Sao Paulo Medical Journal最新文献

{"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":1.2,"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":1.2,"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":1.2,"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":1.2,"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}

{"title":"Prevalence of alcohol use disorders in individuals with borderline personality disorder: a meta-analysis and meta-regression study.","authors":"Stefani Gonzalez Silva, Maria Olivia Pozzolo Pedro, Joao Mauricio Castaldelli-Maia","doi":"10.1590/1516-3180.2024.0480.R1.04112025","DOIUrl":"10.1590/1516-3180.2024.0480.R1.04112025","url":null,"abstract":"<p><strong>Background: </strong>This review examined the prevalence rate of alcohol use disorders (AUDs)-including heavy episodic drinking, heavy drinking, alcohol abuse, and alcohol dependence-among individuals with borderline personality disorder (BPD).</p><p><strong>Objectives: </strong>The primary objective of this meta-analysis and meta-regression study was to investigate the prevalence AUDs associated with BPD.</p><p><strong>Design and setting: </strong>We searched PubMed, Google Scholar, Virtual Health Library (VHL/BVS), SciELO, LILACS, EMBASE, and PsycINFO for studies, reports, or abstracts published without language restrictions.</p><p><strong>Methods: </strong>We searched for reports published from database inception through March 2024. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis Of Observational Studies in Epidemiology guidelines (MOOSE). Based on the extracted data, we performed meta-analyses and meta-regressions.</p><p><strong>Results: </strong>The final sample included 15 articles with 15,603 individuals aged 18 years or older with BPD. The prevalence of AUDs with BPD was 55.28%, while the prevalence of alcohol dependence (AD) was 44.59%, and alcohol abuse (AA) was 18.84%.</p><p><strong>Conclusion: </strong>Our findings indicate a high prevalence of AUDs among individuals with BPD, underscoring the need for targeted prevention and treatment strategies. Integrated dual-diagnosis approaches addressing both disorders simultaneously are crucial for improving outcomes. This high prevalence has important implications for public health.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"144 1","pages":"e2024480"},"PeriodicalIF":1.2,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12885496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146159039","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":"Implementation of a new histological grading system in ovarian mucinous carcinomas and its association with the risk of recurrence: a retrospective cohort study.","authors":"Adriana Yoshida, Liliana Aparecida Lucci De Angelo Andrade, Ricardo Ruiz Garcia de Almeida, Helymar da Costa Machado, Luís Otávio Sarian, Sophie Derchain","doi":"10.1590/1516-3180.2025.3034.12112025","DOIUrl":"10.1590/1516-3180.2025.3034.12112025","url":null,"abstract":"<p><strong>Background: </strong>This retrospective cohort study evaluated the prognostic significance of the GrowthBased Grade (GBG) system compared to International Federation of Gynecology and Obstetrics (FIGO) grading in ovarian mucinous carcinoma (OMC). Although FIGO grading is commonly used, its prognostic value remains controversial. The GBG system, which classifies tumors as low-grade (G1) or high-grade (G2) based on the proportion of infiltrative growth, has emerged as a potential prognostic tool.</p><p><strong>Objectives: </strong>To assess the prognostic significance of GBG and compare it with FIGO grading in OMC.</p><p><strong>Design and setting: </strong>This retrospective cohort study included 37 women with OMC treated at a single institution between 2009 and 2022.</p><p><strong>Methods: </strong>GBG was determined by a histopathological review of hematoxylin and eosin-stained slides. Clinical and demographic data, including FIGO stage, CA125 levels, surgical procedures, and follow-up information, were collected. Kaplan-Meier analysis and Cox regression were used to assess the associations between GBG grading, FIGO stage, and survival outcomes.</p><p><strong>Results: </strong>GBG 2 tumors were significantly associated with elevated CA125 levels, advanced FIGO stage (III), and bilaterality. Multivariate analysis showed that GBG 2 conferred a 5.4-fold higher risk of recurrence compared with GBG 1. While FIGO stage III was predictive of overall survival, FIGO grading was not associated with recurrence risk.</p><p><strong>Conclusion: </strong>This study suggests a potential prognostic value of the GBG system in mucinous ovarian carcinoma. GBG 2 tumors showed a higher risk of recurrence than GBG 1 tumors, whereas FIGO grading showed no such association. These findings align with previous reports and should be interpreted in the context of additional studies to clarify the system's clinical relevance.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"144 1","pages":"e20253034"},"PeriodicalIF":1.2,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12863438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146120773","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":"Histopathological evaluation in post-mortem renal biopsies of patients with COVID-19 and comorbidities: a case-control study.","authors":"Samya Hamad Mehanna, Mayara Pezzini Arantes, Henrique Machado de Souza Proença, Rafael Weissheimer, Sérgio Ossamu Ioshii, Micheli Ito Gimenes Pires, Julia Wolf Barretto, Eduardo Morais de Castro, Thyago Proença de Moraes, Lucia de Noronha","doi":"10.1590/1516-3180.2024.0376.R1.13102025","DOIUrl":"10.1590/1516-3180.2024.0376.R1.13102025","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury is one of the main systemic complications of severe coronavirus disease 2019 (COVID-19).</p><p><strong>Objectives: </strong>To examine histopathological changes in post-mortem kidney biopsies of patients who died as a result of the disease caused by SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2).</p><p><strong>Design and setting: </strong>A case-control study was conducted at a tertiary hospital located in Curitiba, Paraná, Brazil.</p><p><strong>Methods: </strong>The study group, called \"COVID,\" consisted of kidney biopsy samples obtained from deceased patients with COVID-19, with a \"Control\" group included for comparison. Samples were selected based on sex, age, and comorbidities, with an emphasis on diabetes mellitus and systemic arterial hypertension (SAH). Morphological evaluation was performed by pathologists using preestablished criteria with glomerular, tubular, and vascular characteristics among the parameters.</p><p><strong>Results: </strong>Tubular atrophy and interstitial fibrosis, markers of chronic kidney injury, were observed with equal frequency in both groups, probably because of the initial pairing of the samples. These findings are in line with what would be expected from chronic exposure to proteinuria. In relation to SAH, the main identification was interstitial vascular damage, particularly arteriolosclerosis/arteriosclerosis. Acute tubular injury was the most frequently observed feature in patients in the COVID group, which was probably related to ischemic damage.</p><p><strong>Conclusion: </strong>This study demonstrated that the main change identified in the renal parenchyma of patients with COVID-19 was acute tubular injury, which was expected considering the context of severe systemic ischemia to which these patients are subjected, with the other findings being the consequences of chronic damage.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"144 1","pages":"e2024376"},"PeriodicalIF":1.2,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12834467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146087751","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":"Postoperative delirium in patients with cancer: a narrative review of major risk factors.","authors":"Alessandra Bittencourt de Oliveira, Adriana Mayumi Handa, Eduardo Sakai, Arthur Caus de Morais, Michael Madeira de la Cruz Quezada, Jorge Kiyoshi Mitsunaga Junior, Assaiah Moreira Marrazzo da Costa Portugal, Eduardo Henrique Giroud Joaquim, Giane Nakamura","doi":"10.1590/1516-3180.2025.0016.R2.13102025","DOIUrl":"10.1590/1516-3180.2025.0016.R2.13102025","url":null,"abstract":"<p><strong>Background: </strong>Postoperative delirium (POD) is a severe complication and the most frequent adverse event in older patients, particularly those with cancer. With the increase in the older surgical population and cancer diagnoses, the incidence of POD is expected to increase.</p><p><strong>Objectives: </strong>To identify and evaluate major risk factors for POD in patients with cancer.</p><p><strong>Design and setting: </strong>Narrative review conducted at the A.C.Camargo Cancer Center in São Paulo, Brazil.</p><p><strong>Methods: </strong>PubMed, LILACS, and Embase database searches were conducted using relevant keywords from June 2023, to September 2024. We identified 279 studies; after screening and applying the eligibility criteria, 49 studies were included in the analysis.</p><p><strong>Results and discussion: </strong>POD risk factors in patients with cancer are associated with inflammation and the cumulative burden of intensive therapeutic modalities. These factors can be categorized into three domains: directly related to cancer, indirectly related to cancer, and preexisting predisposing factors. Among these factors, age is important. Additional relevant contributors include frailty, cognitive impairment, sarcopenia, pain, anxiety, and depression. A complex interaction exists between these factors that renders POD management in patients with cancer challenging; however, the impact of each factor remains unclear.</p><p><strong>Conclusions: </strong>Multiple overlapping risk factors often contribute to POD development in patients with cancer. Age is a significant risk factor, as reported in the literature. Other relevant factors have been described; however, the relative contribution of each factor to the etiology of POD remains unclear. Further research is required to address this knowledge gap.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"144 1","pages":"e2025016"},"PeriodicalIF":1.2,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12810936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146013056","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":"Adverse reactions to etiological treatment in patients with Chagas disease in the Western Potiguar mesoregion of Brazil: a cross-sectional study.","authors":"Henrique Rangelly Gabriel de Melo, Aurélio Julio Silva Dantas, Maria Gabriela Augusto de Medeiros Jácome, Milena Sonely Mendonça Bezerra Lima, Antônia Suellen Fernandes Dantas, José Antonio da Silva Júnior, Ellany Gurgel Cosme do Nascimento, Cléber de Mesquita Andrade","doi":"10.1590/1516-3180.2024.0154.R2.04112025","DOIUrl":"10.1590/1516-3180.2024.0154.R2.04112025","url":null,"abstract":"<p><strong>Background: </strong>Chagas disease is a significant public health challenge in Brazil that is characterized by substantial morbidity and mortality rates, coupled with limited etiological treatment options.</p><p><strong>Objective: </strong>To describe and assess the occurrence of adverse reactions resulting from benznidazole treatment in patients from the Western Potiguar mesoregion of Brazil.</p><p><strong>Design and setting: </strong>This retrospective, longitudinal, descriptive observational study included 106 individuals with Chagas disease who attended the Chagas Disease Outpatient Clinic of the Universidade do Estado do Rio Grande do Norte.</p><p><strong>Results: </strong>Among patients subjected to etiological treatment with benznidazole, 40.5% (43/106) experienced adverse reactions, manifesting in 13 distinct forms. The most prevalent reactions occurred primarily in the dermatological and hematological systems. Thus, despite the notable frequency of adverse reactions, their severity remained low, as evidenced by the minimal treatment suspension rate. The treatment demonstrated potential benefits to those affected by the disease.</p><p><strong>Conclusions: </strong>This study characterized the most frequent adverse reactions to benznidazole, mainly dermatological and hematological reactions, which were mostly mild and rarely led to treatment suspension. Recognizing these events is essential for guiding professionals, enhancing patient confidence, and improving adherence to etiological treatments for Chagas disease.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"144 1","pages":"e2024154"},"PeriodicalIF":1.6,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12795519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145985748","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}