Sao Paulo Medical Journal最新文献

{"title":"Prognostic value of chemotherapy response score in advanced ovarian cancer: a single-center retrospective analysis.","authors":"Hamdullah Sözen, Yagmur Minareci, Atahan Toyran, Ibrahim Yalçin, Semen Önder, Aysel Bayram, Sidar Bağbudar, Mustafa Albayrak, Müge Ateş Tikiz, Pınar Mualla Saip, Samet Topuz, Mehmet Yavuz Salihoglu","doi":"10.1590/1516-3180.2025.2881.15082025","DOIUrl":"10.1590/1516-3180.2025.2881.15082025","url":null,"abstract":"<p><strong>Background: </strong>The chemotherapy response score (CRS) is a histopathological tool used to assess the tumor response in patients with high-grade serous ovarian carcinoma (HGSC) undergoing neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS).</p><p><strong>Design and setting: </strong>This single-center retrospective study was conducted at the Faculty of Medicine at Istanbul University. The study included patients treated between January 1, 2010, and December 31, 2017 at a tertiary care hospital specializing in gynecologic oncology.</p><p><strong>Objectives: </strong>This study aimed to evaluate the prognostic significance of omental and adnexal CRS in predicting overall survival (OS) and disease-free survival (DFS) in patients with advanced HGSC undergoing NACT followed by IDS.</p><p><strong>Methods: </strong>Data from 79 patients with advanced HGSC treated with NACT followed by IDS between 2010 and 2017 were analyzed. CRS was applied to both omental and adnexal samples, and its association with OS and DFS was evaluated. Statistical analyses were performed using univariate and multivariate methods with a significance level of P < 0.05.</p><p><strong>Results: </strong>Omental CRS 1-2 was identified as an independent predictor of decreased OS (hazard ratio 2.69; 95% confidence interval 1.26-5.76, P = 0.010), whereas adnexal CRS 1-2 did not significantly impact DFS or OS in multivariate analysis. Patients with omental CRS 3 had superior outcomes, with a 5-year OS rate of 72%, compared to 30.8% in the CRS 1-2 group. The median DFS of the CRS 1-2 group was 19 months, whereas that of the CRS 3 group was 35 months (P = 0.005).</p><p><strong>Conclusions: </strong>Omental CRS is a strong independent predictor of OS in patients with advanced HGSC, whereas adnexal CRS has limited prognostic value. CRS should be considered in clinical practice to guide treatment decisions, and further research is warranted to refine its use by using molecular and radiological markers.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"143 6","pages":"e20252881"},"PeriodicalIF":1.6,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12591238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453450","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":"Insights for the treatment of depression in the Brazilian Public Health System.","authors":"Thales Marcon Almeida, Ana Lídia Marcon Almeida, Quirino Cordeiro, Ricardo Riyoiti Uchida","doi":"10.1590/1516-3180.2025.3068.14052025","DOIUrl":"10.1590/1516-3180.2025.3068.14052025","url":null,"abstract":"","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"143 6","pages":"e20253068"},"PeriodicalIF":1.6,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12571487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423510","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":"Sleep quality and levels of stress, anxiety, and depression in patients treated with homeopathy: a prospective study in the Brazilian public healthcare service.","authors":"Fernanda Maria Simões da Costa Fujino, Ana Paula Ribeiro, Denise Castanho Antunes, Renato Jimenez Gomez, Guilherme Eustáquio Furtado, Patrícia Colombo-Souza","doi":"10.1590/1516-3180.2025.3033.06082025","DOIUrl":"10.1590/1516-3180.2025.3033.06082025","url":null,"abstract":"<p><strong>Background: </strong>Chronic noncommunicable diseases (NCDs) have a multifactorial etiology and are associated with psychosocial factors, such as stress, anxiety, and depression. Sleep quality also influences general health and is associated with obesity and NCDs. Homeopathy, as a medical specialty, is effective in managing these conditions because of its comprehensive approach to individuals.</p><p><strong>Objective: </strong>To evaluate the influence of homeopathic treatment on sleep quality and levels of stress, anxiety, and depression.</p><p><strong>Design and setting: </strong>Observational, longitudinal, and prospective study on individuals over 18 years of age with homeopathic medical follow-up for 6 months in the public healthcare service of Guarulhos, São Paulo.</p><p><strong>Methods: </strong>Participants were evaluated initially (T0) and after 3 (T1) and 6 months (T2) using validated questionnaires (Pittsburgh Sleep Quality Index and the Depression Anxiety and Stress Scale), following all ethical precepts. The scores were compared over time and correlated with each other (P < 0.05).</p><p><strong>Results: </strong>The mean patient age was 49 years. Initially, 81% of the participants had sleep disorders and severe or extremely severe levels of stress (33.78%), anxiety (28.38%), and depression (27.03%). A total of 26 patients were present at the three evaluation points, which were included as the participants of the study. Homeopathic treatment significantly improved sleep quality and reduced stress, anxiety, and depression. Sleep quality and anxiety were strongly (r = 0.53, P = 0.005) and weakly (r = 0.25, P = 0.021) correlated with stress, respectively.</p><p><strong>Conclusion: </strong>In the short term, homeopathic treatment had a positive impact on the sample, suggesting that this therapy can be used to prevent NCDs.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"143 6","pages":"e20253033"},"PeriodicalIF":1.6,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12571486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423437","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":"Static cold package for transporting organs for transplants: a validation method and pilot test.","authors":"Sibele Maria Schuantes-Paim, Renata Fabiana Leite, Vanessa Ayres Carneiro Gonçalves, Adriana Aparecida Carbonel, Eliana Cavalari Teraoka, Graciana Maria de Moraes Coutinho, Victor Arayama Cruz, Manuel de Jesus Simões, Andre Ibrahim David, Murched Omar Taha, Janine Schirmer, Bartira de Aguiar Roza","doi":"10.1590/1516-3180.2025.2930.29042025","DOIUrl":"10.1590/1516-3180.2025.2930.29042025","url":null,"abstract":"<p><strong>Background: </strong>Logistic and temperature challenges contribute to organ loss during transplantation. Ensuring the safety of static cold packaging for organ transport is essential to improve patient access to transplants. This study aimed to verify a method for validating the packaging used to transport organs for transplantation.</p><p><strong>Design and setting: </strong>Validation study and pilot test using experimental surgery on porcine organs.</p><p><strong>Methods: </strong>Data collection considered the variables related to organ integrity before and after transportation, including temperature (measured thrice with three instruments per organ), macroscopic evaluation (based on photographic and observational assessments), histology (structural analysis of the collected samples), and packaging contamination (triple-swab sampling for microorganism growth). Data analysis was performed using descriptive statistics, visual assessment, histological processing, and microbiological evaluation.</p><p><strong>Results: </strong>By the end of transportation, all the organs reached the ideal temperature range for transplantation. The similarity in swine weight and size enabled macroscopic comparisons. Histological analysis revealed no significant injuries or morphological changes. Regarding packaging, environmental microorganisms predominate, with sustainable post-transport differences.</p><p><strong>Conclusion: </strong>The method developed to validate the package used for transporting organs for transplantation was successfully verified. Furthermore, this method addresses the existing gap in the process of documenting a robust validation method for packaging intended for organ transportation.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"143 6","pages":"e20252930"},"PeriodicalIF":1.6,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12571455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423492","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 and factors associated with actinic keratosis in 1346 patients attending at a public dermatology service: a cross-sectional study.","authors":"Ademar Schultz Junior, Lara Bourguignon Lopes, Roberta Ribeiro Batista Barbosa","doi":"10.1590/1516-3180.2024.0178.07042025","DOIUrl":"10.1590/1516-3180.2024.0178.07042025","url":null,"abstract":"<p><strong>Background: </strong>Actinic keratosis is a common preneoplastic dermatosis and is the third most common reason for dermatological consultations. Identifying the associated factors, diagnosis, and early treatment of actinic keratosis are crucial for reducing the risk of developing skin cancer and costs to the healthcare system.</p><p><strong>Objective: </strong>To evaluate the prevalence and factors associated with actinic keratosis in individuals treated at a public dermatology service.</p><p><strong>Design and setting: </strong>A cross-sectional observational study was conducted with 1346 patients treated by a public dermatology service.</p><p><strong>Methods: </strong>The demographic and dermatological characteristics of patients were recorded. The presence of actinic keratosis was determined by clinical dermatological identification.</p><p><strong>Results: </strong>Most participants were elderly, white, and exposed to the sun without protection or during occupational activity. The evolution time of cutaneous lesions was <1 year in 46.8% of participants. Actinic keratosis was the most common skin lesion, being present in 29.3% of participants. The main approach adopted was cryotherapy. Keratosis was associated with white skin color, elderly age, personal and family history of skin cancer, exposure to the sun without protection at work, and limb involvement. When the associated factors were analyzed using a regression model, skin color and affected body segments were the main predictors of actinic keratosis.</p><p><strong>Conclusions: </strong>The prevalence of actinic keratosis was 29.3%, being higher in people with fair skin, more than two affected segments, skin lesions on the limbs, older age, and unprotected sun exposure. These indicators are important for supporting decision-making and contributing to improving public policies.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"143 5","pages":"e2024178"},"PeriodicalIF":1.6,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12517640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304334","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":"Postural assessment of children with congenital Zika syndrome and caregivers in the home environment: a cross-sectional pilot study.","authors":"Janiele de Sales Tavares, Thamyris de Sales Regis, Gabriela Lopes Gama, José Geraldo Ribeiro Gregório, Jousilene de Sales Tavares, Adriana Melo, Daniel Scherer","doi":"10.1590/1516-3180.2023.0354.R2.29042025","DOIUrl":"10.1590/1516-3180.2023.0354.R2.29042025","url":null,"abstract":"<p><strong>Background: </strong>Children with congenital Zika syndrome (CZS) present severe motor impairment that hinders their caregivers' positioning during activities of daily living (ADLs).</p><p><strong>Objective: </strong>To assess the posture of children with CZS and their caregivers during ADLs in the home environment.</p><p><strong>Design and setting: </strong>A cross-sectional pilot study conducted in Campina Grande (PB), Brazil.</p><p><strong>Methods: </strong>Nine children with CZS (mean age = 36.77 ± 2.94 months) and their caregivers (n = 9, mean age = 27 years) were assessed. Data were collected at the support home of a center for children with microcephaly in Northeast of Brazil. For postural assessment, children and their caregivers were filmed while performing ADLs in the living room and kitchen of the support home.</p><p><strong>Results: </strong>During the environmental interaction, all children predominantly maintained a sitting position, exhibiting neck and trunk asymmetry; 77.8% (n = 7) showed inadequate postures with elevated arms and shoulders, and none maintained the ankles in a neutral position with supported feet. During feeding, 88.9% (n = 8) of children were positioned on the lap of caregivers, 88.9% (n = 8) exhibited neck and trunk asymmetry, 66.7% (n = 6) displayed inadequate upper-limb posture, and none maintained their ankles in a neutral position. During this activity, 66.7% (n = 6) of caregivers presented with trunk and neck asymmetry, 66.7% (n = 6) did not provide support for the upper limbs, and 55.6% (n = 5) did not maintain their knees flexed at 90o.</p><p><strong>Conclusions: </strong>Children with CZS and their caregivers present with inadequate postures during ADLs in the home environment, which may represent health risks.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"143 5","pages":"e2023354"},"PeriodicalIF":1.6,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12517641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304298","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":"Patient activation levels in cardiovascular disease: a cross-sectional study in Brazilian community pharmacies.","authors":"Fabianna Marangoni Iglecias, Eduardo Riano, Francisco Javier Ferreira-Alfaya, Maria Isabel Valverde-Merino, Manuel Gomez-Guzman, Celia Piquer-Martinez, Maria José Zarzuelo","doi":"10.1590/1516-3180.2024.0411.R1.13062025","DOIUrl":"10.1590/1516-3180.2024.0411.R1.13062025","url":null,"abstract":"<p><strong>Background: </strong>Preventable cardiovascular diseases are among the leading causes of death in individuals aged < 70 years in Brazil.</p><p><strong>Objective: </strong>This study assessed the level of patient activation among individuals with cardiovascular disease in Brazilian community pharmacies.</p><p><strong>Design and setting: </strong>This cross-sectional study included 348 Brazilian participants diagnosed with hypercholesterolemia and/or hypertension.</p><p><strong>Methods: </strong>The Patient Activation Measure (PAM-13) questionnaire was used. In addition, sociodemographic and clinical variables were collected, including coronary risk evaluation and quality of life assessment. Student's t-test was used to compare baseline quantitative variables between groups, and the chi-square test was used to assess associations for categorical variables. Pearson's correlation was used to examine the relationships among the quality of life, clinical variables, sociodemographic data, and activation levels.</p><p><strong>Result: </strong>Participants had an average age of 59.0 ± 16.7 years and a low to moderate risk. The mean patient activation level was 2.8 out of 4, with high self-care responsibility and treatment adherence but lower confidence in maintaining lifestyle changes. Factors linked to lower activity included low physical activity (P < 0.001), multiple chronic conditions (P = 0.003), smoking (P = 0.016), age > 65 years (P = 0.033), low quality of life (P < 0.001), and high CVR (P < 0.001).</p><p><strong>Conclusion: </strong>Patient activation in cardiovascular care in the Brazilian population is positively affected by lifestyle factors, particularly physical activity. Intervention strategies that promote lifestyle changes can enhance patient activity and improve health outcomes in this population.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"143 6","pages":"e2024411"},"PeriodicalIF":1.6,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253649","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 the use of midazolam, fentanyl, propofol, ketamine, and dexmedetomidine and the incidence of delirium in elderly patients in intensive care units: a systematic review.","authors":"Willian Setubal Dos Santos, Omar Carrión-Torres, Matheus Galvão Valadares Bertolini Mussalem, Vinicius Santos Baptista, Samira Yarak","doi":"10.1590/1516-3180.2024.0311R1.14072025","DOIUrl":"10.1590/1516-3180.2024.0311R1.14072025","url":null,"abstract":"<p><strong>Background: </strong>Delirium is a common and serious complication among elderly patients in intensive care units (ICUs), and is often associated with increased morbidity and mortality rates. The choice of sedoanalgesic may influence the incidence of delirium; however, the evidence remains unclear, particularly in the elderly population.</p><p><strong>Objectives: </strong>To evaluate the association between the use of different sedoanalgesics and the incidence of delirium in elderly ICU patients, based on data from randomized clinical trials.</p><p><strong>Design and setting: </strong>This systematic review was conducted using data from randomized clinical trials performed in various ICU settings.</p><p><strong>Methods: </strong>A systematic search of the MEDLINE, Embase, and CENTRAL databases was performed in January 2024. The review included randomized clinical trials involving patients aged 60 years or older that examined the relationship between sedoanalgesics (midazolam, fentanyl, propofol, ketamine, and dexmedetomidine) and delirium incidence. Studies involving COVID-19 patients and non-randomized studies were excluded.</p><p><strong>Results: </strong>A total of 1,331 patients from six studies were included. The mean age of the patients ranged from 71 to 74.7 years. Four studies compared dexmedetomidine with propofol; two found no significant difference in delirium incidence, whereas two suggested a lower incidence with dexmedetomidine. The remaining studies compared propofol with ketamine and dexmedetomidine with midazolam and showed no significant differences in the incidence of delirium.</p><p><strong>Conclusions: </strong>Dexmedetomidine may be associated with a lower incidence of delirium than propofol or midazolam in elderly ICU patients. However, further research is needed to confirm these findings and explore the factors contributing to delirium in this population.</p><p><strong>Systematic review registration: </strong>Registered with PROSPERO, CRD42024575693, available at https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=575693.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"143 6","pages":"e20240311"},"PeriodicalIF":1.6,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253652","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":"Determinants of mortality risk in older adults from the ELSIA study: a prospective cohort study.","authors":"Lucas Lima Galvão, Douglas de Assis Teles Santos, Claudio Andre Barbosa de Lira, Jair Sindra Virtuoso Júnior, Sheilla Tribess, Ricardo Borges Viana, Anne Sulivan Lopes da Silva Reis, Katja Weiss, Beat Knechtle, Rodrigo Luiz Vancini","doi":"10.1590/1516-3180.2024.0402.R1.24032025","DOIUrl":"10.1590/1516-3180.2024.0402.R1.24032025","url":null,"abstract":"<p><strong>Background: </strong>This study investigated factors that may determine longevity in older adults, aiming to prolong their life expectancy and improve projections from before the coronavirus disease 2019 pandemic.</p><p><strong>Objective: </strong>To identify risk factors for mortality in older Brazilian adults.</p><p><strong>Design and setting: </strong>A prospective cohort study, part of the Estudo Longitudinal de Saúde do Idoso de Alcobaça.</p><p><strong>Methods: </strong>This study included 332 older adults of both sexes who were followed up for over five years (2015-2020). Vital status was determined via telephone follow-up, information provided by family members, and death certificates. To identify the sociodemographic, health, functional, and behavioral factors associated with mortality risk among older adults, Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).</p><p><strong>Results: </strong>The risk factors for mortality among older adults included the number of people living with them (HR = 1.22; 95%CI = 1.07-1.38) and the number of prescribed drugs (HR = 1.15; 95%CI = 1.00-1.32). Factors associated with a lower risk of mortality were greater time spent in physical activity (HR = 0.99; 95%CI = 0.90-0.99) and greater hip circumference (HR = 0.95; 95%CI = 0.31-0.99).</p><p><strong>Conclusions: </strong>Sociodemographic, health, functional, and behavioral factors are determinants of mortality risk among older adults. Regular screening of the older adult population should be conducted to assess their general health status, allowing for more appropriate interventions to increase their quality of life and improve aging.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"143 5","pages":"e2024402"},"PeriodicalIF":1.6,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253662","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":"Transplantation Beyond Species: The Present and Future of Xenotransplantation.","authors":"Luiz Fernando Caneo, Tadeu Thomé, Paulo Manuel Pêgo-Fernandes","doi":"10.1590/1516-3180.2025.1435.15072025","DOIUrl":"10.1590/1516-3180.2025.1435.15072025","url":null,"abstract":"","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"143 5","pages":"e20251435"},"PeriodicalIF":1.6,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253625","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}