Sao Paulo Medical Journal最新文献

{"title":"hTERT gene methylation in circulating DNA, tumor, and surrounding tissue in breast cancer: a prospective study.","authors":"Luiz Fernando de Queiroz, Marcelo Soares da Mota E Silva, Heitor Siffert Pereira de Souza, Siane Lopes Bittencourt Rosas, Maria da Glória da Costa Carvalho","doi":"10.1590/1516-3180.2023.0140.R1.04032024","DOIUrl":"10.1590/1516-3180.2023.0140.R1.04032024","url":null,"abstract":"<p><strong>Background: </strong>The human telomerase reverse transcriptase (hTERT) enzyme, encoded by the hTERT gene, synthesizes protective telomeric sequences on chromosomes and plays a fundamental role in cancer formation. Methylation of the hTERT gene has an upregulatory effect, increasing hTERT enzyme synthesis and allowing continuous tumor cell division.</p><p><strong>Objective: </strong>In a group of patients with breast cancer, we aimed to analyze the methylation status of hTERT in the tumor, surrounding tissue, and circulating free deoxyribonucleic acid (cfDNA) of blood collected on the day of mastectomy and then approximately one year later.</p><p><strong>Design and setting: </strong>A prospective study was conducted at a university hospital in Rio de Janeiro, Brazil.</p><p><strong>Methods: </strong>Samples were collected from 15 women with breast cancer on the day of mastectomy and approximately one year postoperatively. cfDNA was analyzed by sodium bisulfite conversion, followed by polymerase chain reaction, electrophoresis, and silver nitrate staining.</p><p><strong>Results: </strong>Methylation of hTERT was detected in the tumors and surrounding tissues of all 15 patients. Five patients displayed hTERT methylation in the cfDNA from the blood of the first collection. Of the ten patients who returned for the second collection, three showed methylation. Two patients with methylation in the first collection did not display methylation in the second collection. One patient with no methylation in the first collection displayed methylation in the second collection, and one patient had a diminished level of methylation in the second collection.</p><p><strong>Conclusion: </strong>Only one-third of patients displayed methylation in their cfDNA, which may be related to the success of chemotherapy.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"142 5","pages":"e2023140"},"PeriodicalIF":1.3,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11087006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923675","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":"Emicizumab prophylaxis in people with hemophilia A and inhibitors: a systematic review and meta-analysis.","authors":"Tiago Paiva Prudente, Ricardo Mesquita Camelo, Rafael Alves Guimarães, Maria do Rosário Ferraz Roberti","doi":"10.1590/1516-3180.2023.0102.R1.20022024","DOIUrl":"10.1590/1516-3180.2023.0102.R1.20022024","url":null,"abstract":"<p><strong>Background: </strong>Until recently, the treatment of people with hemophilia A and inhibitors (PwHAi) was based on the use of bypassing agents (BPA). However, the advent of emicizumab as prophylaxis has demonstrated promising results.</p><p><strong>Objectives: </strong>We aimed to compare the bleeding endpoints between PwHAi on BPA and those on emicizumab prophylaxis.</p><p><strong>Design and setting: </strong>Systematic review of interventions and meta-analysis conducted at the Universidade Federal de Goiás, Goiânia, Goiás, Brazil.</p><p><strong>Methods: </strong>The CENTRAL, MEDLINE, Scopus, and LILACS databases were searched on February 21, 2023. Two authors conducted the literature search, publication selection, and data extraction. The selected publications evaluated the bleeding endpoints between PwHAi on emicizumab prophylaxis and those on BPA prophylaxis. The risk of bias was evaluated according to the Joanna Briggs Institute criteria. A meta-analysis was performed to determine the annualized bleeding rate (ABR) for treated bleeds.</p><p><strong>Results: </strong>Five publications (56 PwHAi) were selected from the 543 retrieved records. Overall, bleeding endpoints were lower during emicizumab prophylaxis than during BPA prophylaxis. All the publications had at least one risk of bias. The only common parameter for the meta-analysis was the ABR for treated bleeds. During emicizumab prophylaxis, the ABR for treated bleeds was lower than during BPA prophylaxis (standard mean difference: -1.58; 95% confidence interval -2.50, -0.66, P = 0.0008; I2 = 68.4%, P = 0.0031).</p><p><strong>Conclusion: </strong>Emicizumab was superior to BPA in bleeding prophylaxis in PwHAi. However, both the small population size and potential risk of bias should be considered when evaluating these results.</p><p><strong>Systematic review registration: </strong>CRD42021278726, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=278726.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"142 5","pages":"e2023102"},"PeriodicalIF":1.4,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11087007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923674","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":"Suicide ideation and psychotropic recreational drug use by adolescents: a systematic review and meta-analysis.","authors":"Cássia Lima de Oliveira Gracini, Gustavo Giacomelli Nascimento, Maria Tereza Campos Vidigal, Murilo Navarro de Oliveira, Álex Moreira Herval, Cauane Blumenberg, Walbert A Vieira, Rafael Rodrigues Lima, Luiz Renato Paranhos","doi":"10.1590/1516-3180.2022.0641.R2.23012024","DOIUrl":"10.1590/1516-3180.2022.0641.R2.23012024","url":null,"abstract":"<p><strong>Background: </strong>Adolescence is characterized by complex and dynamic changes, often involving experimentation, including the use of psychotropic substances. Although it is well-established that recreational psychotropic drugs are associated with suicide ideation in adults, evidence of this association in adolescents remains limited.</p><p><strong>Objective: </strong>To investigate the relationship between suicide ideation and psychotropic recreational drug use among adolescents.</p><p><strong>Design and setting: </strong>Systematic review with meta-analysis developed at Universidade Federal de Uberlândia (UFU) and Universidade Estadual de Campinas (UNICAMP), Brazil.</p><p><strong>Methods: </strong>A search across eight electronic databases for observational studies, without language or publication year restrictions, was conducted. The Joanna Briggs Institute tool was used to assess the risk of bias. Random-effects meta-analyses and odds ratios were used to measure the effects.</p><p><strong>Results: </strong>The search yielded 19,732 studies, of which 78 were included in the qualitative synthesis and 32 in the meta-analysis. The findings indicated that suicidal ideation was 1.96 times more likely (95% confidence interval, CI = 1.47; 2.61) for adolescents who used some drug recurrently and 3.32 times more likely (95%CI = 1.86; 5.93) among those who abused drugs. Additionally, adolescents who used cannabis were 1.57 times more likely (95%CI = 1.34; 1.84) to experience suicide ideation compared with non-users, while cocaine users had 2.57 times higher odds (95%CI = 1.47; 4.50).</p><p><strong>Conclusions: </strong>Psychotropic recreational drug use is associated with suicidal ideation among adolescents regardless of current or previous use, abuse, or type of substance used.</p><p><strong>Systematic review registration: </strong>Registered in the PROSPERO database under the identification number CRD42021232360. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021232360.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"142 4","pages":"e2022641"},"PeriodicalIF":1.4,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11034886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140867237","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":"Association between hepatitis A seropositivity and bone mineral density in adolescents and adults: a cross-sectional study using NHANES data.","authors":"Zhuowen Yu, Gunchu Hu, Jiajie Wang, Zhihong Li","doi":"10.1590/1516-3180.2023.0266.R1.08022024","DOIUrl":"10.1590/1516-3180.2023.0266.R1.08022024","url":null,"abstract":"<p><strong>Background: </strong>Osteoporosis, characterized by decreased bone density and increased fracture risk, imposes significant physical, psychosocial, and financial burdens. Early detection and prevention are crucial for managing osteoporosis and reducing the risk of fractures.</p><p><strong>Objectives: </strong>To investigate the relationship between Hepatitis A seropositivity and bone mineral density (BMD) in adolescents and adults and to explore the potential link between Hepatitis A infection and osteoporosis risk.</p><p><strong>Design and setting: </strong>This cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018 to evaluate the association between hepatitis A seropositivity and BMD in 15,693 participants.</p><p><strong>Methods: </strong>Multivariable regression analysis was used to calculate the mean BMD and standard error for adolescents and adults, followed by an independent z-test to determine whether there was a significant difference between the seropositive and seronegative groups.</p><p><strong>Results: </strong>Hepatitis A seropositive adolescents and adults had lower BMD than their seronegative counterparts, with significant differences in lumber spine (mean difference = -0.03 g/cm2, P < 0.01 for both age groups) and pelvis BMDs (mean difference = -0.02 g/cm2, P < 0.01 for the adult age groups), after adjusting for various covariates.</p><p><strong>Conclusions: </strong>This study confirmed that both adolescent and adult individuals seropositive for Hepatitis A antibodies had reduced BMD among both adolescents and adults, especially in the adult group. This finding suggests a possible link between Hepatitis A infection and risk of osteoporosis.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"142 5","pages":"e2023266"},"PeriodicalIF":1.4,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11034701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140856735","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":"Effects of probiotics on gastrointestinal symptoms, anthropometric measurements, and breastfeeding duration in infants with colic: a randomized control trial.","authors":"Aysu Yıldız Karaahmet, Gülümser Dolgun, Metehan Özen","doi":"10.1590/1516-3180.2023.0069.R1.31052023","DOIUrl":"10.1590/1516-3180.2023.0069.R1.31052023","url":null,"abstract":"<p><strong>Background: </strong>Infantile colic has a multifactorial etiology. Recent studies have suggested that probiotics may be effective in its management.</p><p><strong>Objective: </strong>This study was carried out to evaluate the effect of the Actiregularis strain (5×106 cfuml) included in maternal nutrition on gastrointestinal problems, growth development, and breastfeeding outcomes in infantile colic.</p><p><strong>Design and setting: </strong>The study was a randomized controlled trial conducted in the neonatal outpatient clinic of a training and research hospital in Turkey.</p><p><strong>Methods: </strong>A probiotic drink containing the Actiregularis (5×106 cfuml) strain was added to the diet of mothers in the probiotics group once daily for 15 consecutive days. Data were collected for each infant's 0th (birth), 1st, 4th, and 6th months.</p><p><strong>Results: </strong>Infants whose mothers were administered Actiregularis for 15 days had decreased crying intensity (P = 0.000). When the difference in breastfeeding rates between the groups was significant at the 4th and 6th months (P = 0.044; P = 0.035). There was no difference in anthropometric values except the babies' weights at the 6th month. (P < 0.001).</p><p><strong>Conclusion: </strong>Infants treated with Actiregularis, which was added to their mothers' diet for 15 days, showed a decrease in the frequency of crying, and the difference in breastfeeding rates between the groups was significant at the 4th and 6th months. There was no difference in anthropometric values except the babies' weights at the 6th month.</p><p><strong>Clinical trials registration: </strong>NCT04374955 (https://clinicaltrials.gov/ct2/show/).</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"142 4","pages":"e2023069"},"PeriodicalIF":1.3,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11034883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140873344","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":"Alcohol consumption during pregnancy by women from southern Brazil: a cross-sectional study.","authors":"Laira Francielle Ferreira Zottis, Mateus Arenhardt de Souza, Jéssica Karine Hartmann, Thiago Kenji Kurogi Gama, Laís Borges Rizental, Anita Machado Maciel, Merialine Gresele, Ernani Bohrer da Rosa, Maurício Rouvel Nunes, Juliana Trevisan da Rocha, Jorge Alberto Bianchi Telles, André Campos da Cunha, Paulo Ricardo Gazzola Zen, Rafael Fabiano Machado Rosa","doi":"10.1590/1516-3180.2023.0186.R1.08022024","DOIUrl":"10.1590/1516-3180.2023.0186.R1.08022024","url":null,"abstract":"<p><strong>Background: </strong>Some maternal characteristics are related to alcohol intake during pregnancy, which irreversibly compromises the maternal-fetal binomial integrity.</p><p><strong>Objectives: </strong>To identify the frequency, impact, and factors associated with alcohol consumption during pregnancy.</p><p><strong>Design and setting: </strong>A cross-sectional study was performed at the Hospital Materno Infantil Presidente Vargas (HMIPV) in Porto Alegre/RS between March and December 2016.</p><p><strong>Methods: </strong>A structured questionnaire was administered along with a medical records review. They refer to the maternal sociodemographic and gestational status, alcohol consumption patterns, and characteristics of the fetus/newborn. In the statistical analysis, P values < 0.05 were considered significant.</p><p><strong>Results: </strong>The frequency of alcohol intake was 37.3%; this was characterized by the consumption of fermented beverages (89.3%), especially during the first trimester (79.6%). Risky consumption (high and/or early) occurred for 30.2% of participants. Risk factors associated with maternal alcohol consumption during pregnancy were tobacco use (P < 0.001) and abortion attempt (P = 0.023). Living with a partner (P = 0.002) and planning pregnancy (P = 0.009) were protective factors. Risky consumption was related to all of the aforementioned variables as well as threatened abortion (P = 0.023).</p><p><strong>Conclusions: </strong>Alcohol intake during pregnancy is common and affects nearly one-third of pregnant women. Knowledge of the population at risk and protective factors is essential for the development of campaigns that seek to reduce consumption and, therefore, its consequences for the mother and fetus.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"142 5","pages":"e2023186"},"PeriodicalIF":1.4,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11034884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140870958","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":"Comparison between use of a pleural drainage system with flutter valve and a conventional water-seal drainage system after lung resection: a randomized prospective study.","authors":"Rodrigo Caetano de Souza, Lilianne Louise Silva de Morais, Mario Claudio Ghefter, Juliana Pereira Franceschini, Fernando Campos Gomes Pinto","doi":"10.1590/1516-3180.2023.0224.R1.08022024","DOIUrl":"10.1590/1516-3180.2023.0224.R1.08022024","url":null,"abstract":"<p><strong>Background: </strong>There is still a debate regarding the most appropriate pleural collector model to ensure a short hospital stay and minimum complications.</p><p><strong>Objectives: </strong>To study aimed to compare the time of air leak, time to drain removal, and length of hospital stay between a standard water-seal drainage system and a pleural collector system with a unidirectional flutter valve and rigid chamber.</p><p><strong>Design and setting: </strong>A randomized prospective clinical trial was conducted at a high-complexity hospital in São Paulo, Brazil.</p><p><strong>Methods: </strong>Sixty-three patients who underwent open or video-assisted thoracoscopic lung wedge resection or lobectomy were randomized into two groups, according to the drainage system used: the control group (WS), which used a conventional water-seal pleural collector, and the study group (V), which used a flutter valve device (Sinapi® Model XL1000®). Variables related to the drainage system, time of air leak, time to drain removal, and time spent in hospital were compared between the groups.</p><p><strong>Results: </strong>Most patients (63%) had lung cancer. No differences were observed between the groups in the time of air leak or time spent hospitalized. The time to drain removal was slightly shorter in the V group; however, the difference was not statistically significant. Seven patients presented with surgery-related complications: five and two in the WS and V groups, respectively.</p><p><strong>Conclusions: </strong>Air leak, time to drain removal, and time spent in the hospital were similar between the groups. The system used in the V group resulted in no adverse events and was safe.</p><p><strong>Registration: </strong>RBR-85qq6jc (https://ensaiosclinicos.gov.br/rg/RBR-85qq6jc).</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"142 5","pages":"e2023224"},"PeriodicalIF":1.4,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11034882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140861174","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":"Cognitive and social adaptation in autism spectrum disorder: A prospective cohort study.","authors":"Márcia Regina Fumagalli Marteleto, Jacy Perissinoto","doi":"10.1590/1516-3180.2023.0184.R1.16022024","DOIUrl":"10.1590/1516-3180.2023.0184.R1.16022024","url":null,"abstract":"<p><strong>Background: </strong>During development, children face a number of demands and cognitive, behavioral, and social challenges necessary for growth. Cognitive skills make individuals competent and allow them to interact with their environment.</p><p><strong>Objective: </strong>To identify the cognitive skills that promote better social insertion in children with autism spectrum disorder within 12 months.</p><p><strong>Design and setting: </strong>Prospective cohort study.</p><p><strong>Methods: </strong>In this study, 21 children aged 3-12 years were assessed, and their mothers were interviewed. Children were enrolled in regular or special autistic schools. Twelve months after the first assessment, the same children participated in the second assessment. In individual interviews, mothers provided data by answering the Vineland Adaptive Behavior Scale. Each child was assessed individually using the fourth edition of the Stanford Binet Intelligence Scale 4th Edition.</p><p><strong>Results: </strong>In the first assessment, the Stanford Binet areas and total scores correlated with the communication domains, daily life abilities, socialization, and total score of the Vineland Scale. After 12 months, a correlation was observed between the Stanford Binet areas and the total and communication domains, daily life abilities, socialization, motor abilities, and total score on the Vineland Scale.</p><p><strong>Conclusion: </strong>Logic mathematics and memory promote better social insertion in children with autism spectrum disorder. General cognitive ability promotes communication.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"142 5","pages":"e2023184"},"PeriodicalIF":1.4,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11034700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140866995","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":"Organ donation consent after death.","authors":"Valter Duro Garcia, José Osmar Medina de Abreu Pestana, Paulo Manuel Pêgo-Fernandes","doi":"10.1590/1516-3180.2024.1422.120324","DOIUrl":"https://doi.org/10.1590/1516-3180.2024.1422.120324","url":null,"abstract":"","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"142 2","pages":"e20241422"},"PeriodicalIF":1.4,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140873345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Portuguese Advance Directives-a twist against futility? A cross sectional study.","authors":"Catarina Sampaio Martins, Rui Nunes","doi":"10.1590/1516-3180.2022.0537.R2.201023","DOIUrl":"10.1590/1516-3180.2022.0537.R2.201023","url":null,"abstract":"<p><strong>Background: </strong>Advance Directive documents allow citizens to choose the treatments they want for end-of-life care without considering therapeutic futility.</p><p><strong>Objectives: </strong>To analyze patients' and caregivers' answers to Advance Directives and understand their expectations regarding their decisions.</p><p><strong>Design and setting: </strong>This study analyzed participants' answers to a previously published trial, conceived to test the document's efficacy as a communication tool.</p><p><strong>Methods: </strong>Sixty palliative patients and 60 caregivers (n = 120) registered their preferences in the Advance Directive document and expressed their expectations regarding whether to receive the chosen treatments.</p><p><strong>Results: </strong>In the patient and caregiver groups, 30% and 23.3% wanted to receive cardiorespiratory resuscitation; 23.3% and 25% wanted to receive artificial organ support; and 40% and 35% chose to receive artificial feeding and hydration, respectively. The participants ignored the concept of therapeutic futility and expected to receive invasive treatments. The concept of therapeutic futility should be addressed and discussed with both the patients and caregivers. Legal Advanced Directive documents should be made clear to reduce misinterpretations and potential legal conflicts.</p><p><strong>Conclusion: </strong>The authors suggest that all citizens should be clarified regarding the futility concept before filling out the Advance Directives and propose a grammatical change in the document, replacing the phrase \"Health Care to Receive / Not to Receive\" with the sentence \"Health Care to Accept / Refuse\" so that patients cannot demand treatments, but instead accept or refuse the proposed therapeutic plans.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov ID NCT05090072.</p><p><strong>Url: </strong>https://clinicaltrials.gov/ct2/show/NCT05090072.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"142 3","pages":"e2022537"},"PeriodicalIF":1.4,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10962926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140307579","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}