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Revista da Associação Médica Brasileira, Volume: 68, Número: 3, Publicado: 2022
  • Minimum minimorum: thyroid minimally invasive FNA, less is more concept? Volens nolens? Editorial

  • Endoscopic biliary sphincterotomy: electric current mode Guideline

    Funari, Mateus Pereira; Sagae, Vitor Massaro Takamatsu; Moura, Eduardo Guimarães Hourneaux de; Bernardo, Wanderley Marques
  • The Pulmonary Metastasectomy in Colorectal Cancer study calls for reconsideration of the clinical effectiveness of this widespread practice Letter To The Editor

    Treasure, Tom; Macbeth, Fergus; Younes, Riad
  • Comment on “Nuances between sedentary behavior and physical inactivity: cardiometabolic effects and cardiovascular risk” Letter To The Editor

    Zhang, Yangfen; Ma, Meilin; He, Lianping
  • Comment on “Effect of the Mediterranean diet in patients with chronic spontaneous urticaria” Letter To The Editor

    Jiang, Junxiang; Ma, Meilin; He, Lianping
  • Doxofylline in acute exacerbation of chronic obstructive pulmonary disease Letter To The Editor

    Sevik, Omer Erdem; Canakci, Mustafa Emin
  • “Similitude in Modern Pharmacology”: two decades of studies contributing to the scientific basis of the homeopathic healing principle Letter To The Editor

    Teixeira, Marcus Zulian
  • Public interest in “early treatments” for coronavirus disease 2019 in Brazil: insights from Google Trends Short Communication

    Martinez, Edson Zangiacomi; Zucoloto, Miriane Lucindo; Aragon, Davi Casale
  • Prognostic assessment of tumor markers in lung carcinomas Original Article

    Bes-Scartezini, Fernanda; Saad Junior, Roberto

    Resumo em Inglês:

    SUMMARY BACKGROUND: Serum tumor markers are molecules that are secreted by tumor cells and may be present in small amounts in the serum of healthy individuals. Their role as prognostic factors in lung cancer remains controversial. OBJECTIVE: To assess the prognostic role of CEA, CA 19-9, CA 15-3, and CA 125 in non-squamous non-small cell lung cancer. PATIENTS AND METHODS: A total of 112 patients with non-squamous non-small cell lung cancer from two Oncology Centers were retrospectively analyzed. Tumor marker levels were measured prior to treatment. Data regarding clinical characteristics and overall survival were collected. RESULTS: Median overall survival of all patients was 15.97 months. Pre-treatment elevations of CA 125 and CA 15-3 were associated with shorter overall survival (p=0.004 and p=0.014, respectively). Single CEA and CA 19-9 elevations were not associated with a worse prognosis. Patients with two or more elevated markers had a statistically significant decrease in overall survival (p=0.008). In the multivariate analysis, smoking status and number of positive tumor markers at diagnosis were independently associated with a worse prognosis. CONCLUSION: High pre-treatment levels of tumor markers were correlated with decreased survival in patients with non-squamous non-small cell lung cancer.
  • Tocilizumab is useful for coronavirus disease 2019 patients: the key point is timing Original Article

    Gülhan, Muhammet; Önal, Uğur; Demirci, Neşe; Cetin, Gulcan; Calisir, Abdullah; Köksalan, Damla; Solmaz, Kübra; Kars, Ayhan; Kilinc, Cetin; Gülten, Sedat

    Resumo em Inglês:

    SUMMARY OBJECTIVE: In coronavirus disease 2019, a rapidly progressive inflammatory process is considered to be the main cause of organ damage and mortality. Therefore, the importance of anti-inflammatory treatments such as tocilizumab is increasing. METHODS: A total of 107 patients who received tocilizumab between March 2020 and March 2021 were included in the study. The primary termination point was mortality. We compared surviving and deceased patients by the stage of the disease and where the drug was given (service or intensive care unit). RESULTS: The mean age was 60.8±14.6 years (minimum 29 years, maximum 96 years). According to the WHO staging system, 16 (15%) patients had moderate, 47 (43.9%) patients had severe, 44 (41.1%) patients had a critical illness. Although all patients were admitted to the service, 26 (24.3%) patients received tocilizumab in the intensive care unit. Of 107 patients, 80 (74.7%) survived and 27 (25.2%) died. Mortality was found to be significantly higher in critical patients (96.3%), severe patients (3.7%), and moderate patients (0%) (p<0.001). Peripheral oxygen saturation measured at admission was found to be significantly lower in patients who died. The initial saturations (p=0.008) were found to have independent effects on mortality. CONCLUSION: The results showed that tocilizumab is an effective treatment option for coronavirus disease 2019 disease and reduces mortality, but the key point is timing.
  • Association between handgrip strength and body composition, physical fitness, and biomarkers in postmenopausal women with metabolic syndrome Original Article

    Miranda, Humberto; Bentes, Claudio; Resende, Monique; Cardoso Netto, Claudia; Nasser, Igor; Willardson, Jeffrey; Marinheiro, Lizanka

    Resumo em Inglês:

    SUMMARY OBJECTIVES: This study examined the association between handgrip strength and body composition, physical fitness, and biomarkers in postmenopausal women with metabolic syndrome. METHODS: A total of 75 postmenopausal women were diagnosed with metabolic syndrome participated in this study. Muscle strength was assessed via a hydraulic grip strength dynamometer; physical fitness tests included a timed-up-and-go, arm curl test, and 30-s chair stand. Body composition was assessed via bioelectrical impedance, from which estimates of fat mass, body fat percentage, fat-free mass, and visceral fat area were determined. Fasting plasma glucose and glycated hemoglobin were measured via blood sample analyses. Multiple linear regression analyses were conducted using handgrip strength as the dependent variable and using body composition, physical fitness, and biomarkers as independent variables. RESULTS: The results revealed that 52% of the total sample were classified as obese, 37.3% as overweight, and only 10.7% as normal weight. Significant correlations were present between handgrip strength and fat-free mass (p=0.002; R=0.590), mean blood pressure (p=0.002; R=0.450), and arm curl (p=0.001; R=0.795). CONCLUSION: This study showed that handgrip strength was predictive of fat-free mass, blood pressure, and upper limb strength performance.
  • Follow-up of a cohort of patients with noncystic fibrosis bronchiectasis for 1 year Original Article

    Mateus, Simone Paulo; Salles, Raquel Esteves Brandão; Costa, Walter; Costa, Claudia Henrique da; Lopes, Agnaldo José; Tura, Bernardo Rangel; Rufino, Rogério

    Resumo em Inglês:

    SUMMARY OBJECTIVE: The objective of this study was to evaluate the quality of life of patients with noncystic fibrosis bronchiectasis during a 1-year follow-up by using the EuroQol – 5 Dimensions – 3 Levels (EQ-5D-3L) questionnaire. METHODS: A cohort study was conducted with 100 patients with noncystic fibrosis bronchiectasis and followed up with face-to-face visits or by telephone contact every 3 months for 1 year. All patients were recruited from a single referral center for bronchiectasis. At the time of recruiting and at the end of 1 year, the EQ-5D-3L questionnaire was applied to evaluate the patients’ quality of life. Variables, such as exacerbation, emergency care, comorbidities, hemoptysis, colonization, and hospitalization, were assessed. RESULTS: Of the 100 patients, 99 completed the study and 72% were women. There were no marked limitations in the mobility and self-care domains during the follow-up. At the end of the follow-up, 32 patients were extremely anxious or depressed. The quality of life assessed by using EQ-5D-3L had an initial mean score of 0.545 and of 0.589 after 1 year, which was statistically significant (p=0.011). CONCLUSION: Patients with noncystic fibrosis bronchiectasis have a poor quality of life, and the EQ-5D-3L questionnaire may be a tool for monitoring patients with bronchiectasis.
  • Anxiety, attitudes-behaviors, coping styles, and social support among high-risk pregnant women in the late period of the coronavirus disease 2019 pandemic Original Article

    Kılıç, Alperen; Gök, Koray; Yaghouti, Lerze; Kökrek, Zekeriya; Özgül, Asude; Kapudere, Bilge; Tüten, Nevin; Köse, Osman; Bostancı, Mehmet Sühha; Özden, Selçuk

    Resumo em Inglês:

    SUMMARY OBJECTIVE: The purpose of this study was to investigate the prevalence of anxiety among high-risk pregnant women in the late period of the coronavirus disease 2019 pandemic and to evaluate the relationship between anxiety levels, attitudes-behaviors, coping styles, and other psychometric parameters. METHODS: Pregnant women who were followed up in our gynecology outpatient clinic were evaluated during their admissions between November 15, 2020 and February 15, 2021. This cross-sectional study analyzes prospectively collected data from a university hospital. Inclusion criteria were those being at risk of pregnancy and between the age of 18 and 45 years, while exclusion criteria were mental retardation and the presence of serious psychiatric illness. The study included 140 participants. Sociodemographic and pregnant attitudes-behaviors data form, State-Trait Anxiety Inventory, Coping Styles Scale Brief Form (Brief-COPE), and Multidimensional Scale of Perceived Social Support were used to collect data. RESULTS: Participants had high anxiety levels (State-STAI: 40.32±9.88; Trait-STAI: 42.71±7.32) and high prevalence of probable clinical anxiety [State-STAI: 84 (60.0%); Trait-STAI: 92 (65.7%)]. The fact concerning the transmission of the coronavirus disease 2019 to the baby during pregnancy/birth, extent to which coronavirus disease 2019 pandemic prevents regular pregnancy checkups, and family subgroup-Multidimensional Scale of Perceived Social Support predicted state probable clinical anxiety. Use of disinfectants predicted trait probable clinical anxiety. Employment status predicted state/trait probable clinical anxiety. The existence of trait probable clinical anxiety was significantly associated with behavioral disengagement and substance use which are considered ineffective coping styles. Participants without trait probable clinical anxiety had significantly more adopted positive reinterpretation, one of emotion-focused coping styles. CONCLUSION: Based on our results, the concern of the transmission of the coronavirus disease 2019 to the babies during pregnancy/birth may be the main factor influencing anxiety among high-risk pregnant women.
  • Prevalence of molecular and serological tests of the new coronavirus (SARS-CoV-2) in Carlos Chagas laboratory – Sabin group in Cuiabá Original Article

    Paula, Cristiane Coimbra de; Shimoya-Bittencourt, Walkiria; Passos, João Pedro Castoldo; Paula, Caroline Aquino Vieira De Lamare; Arunachalam, Karuppusamy; Fontes, Cor Jesus Fernandes; Oliveira, Ruberlei Godinho de

    Resumo em Inglês:

    SUMMARY BACKGROUND: Coronavirus disease 2019, which is caused by the new severe acute respiratory syndrome coronavirus 2, became a pandemic in 2020 with a mortality rate of 2% and high transmissibility, thus making studies with an epidemiological profile essential. OBJECTIVES: The aim of this study was to characterize the population that performed the severe acute respiratory syndrome coronavirus 2 molecular and serological tests in Carlos Chagas Laboratory – Sabin Group in Cuiabá. METHODS: A retrospective cross-sectional study was carried out with all the samples collected from nasal swab tested by RT-PCR and serological for severe acute respiratory syndrome coronavirus 2 IgM/IgG from the population served between April and December 2020. FINDINGS: In the analysis period, 23,631 PCR-coronavirus disease 2019 examinations were registered. Of this total number of cases, 7,649 (32.37%) tested positive, while 15,982 (66.31%) did not detect viral RNA and 374 of the results as undetermined. The peak of positive RT-PCR performed in July (n=5,878), with 35.65% (n=2,096). A total of 8,884 tests were performed on serological test SOROVID-19, with a peak of 1,169 (57.16%) of the positive tests for severe acute respiratory syndrome coronavirus 2 in July. MAIN CONCLUSIONS: Molecular positivity and serological tests, both peaked in July 2020, were mostly present in women aged 20–59 years, characterizing Cuiabá as the epicenter of the Midwest region in this period due to the high rate of transmissibility of severe acute respiratory syndrome coronavirus 2.
  • COVID-19 infection rates among transportation and metal workers Original Article

    Öngel, Ferit Serkan; Gülenç, Nuran; Gürcanli, Gurkan Emre; Arbak, Peri

    Resumo em Inglês:

    SUMMARY OBJECTIVE: The aim of this study was to compare the workers in the metal and transportation sectors in terms of COVID-19 infection frequency and to examine and establish links between infection frequency and the workplace working conditions. METHODS: A survey was prepared and conducted with a questionnaire prepared on the Google Form platform consisting of questions about the pandemic among the members of the All Transport Workers’ and The United Metalworkers’ Union in Turkey. RESULTS: The number of workers diagnosed with COVID-19 was 5.8% in the transportation sector and 2.8% in the metal sector, with a significant difference (p=0.036). The percentage of workers diagnosed with COVID-19 who worked at a physical proximity less than 2 m in the transportation sector was higher than those who worked in the metal sector (p=0.014). The proportion of those who stated that there were COVID-19 patients among their colleagues and working at a physical proximity less than 2 m at the workplace was 18.2% in the transportation and 10.6% in the metal sector, with a significant difference (p=0.003), those who took time off from work was 74%, but 28.5% successively (p<0.001). The share of those who thought that the protective equipment and/or measures were not sufficient during the pandemic was 41.9% in the transportation and 17.7% in the metal sector (p<0.001). CONCLUSION: The results emphasized that the characteristics of jobs, physical proximity during job hours, the use of protective equipment, and size of the workplaces should be considered as reasons for different infection risks in different sectors.
  • Correlation between the range of motion of the tibiotarsal joint and blood circulation in the lower limbs in diabetic individuals Original Article

    Zordão, Catarina Clapis; Gobbi, Aline; Sapalo, André Timóteo; Carvalho, Gabriela de; Guirro, Rinaldo Roberto de Jesus; Guirro, Elaine Caldeira de Oliveira

    Resumo em Inglês:

    SUMMARY OBJECTIVE: The aim of this study was to evaluate the relationship between the range of motion and lower-limb hemodynamic indices in the tibiotarsal joint of individuals with diabetic neuropathy. METHODS: Twenty volunteers of both sexes, with a mean age of 61.45±7.05 years, were diagnosed with type 2 diabetes mellitus and diabetic peripheral neuropathy. Arterial blood flow was assessed using Doppler ultrasound, and the variables such as average velocity, pulsatility index, and resistivity index were also evaluated. A range of dorsiflexion and plantar flexion joint movements were assessed using digital goniometry before and after exercise. Data distribution was assessed using the Shapiro-Wilk test, followed by Pearson's correlation for normal data and Spearman's correlation for non-normal data, in order to verify the association between variables. RESULTS: A moderate correlation was found between dorsiflexion and pulse rate on two occasions before (rs=0.497) and after initial evaluation (rs=0.511). A low correlation was found between plantar flexion and mean velocity (rs=-0.357), pulsatility index (rs=0.439), and resistivity index (rs=0.328); dorsiflexion and mean velocity (rs=0.374), pulse rate (rs=0.332), and resistance index (rs=0.327) before evaluation, and peak (rs=0.346) was observed after the evaluation of blood circulation. CONCLUSION: There is a correlation between the range of motion of the tibiotarsal joint and the blood circulation of diabetics, ranging from moderate to poor for the different variables evaluated.
  • Indoleamine-2,3-dioxygenase-related anti-inflammatory effects of 3-aminobenzamide and infliximab in experimental colitis Original Article

    Menekse, Ebru; Aydin, Sezai; Aydin, Oğuz Uğur; Sahin, Duygu; Akça, Gülçin; Eroğlu, Abdullah; Dinçel, Aylin Sepici; Ozkan, Yesim; Dolapci, Mete

    Resumo em Inglês:

    SUMMARY OBJECTIVE: This study aimed to investigate the presence of indoleamine-2,3-dioxygenase and bacterial translocation after the administration of 3-aminobenzamide and infliximab in the TNBS model of rat colitis. METHODS: The study group was divided into five categories as follows: group 1: (control), group 2: colitis+saline, group 3: colitis+3-aminobenzamide, group 4: colitis+infliximab, and group 5: colitis+3-aminobenzamide+infliximab. Intestinal mesenteric cultures were incubated on specific agar media plates under aerobic and anaerobic conditions, bacterial translocation was evaluated and assessed as colony-forming units per gram of tissue. Colonic tissue samples were evaluated by Western blotting method to detect the presence of indoleamine-2,3-dioxygenase. RESULTS: The results obtained were as follows: group 1: normal gut flora; group 2: eight of nine samples had bacterial translocation, of which six of them had positive indoleamine-2,3-dioxygenase protein; group 3: five of nine samples had bacterial translocation, of which seven of them had positive indoleamine-2,3-dioxygenase; group 4: three of nine samples had bacterial translocation, of which seven of them had positive indoleamine-2,3-dioxygenase; and group 5: only one sample had exact indoleamine-2,3-dioxygenase protein. CONCLUSION: Altered expression of indoleamine-2,3-dioxygenase results in a lower bacterial translocation via infliximab compared with 3-aminobenzamide treatment. Combined treatments emphasized different approaches for the new molecules related to indoleamine-2,3-dioxygenase.
  • Intra- and inter-examiner reliability of digital images of skin donor areas in burns Original Article

    Assunção, Flávia Fernanda de Oliveira; Gomes, Rosana Caetano; Borges, Nathália Cristina de Souza; Murta Junior, Luiz Otávio; Farina Júnior, Jayme Adriano; Guirro, Elaine Caldeira de Oliveira; Guirro, Rinaldo Roberto de Jesus

    Resumo em Inglês:

    SUMMARY OBJECTIVE: The main objective of this study was to evaluate intra- and inter-rater reliability in the analysis of digital images of donor areas for skin in burn patients using the CaPAS plugin in the ImageJ®. METHODS: Donor sites were reviewed by two independent reviewers in duplicate. The capture of images was standardized on the same device and distance (with a millimeter ruler), without a flash. The evaluators were trained to capture the images and use the plugin. RESULTS: We selected 70 images from donor areas, from men and women between 18 and 60 years old. In the analysis of intra-examiner reliability, eight of the nine variables exhibited excellent reliability (0.985–0.998) and one (entropy) exhibited good reliability (0.525). The same was true for the inter-examiner analysis: excellent reliability for eight variables (0.824–0.993) and good reliability for entropy (0.501). CONCLUSIONS: The CaPAS plugin has proven to be a reliable tool for use in research in skin donor areas in burns, as demonstrated by its excellent intra- and inter-examiner reliability values. This is a pioneering study in the quantitative assessment of skin donor areas in burn patients using the CaPAS plugin.
  • Clinical and radiological characteristics of pulmonary actinomycosis mimicking lung malignancy Original Article

    Baykal, Hüsnü; Ulger, A. Fusun; Çelik, Deniz; Tanrikulu, Fatma Benli; Tatci, Ebru

    Resumo em Inglês:

    SUMMARY INTRODUCTION: Pulmonary actinomycosis, clinically and radiologically, mimics abscess, tuberculosis, and lung malignancy, resulting in misdiagnosis or delay in diagnosis. In this study, we analyzed the clinicoradiological features of pulmonary actinomycosis, the presence of any differences between clinical prediagnosis and radiological diagnosis, and whether imaging modalities help distinguish pulmonary actinomycosis from lung cancer. METHODS: A total of 22 patients who had a histopathological diagnosis of actinomycosis in a tertiary health center participated in this study. Of these, 14 had positron-emission tomography/computed tomography. RESULTS: In all, 81.8% of the patients were males. The diagnostic procedures employed for the diagnosis of actinomycosis were surgery in 54.5% of patients, fiberoptic bronchoscopy in 36.4% of patients, and rigid bronchoscopy in 9.1% of patients. Radiological and clinical prediagnosis showed malignancy in 31.8 and 40.9% of patients, respectively. The mean of the maximum standardized uptake value was 6.33±3.6 on positron-emission tomography/computed tomography. Kappa compliance analysis revealed that clinical and radiological diagnoses were significantly compatible with each other and that radiological pre-diagnoses were not superior to clinical diagnoses (κ=0.701 and p<0.001). CONCLUSION: Pulmonary actinomycosis shows high metabolic uptake in positron-emission tomography/computed tomography, and this may mislead clinicians for a diagnosis of malignancy. Our results suggest that positron-emission tomography/computed tomography does not help distinguish pulmonary actinomycosis from lung malignancy and does not provide a clear diagnostic benefit to the clinician, so pathological diagnosis is necessary.
  • Comparison of the effects of duloxetine and pregabalin on pain and associated factors in patients with knee osteoarthritis Original Article

    Illeez, Ozge Gulsum; Oktay, Kubra Neslihan Kurt; Aktas, Ilknur; Ozkan, Feyza Unlu; Nazligül, Tuba; Begoglu, Feyza Akan; Kaysin, Meryem Yilmaz; Atici, Arzu; Akpinar, Pinar

    Resumo em Inglês:

    SUMMARY OBJECTIVES: This study aimed to investigate the effects of duloxetine and pregabalin primarily on pain and functional status in patients with knee osteoarthritis and secondarily on quality of life, depression, anxiety, and sleep disturbance. METHODS: A total of 66 patients with knee osteoarthritis were randomized to use duloxetine or pregabalin. Patients were evaluated by Visual Analog Scale, Neuropathic Pain Diagnostic Questionnaire, Western Ontario and McMaster University Osteoarthritis Index, Short Form-36, Beck Depression Inventory, Beck Anxiety Inventory, and Pittsburg Sleep Quality Index before the treatment and after 4 and 12 weeks of treatment. RESULTS: Improvements occurred in Visual Analog Scale, Neuropathic Pain Diagnostic Questionnaire, Western Ontario and McMaster University Osteoarthritis Index, Short Form-36 (with an exception of the mental health subgroup scores in duloxetine-treated group), Beck Depression Inventory, and Beck Anxiety Inventory scores in both groups from 4 weeks after baseline. Pittsburg Sleep Quality Index total scores and SF-36 mental health subgroup scores started to improve on the 4th and 12th weeks in pregabalin- and duloxetine-treated groups, respectively. CONCLUSION: Osteoarthritis pain, a complex outcome with nociceptive and neuropathic components, leads to central sensitization in a chronic phase. Using centrally acting drugs in the control of pain and associated symptoms would increase the probability of treatment success.
  • The prognostic value of the CHA2DS2-VASc score in coronary collateral circulation and long-term mortality in coronary artery disease Original Article

    Adali, Mehmet Koray; Turkoz, Anil; Yilmaz, Samet

    Resumo em Inglês:

    SUMMARY BACKGROUND: The CHA2DS2-VASc score is used to determine thromboembolic risk in cases of atrial fibrillation. The predictive value of this score in predicting coronary collateral circulation in chronic total occlusion is unknown. OBJECTIVE: The aim of this study was to investigate the relationship between the CHA2DS2-VASc score and coronary collateral circulation in patients with chronic total occlusion. METHODS: A total of 189 patients, who underwent coronary angiography and had a chronic total occlusion in at least one coronary artery, were enrolled in this study. The Rentrop scoring system was used for grouping the patients, and patients were classified as having poorly developed coronary collateral circulation (Rentrop grade 0 or 1) or well-developed coronary collateral circulation (Rentrop grade 2 or 3). RESULTS: The CHA2DS2-VASc score of the good coronary collateral circulation group was significantly lower than the other group (3.1±1.7 vs. 3.7±1.7, p=0.021). During the follow-up period, 30 (32.2%) patients in the poorly developed coronary collateral circulation group and 16 (16.7%) patients in the well-developed coronary collateral circulation group died (p=0.028). According to the multivariable Cox regression model, the CHA2DS2-VASc score [hazard ratio (HR): 1.262, p=0.009], heart rate (HR: 1.049, p=0.003), LVEF (HR: 0.975, p=0.039), mean platelet volume (HR: 1.414, p=0.028), and not taking acetylsalicylic acid during admission (HR: 0.514, p=0.042) were independently associated with a higher risk of mortality. CONCLUSIONS: The CHA2DS2-VASc score is closely related to coronary collateral development and predicts mortality in patients with chronic total occlusion.
  • An examınatıon of the anxıety states of Turkısh health care workers durıng the COVID-19 pandemıc: a cross-sectıonal study Original Article

    Ceylan, Ali; Zirek, Emrah; Akturk, Sibel Ocak; Calik, Bilge Basakci

    Resumo em Inglês:

    SUMMARY OBJECTIVE: The aim of this study was to evaluate the anxiety experienced by health care workers in different branches during the COVID-19 pandemic. METHODS: The cross-sectional study included 373 health care workers. Data were collected using an online questionnaire consisting of the Sociodemographic Form (32 items related to the working conditions of health care professionals during the COVID-19 pandemic) and the Penn State Concern Questionnaire. RESULTS: The anxiety levels of the female workers were significantly higher (p<0.001). The total Penn State Concern Questionnaire points were determined to be statistically significantly higher in those who need to protect the family during the pandemic (p=0.03), who were dissatisfied with their profession (p<0.001), and those whose workload had increased during the pandemic (p=0.007). CONCLUSIONS: The study results demonstrated that the levels of anxiety of health care workers during the COVID-19 pandemic could be increased by young age, low level of experience, female gender, increased workload, and dissatisfaction with the profession.
  • Effects of imipenem combined with glutamine in the treatment of severe acute pancreatitis with abdominal infection in mainland China: a meta-analysis Original Article

    Zhou, Shuang; Jin, Lai-Run; He, Chiyi

    Resumo em Inglês:

    SUMMARY OBJECTIVE: The aim of this study was to explore the efficacy of imipenem combined with glutamine in the treatment of severe acute pancreatitis with abdominal infection in mainland China using meta-analysis. METHODS: We searched China National Knowledge Network, Wanfang Medical Network, Chinese Science Citation Database, PubMed, and Embase Databases for publications of imipenem combined with glutamine in the treatment of severe acute pancreatitis abdominal infection. The search time limit was from the establishment of the database to April 10, 2021. Stata software version 12.0 was used for statistical analysis; the combined effect size odds ratio and standardized mean difference values were calculated for the count data and measurement data, respectively; and the heterogeneity test was performed in this study. RESULTS: A total of five randomized controlled trials were included. A total of 499 cases were included, with 251 in the observation group and 248 in the control group. Meta-analysis results showed that the efficacy of imipenem combined with glutamine in the treatment of severe acute pancreatitis with abdominal infection was significantly better than that of imipenem alone (odds ratio=0.78, 95%CI 0.71–0.86, p=0.040). CONCLUSION: Imipenem combined with glutamine can significantly improve the efficacy in the treatment of severe acute pancreatitis with abdominal cavity infection.
  • Wnt3a but not CDX-2 expression is associated with differentiated thyroid cancer Original Article

    Biagini, Gleyne Lopes Kujew; Ribas, Carmem Austrália Paredes Marcondes; Higashi, Henrique Diez; Hirata, Vanessa Yumi; Zella, Maria Augusta Karas; Bartolomei, Ivan; Biagini, Giuliana; Collaço, Luiz Martins

    Resumo em Inglês:

    SUMMARY OBJECTIVE: Thyroid neoplasm incidence has increased worldwide, mostly due to the advancements in medical imaging and screening rates. The aberrant Wnt/β-catenin pathway has been identified as a key mechanism, and it has also been related to the metastatic activity of differentiated thyroid cancer. We aimed to verify the difference in the expression of Wnt3a, a canonical activator of the β-catenin signaling, and CDX-2, a transcription factor upregulated by Wnt/β-catenin pathway, in multinodular goiter and differentiated thyroid cancer and to determine their prognostic value. METHODS: We included 194 thyroid tissue surgical specimen and their clinicopathological data: study group (differentiated thyroid cancer, n=154) and control group (multinodular goiter, n=40). Immunohistochemistry (IHC) was performed on formalin-fixed, paraffin-embedded tissue by the primary antibodies Wnt3a and CDX-2. RESULTS: High Wnt3a expression was significantly associated with differentiated thyroid cancer (p=0.031). CDX-2 was negative in all differentiated thyroid cancer cases (100%) and also in multinodular goiter. Wnt3a expression was significantly associated with tumors ≤20 mm (p=0.044) and with the absence of capsule invasion (p=0.031). The multivariate analyses suggested that older age (≥55), independent of capsular invasion and tumor size, was an independent prognostic factor for Wnt3a expression (p=0.058). CONCLUSIONS: Wnt3a expression but not CDX-2 is correlated with differentiated thyroid cancer samples in comparison to multinodular goiter. Although its prognostic value was limited to tumor size and capsule invasion, a combined model in a panel of immune markers can add accuracy in the classification of challenging thyroid follicular-derived lesions.
  • Does focal heterogeneity affect survival in postoperative ipsilateral multifocal and multicentric breast cancers? Original Article

    Dal, Fatih; Ökmen, Hasan; Ulusan, Kivilcim; Çolak, Şükrü; Havare, Semiha Battal; Trabulus, Fadime Didem Can; Ferlengez, Ekrem; Sari, Serkan

    Resumo em Inglês:

    SUMMARY OBJECTIVE: In multicentric/multifocal breast tumors, there may be immunological and histological differences between foci that may affect survival and treatment choice. We aimed to evaluate the effect of focal heterogeneity seen in multicentric/multifocal breast tumors on survival. METHODS: We retrospectively collected and analyzed the clinicopathological data of 89 female patients with multifocal/multicentric breast cancer, whose surgical and medical treatment was completed and who were followed up for 5 years. RESULTS: Of all patients, 29.2% (26/89) were heterogeneous. Heterogeneity of these foci was as follows: histologic heterogeneity of index foci (mix type): 15.7% (14/89), histologic heterogeneity of inter-foci: 7.9% (7/89), and immunohistochemical heterogeneity of inter-foci: 10.1% (9/89). When additional foci were evaluated, oncological therapy was changed for 3 (3.3%) of 89 patients. Heterogeneity does not have a significant (p>0.05) effect on recurrence and survival in multicentric/multifocal breast cancers. Pathological N stage is an independent risk factor for disease-free survival (hazard ratio=2.29, 95% confidence interval=1.39–3.76, p=0.001). CONCLUSIONS: In multifocal/multicentric breast cancers, less than 4% of patients may experience heterogeneity requiring change in the therapeutic decision. However, heterogeneity does not have a significant effect on recurrence and survival in multifocal/multicentric breast cancers. The pathological N stage is an independent risk factor for disease-free survival.
  • Frequency of Congenital Aortic Arch Anomaly in COVID-19 Patients Original Article

    Aydin, Mehmet Maruf; Yalçinkaya, Mirsad

    Resumo em Inglês:

    SUMMARY OBJECTIVE: The aim of this study was to investigate the frequency of aortic arch anomaly in COVID-19 patients and to determine whether it will be included in the risk classification. METHODS: The study was retrospectively conducted in a third-level hospital by scanning the contrast-enhanced thoracic computed tomography and thoracic computed tomography angiography examinations of patients who received PCR (+), hospitalization, and known COVID pneumonia between March 2020 and July 2021. The study consists of 88 cases and 88 control groups. RESULTS: The study found that the frequency of aortic arch anomaly was higher in patients with COVID-19 pneumonia and in male patients with bovine-type anomaly. CONCLUSIONS: The higher prevalence of bovine arch anomaly in COVID patients may be considered a risk factor for COVID-19 in individuals with this type of vascular anomaly.
  • Management of ultrasonographic endometrial thickness in postmenopausal asymptomatic women Review Article

    Cantalogo, Letícia Rodrigues; Jammal, Millena Prata; Gomes, Mariana Kefalás Oliveira; Murta, Eddie Fernando Candido; Nomelini, Rosekeila Simões
  • Civil sentencing in health care and their relation with blanket consent in rulings from the Court of Appeals of the State of São Paulo Review Article

    Cabar, Fábio Roberto; Ribeiro, Andre Eduardo Amaral; Gorga, Maria Luiza
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Associação Médica Brasileira R. São Carlos do Pinhal, 324, 01333-903 São Paulo SP - Brazil, Tel: +55 11 3178-6800, Fax: +55 11 3178-6816 - São Paulo - SP - Brazil
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