Sao Paulo Medical Journal最新文献

{"title":"The effects of agmatine treatment on cisplatin-induced hepatotoxicity: an experimental rat study.","authors":"Murat Yeniceri, Mustafa Can Senoymak, Süleyman Bas, Musa Salmanoglu, Alpaslan Tanoglu","doi":"10.1590/1516-3180.2025.3392.02032026","DOIUrl":"10.1590/1516-3180.2025.3392.02032026","url":null,"abstract":"<p><strong>Background: </strong>Cisplatin is a widely used chemotherapeutic agent whose clinical utility is limited by dose-dependent hepatotoxicity, primarily driven by oxidative stress and inflammation. Agmatine, an endogenous polyamine, has demonstrated antioxidant and anti-inflammatory properties in various models; however, its hepatoprotective effects in cisplatin-induced liver injury remain underexplored.</p><p><strong>Methods: </strong>This experimental study investigated the protective effects of agmatine against cisplatin-induced hepatotoxicity in 28 male Sprague Dawley rats. The animals were randomized into four groups: Sham, Cisplatin, Cisplatin + Agmatine (20 g/kg/day, orally), and Placebo. Biochemical markers, including ALT, AST, MDA (malondialdehyde), SOD (superoxide dismutase), GPx (glutathione peroxidase), TNF-α, IL-1β, and TGF-β, were assessed using ELISA (enzyme-linked immunosorbent assay). Histopathological evaluation was performed to assess liver architecture and injury severity.</p><p><strong>Results: </strong>Cisplatin administration significantly increased serum levels of ALT, AST, MDA, and proinflammatory cytokines (IL-1β, TNF-α, and TGF-β), while reducing antioxidant enzyme activities (SOD and GPx) (p < 0.01). Agmatine co-administration significantly reversed these biochemical alterations and ameliorated histopathological damage, as evidenced by reduced inflammatory infiltration, sinusoidal dilatation, and hepatocellular degeneration.</p><p><strong>Conclusion: </strong>Agmatine demonstrates significant hepatoprotective effects against cisplatin-induced liver injury by attenuating oxidative stress and inflammatory responses. These findings suggest its potential role as an adjunctive agent to improve the hepatic safety profile of cisplatin chemotherapy.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"144 3","pages":"e20253392"},"PeriodicalIF":1.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13225681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148151945","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":"Clinical features of chronic tension-type headache combined with hyperacusis: a cross-sectional study.","authors":"Zenghui Fu, Yan Jin, Zaihong Lin, Yang Liu, Kedong Guo","doi":"10.1590/1516-3180.2025.3205.09032026","DOIUrl":"10.1590/1516-3180.2025.3205.09032026","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Chronic tension-type headache (CTTH) is a prevalent primary headache disorder that significantly affects quality of life. Hyperacusis, an abnormal intolerance to everyday sounds, is frequently observed in patients with CTTH, suggesting potential shared neural mechanisms. However, the clinical characteristics of patients with CTTH and comorbid hyperacusis remain poorly characterized.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This study aimed to investigate the clinical characteristics of CTTH patients with comorbid hyperacusis, focusing on headache profiles, auditory sensitivity patterns, and psychological correlates, and to identify factors independently associated with hyperacusis in this population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design and setting: &lt;/strong&gt;A cross-sectional study was conducted at the outpatient department of the Third Affiliated Hospital of Qiqihar Medical College from January 2022 to December 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We consecutively enrolled 234 patients with CTTH diagnosed according to International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria were consecutively enrolled. Hyperacusis was confirmed via otolaryngological evaluation and audiometric testing (pure-tone thresholds and loudness discomfort levels [LDL]). Demographic data, headache features (frequency, intensity, and duration), hyperacusis distress severity, and psychological measures (Generalized Anxiety Disorder-7 [GAD-7], Self-rating Somatic Symptom Scale [SSS], and Pittsburgh Sleep Quality Index [PSQI]) were analyzed. Univariate analyses (Student's t-test and Chi-squared test) and multivariate logistic regression adjusted for potential confounders were performed to compare patients with (n = 47) and without (n = 187) hyperacusis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Hyperacusis prevalence was 20.09% (47/234). Compared to non-hyperacusis patients, hyperacusis patients exhibited longer headache duration (13.9 ± 3.15 versus 8.11 ± 2.74 years, P = 0.01), higher weekly headache frequency (7.30 ± 1.99 versus 4.19 ± 1.2, P = 0.005), more pericranial tenderness (95.74% versus 77.54%, P = 0.008), and poorer sleep quality (PSQI: 14.01 ± 1.13 versus 9.17 ± 0.51, P = 0.004). After adjusting for age, sex, headache duration, and pain intensity in multivariate logistic regression, higher headache frequency (odds ratio [OR] = 1.42, 95% confidence interval [CI]: 1.12-1.79, P = 0.003) and higher PSQI scores (odds ratios = 1.38, 95% CI: 1.15-1.66, P = 0.001) remained independently associated with hyperacusis. Common triggering sounds included children crying (61.7%) and traffic noise (42.55%), with predominant emotional responses being irritability (76.6%) and anxiety (65.96%). LDL classification (analyzed as an ordinal variable) was correlated with headache duration (P &lt; 0.05), while hyperacusis distress severity was linked to headache frequency and PSQI scores (P &lt; 0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;CTTH with hyperacusis represents ","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"144 3","pages":"e20253205"},"PeriodicalIF":1.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13228092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148151934","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":"Reference intervals for complete blood count parameters in the Longitudinal Study of Adult Health (ELSA-Brasil): a cross-sectional analysis.","authors":"Nívea Aparecida Almeida, Sandhi Maria Barreto, Letícia Gonçalves Resende Ferreira, Chams Bicalho Maluf, Pedro Guatimosim Vidigal, Roberta Carvalho Figueiredo, Danyelle Romana Alves Rios","doi":"10.1590/1516-3180.2025.3017.09122025","DOIUrl":"10.1590/1516-3180.2025.3017.09122025","url":null,"abstract":"<p><strong>Background: </strong>Complete blood count (CBC) is the most frequently requested laboratory test worldwide, providing essential clinical information. In Brazil, many laboratories still use reference intervals (RIs) that are inadequately defined or not representative of the local population. Establishing population-specific RIs is crucial for accurate interpretation, diagnosis, and clinical decision making.</p><p><strong>Objective: </strong>To establish RIs for CBC parameters in a sample of Brazilian adults.</p><p><strong>Methods: </strong>This cross-sectional study included 2,417 healthy individuals who participated in the baseline (2008-2010) of the Longitudinal Study of Adult Health (ELSA-Brasil). Venous blood collection and storage were performed according to the procedures established by the Clinical and Laboratory Standards Institute (CLSI) in 2018. CBC was performed in laboratories with laboratory proficiency. The RIs were calculated using the nonparametric method proposed by the CLSI.</p><p><strong>Results: </strong>The RIs were stratified by sex only for the following parameters: Red blood cells (RBC; × 106/mm3): Male (4.4-5.6), Female (3.9-5.1); Hemoglobin (g/dL): Male (13.2-16.7), Female (11.8-14.9); Hematocrit (%): Male (39-49), Female (35.3-44.2); Mean corpuscular hemoglobin concentration (MCHC; g/dL): Male (32.3-35.7), Female (32-35.1); Platelets (× 103/mm3): Male (146-319), Female: (170-352). The other parameters were as follows: mean corpuscular volume (MCV) (fL): (79.9-96); mean corpuscular hemoglobin (MCH) (pg): (26.4-32.5); White blood cells (WBC; /mm3): (3,700-8,610); Neutrophils (/mm 3): (1,666-5,705); Eosinophils (/mm3): (23.8-530); Basophils (/mm3): (0-112); Lymphocytes (/mm3): (1,121-2,824); Monocytes (/mm3): (240-751.7).</p><p><strong>Conclusion: </strong>Our results agree with those of other studies that have proposed RIs for CBC parameters. The differences found in MCV, neutrophil and WBC parameters (total population), and MCHC (both sexes) may be due to differences in the study populations, sample sizes, and pre-analytical and analytical study variables.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"144 2","pages":"e20253017"},"PeriodicalIF":1.2,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13200561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148044488","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":"Health outcomes and medical response during a military deployment in Iraq: a prospective observational study of morbidity, treatments, and evacuations.","authors":"David Ramirez Avellaneda, Marta Elena Losa Iglesias, Ricardo Becerro de Bengoa Vallejo, Juan Gómez-Salgado, Daniel López-López, Carmen de Labra","doi":"10.1590/1516-3180.2025.3543.25022026","DOIUrl":"10.1590/1516-3180.2025.3543.25022026","url":null,"abstract":"<p><strong>Background: </strong>Overseas military deployment poses a significant healthcare challenge, requiring the prevention of morbidity associated with physical strain and the environment, as well as the provision of effective medical care to ensure operational continuity in operations.</p><p><strong>Objectives: </strong>To describe and analyze the medical care activity during the deployment of the Spanish contingent from the General Command of Ceuta at the Union III base (Baghdad) and to evaluate the recorded morbidity, applied treatments, and the need for medical evacuation.</p><p><strong>Study design and settings: </strong>A prospective, observational, and analytical study was conducted during the deployment between May and November 2025 at the Union III military base in Baghdad.</p><p><strong>Methods: </strong>All medical encounters recorded by the deployed medical services were included. Demographic and clinical variables as well as the applied treatment, need for follow-up, and evacuation, were analyzed. Statistical analysis included descriptive statistics and association tests, with a p value < 0.05 considered significant.</p><p><strong>Results: </strong>In total, 506 medical encounters were recorded. Traumatic injuries were the most frequent reason for consultation (25.7%), followed by infectious (20.9%) and digestive (17.2%) conditions. Most cases were resolved at Role 1 level, with a low evacuation rate (3.4%) and a high degree of local resolution.</p><p><strong>Conclusions: </strong>The deployed medical support demonstrated a high resolutive capacity, with a predominance of non-combat-related pathologies and a low need for evacuation. These results highlight the importance of maintaining effective medical structures and reinforcing preventive measures to reduce morbidity during future deployments.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"144 2","pages":"e20253543"},"PeriodicalIF":1.2,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13200562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148044425","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":"E-cigarette use in Brazil-prevalence and associated factors in a national cross-sectional study of 16,093 adults: a short communication.","authors":"Hannae Coelho Damasceno-de-Freitas, André Pontes-Silva, Renata Nogueira Duran Marquez-de-Souza, Francisco Winter Dos Santos Figueiredo, Fernando Rodrigues Peixoto Quaresma, Erika da Silva Maciel","doi":"10.1590/1516-3180.2025.3562.23022026","DOIUrl":"10.1590/1516-3180.2025.3562.23022026","url":null,"abstract":"<p><strong>Background: </strong>Monitoring tobacco consumption is important for supporting national and global agendas and commitments.</p><p><strong>Objective: </strong>To analyze the prevalence and sociodemographic and geographic factors associated with e-cigarette use in Brazil, using data from Vigitel 2023.</p><p><strong>Design and setting: </strong>Cross-sectional analytical study was conducted using secondary data from Vigitel 2023.</p><p><strong>Methods: </strong>Sociodemographic characteristics (sex, age, education, and ethnicity), geographic location, and e-cigarette use were analyzed. Descriptive analyses were performed using Chi-squared and Mann-Whitney U-tests. Additionally, weighted multivariable logistic regression models were used to examine independent associations between sociodemographic factors and current e-cigarette use. Post-stratification weights were applied, and adjusted odds ratios (aOR) with 95% confidence intervals (95% CI) were estimated.</p><p><strong>Results: </strong>Among 16,093 adults, the prevalence of current e-cigarette use was 5.55%. In the adjusted model, younger age was strongly associated with use (aOR per year increase = 0.93; 95% CI 0.92-0.94; p < 1). Men had higher odds of use than women (aOR = 1.34; 95% CI 1.12-1.6; p < 0.01). Educational level was not independently associated with usage. Caucasian individuals had higher odds compared to mixed-race individuals (aOR = 1.29; 95% CI 1.05-1.58; p = 0.015). Residents of the southern region showed increased odds (aOR = 1.48; 95% CI 1.1-1.99).</p><p><strong>Conclusion: </strong>Current e-cigarette use in Brazil is independently associated with younger age, male sex, Caucasian ethnicity, and residence in southern Brazil. These findings underscore the importance of strengthening public policies that regulate and control these devices as well as educational campaigns targeting high-risk groups.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"144 2","pages":"e20253562"},"PeriodicalIF":1.2,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13186074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977071","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":"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":1.2,"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":1.2,"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":1.2,"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":1.2,"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":1.2,"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}