Sao Paulo Medical Journal最新文献

{"title":"Aspects that facilitate access to care for viral hepatitis: An evaluative research.","authors":"Josué Souza Gleriano, Carlise Krein, Lucieli Dias Pedreschi Chaves","doi":"10.1590/1516-3180.2023.0078.R1.29112023","DOIUrl":"10.1590/1516-3180.2023.0078.R1.29112023","url":null,"abstract":"<p><strong>Background: </strong>Viral hepatitis is a major public health concern worldwide.</p><p><strong>Objectives: </strong>This study aimed to analyze the factors that facilitate access to care for viral hepatitis.</p><p><strong>Design and setting: </strong>Using a sequential mixed method, this evaluation research was conducted in the state of Mato Grosso, Brazil.</p><p><strong>Methods: </strong>Mapping of references and selection of regions were made based on the quantity and heterogeneity of services. The stakeholders, including the managers of the State Department of Health and professionals from reference services, were identified. Nine semi-structured interviews were conducted using content analysis and discussions guided by the dimensions of the analysis model of universal access to health services.</p><p><strong>Results: </strong>In the political dimension, decentralizing services and adhering to the Intermunicipal Health Consortium are highly encouraged. In the economic-social dimension, a commitment exists to allocate public funds for the expansion of referral services and subsidies to support users in their travel for appointments, medications, and examinations. In the organizational dimension, the availability of inputs for testing, definition of user flow, ease of scheduling appointments, coordination by primary care in testing, collaboration following the guidelines and protocols, and engagement in extramural activities are guaranteed. In the technical dimension, professionals actively commit to the service and offer different opening hours, guarantee the presence of an infectious physician, expand training opportunities, and establish intersectoral partnerships. In the symbolic dimension, professionals actively listen to the experiences of users throughout their care trajectory and demonstrate empathy.</p><p><strong>Conclusions: </strong>The results are crucial for improving comprehensiveness, but necessitate managerial efforts to enhance regional governance.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10926966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140111964","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":"Translational Medicine and Implementation Science.","authors":"Protásio Lemos da Luz, Paulo Manuel Pêgo-Fernandes","doi":"10.1590/1516-3180.2022.1416011123","DOIUrl":"10.1590/1516-3180.2022.1416011123","url":null,"abstract":"","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10926964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140111998","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":"Physical condition and perceived fatigue in post-covid patients: An observational descriptive study.","authors":"Tamara Iturriaga, Fernanda Salazar-Pérez, Marta Casallo-Cerezo, Guillermo García-Pérez-de-Sevilla, Alicia Sosa-Pedreschi, Ignacio Diez-Vega, Marta Supervia, Olga Arroyo, Margarita Pérez-Ruiz","doi":"10.1590/1516-3180.2023.0167.R1.04122023","DOIUrl":"10.1590/1516-3180.2023.0167.R1.04122023","url":null,"abstract":"<p><strong>Background: </strong>Patients with severe coronavirus disease 2019 (COVID-19) often require hospital admission and experience sequelae such as chronic fatigue or low muscle mass.</p><p><strong>Objective: </strong>To analyze the functional capacity of a cohort of patients with severe acute respiratory syndrome coronavirus 2 who required hospitalization.</p><p><strong>Design and setting: </strong>An observational descriptive study was conducted on post-COVID-19 patients referred to the Rehabilitation Department of Gregorio Marañón Hospital (Madrid, SPAIN).</p><p><strong>Methods: </strong>Cardiorespiratory fitness, muscle strength, body composition, and perception of fatigue and dyspnea were analyzed. Furthermore, the existing correlations between clinical variables and physical conditions were analyzed.</p><p><strong>Results: </strong>Forty-two patients who required hospital admission (80 ± 22.45 days) or intensive care unit (ICU) admission (58 ± 10.52 days) were analyzed. They presented with decreased strength, respiratory capacity, and moderate-to-severe perceived fatigue. Additionally, an inverse correlation was found between right-handgrip strength and days in the ICU, as well as the 6-minute walk test for women. Similarly, strength and fitness were negatively associated with perceived fatigue.</p><p><strong>Conclusions: </strong>Post-COVID-19 patients showed low muscle function and low levels of physical fitness associated with high perceived fatigue.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10926933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140111997","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":"Effect of hyperchloremia on mortality of pediatric trauma patients: a retrospective cohort study.","authors":"Kübra Çeleğen, Mehmet Çeleğen","doi":"10.1590/1516-3180.2022.0370.R2.010923","DOIUrl":"10.1590/1516-3180.2022.0370.R2.010923","url":null,"abstract":"<p><strong>Background: </strong>Hyperchloremia is often encountered due to the frequent administration of intravenous fluids in critically ill patients with conditions such as shock or hypotension in the pediatric intensive care unit, and high serum levels of chloride are associated with poor clinical outcomes.</p><p><strong>Objectives: </strong>This study aimed to determine the association between hyperchloremia and in-hospital mortality in pediatric patients with major trauma.</p><p><strong>Design and setting: </strong>This retrospective cohort study was conducted at a tertiary university hospital in Turkey.</p><p><strong>Methods: </strong>Data were collected between March 2020 and April 2022. Patients aged 1 month to 18 years with major trauma who received intravenous fluids with a concentration > 0.9% sodium chloride were enrolled. Hyperchloremia was defined as a serum chloride level > 110 mmol/L. Clinical and laboratory data were compared between the survivors and nonsurvivors.</p><p><strong>Results: </strong>The mortality rate was 23% (n = 20). The incidence of hyperchloremia was significantly higher in nonsurvivors than in survivors (P = 0.05). In multivariate logistic analysis, hyperchloremia at 48 h was found to be an independent risk factor for mortality in pediatric patients with major trauma.</p><p><strong>Conclusions: </strong>In pediatric patients with major trauma, hyperchloremia at 48-h postadmission was associated with 28-day mortality. This parameter might be a beneficial prognostic indicator.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10926932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140111996","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":"Frequency of skin diseases in renal transplant recipients and patients with chronic kidney disease in a tertiary center: a cross-sectional study.","authors":"Érica Cristina Vieira, Milena Soriano Marcolino, Antônio Carlos Martins Guedes, Mônica Maria Moreira Delgado Maciel, Wandilza Fátima Dos Santos, Luciana Consoli Fernandes Pimentel, Paulo Rodrigues Gomes, Anita Bressan, Kátia de Paula Farah, Marcelo Grossi Araújo","doi":"10.1590/1516-3180.2023.0148.R1.29112023","DOIUrl":"10.1590/1516-3180.2023.0148.R1.29112023","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of chronic kidney disease (CKD) has increased in the recent decades, along with the number of patients in the terminal stages of this disease, requiring transplantation. Some skin disorders are more frequent in patients with CKD and in renal transplant recipients (RTR).</p><p><strong>Objectives: </strong>To evaluate the frequency of skin diseases in RTR and patients with CKD receiving conservative treatment.</p><p><strong>Design and setting: </strong>This observational cross-sectional study recruited consecutive patients with CKD and RTR from a nephrology clinic at a teaching hospital in Brazil between 2015 and 2020.</p><p><strong>Methods: </strong>Quantitative, descriptive, and analytical approaches were used. The sample was selected based on convenience sampling. Data were collected from dermatological visits and participants' medical records.</p><p><strong>Results: </strong>Overall, 308 participants were included: 206 RTR (66.9%, median age: 48 years, interquartile range [IQR] 38.0-56.0, 63.6% men) and 102 patients with CKD (33.1%, median age: 61.0 years, IQR 50.0-71.2, 48% men). The frequency of infectious skin diseases (39.3% vs. 21.6% P = 0.002) were higher in RTR than in patients with CKD. Neoplastic skin lesions were present in nine (4.4%) RTR and in only one (1.0%) patient with CKD. Among the RTR, the ratio of basal cell carcinoma to squamous cell carcinoma was 2:1.</p><p><strong>Conclusions: </strong>This study revealed that an increased frequency of infectious skin diseases may be expected in patients who have undergone kidney transplantation. Among skin cancers, BCC is more frequently observed in RTR, especially in those using azathioprine.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10885634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139998085","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":"Chronic pain: A big challenge.","authors":"Telma Zakka, Hélio Papler, Paulo Manuel Pêgo-Fernandes","doi":"10.1590/1516-3180.2024.1421.131223","DOIUrl":"10.1590/1516-3180.2024.1421.131223","url":null,"abstract":"","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10876186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139933787","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":"Quality indicators of a stroke unit in Curitiba (Brazil)","authors":"Nathália Mitsue Kishi, Gabriela Ávila Rodbard, R. Ducci, M. Lange","doi":"10.5327/1516-3180.141s1.529","DOIUrl":"https://doi.org/10.5327/1516-3180.141s1.529","url":null,"abstract":"Introduction: Stroke represents the second leading cause of death and disability in Latin America. Thus, there is a constant need to understand the profile of patients admitted for stroke, as well as to analyze the quality indicators of treatment in stroke centers. Objectives: The aim of this study was to analyze the quality indicators of a stroke center and to determine the epidemiological profile of inpatients. Methods: This is an observational cross-sectional study that included individuals admitted with stroke or transient ischaemic attack (TIA) in the stroke unit of Complexo Hospital de Clínicas da Universidade Federal do Paraná from November 2020 to October 2022. The variables and quality indicators were collected through the application of questionnaires in two moments, on admission and hospital discharge. Results: Of the 407 patients included, 49.1% were men, with a mean age of 65.4 years (standard deviation ±15.3). Ischemic stroke was the most common type of stroke (84.5%). The majority of patients (62.6%) did not receive specific intervention, while 41.9% underwent intravenous thrombolysis, with a median door-to-needle time of 30 minutes. In 69.1% of the individuals, thrombolysis started in less than 60 minutes. All patients underwent neuroimaging, 90.9% carotid imaging and 92.6% had their cardiac rhythm rated by EKG or 24h-Holter. Dysphagia screening was applied in 62.4% of the cases and smoking cessation advice was provided in 50.5%. Of the patients with ischemic stroke and TIA, only 5 (1.3%) did not receive anticoagulant or antiplatelet agent for secondary prophylaxis and in 14 (3.75%) this data was unknown. Conclusion: Intravenous thrombolysis is not performed in most hospitalized patients, however, when performed, it presents an adequate door-to-needle time. Most patients received secondary prophylaxis. Management of patients in a stroke unit allows for a thorough etiological investigation and optimization of secondary prevention and rehabilitation.","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70952599","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":"Carotid artery stenting in a stroke patient with carotid web: a possibly safe treatment","authors":"Nathália Mitsue Kishi, M. Lange","doi":"10.5327/1516-3180.141s1.735","DOIUrl":"https://doi.org/10.5327/1516-3180.141s1.735","url":null,"abstract":"Introduction: Carotid web (CW ) is a shelf-like luminal protrusion of the intimal layer of the carotid artery, mostly located in the posterior wall of the carotid bulb. It is a rare pathologic finding and an underrecognized cause of stroke. It can be detected on computed tomography angiography (CTA) or digital subtraction angiography (DSA) and treatment options include medically management and carotid revascularization with carotid endarterectomy (CEA) or carotid artery stenting (CAS). CEA is the therapy generally chosen by physicians. The aim is to report a patient with ischemic stroke and CW who was successfully treated with CAS. Case description: A 46-year-old female, current smoker with no comorbidities, was referred to a tertiary hospital in stroke protocol. Two months prior, she started with headache and visual blurring, evolving with reduced strength, hypoesthesia on the right side of the body and speech alteration. She was lucid and the National Institutes of Health Stroke Scale on admission was 3. She presented mild dyslalia and comprehension impairment, in addition to hypoesthesia in the right hemiface and right hand. Reflexes and muscle strength were normal on all four limbs. Her skull computed tomography demonstrated left temporoparietal hypodensity. A CTA and DSA were performed, revealing a shelf-like filling defect along the posterior wall of the bulb of the left internal carotid artery, characteristic of CW. She was treated with dual antiplatelet treatment and statin before she underwent a CAS with placement of a stent at the origin and proximal segment of the left internal carotid artery, seven days after the ictus. There were no complications and the patient was discharged two days after the procedure with the same drugs. Conclusion: Stent placement can be a safe treatment option for carotid web.","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70957936","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":"Non-motor symptoms and signs of Myotonic Dystrophy type 1","authors":"Gabriela Ávila Rodbard, Nathália Mitsue Kishi, R. Ducci, R. H. Cirino, C. Kay, O. Fustes, P. Lorenzoni, R. Scola","doi":"10.5327/1516-3180.141s1.530","DOIUrl":"https://doi.org/10.5327/1516-3180.141s1.530","url":null,"abstract":"Introduction: Myotonic Dystrophy Type 1 (DM1) is a genetic disease that presents neuromuscular manifestations and multisystemic clinical repercussions, such as cardiac and respiratory disorders, sleep disorders and impaired swallowing, among others. It is the most common muscular dystrophy in adults. Objectives: To determine the epidemiological profile of patients with DM1 treated at the Neuromuscular Diseases Outpatient Clinic of the Complexo Hospital de Clínicas da Universidade Federal do Paraná (CHC-UFPR). Methods: A total of 27 individuals diagnosed with DM1, assisted at the Neuromuscular Diseases Outpatient Clinic of the CHC-UFPR, were evaluated between May 2021 and March 2022. For this purpose, their medical records with the clinical data were analyzed. Results: The sample consisted of 78% male subjects with mean age at onset of symptoms of 27.6 ± 10.8. The most frequent muscular manifestations were myotonia (100%), weakness of the distal muscles of the upper (96.3%) and lower (96.3%) limbs, myotonic facies (92.6%). The most common non-motor manifestations were excessive daytime sleepiness (74.1%), frontal baldness (66.7%), pharyngeal globus (62.9%), choking or coughing during and/or at the end of swallowing (62.9%), cataracts (59.2%), dysphagia (55.6%), chest pain (55.6%), cognitive impairment (44.4%), dyspnea (44.4%). Of the patients, 22.2% had a previous history of pneumonia. Conclusion: The DM1 patients in this study presented an epidemiological profile consistent with that described in the literature. Non-motor manifestations are common and should be investigated, since complications such as bronchopneumonia are important causes of mortality in these patients and may negatively impact the quality of life. Therefore, DM1 patients require multidisciplinary monitoring and evaluation.","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70952217","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":"Compression pre-stapler firing and post-ignition wait during sleeve gastrectomy: a prospective randomized trial.","authors":"Medeni Sermet","doi":"10.1590/1516-3180.2023.0163.140823","DOIUrl":"10.1590/1516-3180.2023.0163.140823","url":null,"abstract":"<p><strong>Background: </strong>Insufficient research exists on the stapling technique in and duration of laparoscopic sleeve gastrectomy (LSG).</p><p><strong>Objectives: </strong>This study aimed to assess the clinical outcomes using a 30-second precompression and post-firing waiting time without extra support for the stapling line.</p><p><strong>Design and settings: </strong>Randomized controlled prospective study at a university hospital.</p><p><strong>Methods: </strong>This study included 120 patients treated between January 2022 and February 2023. The patients were divided into the non-waiting group (T0) and waiting group (T1), each with 60 patients. Perioperative complications were analyzed using statistical tests.</p><p><strong>Results: </strong>The waiting group (T1) showed a significant reduction in the number of intraoperative bleeding points requiring intervention compared with the non-waiting group (T0) (81 versus 134, P < 0.05). In T0, postoperative C-reactive protein (CRP) levels increased (P < 0.05) and hemoglobin levels decreased significantly (P <0.05). The study recorded 22 postoperative complications, accounting for 18.3% of all cases during the 30-day postoperative period.</p><p><strong>Conclusions: </strong>The study concluded that the 30 sec + 30 sec stapling technique reduces perioperative bleeding, length of stay, and serious complication rates and is practical and effective for LSG.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov with registration code NCT05703035; link: https://clinicaltrials.gov/ct2/show/NCT05703035.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10727512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138832619","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}