RESUMO
O objetivo do presente estudo foi avaliar em tomografias computadorizadas as dimensões dos tecidos periodontais supracrestais (TPSC). Cem pacientes, 600 dentes anteriores da maxila (200 incisivos centrais, 200 incisivos laterais e 200 caninos), foram avaliados. A distância média da margem gengival até a crista óssea alveolar (COA) foi de 3.25mm (95% IC: 3.20-3.30), enquanto que da junção cemento-esmalte até a COA foi de 1.77mm (95% IC: 1.72-182mm). As medidas foram significativamente diferentes entre os grupos de dentes (ANOVA, p < 0.001). A tomografia, pode representar uma importante ferramenta para a avaliação das dimensões dos TPSC.
The aim of this study was to evaluate the dimensions of the supracrestal periodontal tissues (SPT) on tomographic scans. One hundred patients, 600 maxillary anterior teeth (200 central incisors, 200 lateral incisors and 200 canines), were evaluated. The average distance from the gingival margin to the alveolar bone crest (ABC) was 3.25mm (95% CI: 3.20-3.30), while the distance from the cemento-enamel junction to ABC was 1.77mm (95% CI: 1.72-182mm). The measurements were significantly different between the tooth groups (ANOVA, p < 0.001). When properly indicated, tomography can be an important tool for assessing the dimensions of TPSCs on a case-by-case basis.
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Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Tecidos , Periodonto , Tomografia Computadorizada de Feixe Cônico , MaxilaRESUMO
Purpose: To quantify outer retina structural changes and define novel biomarkers of inherited retinal degeneration associated with biallelic mutations in RPE65 (RPE65-IRD) in patients before and after subretinal gene augmentation therapy with voretigene neparvovec (Luxturna). Methods: Application of advanced deep learning for automated retinal layer segmentation, specifically tailored for RPE65-IRD. Quantification of five novel biomarkers for the ellipsoid zone (EZ): thickness, granularity, reflectivity, and intensity. Estimation of theâ EZarea in single and volume scans was performed with optimized segmentation boundaries. The control group was age similar and without significant refractive error. Spherical equivalent refraction and ocular length were evaluated in all patients. Results: We observed significant differences in the structural analysis of EZ biomarkers in 22 patients with RPE65-IRD compared with 94 healthy controls. Relative EZ intensities were already reduced in pediatric eyes. Reductions of EZ local granularity and EZ thickness were only significant in adult eyes. Distances of the outer plexiform layer, external limiting membrane, and Bruch's membrane to EZ were reduced at all ages. EZ diameter and area were better preserved in pediatric eyes undergoing therapy with voretigene neparvovec and in patients with a milder phenotype. Conclusions: Automated quantitative analysis of biomarkers within EZ visualizes distinct structural differences in the outer retina of patients including treatment-related effects. The automated approach using deep learning strategies allows big data analysis for distinct forms of inherited retinal degeneration. Limitations include a small dataset and potential effects on OCT scans from myopia at least -5 diopters, the latter considered nonsignificant for outer retinal layers.
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Aprendizado Profundo , Terapia Genética , Mutação , Tomografia de Coerência Óptica , cis-trans-Isomerases , Humanos , cis-trans-Isomerases/genética , Tomografia de Coerência Óptica/métodos , Masculino , Feminino , Terapia Genética/métodos , Adulto , Criança , Adolescente , Adulto Jovem , Pessoa de Meia-Idade , Degeneração Retiniana/genética , Degeneração Retiniana/terapia , Pré-Escolar , Acuidade Visual/fisiologia , Retina/diagnóstico por imagem , Retina/patologiaRESUMO
PURPOSE: The presence of chaperones during intimate physical examinations is a matter of ongoing debate. While most guidelines recommend the use of chaperones in all cases, there are no clinical trials specifically investigating intimate exams performed on women by male physicians. We aimed to evaluate female patients' perceptions regarding the presence or absence of chaperones during proctological examinations conducted by male physicians. METHODS: In this randomised clinical trial, patients were assigned, unaware that they were participating in a study, to either Group 1 (without a chaperone during their proctological exam) or Group 2 (with a chaperone). After the appointment, they completed a questionnaire regarding the examination they had just undergone. The study was conducted at two hospitals in Southern Brazil. RESULTS: Ninety-five patients were included in each group. The mean (SD) comfort score was 8.3 (2.9) with a chaperone and 8.8 (2.5) without a chaperone (P = 0.25). When asked if they would want the exam performed the same way in the future, 72.6% in Group 1 answered 'yes', compared to 58.9% in Group 2 (P = 0.046). In Group 2, 48.4% of patients did not feel more protected by the chaperone, while none of the patients in Group 1 felt less protected without one. CONCLUSIONS: Forgoing chaperones during proctological examinations of women, when the physician is male, is well accepted by most patients. Preferences regarding chaperones are complex, demanding a selective approach. The use of chaperones should remain a recommendation, not a requirement, to accommodate individual needs while maintaining the doctor-patient relationship. TRIAL REGISTRATION: ClinicalTrials.gov number, NCT03615586.
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Acompanhantes Formais em Exames Físicos , Preferência do Paciente , Humanos , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Inquéritos e Questionários , Médicos/psicologia , Exame Físico , Relações Médico-PacienteRESUMO
INTRODUCTION: Very low-calorie diets with hospitalization have demonstrated promise as a viable therapeutic option for severe obesity and its associated comorbidities. However, large studies providing a comprehensive longitudinal observation of patients undergoing this therapy are lacking. We evaluated the effectiveness of treating severe obesity in hospitalized patients, using very low-calorie diets and clinical support to develop lifestyle changes. METHODS: This study was a retrospective cohort comparing exposure variables in a secondary data analysis with a pre-post treatment design. Data were obtained from medical records of patients with severe obesity (grade II or III) treated in a Brazilian obesity specialist hospital from 2016 to 2022. The patients underwent a very low-calorie diet (500-800 kCal/day) and immersive changes in lifestyle habits, monitored by a multidisciplinary team. At 3 months, 777 patients presented complete data and 402 presented complete data at 6 months. The study compared changes in bioimpedance and laboratory tests, between men and women and age groups. RESULTS: Three months of hospitalization yielded significant reductions in weight, body mass index (BMI), body fat, skeletal muscle mass, glucose, inflammatory, and lipid parameters. These reductions were more pronounced after 6 months, nearly doubling those observed at 3 months. In women, BMI and fat mass reduced by 10.4% and 15.2% at 3 months and 20.4% and 31.3% at 6 months, respectively. In men, BMI and fat mass decreased by 12.9% and 25.3 at 3 months and 23.6% and 45.3% at 6 months, respectively. Elderly individuals (aged ≥ 60 years) had smaller reductions in BMI and fat mass than non-elderly individuals (aged < 60 years) but still presented significant improvements. CONCLUSION: This study suggests the viability of treating severe obesity by hospitalization with low-calorie diets and immersive lifestyle changes. This treatment modality significantly improves anthropometric measurements, glucose, lipids, and inflammatory markers, thereby reducing cardiovascular risk.
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Índice de Massa Corporal , Pacientes Internados , Obesidade Mórbida , Humanos , Feminino , Masculino , Estudos Retrospectivos , Pessoa de Meia-Idade , Brasil/epidemiologia , Adulto , Obesidade Mórbida/terapia , Obesidade Mórbida/dietoterapia , Hospitalização , Restrição Calórica/métodos , Idoso , Análise de Dados , Estilo de Vida , Análise de Dados SecundáriosRESUMO
Polymorphisms in the MBL2 gene exon 1 can decrease serum levels of mannose-binding lectin (MBL), increasing the risk of infection in immunocompromised individuals. This study evaluated the association between the polymorphism in exon 1 of the MBL2 gene, genotypes, serum MBL levels, and infection in 122 patients with acute lymphoid leukemia (ALL). The MBL*A allele exhibited the highest frequency (0.37) within the study population. The MBL*D (0.32) was the predominant variant. The combined frequency of O polymorphic alleles (either B or D) was 0.63. The frequencies of the A/A, A/O and O/O genotypes were 0.13, 0.49 and 0.38, respectively. All patients exhibited consistently low levels of serum MBL, irrespective of their exon 1 genotype. Parasitic infections (n = 103), bacterial (n = 69) and viral (n = 48). A/O genotype (0.49) had higher infection rates, A/A (0.13) had lower rates, and O/O showed increased viral susceptibility (OR: 0.37; 95% CI 0.13-1.06; p = 0.05). Our findings demonstrated that the study population were MBL-deficient, regardless of their MLB2 genotype. Individuals with the A/O genotype had more infections, while those with the O/O genotype appeared more susceptible to viral infections. These findings highlight the impact of MBL levels and genetic variants on infection susceptibility in ALL patients.
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Éxons , Predisposição Genética para Doença , Lectina de Ligação a Manose , Leucemia-Linfoma Linfoblástico de Células Precursoras , Humanos , Lectina de Ligação a Manose/genética , Lectina de Ligação a Manose/sangue , Masculino , Feminino , Éxons/genética , Adulto , Leucemia-Linfoma Linfoblástico de Células Precursoras/genética , Leucemia-Linfoma Linfoblástico de Células Precursoras/sangue , Pessoa de Meia-Idade , Adolescente , Genótipo , Adulto Jovem , Idoso , Alelos , Polimorfismo de Nucleotídeo Único , Criança , Frequência do Gene , Polimorfismo GenéticoRESUMO
Unhealthy lifestyles risk factors, such as smoking, alcohol consumption, physical inactivity, poor diet, and obesity, have been associated with a higher risk of all-cause and cause-specific mortality. However, composite score of these unhealthy behaviours has not been considered, particularly in Latin American populations. Herein, we examined the association of lifestyle risk factors score with all-cause and cause-specific mortality in Mexican adults. A total of 159,517 adults from the Mexico City Prospective Study (MCPS) were included. Data on sociodemographic, lifestyle risk factors and medical histories was collected through a self-reported baseline questionnaire in a census-style door-to-door interviews. Lifestyle risk factors assessment was based on five modifiable lifestyle risk factors and their respective cut-off points according to current health recommendations, including obesity, physical inactivity, tobacco, alcohol consumption and fruits and vegetables intake. Multivariable Cox regression models were used to estimate the associations of lifestyle risk factor score (ranging from 0 to 5) with all-cause and cause-specific mortality (cardiovascular disease, renal or hepatobiliary diseases, diabetes, respiratory diseases, cancer and all-cause mortality). We excluded the first 2, 5, 10, and 15 years of follow-up to account for reverse causation bias. We found a high prevalence (77%) of Mexican adults, with two or more lifestyle risk factors. Hazard ratio for respiratory diseases and renal or hepatobiliary diseases were 1.86 (95%CI: 1.45-2.39) and 2.00 (95%CI: 1.60-2.52) comparing participants with 4-5 lifestyle risk factors vs. those with none. For all-cause mortality, participants with 4-5 lifestyle risk factors had a 49% (HR: 1.49; 95%CI: 1.03-2.16) higher risk as compared to participants with none. The magnitude of the associations increased as the exclusion of follow-up time increased after 2, 5, 10 and 15 years. There was a positive association between the number of lifestyle risk factors and all-cause and cause-specific mortality, showing the highest rate of respiratory, renal or hepatobiliary and all-cause mortality among participants with 4-5 lifestyle risk factors. After accounting for reverse causation, associations were stronger.
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Estilo de Vida , Humanos , México/epidemiologia , Masculino , Feminino , Fatores de Risco , Estudos Prospectivos , Pessoa de Meia-Idade , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/efeitos adversos , Idoso , Fumar , Obesidade/mortalidade , Obesidade/epidemiologia , Mortalidade , Causas de MorteRESUMO
This study compared the degree of secondary hyperalgesia and somatosensory threshold changes induced by topical capsaicin between spinal and trigeminal innervation. This crossover clinical trial included 40 healthy individuals in which 0.25 g of 1% capsaicin cream was randomly applied for 45 minutes to a circular area of 2 cm2 to the skin covering the masseter muscle and forearm in 2 different sessions, separated by at least 24 hours and no more than 72 hours (washout period). The main outcome variables were the area of allodynia and pinprick hyperalgesia, as well as electrical and mechanical pain thresholds within the area of pinprick hyperalgesia. Mixed ANOVA models and McNemar tests were applied to the data (p = 0.050). The occurrence of allodynia and pinprick hyperalgesia was higher in the forearm than in the masseter (p < 0.050). Additionally, the areas of pinprick hyperalgesia and allodynia were larger in the forearm compared to the masseter (p < 0.050). The electrical and mechanical pain thresholds demonstrated a loss of somatosensory function following capsaicin application to the masseter (p < 0.050). However, no significant somatosensory threshold changes were observed at the forearm after capsaicin (p > 0.050). In conclusion, these findings indicate potential differences compatible with central sensitization related to secondary hyperalgesia between trigeminal and spinal innervation.
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Capsaicina , Hiperalgesia , Limiar da Dor , Humanos , Capsaicina/efeitos adversos , Capsaicina/farmacologia , Hiperalgesia/induzido quimicamente , Hiperalgesia/fisiopatologia , Masculino , Feminino , Adulto , Limiar da Dor/efeitos dos fármacos , Nervo Trigêmeo/efeitos dos fármacos , Nervo Trigêmeo/fisiopatologia , Músculo Masseter/inervação , Músculo Masseter/efeitos dos fármacos , Músculo Masseter/fisiopatologia , Adulto Jovem , Estudos Cross-Over , Antebraço/inervação , Nervos Espinhais/efeitos dos fármacos , Nervos Espinhais/fisiopatologiaRESUMO
OBJECTIVE: To investigate gender disparities in applications and admissions to the medical residency programs in Peru, focusing on differences in application and admission proportions between male and female. METHODS: We conducted a cross-sectional study to assess the proportions of female applicants and admissions to medical residency programs in Peru from 2016 to 2023. Bayesian multilevel linear models were employed, incorporating random intercepts and slopes by specialty to account for variability across specialties. This approach provided initial proportions of female in 2016 (intercepts) and annual percentage changes (beta coefficients) for each specialty. A multilevel Poisson regression model with robust variance was used to determine if being female was associated with higher admission frequency. RESULTS: Of the 48,013 applicants, 48% were considered female applicants. Most specialties exhibited an increasing trend in female applicants (+0.2% to +2% annually), except for Family Medicine, Hematology, Pediatric Neurology, and Pathological Anatomy (-0.6%, -0.6%, -0.7%, and -0.9% annually, respectively). The specialties with the highest proportions of female admissions were in Physical Medicine and Rehabilitation (71.9%), Dermatology (71.2%), and Pathological Anatomy (71.2%). In contrast, the lowest proportions were observed in Neurosurgery (18.9%), Thoracic and Cardiovascular Surgery (17.7%), and Urology (15.6%). Declining trends in female admissions were noted in Family Medicine, Hematology, and Pathological Anatomy (-0.6%, -0.6%, and -0.8% annually, respectively). In addition, being female was associated with an 18% lower probability of admission to the medical residency program (prevalence ratio: 0.82; 95% CI: 0.78-0.85; p-value: <0.001). CONCLUSION: This study identified persistent gender disparities in medical residency programs in Peru, with female applicants facing reduced probabilities of admission and exhibiting specialty-specific trends from 2016 to 2023.
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Internato e Residência , Humanos , Peru , Internato e Residência/estatística & dados numéricos , Feminino , Masculino , Estudos Transversais , Teorema de Bayes , Adulto , Critérios de Admissão Escolar/estatística & dados numéricos , Critérios de Admissão Escolar/tendências , Fatores Sexuais , Sexismo/estatística & dados numéricos , Sexismo/tendênciasRESUMO
INTRODUCTION: Tackling the inertia of growing threat of antimicrobial resistance (AMR) requires changes in how antibiotics are prescribed and utilized. The monitoring of antimicrobial prescribing in hospitals is a critical component in optimizing antibiotic use. Point prevalence surveys (PPSs) enable the surveillance of antibiotic prescribing at the patient level in small hospitals that lack the resources to establish antimicrobial stewardship programs (ASP). In this study, we analyzed antibiotic use at two public secondary care hospitals in Mexico using PPSs. METHODS: Following WHO methodology, we conducted four cross-sectional PPSs on antibiotic use in two public secondary care facilities in Mexico: two surveys in a women's specialty hospital (H1) and two in a general referral hospital (H2). We collected data from clinical records of all patients with active antibiotic prescriptions (APs) across the medical, surgical, and mixed (MIX) wards, and intensive care units (ICUs). Descriptive statistics were computed to analyze the PPSs data using Stata. RESULTS: The PPSs collected data on 127 patients, and 283 active APs. The prevalence of antibiotic use was 60.4% (H1, n = 29/48) and 70.5% (H2, n = 98/139). Antibiotics were more frequently used among patients in the MIX wards (H1: 87.5%, n = 14/16) and ICUs (H2: 90%, n = 9/10). The most frequent patient indications for antibiotic use were medical prophylaxis (H1: 51.7%, n = 15/29), community-acquired infections (H2: 42.9%, n = 42/98), and preoperative prophylaxis (H1: 27.6%, n = 8/29; H2: 23.5%, n = 23/98). The APs were mostly empirical (H1: 97%, n = 64/66; H2: 98.2%, n = 213/217), and parenterally administered (H1: 90.9%, n = 60/66; H2: 96.8%, n = 210/217). Most clinical records lacked documented post-prescription reviews (H1: 82.8%, n = 24/29; H2: 98%, n = 96/98). Preoperative prophylaxis was predominantly administered as multiple doses for more than one day. Penicillins with extended-spectrum (24.2%, n = 16/66), aminoglycosides (22.7%, n = 15/66), and first-generation cephalosporins (16.7%, n = 11/66) were the most prescribed antibiotic classes in H1, while third-generation cephalosporins (35%, n = 76/217), fluoroquinolones (14.3%, n = 31/217), and carbapenems (13.4%, n = 29/217) were the most prescribed in H2. No hospital had formally established ASP. CONCLUSIONS: This study shows high prevalence rates of antibiotic use and variations in commonly prescribed antibiotic classes in public Mexican secondary care hospitals, along with shared practices in broad-spectrum antibiotic prescription. PPS-based surveillance enables the identification of specific targets to optimize antibiotic use according to the healthcare needs of patients in each hospital and facilitates comparative evaluations across hospitals.
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Antibacterianos , Gestão de Antimicrobianos , Humanos , México/epidemiologia , Antibacterianos/uso terapêutico , Feminino , Estudos Transversais , Pessoa de Meia-Idade , Adulto , Masculino , Prevalência , Idoso , Centros de Cuidados de Saúde Secundários/estatística & dados numéricos , Atenção Secundária à Saúde/estatística & dados numéricos , Adulto Jovem , Inquéritos e Questionários , Adolescente , Prescrições de Medicamentos/estatística & dados numéricosRESUMO
Studies have noted the connection between Mycobacterium avium subspecies paratuberculosis (MAP) and autoimmunity. MAP is an intracellular pathogen that infects and multiplies in macrophages. To overcome the hostile environment elicited by the macrophage, MAP secretes a battery of virulence factors to neutralize the toxic effects of the macrophage. One of the virulence factors is the Protein Tyrosine Phosphatase A (PtpA), a protein secreted by MAP that interferes in the phago-lysosome fusion, rendering the pathogen unnoticed in the cytoplasm of the macrophage. This study aimed to assess the presence of PtpA antibodies in the sera of Mexican individuals with rheumatoid arthritis (RA) and investigate its possible use as a biomarker for disease activity. We compared RA patients (n = 100) to control subjects (CS) (n = 100) by assessing specific immune responses to PtpA (the antigen) by an indirect ELISA method. Results showed a significant difference in PtpA levels between RA and CS, with RA patients having a median OD of 0.4645 compared to 0.1372 in CS. Antibodies against PtpA were present in 95% of RA patients and 16% of CS (AUC = 0.9163, p = 0.0001). Male control subjects showed higher PtpA reactivity than female CS. The Disease Activity Score (DAS-28) analysis showed that individuals with moderate to high disease activity had lower levels of PtpA reactivity. The results suggest a potential connection between RA and MAP infection.
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Artrite Reumatoide , Biomarcadores , Mycobacterium avium subsp. paratuberculosis , Humanos , Artrite Reumatoide/imunologia , Artrite Reumatoide/sangue , Artrite Reumatoide/microbiologia , Feminino , Masculino , Mycobacterium avium subsp. paratuberculosis/imunologia , Biomarcadores/sangue , Pessoa de Meia-Idade , Adulto , Proteínas de Bactérias/imunologia , Anticorpos Antibacterianos/sangue , Anticorpos Antibacterianos/imunologia , Idoso , Estudos de Casos e Controles , Proteínas Tirosina Fosfatases/imunologiaRESUMO
Patients with radiographic axial spondyloarthritis (r-axSpA) experience a higher prevalence of fragility fractures, though the pathophysiology of osteoporosis associated with this disease remains poorly understood. The objective of this study was to evaluate the histomorphometric data in r-axSpA patients. Male r-axSpA patients up to 55 years old were enrolled in this cross-sectional study. Clinical, lab, and imaging data, including spine X-Ray to evaluate vertebral fractures and new bone formation, as well as dual-energy X-ray absorptiometry (DXA) at spine, hip, and forearm and trabecular bone score (TBS), were performed in all patients. Transiliac histomorphometry was also underwent in all patients, and data were compared with 21 male cadavers' material. A total of 21 patients were included, with a mean age of 45.8 years, long disease duration (median 17.5 years), mostly white (66.7%) and positive for HLA-B27 (90.5%). The prevalence of DXA abnormalities and low TBS (≤ 1.338) was 42.8% and 57.1%, respectively. There was higher osteoid trabecular thickness (p = 0.027) and cortical bone changes, including reduced thickness (p = 0.031) and increased porosity (p = 0.015) in r-axSpA patients. In addition, a pattern of cortical trabecularization was observed in 52.3%. Dynamic evaluation revealed a longer mineralization lag time (p = 0.0074) and lower mineralized surface (p = 0.0029) and bone formation rate (p = 0.0074) in patients compared to reference values. Our results showed a pattern of low trabecular remodeling, bone mineralization impairment, as well as cortical thickness and porosity abnormalities in men with r-axSpA. These findings may impact future treatment of bone fragility in this disease.
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Absorciometria de Fóton , Espondiloartrite Axial , Densidade Óssea , Remodelação Óssea , Humanos , Masculino , Pessoa de Meia-Idade , Remodelação Óssea/fisiologia , Estudos Transversais , Adulto , Densidade Óssea/fisiologia , Espondiloartrite Axial/epidemiologia , Osso Cortical/diagnóstico por imagem , Osso Cortical/patologia , Osteoporose/patologia , Calcificação Fisiológica/fisiologiaRESUMO
To assess and compare two techniques of low-level laser application-transgingival (TLLLT) and intrasulcular (ILLLT)-used in photobiomodulation as an adjunct to basic periodontal therapy (BPT) in patients with periodontitis. A randomized, split-mouth, double-blind clinical trial was conducted, selecting three diseased periodontal sites from different quadrants in each patient. These sites were assigned to one of three treatment groups: SRP (control), SRP + TLLLT (test 1), and SRP + ILLLT (test 2). Low-level laser therapy in the test groups was applied at 48 h, 7 days, and 14 days after full-mouth SRP. Clinical parameters such as probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were assessed at baseline (T0), 3 months (T1), and 6 months (T2). Standardized periapical radiographs were used to assess radiographic bone density (RBD) 6 months post-treatment. Statistical analyses included repeated measures ANOVA for continuous variables and chi-square tests for categorical variables, with significance set at p < 0.05 and a 95% confidence interval. Significant reductions in PD (p < 0.001) and CAL (p < 0.001) were observed across all groups at 3 and 6 months, with no significant differences between groups. There were also no significant changes in BOP and RBD between groups at the follow-up intervals. Adjunctive photobiomodulation did not provide additional clinical or radiographic benefits over SRP alone, regardless of the laser application technique employed.
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Terapia com Luz de Baixa Intensidade , Humanos , Terapia com Luz de Baixa Intensidade/métodos , Método Duplo-Cego , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Periodontite/radioterapia , Periodontite/terapia , Raspagem Dentária/métodos , Resultado do TratamentoRESUMO
BACKGROUND: Breast cancer (BC) is a significant burden on healthcare systems, especially in low- and middle-income countries where access to diagnosis and treatment is challenging. OBJECTIVES: The purpose of this study was to assess the diagnostic accuracy and cost using tissue microarray (TMA) instead of traditional immunohistochemical (IHC) evaluation for estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor 2 (HER2), and the proliferation marker Ki-67 and BC subtyping within the Brazilian public health system. DESIGN: This is a retrospective cohort study comparing TMA slides with traditional whole-slide evaluation for IHC markers in 242 BC cases. METHODS: We used formalin-fixed tissue blocks for TMA assembly. Clinical data and IHC scores for ER, PR, HER2, and Ki-67 were obtained from pathology reports. Cohen's kappa (k) was used to assess TMA performance. RESULTS: BC samples were distributed in 10 TMAs and 968 cores were scored (242 BC cases × 4 markers). In 97% of these, TMA reached high quality to adequate IHC scoring with minimal technical issues. Inter-examiner agreement was almost perfect for all markers (ranging from 0.85 for HER2 to 0.91 for ER, p < 0.001). The intratumoral heterogeneity ranged from almost perfect agreement for ER and HER2 to moderate to substantial for PR and Ki-67. TMA offers substantial time and cost savings, with an approximately 11-fold reduction compared to traditional methods. The concordance between TMA and original reports was almost perfect, with 93% overall agreement (k = 0.81, p < 0.001). However, TMA performance varied between markers, with intratumoral heterogeneity significantly impacting discordant results, particularly for Ki-67 and HER2. This ultimately affected the accuracy of BC subtyping. TMA performed well in identifying luminal A and triple-negative cases, but misclassification was common for luminal B and HER2-positive cases. CONCLUSION: TMA offers accurate and lower-cost results in the individualized IHC assessment of BC markers. However, we do not recommend the use of TMA in the subtyping of BC, where analysis of the whole section remains necessary for more accurate results. We advocate more studies using the TMA approach in the Brazilian public health system to advance women's health care.
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Biomarcadores Tumorais , Neoplasias da Mama , Imuno-Histoquímica , Antígeno Ki-67 , Receptor ErbB-2 , Receptores de Estrogênio , Receptores de Progesterona , Análise Serial de Tecidos , Humanos , Feminino , Neoplasias da Mama/patologia , Neoplasias da Mama/diagnóstico , Brasil , Imuno-Histoquímica/métodos , Estudos Retrospectivos , Receptores de Progesterona/metabolismo , Receptores de Estrogênio/metabolismo , Receptor ErbB-2/metabolismo , Biomarcadores Tumorais/metabolismo , Pessoa de Meia-Idade , Antígeno Ki-67/metabolismo , Adulto , Idoso , Saúde PúblicaRESUMO
Introduction: This case report presents the intentional periodontal maintenance of two periodontal hopeless lower central incisors with a multidisciplinary approach and 20-year follow-up. Case presentation: A 36-year-old male, in 2001, was diagnosed with aggressive periodontitis, gingival swelling, bleeding, and mandibular central incisors with mobility and poor prognosis. Following periodontal therapy (phase I), root canal treatment, and occlusal adjustment, #31 and #41 were gently extracted to remove the granulation tissues, calculus, and infected cementum from the root surface. Then, tetracycline-HCl was applied for 5 minutes on the root surfaces. The teeth were repositioned into the sockets and splinted with a lingual bar. At 3 months, the bar was removed, and a free gingival autogenous graft was done to improve the local keratinized tissue width. Mobility scores, pocket depths, and clinical attachment levels were recorded, and radiographs were taken at 1, 5, and 20 years. The 5-year follow-up showed that the teeth were clinically and radiographically in function. There was a reduction in probing depth and a gain in clinical attachment and radiographic alveolar bone levels. After 20 years, #41 was stable, but #31 had external root resorption, leading to a new treatment plan (dental implants) and extraction. Conclusion: The clinical result of this case was satisfactory for 20 years. Intentional periodontal maintenance of the teeth may be an alternative treatment, even considering the high level of complexity.
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Humanos , Masculino , Adulto , Planejamento de Assistência ao Paciente , Periodontia , Procedimentos Cirúrgicos Operatórios , Tempo , Perda da Inserção PeriodontalRESUMO
A hiperplasia hemimandibular é responsável por prejuízos estéticos, funcionais, motores e psicossociais. Com etiologia incerta, ocorre frente ao desequilíbrio de fatores regulatórios de crescimento presentes na camada cartilaginosa do côndilo. O relato objetiva descrever a tomada de decisões baseada em exames complementares específicos aliados à adequada intervenção cirúrgica da lesão. Paciente gênero feminino, 33 anos de idade, compareceu à clínica particular com queixa principal de "face assimétrica", foi requerido uma avaliação cintilográfica objetivando e confirmando a interrupção do crescimento condilar, descartando a hipótese de Osteocondroma e condilectomia. Após preparo ortodôntico prévio, os exames tomográficos foram utilizados na criação de um protótipo que foi impresso após a realização dos movimentos ósseos planejados. Mediante à reconstrução, foi concluído que a assimetria presente não seria totalmente corrigida somente através da intervenção ortognática, sendo necessária também uma osteotomia removendo parte da base do corpo e ângulo mandibular, através da confecção de um guia de corte, promovendo à reanatomização sem a necessidade de acesso extra oral submandibular, evitando uma cicatriz em face feminina. Paciente encontra-se em pós-operatório de 60 meses, sem queixas e satisfeita. Portanto, é evidenciado cada vez mais a influência positiva que o planejamento virtual pode trazer aos profissionais na otimização dos resultados cirúrgicos.
Hemimandibular hyperplasia is responsible for aesthetic, functional, motor, and psychosocial impairments. With an uncertain etiology, it occurs due to the imbalance of regulatory growth factors present in the cartilaginous layer of the condyle. The report aims to describe decision-making based on specific complementary exams combined with the appropriate surgical intervention for the condition. A 33-year-old female patient presented at a private clinic with the main complaint of "asymmetric face." A scintigraphic evaluation was requested to objectively confirm the interruption of condylar growth, ruling out the hypothesis of Osteochondroma and condylectomy. After prior orthodontic preparation, tomographic exams were used to create a prototype that was printed after planned bone movements. Through the reconstruction, it was concluded that the existing asymmetry would not be entirely corrected through orthognathic intervention alone, necessitating also an osteotomy to remove part of the base of the body and mandibular angle. This was done through the creation of a cutting guide, allowing for reanatomization without the need for submandibular extraoral access, thus avoiding a scar on the female face. The patient is 60 months postoperative, with no complaints and satisfied. Therefore, the increasingly positive influence of virtual planning on optimizing surgical outcomes for professionals is evident.
Assuntos
Humanos , Feminino , Adulto , Procedimentos Cirúrgicos Operatórios , Cintilografia , Planejamento , Assimetria Facial , Tomada de Decisão Clínica , Hiperplasia , Côndilo MandibularRESUMO
BACKGROUND AND PURPOSE: The integration of evidence-based practice (EBP) into clinical decision-making is crucial for ensuring optimal patient care. However, there are various factors influencing the utilization of academic sources among physiotherapists, highlighting the need for a deeper understanding of these dynamics. The present study aimed to investigate the association between personal factors (age, time since graduation, number of patients, and education level), barriers to EBP implementation and perceptions about EBP, and physiotherapists' preference for using non-academic sources when seeking technical information about physiotherapy. METHODS: This was a cross-sectional study involving 610 physiotherapists. Participants completed an online questionnaire covering demographic characteristics, sources of information, barriers to EBP implementation, and perceptions regarding the importance of scientific information in clinical practice. Logistic regression was used to investigate the factors associated with the preference for non-academic sources of information. RESULTS: Nearly a quarter of the sample exhibited a preference for non-academic sources, with age over 34 years, perceived lack of abilities to apply scientific findings, and understanding issues related to EBP being significant associated with the preference of this types of sources of information. Physiotherapists with these characteristics were twice as likely to prefer non-academic sources when compared to physiotherapists who do not have these characteristics. DISCUSSION: These findings underscore the importance of enhancing professional competencies in EBP and fostering confidence in utilizing academic sources. While efforts have been made to incorporate EBP promotion in academic curricula, further initiatives are needed to bridge the gap between established knowledge and the competencies required for daily practice. Future studies should continue to explore the role of age in EBP applicability and the adoption of scientific knowledge, aiming to inform targeted interventions and educational programs tailored to the evolving needs of physiotherapy professionals.
Assuntos
Prática Clínica Baseada em Evidências , Fisioterapeutas , Humanos , Estudos Transversais , Fisioterapeutas/educação , Feminino , Masculino , Brasil , Adulto , Inquéritos e Questionários , Pessoa de Meia-Idade , Atitude do Pessoal de Saúde , Comportamento de Busca de InformaçãoRESUMO
ABSTRACT: A 41-year-old woman presented with a left breast mass for which mammography was performed. Mammogram revealed a suspicious BI-RADS 4, palpable left breast mass with associated nipple retraction. As malignancy was suspected, the patient underwent breast MRI and 18F-FDG PET/CT for staging. Multiple ultrasound guided biopsies were then performed of the left breast, left axillary lymph nodes, and left cervical lymph nodes. Final pathology was negative for malignancy, but final cultures grew Mycobacterium tuberculosis (Tb). The patient was initially intolerant to frontline medications, but eventually successfully treated with isoniazid, ethambutol, pyrazinamide, and moxifloxacin, as demonstrated by posttreatment mammography.
Assuntos
Fluordesoxiglucose F18 , Achados Incidentais , Mycobacterium tuberculosis , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Tuberculose , Humanos , Feminino , Adulto , Tuberculose/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Imagem MultimodalRESUMO
BACKGROUND: Graduate students face higher depression rates worldwide, which were further exacerbated during the COVID-19 pandemic. This study employed a machine learning approach to predict depressive symptoms using academic-related stressors. METHODS: We surveyed students across four graduate programs at a Federal University in Brazil between October 15, 2021, and March 26, 2022, when most activities were restricted to taking place online due to the pandemic. Through an online self-reported screening, participants rated ten academic stressors and completed the Patient Health Questionnaire (PHQ-9). Machine learning analysis tested whether the stressors would predict depressive symptoms. Gender, age, and race and ethnicity were used as covariates in the predictive model. RESULTS: Participants (n=172), 67.4â¯% women, mean age: 28.0 (SD: 4.53) fully completed the online questionnaires. The machine learning approach, employing an epsilon-insensitive support vector regression (Æ-SVR) with a k-fold (k=5) cross-validation strategy, effectively predicted depressive symptoms (r=0.51; R2=0.26; NMSE=0.79; all p=0.001). Among the academic stressors, those that made the greatest contribution to the predictive model were "fear and worry about academic performance", "financial difficulties", "fear and worry about academic progress and plans", and "fear and worry about academic deadlines". CONCLUSIONS: This study highlights the vulnerability of graduate students to depressive symptoms caused by academic-related stressors during the COVID-19 pandemic through an artificial intelligence methodology. These findings have the potential to guide policy development to create intervention programs and public health initiatives targeted towards graduate students.
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COVID-19 , Depressão , Aprendizado de Máquina , Estresse Psicológico , Estudantes , Humanos , Feminino , Masculino , Depressão/diagnóstico , Adulto , Estudantes/psicologia , Universidades , Adulto Jovem , Brasil , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Depression is the leading cause of mental health-related illnesses and disabilities. Physical activity (PA) has been included as part of therapeutic approaches for patients with depression. This study aimed to investigate the associations between depressive symptoms and PA levels in a large representative cohort of Brazilian adults and older individuals. METHODS: Data from 58,445 Brazilian adults (68.6 % males and 31.4 % females) aged 18 years or older (42.2 ± 10 years) who participated in health screening initiatives between 2008 and 2022 at the Center for Preventive Medicine at a quaternary hospital in Sao Paulo, Brazil were analyzed. Standardized health data (anthropometric, laboratory, clinical, and behavioral) were collected. A hierarchical regression model was used to examine the associations based on the presence and absence of depressive symptoms. RESULTS: In the final model, age, gender (female), body mass index (BMI) (each kg/m2), presence of hypertension, presence of diabetes mellitus, risk of alcohol consumption, smoking status, and perceived stress were associated with higher odds of depressive symptoms. However, PA levels were associated with lower odds of depressive symptoms. CONCLUSION: The findings revealed that any level of PA was independently and significantly associated reduced risk of depressive symptoms.
Assuntos
Índice de Massa Corporal , Depressão , Exercício Físico , Humanos , Masculino , Feminino , Estudos Transversais , Adulto , Pessoa de Meia-Idade , Depressão/epidemiologia , Depressão/psicologia , Brasil/epidemiologia , Adulto Jovem , Fatores Sexuais , Idoso , Adolescente , Fatores de RiscoRESUMO
We are reporting the case of JB, a 28-year-old male who presented to our hospital in 2009. The patient reported a progressive increase in a known mass that had been deforming their head since 2005. He had suffered from a first-time seizure four years later (in 2009). Neurological examination revealed a large tumor protruding in the parietal region, which was confirmed by CT. A subsequent MRI demonstrated a hyperostotic contrast-enhancing parasagittal tumor occluding the middle third of the superior sagittal sinus, with cortical veins joining the sinus adjacent to the tumor.The patient was taken to the OR for a craniotomy and a resection of the tumor with cranioplasty in the same setting. The tumor was exposed by using a straight incision on the scalp. A craniotomy was performed around the tumor by using multiple burr holes; now the bone could be separated from the dura and removed. The intradural tumor was exposed, and a cortical vein draining into the tumor could not be preserved. Some residual tumor was left close to the anterior part of the superior sagittal sinus. The dura was reconstructed with pericranium, and the bony defect was closed with titanium mesh. The patient woke up initially paraplegic, but 7 days later, he started with proximal movements in both legs. Unfortunately, he died suddenly in the second postoperative week, due to pulmonary embolism. The case is reviewed in this manuscript to analyze the contributing factors of the complications that were observed and to suggest management strategies to avoid them.