary approach in managing groove pancreatitis and underscores the potential efficacy of surgical intervention in achieving symptomatic relief and improving quality of life, even in atypical patient demographics.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eRC1216"},"PeriodicalIF":0.9,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12539842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453123","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":"Assessing the impact of sex and circadian rhythms on rodent behavior: refining preclinical study designs.","authors":"Olívia Furiama Metropolo Dias, Nicole Mastandrea Ennes do Valle, Fernando Anselmo de Oliveira, Arielly da Hora Alves, Javier Bustamante Mamami, Gabriel Nery de Albuquerque Rego, Keithy Felix da Silva, Marta Caetano Dos Santos Galanciak, Juan Matheus Munoz, Luciana Cintra, Mariana Penteado Nucci, Lionel Fernel Gamarra","doi":"10.31744/einstein_journal/2025AO1614","DOIUrl":"10.31744/einstein_journal/2025AO1614","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the effects of sex and time of day on behavioral parameters in healthy rats, focusing on locomotion, cognition, and memory (both spatial and episodic).</p><p><strong>Methods: </strong>Twenty-four Wistar rats (12 males and 12 females) were divided into morning and afternoon groups. Behavioral tests included actimetry for spontaneous locomotion, novel object recognition test for episodic memory, and the Morris water maze test for spatial memory. Data were analyzed cross-sectionally and longitudinally, considering sex and time of day as variables. The evaluated parameters included fast and slow horizontal and vertical movements, recognition index, average speed, and quadrant preference in the Morris water maze.</p><p><strong>Results: </strong>Females exhibited higher frequencies of rapid horizontal and vertical movements than males, especially in the morning. Novel object recognition test results showed higher recognition index values in the morning, with females displaying greater exploration of novel objects, while the Morris water maze test results indicated that the time spent in the target quadrant was consistent across groups, but females demonstrated longer latencies in the afternoon.</p><p><strong>Conclusion: </strong>These results highlight the significant influence of sex and circadian timing on behavioral performance in healthy animals. These factors should be carefully considered when designing and interpreting preclinical behavioral studies to improve experimental consistency and data reproducibility.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAO1614"},"PeriodicalIF":0.9,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12564045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453026","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":"Neutrophil-to-lymphocyte ratio as a predictor of mortality in patients with acute kidney injury: a systematic review and meta-analysis.","authors":"Idrys Henrique Leite Guedes, Fernando Uvinha, Isabela Lino Costa, Gustavo Martins de Ferreira, Luciano César Pontes de Azevedo, Paulo Ricardo Gessolo Lins","doi":"10.31744/einstein_journal/2025RW1555","DOIUrl":"10.31744/einstein_journal/2025RW1555","url":null,"abstract":"<p><strong>Introduction: </strong>Acute kidney injury is a common and serious condition in critically ill patients. Current biomarkers, such as serum creatinine, are limited in early detection and prognostic assessment. The neutrophil-to-lymphocyte ratio has emerged as a promising inflammatory biomarker, reflecting systemic inflammation and potentially serving as a tool for risk stratification in high-risk groups.</p><p><strong>Objective: </strong>To evaluate the prognostic value of the neutrophil-to-lymphocyte ratio in predicting mortality in patients with acute kidney injury through a systematic review and meta-analysis.</p><p><strong>Methods: </strong>A comprehensive search was conducted in PubMed, Embase, Cochrane, and LILACS databases for full-text articles published from the inception of each database until June 2024, using terms related to neutrophil-to-lymphocyte ratio and acute kidney injury. Studies were included if they evaluated the relationship between neutrophil-to-lymphocyte ratio and mortality in acute kidney injury patients. Data were pooled for meta-analysis using a random-effects model, with sensitivity, specificity, and area under the curve (AUC) calculated.</p><p><strong>Results: </strong>Of the 806 studies identified, five met the inclusion criteria, encompassing a total of 2,424 patients. The pooled sensitivity and specificity of the neutrophil-to-lymphocyte ratio for predicting mortality were 0.58 (95%CI=0.51-0.65) and 0.65 (95%CI=0.59-0.71), respectively. The AUC was 0.65, suggesting moderate predictive power. Significant heterogeneity was observed across studies owing to differences in neutrophil-to-lymphocyte ratio cutoff points, patient populations, and outcomes analyzed.</p><p><strong>Conclusion: </strong>An elevated neutrophil-to-lymphocyte ratio is associated with a worse prognosis in patients with acute kidney injury, highlighting its potential as a readily available biomarker for risk stratification.Prospero database registration: CRD42024569162.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eRW1555"},"PeriodicalIF":0.9,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12539831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453329","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":"Nationwide epidemiological analysis of surgically treated upper limb vascular trauma over 16 years in Brazil.","authors":"Marcella Moura Ceratti, Carolina Carvalho Jansen Sorbello, Felipe Soares Oliveira Portela, Marcelo Fiorelli Alexandrino da Silva, Marcelo Passos Teivelis, Nelson Wolosker","doi":"10.31744/einstein_journal/2025AO1339","DOIUrl":"10.31744/einstein_journal/2025AO1339","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the epidemiology of upper limb vascular trauma across Brazil and evaluate the incidence rates, demographic characteristics, lethality, days of hospitalization, and related healthcare costs.</p><p><strong>Methods: </strong>This retrospective analysis used data from the Brazilian public health system over sixteen years (2008-2023). Automated data extraction utilized Python-based tools to gather information on vascular trauma procedures identified by ICD-10 codes. Statistical analyses were performed to assess variations in incidence, lethality, and treatment costs across Brazilian regions.</p><p><strong>Results: </strong>A total of 25,573 cases of upper limb vascular trauma were recorded. Most cases occurred in males (79.8%) with a mean age of 34.7 years. The region in Brazil with the highest incidence of upper limb vascular trauma was the North (16.6 cases per 100,000 inhabitants), while the Southeast had the lowest (10.7 cases per 100,000 inhabitants). The average length of hospital stay was 4.39 days, and 92.8% of the patients did not require admission to the intensive care unit. Among patients admitted to the intensive care unit, the average length of stay was 4.52 days. The overall lethality of upper limb vascular trauma was 2.37%, with higher lethality observed in bilateral upper limb vascular trauma (3.81%).</p><p><strong>Conclusion: </strong>The incidence of upper limb vascular trauma is higher in Brazil than in developed countries, even after adjusting for population size. However, lethality and hospitalization duration did not appear to differ significantly from those in developed countries.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAO1339"},"PeriodicalIF":0.9,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12539836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145558099","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}