Sao Paulo Medical Journal最新文献

{"title":"FINE, a novel laboratory-based frailty index for elderly patients: a retrospective descriptive study.","authors":"Yasin Altun, Halime Dilber Balci, Nilay Çom Aybal","doi":"10.1590/1516-3180.2025.3337.13022026","DOIUrl":"10.1590/1516-3180.2025.3337.13022026","url":null,"abstract":"<p><strong>Background: </strong>Frailty in older adults is a multifactorial geriatric syndrome associated with inflammation, malnutrition, and hematological decline. Objective and easily applicable laboratory-based indices may complement clinical frailty assessment by providing rapid and low-cost screening tools, particularly in primary care and resource-limited settings.</p><p><strong>Objectives: </strong>To develop a simple laboratory-based frailty screening index (FINE, Frailty Index for the Elderly) using C-reactive protein (CRP), albumin, hemoglobin, and sex, and to evaluate its association with the Clinical Frailty Scale (CFS) in older adults.</p><p><strong>Design and setting: </strong>A retrospective descriptive study conducted using electronic health records of individuals aged 80 years and older.</p><p><strong>Methods: </strong>Data from 322 older adults were analyzed. Their FINE scores were calculated by assigning 0 or 1 point to CRP, albumin, hemoglobin, and sex based on clinically accepted reference thresholds, yielding a total score ranging from 0 to 4. Frailty was assessed using pre-recorded CFS scores. Associations between FINE scores, CFS, and individual biomarkers were examined. The screening performance was evaluated using receiver operating characteristic (ROC) curve analysis.</p><p><strong>Results: </strong>The mean age of participants was 84.9 ± 4.0 years, and 55.6% were female. The prevalence rate of frailty was 46.6%. FINE scores exhibited a positive correlation with CFS and CRP levels, and a negative correlation with albumin and hemoglobin levels (p < 0.005). ROC analysis demonstrated a statistically significant but moderate discriminatory ability for frailty (area under the curve = 0.642; 95% confidence interval: 0.5820.703). At a cut-off value of ≥ 0.5, FINE scores demonstrated high sensitivity (89.3%) but low specificity (22.1%).</p><p><strong>Conclusion: </strong>The FINE score is a simple, rapid, and low-cost laboratory-based frailty screening tool that is significantly associated with clinical frailty and key biological processes underlying frailty. Although low specificity limits its use as a diagnostic instrument, it may serve as a practical first-step screening approach in primary care and resource-limited settings. Further multicenter prospective studies are required to validate these findings.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"144 2","pages":"e20253337"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence in Cardiac Surgery: From Assistance to Assurance.","authors":"Guilherme Machado Rabello, Paulo Manuel Pêgo-Fernandes, Fabio Biscegli Jatene","doi":"10.1590/1516-3180.2026.1442.09122025","DOIUrl":"10.1590/1516-3180.2026.1442.09122025","url":null,"abstract":"","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"144 2","pages":"e20261442"},"PeriodicalIF":1.6,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telenutrition promoting equity of access in the SUS: a descriptive study.","authors":"Mariana Setanni Grecco, Laís Fileti Fraga, Mônica Rossatti Molina, Marcus Vinicius Dutra Zuanazzi, Camilla do Rosario Nicolino Chiorino, Soraya Camargo Ito Süffert","doi":"10.1590/1516-3180.2025.3462.26012026","DOIUrl":"10.1590/1516-3180.2025.3462.26012026","url":null,"abstract":"<p><strong>Background: </strong>In the area of nutrition, telehealth regulations were established on October 22, 2023, through Resolution No. 760, which defines and regulates telenutrition as a form of care and/or provision of services in food and nutrition through Information and Communication Technologies.</p><p><strong>Objectives: </strong>To present the profile of telenutrition users in the TeleNordeste-BP project. Design and setting: Descriptive study carried out by hospital BP - A Beneficência Portuguesa de São Paulo.</p><p><strong>Methods: </strong>All services were provided through teleconsultation with nutritionists from the TeleNordeste project between May and December 2023.</p><p><strong>Results: </strong>Of the 884 services, 873 (98.8%) were tele-interconsultation. The distribution of services by state was: 430 (48.6%) from Maranhão; 301 (34%) from Alagoas and 153 (17.3%) are from patients from Piauí. Among the services provided, 671 (75.9%) users were female and 213 (24.1%) were male; the average age was 39.54 years (standard deviation +/- 19.9). Most adult patients were overweight: 135 (25.9%) were classified as overweight, 121 (23.2%) as grade 1 obese, 100 (19.2%) as grade 2 obese, and 66 (12.6%) as grade 3 obese.</p><p><strong>Conclusion: </strong>chronic non-communicable diseases (NCDs) were the main reasons for seeking nutritional services, with more than 90% of the main reasons for consultation. Access to the telenutrition service offered by the TeleNordeste-BP project not only impacted the patient in ensuring access to nutritional care but also enabled the increase of Vigilância Alimentar e Nutricional (VAN).</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"144 2","pages":"e20253462"},"PeriodicalIF":1.6,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of surgical volume and specialist availability on thyroidectomy outcomes in Brazil: an ecological study with a nationwide retrospective analysis of 230,345 cases (2008-2023).","authors":"Ricardo Yugi Eri, Leandro Luongo Matos, Marcelo Passos Teivelis, Nelson Wolosker, Ana Kober Nogueira Leite","doi":"10.1590/1516-3180.2025.2938.11112025","DOIUrl":"10.1590/1516-3180.2025.2938.11112025","url":null,"abstract":"<p><strong>Introduction: </strong>Thyroid disorders affect a significant proportion of the population and often necessitate surgical intervention, particularly in cases of malignancy. In this study, we analyzed thyroidectomy procedures performed within the public health system (SUS) of Brazil from 2008 to 2023, with a focus on factors influencing in-hospital mortality.</p><p><strong>Methods: </strong>In the retrospective analysis, data on 230,345 thyroidectomies were extracted from SUS records and stratified by hospital volume and state-level distribution of head and neck specialists. Mortality rates were evaluated using non-parametric statistical analyses, including the Kruskal-Wallis and Spearman's correlation tests.</p><p><strong>Results: </strong>The overall in-hospital mortality rate was 0.15%. States with fewer than 0.5 head and neck specialists per 100,000 inhabitants exhibited significantly higher mortality rates (0.2 versus 0.15, p = 0.02). Hospitals performing fewer than 25 procedures annually (very low-volume) had a fivefold increase in mortality compared with high-volume hospitals (0.51 versus 0.10, p < 0.001). When hospitals performing fewer than 10 procedures per year were excluded, significant differences in mortality among volume groups were no longer observed.</p><p><strong>Conclusion: </strong>Mortality increased significantly in very low-volume hospitals performing fewer than 25 thyroidectomies per year; however, this difference was no longer observed after excluding hospitals that performed fewer than 10 interventions per year. These results support restricting thyroidectomies to hospitals performing at least 10 procedures annually and promoting centralization to improve outcomes. Structured regionalization policies are needed to ensure equitable access to specialized surgical care across Brazil.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"144 2","pages":"e20252938"},"PeriodicalIF":1.6,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Christiaan Neethling Barnard - A controversial figure: Courage, innovation, and the global impact of the world's first human heart transplant.","authors":"Noedir Antônio Groppo Stolf","doi":"10.1590/1516-3180.2026.3619.16122025","DOIUrl":"10.1590/1516-3180.2026.3619.16122025","url":null,"abstract":"","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"144 2","pages":"e20263619"},"PeriodicalIF":1.6,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Synovitis detection in rheumatology: a systematic review and meta-analysis of contrast-enhanced ultrasound and magnetic resonance imaging.","authors":"Bruno Fernandes Barros Brehme de Abreu, Gabriella Simões Scarmagnan, Márcio Luís Duarte, Mayara Oliveira da Silva, Wagner Iared","doi":"10.1590/1516-3180.2025.3088.11112025","DOIUrl":"10.1590/1516-3180.2025.3088.11112025","url":null,"abstract":"<p><strong>Background: </strong>Synovial tissue proliferation in the bare area of the joint is an early indicator of synovitis. Vascularization of the pannus helps differentiate between inactive and inflammatory processes, directly impacting therapeutic management. Synovitis can be diagnosed through clinical assessment, ultrasound, and magnetic resonance imaging (MRI); however, uncertainty remains regarding the optimal imaging modality.</p><p><strong>Objective: </strong>This study aimed to determine the accuracy of ultrasonography with microbubble contrast and contrast-enhanced MRI in diagnosing synovitis, irrespective of its etiology. In addition, the study aimed to determine the joints that were most accurately assessed for synovitis using microbubble ultrasound.</p><p><strong>Methods: </strong>Electronic searches were conducted in the Cochrane Library, MEDLINE, EMBASE, LILACS, SCOPUS, CINAHL, and Web of Science up to February 8, 2025, with additional screening of reference lists. Studies assessing diagnostic accuracy or detection rates of contrast-enhanced ultrasound (CEUS) and contrast-enhanced MRI for synovitis were included without restrictions on language or publication status. Two studies were selected after quality assessment using QUADAS-2, and eight studies were assessed using the RTI item bank methodology.</p><p><strong>Results: </strong>Diagnostic accuracies of contrast-enhanced ultrasonography (87%) and contrast-enhanced MRI (87.7%) were comparable. For knee evaluation, CEUS showed a higher detection rate (93.8%) than MRI (82.9%). Across different joints and underlying diseases, the detection rates were 81.9% and 88.3% for contrast-enhanced MRI. In patients with rheumatoid arthritis, MRI demonstrated a higher detection rate (96.2%) compared with ultrasound (67.2%). These findings indicate a similar overall diagnostic performance, although the limited number of included studies restricted generalizability.</p><p><strong>Conclusion: </strong>CEUS demonstrated diagnostic accuracy comparable to contrast-enhanced MRI, except in patients with rheumatoid arthritis. Given its low cost, portability, and favorable safety profile, CEUS may serve as a useful screening or follow-up tool for synovitis, pending validation in larger multicenter studies.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"144 2","pages":"e20253088"},"PeriodicalIF":1.6,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is photobiomodulation therapy free from racial bias?: a narrative review of skin pigmentation.","authors":"Carlos Eduardo Girasol, Luciano Bachmann","doi":"10.1590/1516-3180.2025.3358.26012026","DOIUrl":"10.1590/1516-3180.2025.3358.26012026","url":null,"abstract":"<p><strong>Background: </strong>Photobiomodulation therapy (PBMT) has been extensively researched for tissue repair, pain relief, and muscle recovery. However, melanin, a primary skin chromophore, can impede photon penetration into darker skin, potentially diminishing the efficacy of PBMT. Despite this, clinical protocols and guidelines seldom account for skin pigmentation when setting parameters, possibly exacerbating racial disparities in healthcare.</p><p><strong>Objective: </strong>To examine the effect of melanin on the efficacy of PBMT and highlight the necessity for personalized strategies that account for skin pigmentation.</p><p><strong>Design and setting: </strong>Short communication conducted at the Universidade de São Paulo (USP), Ribeirão Preto, São Paulo.</p><p><strong>Methods: </strong>A narrative review of PBMT mechanisms, light-tissue interactions, and the impact of melanin absorption on treatment outcomes was conducted.</p><p><strong>Results: </strong>The clinical outcomes of PBMT depend on the technical parameters (wavelength, energy, and dose) and skin pigmentation. Darker skin tones with higher melanin content may lead to reduced photon penetration effectiveness. However, most studies and protocols do not consider this variable. Only a few clinical trials have categorized outcomes by skin tone, exposing a notable knowledge gap.</p><p><strong>Conclusion: </strong>Melanin plays a crucial role in PBMT response, and overlooking skin pigmentation in research and clinical practice could perpetuate disparities. Enhanced and tailored protocols are essential to optimize PBMT outcomes among diverse populations.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"144 2","pages":"e20253358"},"PeriodicalIF":1.6,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ERRATUM: Prevalence of alcohol use disorders in individuals with borderline personality disorder: a meta-analysis and meta-regression study.","authors":"","doi":"10.1590/1516-3180.2024.0480.R1.04112025erratum","DOIUrl":"10.1590/1516-3180.2024.0480.R1.04112025erratum","url":null,"abstract":"<p><p>[This corrects the article doi: 10.1590/1516-3180.2024.0480.R1.04112025].</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"144 1","pages":"e2024480ERRATUM"},"PeriodicalIF":1.6,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13078679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of the outcome and costs of lower back pain should not only rely on electronic data but also use real-world experiences.","authors":"Josef Finsterer","doi":"10.1590/1516-3180.2025.3106.11112025","DOIUrl":"10.1590/1516-3180.2025.3106.11112025","url":null,"abstract":"","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"144 2","pages":"e20253106"},"PeriodicalIF":1.6,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13029801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147595788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brazilian version of the Cognitive Risk Profile for Pain Scale: translation, cross-cultural adaptation, and validation.","authors":"Lucianna Mirelle de Sá Trabulsi, Almir Vieira Dibai Filho, André Pontes-Silva, Sulamizia Filomena Costa de Jesus, Letícia Padilha Mendes, Gabriel Gardhel Costa Araujo, Cid André Fidelis-de-Paula-Gomes, Daniela Bassi-Dibai, Adriana Sousa Rêgo","doi":"10.1590/1516-3180.2025.0007.R1.23092025","DOIUrl":"10.1590/1516-3180.2025.0007.R1.23092025","url":null,"abstract":"<p><strong>Objectives: </strong>To translate, cross-culturally adapt, and validate the Cognitive Risk Profile for Pain (CRPP) scale for Brazilians with chronic pain.</p><p><strong>Methods: </strong>We conducted a questionnaire-based validation study. Patients (males and females) with pain in any part of the body for > 3 months were included (n = 191). The participants were assessed using the CRPP scale, the Numeric Pain Rating Scale (NPRS), the Hospital Anxiety and Depression Scale (HADS), the Pain-Related Catastrophizing Thoughts Scale (PCTS), and the Brunel Mood Scale (BRUMS). After the translation, cross-cultural adaptation, and validation of the CRPP scale, we tested for ceiling or floor effects, construct validity, reliability, and internal consistency. Finally, the second application of the CRPP scale was used to measure test-retest reliability.</p><p><strong>Results: </strong>Most participants were female, over 36 years of age, overweight, physically active, and had an average pain history of approximately 41 months. No ceiling or floor effects are observed. Nine domains of the CRPP scale correlated with the NPRS score, two domains of the HADS and PCTS, and six domains of the BRUMS. All CRPP domains demonstrated adequate reliability and internal consistency.</p><p><strong>Conclusion: </strong>The Brazilian version of the CRPP scale demonstrated adequate measurement properties in patients with chronic pain.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"144 1","pages":"e2025007"},"PeriodicalIF":1.6,"publicationDate":"2026-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12904494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146229560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}