Revista da Associação Médica Brasileira

Journal Information
ISSN / EISSN : 0104-4230 / 1806-9282
Current Publisher: FapUNIFESP (SciELO) (10.1590)
Former Publisher: Elsevier BV (10.1016)
Total articles ≅ 3,964
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Revista da Associação Médica Brasileira, Volume 66, pp 1651-1656; doi:10.1590/1806-9282.66.12.1651

Abstract:
SUMMARY OBJECTIVE: Ionizing radiation can cause radio-induced changes in the cellular metabolome due to the breakdown of DNA bonds. Our goal was to find the early tissue response to radiation exposure supported by distinct analytical methods. METHODS: Histological analyses were performed on the organs extracted from rats to search for microscopic changes. The histological slides stained with hematoxyline-eosin (HE) were analyzed in magnification (40x). Subsequently, the tissues were subjected to mass spectrometry that allowed molecular analysis and DESI-MSI that generated the molecular image of lipids, assessing changes in intensities, especially in the brain. RESULTS: The histological analysis found nonspecific inflammatory changes; no areas of fibrosis, necrosis, or apoptosis were identified, suggesting non-morphological tissue alterations. However, the DESI-MSI images of brain lipids allowed the observation of many radio-induced changes in the lipid's intensities. CONCLUSIONS: No early radio induced histological or mass weight changes in the radiation exposed rats could be observed at 5 Gy. However, early changes in the molecular level were observed in the DESI-MSI images of the brain lipids. The DESI-MSI method proved to be efficient and relevant, allowing a regional molecular analysis of the tissues, expanding a new field of study that is still in its infancy: radiometabolomics.
Adriano Anzai, Armelin Utino, Haroldo Katayama, Ighor A. Z. Spir, Marcio A. Lemos, Mauricio Anhesini, Oswaldo S. Tiezzi, Patricia R. N. Spir, Pericles Otani,
Revista da Associação Médica Brasileira, Volume 66, pp 1620-1620; doi:10.1590/1806-9282.66.12.1620

, Bengu Saylan
Revista da Associação Médica Brasileira, Volume 66, pp 1679-1684; doi:10.1590/1806-9282.66.12.1679

Abstract:
SUMMARY OBJECTIVE: We aimed to explore the prevalence of smoking rates and comorbidities and evaluate the relationship between them and disease severity and mortality in inpatients with COVID-19. METHODS: COVID-19 patients were divided into the following groups: clinic group, intensive care unit (ICU) group, survivors, and non-survivors. Non-COVID-19 patients were included as a control group. The groups were compared. RESULTS: There was no difference between patients with and without COVID-19 in terms of smoking, asthma, diabetes, dementia, coronary artery disease (CAD), hypertension, chronic renal failure and arrhythmia (p>0.05). Older age (Odds ratio (OR), 1.061; 95% confidence interval (CI): 1.041-1.082; p< 0.0001), chronic obstructive pulmonary disease (COPD) (OR, 2.775; 95% CI: 1.128-6.829; p=0.026) and CAD (OR, 2.696; 95% CI: 1.216-5.974; p=0.015) were significantly associated with ICU admission. Current smoking (OR, 5.101; 95% CI: 2.382-10.927; p
César Antonio Tavares Da Rocha, Lia Mayumi Kubota Kamada, , Isabela Araujo Villaverde, Jacqueline Yamahata Barbosa Shiro,
Revista da Associação Médica Brasileira, Volume 66, pp 1725-1730; doi:10.1590/1806-9282.66.12.1725

Abstract:
SUMMARY OBJECTIVE: Bronchoaspiration of gastric content is associated with high morbidity and mortality, but evaluating this complication is a difficult task. However, gastric ultrasonography can safely assess gastric content and prevent bronchoaspiration. Therefore, a systematic review was performed in order to verify the efficacy of ultrasonography in the qualitative and quantitative analyses of gastric content. METHODS: A literature review of articles published between 2009 and 2019 in the PubMed and LILACS databases was conducted using combinations of the keywords “gastric ultrasound,” “gastric emptying,” and “gastric content.” RESULTS: Of the 20 articles found, 19 chose the antral region as the best site for qualitative analysis of the gastric content. Regarding quantitative measurement, the most commonly used method to calculate the gastric volume in eight articles was the formula “Gastric Volume = 27 + (14.6 × ATAG) − (1.28 × Age),” in which the area of the transverse section of the gastric antrum (ATAG) could also be calculated by the largest antral diameters or by free tracing. CONCLUSION: An efficient evaluation of the gastric content can be performed by ultrasonography of the antral region, contributing to greater safety in the clinical management of patients with increased risk for bronchoaspiration during airway management.
Revista da Associação Médica Brasileira, Volume 66, pp 1742-1749; doi:10.1590/1806-9282.66.12.1742

Abstract:
SUMMARY There is no pooled information about pelvic floor parameters (muscle assessment, disorders) of women with gynecologicaL endocrinopathies (eg. polycystic ovary syndrome, congenital adrenal hyperplasia, premature ovarian insufficiency). Given that, a systematic review was performed on the Pubmed, Scopus, Google Scholar, Scielo and PEDro databases regarding the main gynecological endocrinopathies [polycystic ovary syndrome (PCOS), premature ovarian insufficiency (POI), congenital adrenal hyperplasia (CAH) and hyperprolactinemia (HPL)] since their inception to April 2020. Data quality assessment was made by the Newcastle-Ottawa Scale (NOS) adapted for cross-sectional studies. A total of 4,272 results were retrieved from all databases. After excluding duplicate results and screening by title and abstract, nine studies were selected for quantitative analysis. Seven studies were performed with women with PCOS and two studies with POI. Women with PCOS presented a higher prevalence of urinary incontinence (UI) among obese women, a higher thickness of the levator ani muscle, and higher levels of muscle activity measured by surface electromyograph when compared to the control women. Regarding POI, there was no association with UI, FI, and POP. NOS found that the quality assessment for these selected studies ranged from 5 to 8. We concluded that higher pelvic muscle activity and volume were found in women with PCOS, with further studies needed to confirm this data. Literature was scant about POI, CAH, and HPL.
Renato De Oliveira Pereira,
Revista da Associação Médica Brasileira, Volume 66, pp 1610-1612; doi:10.1590/1806-9282.66.12.1610

Revista da Associação Médica Brasileira, Volume 66, pp 1750-1756; doi:10.1590/1806-9282.66.12.1750

Abstract:
SUMMARY Cardiovascular diseases are important causes of morbidity and mortality in the course of chronic kidney disease (CKD). Diastolic dysfunction (DD) may progress with the clinical manifestation of heart failure, known as heart failure with preserved ejection fraction, a condition that precedes systolic dysfunction. The early identification of DD by echocardiography at the point-of-care before the appearance of symptoms and signs of pulmonary congestion and the implementation of appropriate treatment can improve the prognosis of CKD. This review article briefly addresses DD in kidney disease and presents a practical approach to the echocardiographic diagnosis of DD at the point of care.
Paula Antas Barbosa De Vasconcelos, Anderson De Jesus Rocha, Rodrigo Jorge De Souza Fonseca, Thiago Rhangel Gomes Teixeira, Enilton De Santana Ribeiro Mattos,
Revista da Associação Médica Brasileira, Volume 66, pp 1702-1706; doi:10.1590/1806-9282.66.12.1702

Abstract:
SUMMARY OBJECTIVES: To describe the incidence by gender and region, lethality, and costs associated with the treatment of femoral fractures in the elderly (≥ 60 years) hospitalized in the Unified Health System (SUS) of Brasil between 2008 and 2018. METHODS: This is a cross-sectional, descriptive, retrospective study of hospitalizations of elderly people due to femoral fractures by analyzing secondary data obtained from the SUS Hospital Information System (SIH/SUS) between 2008 and 2018; for calculation of epidemiological coefficients, we used information from demographic censuses (2000 and 2010) of the Brazilian Geography and Statistics Institute (IBGE). RESULTS: A total of 478,274 hospitalizations were recorded in the period; the incidence was 1.7 times higher in females (overall average of 274.91/100,000 for women and 161/100,000 for men). The Southeast region had the highest absolute number of hospitalizations and the South region presented the highest annual overall average incidence (224.02/100,000). The average annual cost for SUS for the treatment of femoral fractures in the elderly was R$ 99,718,574.30. CONCLUSIONS: In the evaluated period (2008-2018), femoral fractures in the elderly had a high incidence (478,274 hospitalizations; 224.02 cases/100,000 elderly), a predominance of females (1.7F/1.0M), a higher absolute number of hospitalizations in the Southeast region and a higher incidence in the South region; the lethality was high (an increase of 17.46%; overall mean coefficient of 4.99%/year); and the costs for the SUS were huge (an increase of 126.24%; average annual expenditure of R$ 99,718,574.30).
Revista da Associação Médica Brasileira, Volume 66, pp 1615-1619; doi:10.1590/1806-9282.66.12.1615

Abstract:
The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.
, Regina S. Carvalho, , , , , Miguel Srougi, William C. Nahas, Eduardo Mazzucchi
Revista da Associação Médica Brasileira, Volume 66, pp 1696-1701; doi:10.1590/1806-9282.66.12.1696

Abstract:
SUMMARY INTRODUCTION: Patients with bilateral kidney stones and burdened by large stones are challenging cases for endourologists. Simultaneous bilateral percutaneous nephrolithotomy (sbPCNL) is an option; however, it may be accompanied by important morbidity. An alternative is a staged PCNL, operating one side each time. Herein, we compare the impact of sbPCNL and staged PCNL on complication rates and renal function. METHODS: Patients who underwent sbPCNL or staged bilateral PCNL with a frame time of 6 months were searched in our prospectively collected kidney stone database. Groups were compared for age, gender, body mass index (BMI), comorbidities (classification by the American Society of Anesthesiology - ASA), stone size, Guy's score, stone-free status, renal function, blood loss, blood transfusion rate, complication rate, and length of hospital stay. RESULTS: Twenty-six patients and 52 kidney units were enrolled. The mean operative time was 134.7 min. Only 11.3% of cases had complications, all of them minor (Clavien ≤ 2). Overall, the stone-free rate was 61.50%. Comparing the groups, there was a significantly longer operative time in the sbPCNL group (172.5 vs. 126.3 min; p=0.016), as well as a higher transfusion rate (12.5% vs. 5.6%; p=0.036). There was no statistically significant difference in creatinine levels between the groups. Regarding the stone-free rate, there was a significantly higher proportion of patients in the staged PCNL group (64.9% vs. 43.8%; p=0.012). CONCLUSION: sbPCNL is a safe procedure; however, when compared to staged procedures it has a higher transfusion and lower stone-free rate.
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