Abstract in English:

ABSTRACT BACKGROUND: Functional constipation is characterized by a set of symptoms including hardened stools, abdominal discomfort, a tendency to retain stools, and eventual fecal incontinence. This condition negatively affects the quality of life of the affected individuals and has potential psychosocial repercussions. OBJECTIVES: To assess the epidemiological, clinical, and therapeutic aspects of functional constipation in patients treated at a pediatric gastroenterology outpatient clinic. DESIGN AND SETTING: Descriptive observational study with a quantitative approach using secondary data collected from the medical records of a pediatric gastroenterology outpatient clinic in Criciúma between 2018 and 2023. METHODS: This study was approved by the Human Research Ethics Committee of the Universidade do Extremo Sul Catarinense (Unesc) under number 6.788.465. Sociodemographic, clinical, and therapeutic variables were evaluated in 67 patients aged 0–18 years who were diagnosed with Functional Constipation (ICD K590) during the study period. Data were analyzed using descriptive statistics in the Statistical Package for the Social Sciences (SPSS), version 25.0. RESULTS: There was a predominantly female profile (36; 53.7%), with an average age at diagnosis of 7.75 years (± 3.96). The main symptoms included abdominal pain (52, 77.6%) and hardened stools (42, 62.7%), with an average interval of 4 days between bowel movements. Treatment consisted of macrogol prescriptions (60, 89.6%), with most patients showing complete symptom improvement (49, 73.1%). CONCLUSION: Analysis of medical records highlighted the need for continuous monitoring and targeted interventions, considering the variability of symptoms and individual characteristics of patients.

Abstract in English:

ABSTRACT BACKGROUND AND OBJECTIVES: Acute pain following laparoscopic cholecystectomy is most intense in the first 24 h. The use of shorter-acting opioids for pain management may contribute to increased postoperative morbidity. The combination of methadone and ketamine has been associated with lower postoperative pain scores and less opioid use. We aimed to determine whether the combination of ketamine and methadone improves the quality of recovery. METHODS: This prospective cohort study included patients undergoing laparoscopic cholecystectomy. Patients who received either methadone alone or a combination of methadone and ketamine (0.3 mg/kg) were followed up for 24 h after surgery. The primary outcome was the quality of recovery, measured using the quality of recovery-40 (QoR-40) questionnaire. Secondary outcomes included postoperative pain intensity, opioid consumption, and the incidence of nausea and vomiting. RESULTS: The QoR-40 scores were higher in patients who received methadone and ketamine than in those who received methadone alone [197 (194.7–198) versus 195 (189–197), P = 0.01]. Postoperative pain scores, the incidence of postoperative nausea and vomiting, and postoperative opioid use were similar between the groups. The combination of methadone and ketamine was not associated with lower incidence of moderate-to-severe pain in propensity score analysis. CONCLUSIONS: Although the combination of methadone and ketamine showed a slight increase in QoR40 scores at 24 h postoperatively, the observed difference between the groups was not clinically significant. Moreover, the absence of a reduction in postoperative pain intensity and similar perioperative opioid consumption between the groups further support the hypothesis that small, isolated doses of ketamine may not be effective in improving recovery quality compared with methadone alone.

Abstract in English:

ABSTRACT INTRODUCTION: Essential hypertension is an important health condition responsible for conditions such as heart attack, stroke, and kidney disease. Traditional risk factors and their control are important for reducing mortality. Inflammation caused by organ damage plays a role in the undesirable outcomes of hypertension. Biomarkers, such as the systemic immune-inflammatory index (SII), are predictors, but their relationship with risk factors is poorly understood. OBJECTIVE: To evaluate the correlation between the SII and risk factors in patients with hypertension. METHODS: This cross-sectional study was conducted in 2020 in Bahia with hypertensive patients from an outpatient clinic. We collected demographic and clinical data such as age, body mass index, and the following biomarkers: low-density lipoprotein level, glomerular filtration rate, interleukin 6 level, C-reactive protein level, neutrophil/lymphocyte ratio (NLR), hemogram, creatinine level, urea level, ferritin level, and vitamin D level. RESULTS: A total of 61 patients, most of them black women, participated in the study. The prevalence of type 2 diabetes was 19%, and there was no prevalence of stroke or heart attacks. According to the Framingham risk index, a large part of the sample presented high and very high risks. The bivariate analysis between SII and NLR was positive. Multivariate analysis showed that age, renal function, and NLR were positively correlated with the SII. The patients’ Framingham risk did not correlate with the SII. CONCLUSIONS: Inflammation is important for vascular damage in arterial hypertension caused by increased oxidative stress. We evaluated SII and NLR as indices of correlation with risk factors. The SII is a lowcost tool that can be used to screen for chronic conditions, such as hypertension. In summary, higher SII was positively associated with older age and worse renal function in patients with high-risk hypertension.

Abstract in English:

ABSTRACT BACKGROUND: The atherogenic index of plasma (AIP), derived from the logarithmic transformation of the triglyceride to high-density lipoprotein cholesterol ratio, is frequently used to predict cardiovascular events. OBJECTIVE: This study aimed to investigate the association between AIP and 1-month mortality in patients with acute ischemic stroke (AIS). DESIGN AND SETTING: Retrospective study was conducted in Türkiye. METHODS: In total, 530 AIS patients were enrolled in this study. Clinical, demographic, and laboratory characteristics were recorded within 24 hours of admission. One-month mortality outcomes were analyzed in relation to the AIP of the patients. RESULTS: Of the 530 patients, 140 patients did not survive during the follow-up period. The mean AIP was 0.50 ± 0.33 in survivors and 0.11 ± 0.27 in the mortality group (P = 0.001). In the receiver operating characteristic analysis, the AIP value of 0.291 had a sensitivity of 74.4%, specificity of 76.4%, positive predictive value of 75.92%, and negative predictive value of 74.9% for mortality. The AIP value above 0.291 had an AUC (area under curve) of 0.829 (95% CI [confidence interval] 0.78–0.88, P = 0.0001). In Cox regression analysis, AIP values below 0.291 (HR 3.962; 95% CI 2.643–5.937) were identified as an independent predictor of mortality. Higher mortality rates were observed in patients with cryptogenic stroke and AIP below 0.291 after stratification by stroke TOAST (P = 0.003). CONCLUSIONS: Lower AIP is an independent predictor of short-term mortality in AIS patients, surpassing the sensitivity of traditional lipid parameters. This study provides a valuable prognostic tool for clinicians, offering a non-invasive and cost-effective test for a condition associated with substantial mortality and morbidity.

Abstract in English:

ABSTRACT BACKGROUND: 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. OBJECTIVES: 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. DESIGN AND SETTING: This systematic review was conducted using data from randomized clinical trials performed in various ICU settings. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. SYSTEMATIC REVIEW REGISTRATION: Registered with PROSPERO, CRD42024575693, available at https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=575693.

Abstract in English:

ABSTRACT BACKGROUND: Preventable cardiovascular diseases are among the leading causes of death in individuals aged < 70 years in Brazil. OBJECTIVE: This study assessed the level of patient activation among individuals with cardiovascular disease in Brazilian community pharmacies. DESIGN AND SETTING: This cross-sectional study included 348 Brazilian participants diagnosed with hypercholesterolemia and/or hypertension. METHODS: 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. RESULT: 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). CONCLUSION: 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.

Abstract in English:

ABSTRACT BACKGROUND: 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. OBJECTIVE: To evaluate the influence of homeopathic treatment on sleep quality and levels of stress, anxiety, and depression. DESIGN AND SETTING: 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. METHODS: 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). RESULTS: 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. CONCLUSION: In the short term, homeopathic treatment had a positive impact on the sample, suggesting that this therapy can be used to prevent NCDs.

Abstract in English:

ABSTRACT BACKGROUND: 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. DESIGN AND SETTING: Validation study and pilot test using experimental surgery on porcine organs. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Abstract in English:

ABSTRACT BACKGROUND: 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). DESIGN AND SETTING: 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. OBJECTIVES: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.

Abstract in English:

ABSTRACT BACKGROUND: Acute pancreatitis (AP) is a major cause of gastrointestinal hospitalization, with an annual global incidence of 3.07%. Severe AP develops in up to 20% of cases, with sepsis occurring in 40–70% of such cases, leading to higher mortality. The early detection of sepsis is crucial. Hematocrit (HCT) and albumin (ALB) levels are individually linked to sepsis. Their combined measure, HCT-ALB, indicates blood and nutritional health. HCT-ALB can predict sepsis and infection outcomes; however, its effectiveness in treating AP-related sepsis has not been investigated. OBJECTIVE: This study aimed to examine the association between HCT-ALB values and sepsis risk in patients with AP. METHODS: This retrospective cohort study used Medical Information Market for Intensive Care IV database data. The primary outcome was the risk of sepsis in patients with AP. The HCT-ALB value refers to the difference between HCT and ALB levels, which we categorized into three groups according to quantiles: < 0.5, 0.5–7.6, and ≥ 7.6. Logistic regression models were used to assess the association between HCT-ALB values and sepsis. The predictive value of HCT-ALB was assessed using a receiver operating characteristic curve. Subgroup analyses were conducted for different subgroups. RESULTS: Among 565 patients with AP, 163 developed sepsis. In the multivariable model, HCT-ALB ≥ 7.60 was associated with sepsis risk for patients with AP [odds ratio (OR) 1.82, 95% confidence interval (CI) 1.06–3.14]. The area under the curve (AUC) value of HCT-ALB in predicting sepsis risk among patients with AP was 0.599 (95% CI 0.544–0.654), which was higher than that of the bedside index for severity in acute pancreatitis score (AUC 0.558, 95% CI 0.509–0.607). Subgroup analysis showed that HCT-ALB was only related to sepsis risk in male patients with acute kidney injury and Sequential Organ Failure Assessment in < 2 subgroups. CONCLUSION: HCT-ALB values ≥ 7.6 were associated with increased sepsis risk in patients with AP. HCTALB may contribute to identifying the risk of sepsis in patients with AP.

Abstract in English:

ABSTRACT BACKGROUND: The relationship between thyroid gland volume and hypoparathyroidism after total thyroidectomy remains controversial. OBJECTIVE: To evaluate thyroid gland mass as a risk factor for hypoparathyroidism after total thyroidectomy. DESIGN AND SETTING: A Retrospective cross-sectional observational study was conducted at Centro Universitário Lusíada (UNILUS), Santos/SP, Brazil. METHODS: Patients undergoing total thyroidectomy between January 2022 and September 2023 were retrospectively evaluated for serum levels of ionized calcium and ultrasensitive parathyroid hormone (PTH), measured preoperatively and 30–60 days postoperatively, and thyroid mass, obtained by weighing the specimen. RESULTS: A total of 174 patients were evaluated, with a predominance of women (89.7%), a median age of 50.5 years, and a median goiter volume of 36.3 mL. A reduction in both PTH and ionized calcium levels was observed in the postoperative period compared with the preoperative period (P < 0.05). No significant changes were observed in PTH levels and volume (P = 0.481). For calcium, there was a tendency towards an association between volume measurements and its change between the pre- and postoperative periods, which was marginally significant (P = 0.051). CONCLUSION: There was a marginal association between volume and changes in pre- and postoperative ionized calcium levels, but no significant association with pre- and postoperative PTH measurements.