Brazilian Journal of Clinical Medicine and Review

Telogen Effluvium in Patients After Bariatric Surgery: A Scoping Review

Wed, 24 Jul 2024 00:00:00 -0400

Telogen Effluvium (TE) is excessive hair loss caused by the premature transition of follicles to the resting phase. After bariatric surgery, especially in women, hair loss is associated with nutrient deficiencies, although the exact cause is still uncertain. A structured review, following PRISMA-ScR, was conducted in July 2023 to evaluate the prevalence of telogen effluvium after bariatric surgery, using data from PubMed, BVS, and Scielo. After bariatric surgery, hair loss is linked to nutritional deficiencies (zinc, iron, proteins, vitamin B12, and folic acid) and rapid weight loss. The surgery affects nutrient absorption, making it essential to monitor and address the nutritional needs of patients. Hair loss after bariatric surgery is common, especially in women between the third and sixth months, due to nutritional deficiencies, stress, and restrictive diets. Supplementation with zinc, vitamins C and D, as well as medications, can help. The study highlights the relationship between vitamin deficiencies (such as zinc, iron, and vitamin B12) and telogen effluvium after bariatric surgery. However, it notes the need for more studies, including randomized research. This underscores the importance of monitoring and treating these deficiencies in post-bariatric surgery patients.

Extralaryngeal Complications in Laryngeal Microsurgeries: A Narrative Review

Guilherme Catani, Maria Eduarda Catani — Fri, 11 Apr 2025 00:00:00 -0400

This narrative review aims to investigate extralaryngeal complications associated with laryngeal microsurgeries (LMS), focusing on their incidence, risk factors, and preventive strategies. Although LMS primarily target intralaryngeal pathologies, complications involving the teeth, oral mucosa, cranial nerves, and cardiovascular system can significantly impact postoperative recovery. A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, Cochrane, Google Scholar and OVID databases, covering the past 20 years. Studies reporting on extralaryngeal complications such as dental trauma, mucosal injuries, nerve damage, and cardiovascular events during LMS were included. Relevant data on incidence, risk factors, and preventive measures were analyzed and synthesized narratively. The most frequently reported complications included dental injuries, mucosal trauma, and nerve damage—particularly involving the lingual, glossopharyngeal, and hypoglossal nerves. Cardiovascular complications, although rare, were also documented. Identified risk factors included pre-existing dental disease, prolonged surgical duration, and inadequate protection during suspension laryngoscopy or intubation. Most complications were minor and self-limiting, but some resulted in prolonged recovery or patient discomfort. Extralaryngeal complications in LMS are common but largely preventable. Strategies such as preoperative dental assessment, the use of protective mouthguards, minimizing suspension time, and appropriate anesthetic management are essential to reduce these risks. Further research is warranted to evaluate long-term outcomes and improve preventive approaches, especially in high-risk and pediatric populations.

Methods: Relevant literature was reviewed to assess the frequency and nature of extralaryngeal complications in laryngeal microsurgeries. Studies reporting on dental trauma, mucosal injuries, nerve damage, and cardiovascular complications were included. Data regarding the incidence, risk factors, and recommended preventive measures were analyzed.

Results: The most common complications identified were dental injuries, mucosal trauma, and nerve damage. Dental injuries were notably more frequent in patients with pre-existing dental conditions and occurred more often during perioperative intubation compared to suspension laryngoscopy. Mucosal injuries, such as erosions and hematomas, were also common, with most cases resolving spontaneously. Nerve injuries, particularly involving the lingual and hypoglossal nerves, were less frequent but led to prolonged recovery times in some patients. Cardiovascular events, although rare, were reported in certain cases, especially in high-risk patients.

Conclusion: While most extralaryngeal complications in laryngeal microsurgeries are minor and self-limiting, they can significantly impact patient comfort and prolong recovery. Preventive strategies, including the use of protective dental devices, limiting suspension time, and optimizing anesthesia, are crucial in minimizing these risks. Future research should focus on refining surgical techniques and developing better preventive measures to further reduce the incidence of these complications.

The Role of Medical Research in Advancing Knowledge in Health: where are we?

Howard Lopes Ribeiro-Junior — Thu, 30 May 2024 00:00:00 -0400

This editorial discusses the importance of medical research in expanding knowledge and improving patient outcomes. It highlights the evolution of clinical research methodologies, from case studies to randomized clinical trials, systematic reviews, and meta-analyses, and the role of technology in analyzing large data sets. The article also emphasizes the impact of scientific discoveries on medical treatments, including advances in genomics, immunology, and biotechnology. Additionally, it discusses the need for continuous funding and collaboration in research, as well as the challenges and benefits of international collaboration, especially in low- and middle-income countries. Finally, the article reiterates the commitment of the Brazilian Journal of Clinical Medicine and Review to supporting and disseminating innovative research. It concludes that the future of healthcare depends on our commitment to research, which can improve patient outcomes and quality of life worldwide.

Electrochemical Analysis of the Influence of Brushing on the Corrosion Resistance of CP Ti Alloy

Mon, 15 Jul 2024 00:00:00 -0400

The use of metal alloys in dentistry continues to be applied in a large number of clinical situations involving conventional prostheses or those on implants. The objective of this study was to evaluate the effect of brushing and corrosion on the surface of CP Ti. Specimens with a diameter of 15 mm and a thickness of 2.5 mm were prepared using the lost-wax casting method. They were then divided into 2 groups (n=6) and subjected to different tests, as described in the materials and methods section. The results obtained showed no statistically significant change in the surface roughness of the specimens between the tested groups. However, images obtained through 3D Digital Interferometry and Scanning Electron Microscopy suggested the formation of surfaces with fewer irregularities in group 2, which was subjected to mechanical brushing before the electrochemical tests. The oxide resistance (Roxide) values observed after EIS at -250 mV were statistically different from each other (p≤0.05), with group 1, subjected only to the electrochemical test, showing lower oxide resistance compared to group 2, which was brushed mechanically before the electrochemical test. It was concluded that brushing positively influences the corrosion resistance of CP Ti.

Validation of Thyroid-Specific Quality of Life questionnaire Thypro-39 in Brazilian Portuguese

Mon, 22 Jul 2024 00:00:00 -0400

The purpose of the study is to validate ThyPRO-39 questionnaire to Brazilian Portuguese. The validated Portugal Portuguese version of ThyPRO-39, provided by the questionnaire developer, was used to adapt it to Brazilian Portuguese and these changes were validated by a translator. A cross-sectional study was carried out on people with thyroid disease, who were invited to participate in the research through the study author's social media. The study occurred between August 2020 and October 2020 and included 516 participants. Results obtained in both questionnaires, SF-36 and ThyPRO-39br, showed moderate correlation in all similar scales, Cronbach's alpha was higher than 0.7 in 10 of the 12 scales, and the clinical validation showed that results obtained were compatible with the expected for the patient diagnosis. Regarding the convergent validation between the ThyPro-39br and SF-36 questionnaires, the strongest correlations were found between the final composite score of ThyPRO-39br and SF-36 functional capacity (-0.591, p<0.001), impact on daily life and physical aspects (-0.568, p<0.001), and anxiety and mental health (-0.541, p<0.001). The ThyPRO-39br version was satisfactorily validated through 3 different methods and is available for future thyroid diseases quality of life research in Brazil.

Effects of Sensory-Motor Stimulation by the Padovan® Method on Weight Gain in Premature Infants Weighing Less than 1,500g

Fri, 09 Aug 2024 00:00:00 -0400

An observational analytical retrospective study was conducted to assess the efficacy of the Padovan® Method in promoting weight gain in very low birth weight premature infants. The study took place at a hospital and maternity ward in the Cariri region between 2020 and 2023. The sample included premature infants weighing less than 1500g admitted to the Neonatal Intensive Care Unit. Data were correlated with the scientific literature using descriptors such as “early stimulation,” “sensory-motor stimulation,” “very low birth weight,” and “premature infant”.The study involved 34 premature infants with gestational ages between 25 and 34 weeks and 5 days, all with very low birth weight and hemodynamically stable. These patients received a minimum fluid intake of 180 mL/kg/day for at least 14 days without sensory-motor stimulation. After this period, the Padovan® Method was applied until hospital discharge or until the newborns reached 1700g. A comparative analysis of weight gain before and after the application of the method revealed that 82.3% of the patients showed significant weight gain, while 17.6% did not show significant changes. The Padovan® Method may be an effective tool for promoting weight gain in premature infants, contributing to faster clinical improvement and reduced hospitalization time.

Factors Associated with High Lethality in Newborns with Gastroschisis in a Reference Hospital Unit in Angola

Isaura Lopes, Henrique Muela, Pedro Magalhães, Silvana Belo, Amílcar Silva — Wed, 11 Sep 2024 00:00:00 -0400

Gastroschisis has an important impact on newborn (NB) mortality. In sub-Saharan Africa, the mortality rate remains high at around 60 per cent. This study analyzed the factors associated with lethality in newborns with gastroschisis in a reference hospital unit in Angola. An observational, descriptive, and cross-sectional, hospital-based study was carried out and included information from 361 clinical files of newborns with gastroschisis evaluated at the David Bernardino Paediatric Hospital from 1st January 2010 to 15th July 2021. The mean maternal age was 22.34±4.5 years (range:14-40 years); the mean birth weight was 2453.9±515.6 with a significant difference between discharged and deaths groups (p<0.001). The high lethality rate (96,1%) was associated with low birth weight (Exp β = 7.956; 95% CI 1.758 – 36.163; p =0.007), parity (Exp β = 0.296; 95% CI 0.096 – 0.919; p =0.035), as well as sepsis (Exp β = 4.827; 95%CI 1.119 – 20.814; p =0.035). The results show that the high lethality of gastroschisis is particularly associated with factors related to the NB such as birth weight, sepsis and parity.

Biological Age and its Relationship with Mortality of Elderly People with COVID-19 in a Public Hospital in Northeastern Brazil

Thu, 31 Oct 2024 00:00:00 -0400

To estimate the biological age of elderly people hospitalized with a confirmed diagnosis of COVID-19, and its relationship with mortality. A retrospective and quantitative cohort study, carried out in a public hospital in the city of Recife-PE, from April 2020 to April 2021, with 115 elderly people of both sexes. The biological age of the participants was estimated by a calculator that uses nine laboratory blood tests and mortality was analyzed. Of the 115 elderly people hospitalized in a public referral hospital for COVID-19, the predominant gender was male, age ≥ 70 years, black/brown skin color, illiterate/low education, with a partner. Arterial hypertension and diabetes were the most common comorbidities in the study population. Regarding ICU admission, use of mechanical ventilation, length of ICU stays and mortality, there was a significant association with premature aging (p-value = 0.009, 0.009, 0.042 and 0.009 respectively). The biological Age was able to predict clinical outcomes, proving to be superior to Chronological Age.

Factors Associated with Dental Caries Prevalence Among Socially Vulnerable Children

Wed, 13 Nov 2024 00:00:00 -0500

The aim of this study was to evaluate the association between socioeconomic factors and the oral health status (OHS) of children in socially vulnerable situations assisted by a prominent nongovernmental organization in Fortaleza, Ceará state, Brazil. This is a cross-sectional observational study with a quantitative approach. One hundred children aged 5 to 6 years were included. Most children (n = 71, 71%) had dental caries. Only access to running water showed a statistically significant difference (p = 0.005) in relation to the level of dental pain. Correlations were tested through multiple linear regression analysis, revealing that the number of rooms in the home (p = 0.023) and family income (p = 0.022) were predictors of the DMFT index. Access to running water (p = 0.001) and the DMFT index (p = 0.010) were predictors of the level of pain. Children in situations of social vulnerability have a higher prevalence of dental caries associated with socioeconomic factors. It is essential that continuous strategies for promotion and prevention in oral public health be renewed to monitor children's development and growth.

Demographic and Behavioral Determinants Related to ART Adherence Among HIV-Positive Patients in Luanda, Angola

Wed, 27 Nov 2024 00:00:00 -0500

Adherence to antiretroviral therapy (ART) improves the quality of life of people living with HIV (PLHIV), with emphasis on improving their immune status, reducing viral load and reducing the mortality rate from the Human Immunodeficiency Virus (HIV). To characterize the status of adherence to antiretroviral therapy and the factors associated with non-adherence among adult HIV patients in two health units of reference for people living with HIV/AIDS in Luanda, the capital of Angola (Hospital Divina Providência and Hospital Esperança/Centro de Saúde do Rangel). This is a cross-sectional study of 378 PLHIV on ART, who were interviewed to obtain sociodemographic data and completed a questionnaire to assess ART adherence. It was found that 95.5% of patients had moderate adherence, 4.20% had excellent adherence and 0.3% had poor adherence. Adherence to ART was related to monthly income (p<0.05). In addition, borderline significance was observed between adherence rate and education level, with patients with primary or secondary education having moderate (35% - 50%) or excellent (38% - 56%) adherence rates. Patients over 30 had higher adherence rates, either moderate (30% - 57%) or excellent (44% - 56%). Women had approximately double the rates of moderate (75%) or excellent (63%) adherence to ART compared to men. Low adherence to ART was observed in married individuals and patients who use drugs or alcohol. This study looked at adherence to antiretroviral therapy among HIV-positive individuals in Luanda, Angola. The findings highlight the key role of socioeconomic factors, especially monthly income, in influencing the adherence levels of HIV patients in Angola. In addition, age, gender, education and marital status emerged as additional determinants that negatively affect adherence rates. These determinants emphasize the need for personalized interventions aimed at addressing the various barriers to ART adherence, with the aim of increasing the effectiveness of HIV/AIDS management to ensure a better quality of life for people living with HIV in Angola.

Clinical and Epidemiological Profile of Newborns with Gastroschisis Operated on in a Referral Hospital in Angola

Wed, 15 Jan 2025 00:00:00 -0500

Gastroschisis is a congenital malformation characterized by non-closure of the anterior abdominal wall, a paraumbilical defect usually to the right of the umbilical cord with externalization of the intestinal viscera. This study aims to analyze the clinical and epidemiological profiles of gastroschisis cases and examine associations between maternal and neonatal factors in a public referral hospital in Angola. This is an observational, descriptive cross-sectional hospital-based study conducted with the collection of information in 361 newborns medical records with gastroschisis treated at the David Bernardino Pediatric Hospital from January 1st, 2010 to July 15th, 2021. The variables that characterize the clinical, socioeconomic and demographic profile of 361 newborns (NB) with gastroschisis presented the following characteristics: 28% of mothers aged < 20 years; maternal mean age was 22,34+ 4.5 years, the occurrence of death was higher among NB of mothers aged 20 years corresponding to 96.5%, primiparous 127 (35.2%); without schooling 10 (2.8%), primary education 59 (16.3%), secondary education 43 (11.9%); out-of-hospital births 201 (55.7%); simple gastroschisis 326 (90.3%); primary closure 115 (31.9%); neonatal sepsis 145 (40.2%); mucosal skin pallor 70 (19.4%); gastroschisis-related mortality was 347 (96.1%). The clinical, socioeconomic and demographic profile of mothers and newborns with gastroschisis are widely studied and associated with well-known risk factors, including maternal age under 20 years, out-of-hospital delivery, low level of education, and reduction of the number of prenatal consultations as well as absence of prenatal diagnosis and multiparity.

Prevalence, Awareness, Treatment and Control of Hypertension in Residents’ Sample of Luanda, Angola

Thu, 16 Jan 2025 00:00:00 -0500

Hypertension (HTN) is an important risk factor for cardiovascular complications and is considered a public health problem worldwide. We aimed to evaluate the prevalence, awareness, treatment and control of HTN in a population sample in Luanda, Angola. A cross-sectional study was carried out which included 1480 individuals, between May 2018 and June 2019; we recruited participants at three different points of the city. Blood pressure (BP) was measured with semi-automatic device (Omron®, EM-7131-E). For each participant, three BP measurements were taken after 5 minutes resting and the mean of the two last measurements was used for systolic and diastolic BP. HTN was defined as BP ≥140/90 mmHg or use of antihypertensive drugs. The sample included mostly young people (39.7±11.6 years old) and male (69.3%). HTN prevalence was 34.9%; 47.4% of patients were aware of their condition; 36.8% were taking medication and of these only 35.8% had BP under control. There was a positive correlation between BP and age. The prevalence of HTN was high, almost half of the patients were unaware and, among the hypertensive patients who were under medication, most of them did not have their BP under control. HTN prevalence was high; awareness, treatment and control were low.

Inferences about HIV Transmission: Phylogenetics in Forensic Science

Carlos Victor Montefusco Pereira, Renan Montefusco Pereira — Sun, 09 Jun 2024 00:00:00 -0400

Connecting people with infectious diseases is not only a matter of epidemiological interest but also has legal implications when the disease is transmitted during a criminal act or when there is a civil dispute for compensation made by an infected person who acquired the disease as a result of lifestyle or work-related accidents (such as needle injuries). When the disease is a consequence of crimes like rape, the characteristics can be useful in linking the criminal and the victim, and the transmission itself can be inferred as the criminal's responsibility. Using phylogenetics as an inference method, it is possible to analyze the viral population genomes of people infected with HIV. Brazil already has ongoing judicial cases and can indeed benefit from the aid of complementary evidence, especially molecular-level proof that can have high reliability.

Analysis of Stress Levels in University Students During Examination Periods

Sun, 09 Jun 2024 00:00:00 -0400

The academic routine, with its responsibilities and commitments, is crucial for professional life but can cause significant stress for students. This study analyzed the stress levels in physiotherapy students at a private college before and after exams. It is an analytical, observational, quantitative, and cross-sectional study conducted with 16 students (10 in the morning shift and 6 in the evening shift) during October 2019. Heart rate variability was measured with a sensor placed on the ear, using the Inner Balance app, before and after the exams. The data were analyzed by Kubius HRV. Additionally, the Lipp's Adult Stress Symptoms Inventory (ISSL) and Whoqol-bref questionnaires were used. The results showed a significant increase in sympathetic nervous system activity after the exams, indicating stress related to the evaluations. 45% of the students exhibited typical symptoms of increased sympathetic activity, corroborating the heart rate variability data. These findings suggest the need for longitudinal studies to understand the duration and effects of academic stress on students' bodies.

The Benefits of Laser Therapy and Hooking in the Treatment of Plantar Fasciitis: A Narrative Review

Tue, 11 Jun 2024 00:00:00 -0400

Plantar fasciitis is an inflammation that affects the plantar aponeurosis, causing pain. Although it is not a lethal injury, if left untreated, it can become a disabling condition. Laser therapy is a physiotherapy treatment that provides an analgesic effect, acting on acute or chronic bone and tendon injuries, increasing collagen synthesis and phagocytic activity, repair, and the release of cytokines that will reduce the inflammatory reaction. Hooking is a tool that has been widely used by physiotherapists due to its low cost, ease of use, non-invasive nature, and its indication for the treatment of numerous traumatic injuries and inflammations of the musculoskeletal system in general, as well as scar tissue adhesions. The aim of this study was to report the benefits of laser therapy and hooking in the treatment of plantar fasciitis. Here, Laser therapy demonstrated significant improvement in 2 of the 3 articles found for this review, potentially providing improvement in pain, healing process, among others. Therefore, more high-quality studies are needed to prove the efficacy of laser treatment in plantar fasciitis. The present study showed positive effects of both techniques. Reports show good results and efficacy in the treatment of plantar fasciitis

Role of Gut-Microbiome-Brain-Axis in Neurodegenerative Diseases: A Review on Mechanisms and Potential Therapeutics

Wed, 10 Jul 2024 00:00:00 -0400

Neurodegenerative diseases encompass a group of disorders with diverse etiologies characterized by the accumulation of neurotoxic substances that contribute to neuronal damage and brain degeneration. The integration of the microbiota-intestine-brain axis mechanism occurs via afferent and efferent pathways with the assistance of the vagus nerve and peripheral circulation. The gut microbiota produces pathogenic proteins and other harmful substances that can cross the blood-brain barrier and develop into even more pathogenic proteins when in contact with the bloodstream. The microbial metabolites most commonly associated with neurodegenerative diseases are butyrate and amyloid, although the precise role and mechanism of their relationship with the microbiota have yet to be fully elucidated. Additionally, in Parkinson's disease, the microbiome is directly linked to an increase in opportunistic pathogens, a decrease in beneficial anti-inflammatory species, and higher levels of carbohydrate metabolizers.

Renal Artery Thrombosis Associated with COVID-19: A Systematic Review

Sun, 21 Jul 2024 00:00:00 -0400

Arterial thromboembolism associated with COVID-19 is a rare complication in the renal arteries and, when present, can lead to severe conditions. The aim of this study is to understand renal artery thrombosis associated with acute or previous SARS-CoV-2 infection. This review was conducted according to PRISMA guidelines and registered with PROSPERO. Articles were searched in the following databases: MEDLINE, LILACS, PubMed, and SciELO. The exclusion criteria included patients with risk factors for thrombosis. A total of 139 studies were found, of which thirteen met the pre-established criteria. The review emphasizes that this complication is more prevalent during infection and is more common in young male patients, with a predilection for the left renal artery. In these cases, no benefit was identified from thromboprophylaxis after a COVID-19 diagnosis. The clinical presentation was marked by sudden lower back pain, and occasionally fever, nausea, and oliguria. Contrast-enhanced computed tomography was sufficient to make the diagnosis. There was a preference for conservative treatment, and a cycle of therapeutic anticoagulation was also performed after hospital discharge. Information regarding renal function impairment is more related to acute manifestations, revealing limited knowledge of long-term consequences.

Identification of Increased Buccal Facial Fat as a Premature Predictor of Metabolic Syndrome: A Scoping Review

Wed, 24 Jul 2024 00:00:00 -0400

In recent decades, there has been a notable increase in the prevalence of obesity, particularly visceral obesity, which is associated with heightened morbidity and mortality worldwide. Recently, a series of studies have suggested that facial features, including buccal fat tissue, may serve as alternative indicators of insulin resistance, metabolic syndrome, and cardiovascular diseases, given that buccal and visceral adipose tissues share histological and metabolic similarities. This review followed the structure of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) protocol yo platforms to answer the research question: How does buccal facial fat act as an early predictor of metabolic syndrome? Buccal fat pad (BFP) was discovered by Xavier Bichat in 1801. Facial fat loss is related to a reduction in visceral fat. Facial parameters, such as the distance between earlobes and jaw width, were used to identify visceral obesity. The reviewed studies emphasize the relationship between facial adipose tissue, especially BFP, and visceral obesity, with valuable implications for clinical practice. Individuals with higher BFP tend to have more visceral fat, highlighting its potential in the early identification of metabolic risks.

The Role of Microglia in Parkinson's Disease and Possible Therapeutic Targets

Wed, 31 Jul 2024 00:00:00 -0400

Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by the degeneration of dopaminergic neurons in the substantia nigra pars compacta, leading to significant motor and non-motor symptoms. Recent research highlights the critical role of microglia, the resident immune cells of the central nervous system, in the pathogenesis and progression of PD. Microglia contribute to neuroinflammation through the release of pro-inflammatory cytokines and reactive oxygen species, exacerbating neuronal damage. Moreover, α-synuclein aggregates, a hallmark of PD, activate microglia, further promoting inflammation and neurodegeneration. This review explores the dual role of microglia in PD, encompassing both their neuroprotective functions and their contribution to neuroinflammation. We discuss the molecular mechanisms underlying microglial activation and their interactions with astrocytes, another crucial glial cell type. The review also examines potential therapeutic targets aimed at modulating microglial activity to mitigate neuroinflammation and slow the progression of PD. Current therapeutic strategies predominantly focus on symptomatic relief through dopaminergic medications. However, emerging therapies targeting microglial activation, such as anti-inflammatory drugs, immunomodulators, and novel agents like metabotropic glutamate receptor 5 (mGluR5) modulators, offer promising avenues for disease modification. Understanding the complex interplay between microglia and other cellular components in the PD brain is essential for developing effective treatments that address the underlying pathophysiological mechanisms of the disease.

Prodromal Parkinson's Disease: What We Know and What We do Not Know

Tue, 03 Sep 2024 00:00:00 -0400

Prodromal Parkinson's Disease (PD) represents a critical phase preceding the clinical onset of the disease, characterized by subtle and often non-motor symptoms that precede the classic motor manifestations. Understanding this prodromal phase is essential for early diagnosis, intervention, and potentially altering the disease course. This narrative review aims to elucidate the current knowledge on the prodromal phase of PD, highlighting known biomarkers, genetic predispositions, and environmental factors that contribute to early detection. Furthermore, it examines the limitations and gaps in our understanding, including the variability in prodromal symptoms, challenges in identifying definitive biomarkers, and the need for longitudinal studies. By synthesizing the existing literature, this review provides a comprehensive overview of what we know about prodromal PD and underscores the areas that require further research to enhance early diagnostic accuracy and develop preventative strategies.

Evaluation of Head and Neck Squamous Cell Cancer Treatment and Outcomes: Low-Dose Nivolumab in Palliative Treatment, A Literature Review

Julia Pastorello, Emanuela Lando — Wed, 11 Sep 2024 00:00:00 -0400

The chemotherapy treatment based on Taxol, paclitaxel is widely used in the treatment of neoplastic conditions in the head and neck, however in the last decades immunotherapy has made a revolution in the context of oncological treatments. The Anti-PDL1 agent, Nivolumab, has been proving to be of great value in the treatment of solid tumors. Through the review method this study aims to synthesize and analyze treatments for advanced head and neck cancer, in addition to critically analyzing existing studies on the use of reduced doses of nivolumab in patients with head and neck cancer. Thus, we aim to elucidate the action of oncological agents used in the treatment of SCC, as well as confirm the superiority of immunotherapeutic treatment in cases of advanced stage SCC.

Evaluation of the Neutrophil-to-Lymphocyte Ratio in Mortality of Individuals with Acute Heart Failure: An Integrative Literature Review

Thu, 12 Sep 2024 00:00:00 -0400

Acute heart failure (AHF) is a syndrome resulting from structural or functional abnormalities of the heart, possibly associated with systemic inflammation. In this context, the neutrophil-to-lymphocyte ratio (NLR) has been studied as a potential inflammatory marker easily accessible in clinical practice. This study aims to verify whether there is a relationship between NLR and mortality from AHF, as well as its contribution to the management and prognosis of the disease. The countries of origin of these studies include South Korea, Spain, the United States, Romania, and Turkey. Positive evidence was found for the hypothesis that NLR is related to mortality in AHF. The following considerations should be made elevated NLR values were predictors of AHF decompensation and in-hospital mortality; the higher the marker, the worse the survival rates. Additionally, the low cost and wide availability of complete blood counts support its high applicability. In this sense, the development of further studies will allow for more precise cut-off values and greater accuracy. It is concluded that NLR is related to mortality in AHF. Therefore, the biomarker is effective in risk stratification and prognosis of these patients.

Mortality of Individuals with Acute Heart Failure Admitted to the Intensive Care Unit: Integrative Literature Review

Wed, 18 Sep 2024 00:00:00 -0400

Acute heart failure occurs when urgent medical intervention is needed due to signs and symptoms resulting from functional and structural abnormalities of the heart. It is one of the most common causes of hospitalization in Brazil, with a high mortality rate. Thus, this article aims to highlight the aspects related to the mortality of this disease and the factors leading to unfavorable outcomes. Evidence points to predictors that increase the chance of mortality after hospitalization, such as male sex, myocardial infarction, chronic kidney disease, and cancer. Other factors that increase the likelihood of in-hospital mortality include stroke and pneumonia. The studies indicate a high admission rate of acute heart failure exacerbations in ICUs and the significant costs this imposes on the healthcare system. Additionally, further aspects related to mortality were observed throughout the research, such as PaCO₂ levels, with lower admission levels being associated with higher mortality risk, prognostic scoring systems like NEWS-L, and non-invasive ventilation (NIV), which seemingly does not alter all-cause mortality within 30 days and may be associated with longer hospitalizations, with some exceptions. In conclusion, the predictors that influence and increase the chances of heart failure mortality are evident.

Clinical and laboratory profile of HELLP Syndrome: Integrative Literature Review

Thu, 10 Oct 2024 00:00:00 -0400

The objective of this study is to gather information that corroborates the main clinical and laboratory findings involving Hellp Syndrome, its repercussions and consequences during pregnancy. An Integrative review was carried out in August 2024, using the digital library Scientific Electronic Library Online (SciELO), the Virtual Health Library (VHL) and PUBMED in the databases using the Boolean operators: AND and OR. The results were obtained through management with the Rayyan 16 QCRI application and were structured in PRISMA flowcharts. With the search in the databases, 219 articles were found, of which 122 were selected for reading and, according to the objective of the present work, 10 articles were included in the research. In the studies observed, it is concluded that among the main hypertensive syndromes in pregnancy, HELLP syndrome is a specific clinical and laboratory entity, requiring early diagnosis, precisely because of the repercussions at the maternal-fetal level, as it increases complications such as the syndrome from respiratory distress, infections and long-term developmental problems.

Dengue: An emerging public health issue in Brazil

Fri, 01 Nov 2024 00:00:00 -0400

Dengue is a viral disease transmitted by the Aedes aegypti mosquito and represents a major public health challenge in Brazil, where deficiencies in vector control favor its spread. The objective of this study is to analyze dengue fever as an emerging public health problem in Brazil. The study is an integrative review conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The PubMed, SciELO and VHL databases were used. The inclusion criteria were studies published between 2021 and 2024, written in English or Portuguese and that addressed the topic in question. The exclusion criteria were articles that were disconnected from the inclusion criteria. The vulnerability of urban areas, the vector's resistance to insecticides and the need for integrated control strategies contribute to the emergence of dengue in Brazil. Epidemiological surveillance, awareness campaigns, improvements in basic sanitation are essential measures for the effective fight against dengue. Therefore, a continuous and collaborative effort between the government, health professionals and the population are necessary, with an emphasis on prevention, education and innovation in the fight against Aedes aegypti.

Sleep Disturbances in Parkinson's Disease: A Scoping Review

Thu, 21 Nov 2024 00:00:00 -0500

Neurodegenerative diseases (ND), such as Parkinson's disease (PD) and Alzheimer's disease (AD), are characterized by progressive neuronal loss and degeneration, leading to both motor and non-motor symptoms, including sleep disturbances. Sleep disorders are highly prevalent in PD, affecting between 60% and 98% of patients. These include insomnia, excessive daytime sleepiness (EDS), sleep-disordered breathing, obstructive sleep apnea (OSA), restless legs syndrome (RLS), circadian rhythm disorders, and REM sleep behavior disorder (RBD). This article provides a comprehensive literature review on the pathophysiology, diagnosis, and management of sleep disorders in patients with PD. We highlight the significant impact these disturbances have on quality of life and emphasize the importance of regular screening and individualized treatment plans. Additionally, we discuss the challenges posed by non-motor symptoms in PD, particularly those related to sleep, as they often do not respond well to traditional dopaminergic therapies. Future research should aim to enhance diagnostic techniques and develop more targeted, patient-centered interventions to improve the management of sleep disorders in PD.

A Promising Frontier: Cannabis's Medicinal Prospects in Alagoas, Brazil

Fri, 27 Dec 2024 00:00:00 -0500

In 2022, the state of Alagoas, located in the northeastern region of Brazil, published new legislation regarding the medicinal use of Cannabis, which includes provisions for medical prescription, support for scientific research, continued education for healthcare professionals, and public events on the topic. Therefore, this study aimed to conduct a survey within the state of Alagoas, focusing on local scientific publications, the number of Cannabis-based medications prescribed, the development of clinical research and patents involving Cannabis, and initiatives for public events on the subject. The findings revealed that scientific research remains limited to publications in regional journals, with minimal international reach. Additionally, the number of prescribed and sold medications in Alagoas could not be obtained due to a failure in the national registration system. There is no development of clinical research or patents in Alagoas involving Cannabis. Lastly, there is a significant number of initiatives aimed at informing the non-specialized population and patients about the topic. Thus, our study showed that the local legislation is promising for the therapeutic use of Cannabis, but the state of Alagoas has yet to fully embrace all the possibilities authorized by the law.

Attention-Deficit Hyperactivity Disorder (ADHD) and Sleep Disorders: What We Know Now and Where We are Headed

Sun, 05 Jan 2025 00:00:00 -0500

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder observed in children and adolescents, the manifestations of which affect personal, social and academic performance. The aim of this paper is to explore the relationship between sleep disorders and ADHD symptoms, highlighting the importance of investigating the bidirectional relationship between these two conditions for the management of patients with this neurodevelopmental disorder and its comorbidities. This narrative review synthesizes the current literature to elucidate the interaction between sleep and ADHD, exploring the bidirectional communication between sleep and the comorbid symptoms of ADHD. In addition, it discussed how independent drug therapy can lead to sleep problems, showing how interaction with non-drug therapy is essential for the treatment of ADHD and sleep disorders, improving patient prognosis. Some recent research has revealed a possible link between ADHD and sleep disorders, and how they have a bidirectional relationship with each other, potentially affecting the quality of life and mental health of the individual with these disorders. As we delve deeper into the bidirectional relationship between the disorders, this review provides a comprehensive overview of current knowledge and possible implications for the diagnosis, treatment and approach of ADHD when associated with sleep disorders. Addressing the comorbid conditions of ADHD, such as sleep disorders, is fundamental as a coping strategy for the treatment of this neurodevelopmental condition, which involves both non-pharmacological and pharmacological interventions.

Chronic post-Chikungunya arthritis: a systematic review of long-term therapeutic strategies in the adult population

Tue, 04 Mar 2025 00:00:00 -0500

Chikungunya is a tropical disease caused by the Chikungunya virus (CHIKV); an arbovirus transmitted by Aedes spp mosquitoes. CHIKV infection is characterized mainly by severe joint pain and myalgia, and presents the acute and chronic phases, the latter characterized by polyarthralgia, which can last for months or even years. The main objective of this research is to describe the alternatives of long-term management of chronic post-Chikungunya arthritis in adults through a systematic review of specialized literature. The databases used were: Scientific Electronic Library Online (SciELO), the Virtual Health Library (VHL) and PUBMED (NCBI). The Rayyan Qatar Computing Research Institute program was used to manage the results and were structured in PRISMA flowcharts. After an exploratory, selective and analytical reading of all the studies was carried out, as well as the stratification of fragments that addressed the guiding question, resulting in a total of 8 articles used in the review. Current treatments focus on anti-inflammatory drugs, corticosteroids, physiotherapy, and psychological support, with methotrexate (MTX) being the most recommended pharmacological option. The review highlights the need to improve treatment and management strategies for post-Chikungunya chronic arthritis, in order to mitigate the associated morbidity and its impact on public health.

Non-Motor Features of Parkinson Disease: A New Clinical State of The Art

Sat, 15 Mar 2025 00:00:00 -0400

Parkinson's disease (PD) is a multisystemic, progressive disorder in which there is dopaminergic neuronal degeneration, with involvement of the substantia nigra and consequently the development of pre-motor, non-motor and motor symptoms, leading to a difficulty in the patient's quality of life. The aim of this study was to carry out a narrative review of the literature to update the state of the art on the non-motor symptoms of PD. A review of the literature from the last 10 years was carried out, highlighting mainly the prodromal manifestations of PD, such as sleep symptoms, sensory symptoms, neuropsychiatric and autonomic symptoms in their prodromal phases and their relationship with motor symptoms. Thus, we reiterate that premotor manifestations precede motor symptoms by up to 20 years and, consequently, the diagnosis of this neurodegenerative disease with a guarded prognosis. Thus, more longitudinal studies are needed looking at the prodromal symptoms of PD to gain a broad understanding and consequent early diagnosis of the disease, in order to provide biomarkers and support for early treatment with an improved prognosis for individuals living with this neurodegenerative condition.

Autism Spectrum Disorder and Intellectual Disability: Where are We Now and What Challenges Lay Ahead?

Tue, 01 Apr 2025 00:00:00 -0400

The coexistence of Intellectual Disability (ID) and Autism Spectrum Disorder (ASD) presents a complex clinical scenario that requires comprehensive and personalized interventions. This article explores the neurobiological mechanisms underlying the comorbidity of ID and ASD, highlighting the shared genetic and synaptic pathways that contribute to both conditions. The discussion also covers the prevalence of comorbidities such as epilepsy, sleep disorders, and gastrointestinal issues, which exacerbate the challenges in diagnosis and treatment. A multidisciplinary approach, combining behavioral, educational, and pharmacological interventions, is essential for addressing the unique needs of individuals with ID and ASD. Future directions point to the use of advanced neuroimaging, artificial intelligence, and personalized therapies based on genetic markers, which promise to revolutionize treatment strategies. Emphasis is placed on the importance of early intervention and lifelong support to improve functional outcomes and quality of life. The need for ongoing research, policy development, and family involvement is underscored as critical factors in optimizing care and inclusion for this population.

The Association Between Hematocrit Ratio and Outcomes in Kidney Transplantation: An Integrative Literature Review

Mon, 28 Apr 2025 00:00:00 -0400

With the increasing number of people affected by chronic diseases, such as chronic kidney disease, advances in treatments are being widely studied. Kidney transplantation is a commonly used curative measure when viable, and numerous studies focus on improving techniques and prognosis for both the patient and the graft. Recently, various cellular ratios have been applied and tested with the aim of clinically evaluating and estimating the likelihood of organ rejection after transplantation. The main one is the neutrophil-to-lymphocyte ratio (NLR), an effective, economical, and accessible measure for the practical clinical assessment of the degree of inflammation after kidney transplantation and, consequently, for predicting acute rejection (AR). The objective of this study was to search the literature for evidence regarding the behavior of cellular ratios and the status of kidney transplantation, investigating the association between the neutrophil-to-lymphocyte ratio and potential complications or outcomes in kidney transplantation. An integrative review was conducted through a bibliographic survey on the PubMed, Lilacs, and Scielo platforms between August 2023 and October 2024, selecting articles through pre-established filters related to the topic, such as cellular ratios and kidney transplantation, resulting in the final inclusion of six articles published between 2013 and 2024. Upon analyzing the results, it was evidenced that a high preoperative neutrophil-to-lymphocyte ratio (NLR > 3.5) may be considered a predictor for delayed graft function as well as the detection of acute rejection. This study aimed to contribute to advancements in kidney transplantation and assist in the early detection of post-transplant outcomes, given the importance of this treatment and the maintenance of a good prognosis for transplant patients. It also sought to encourage further research to better define the relevance and applicability of cellular ratio analysis, which is still underutilized in clinical practice, since there is no consensus regarding the sensitivity and specificity of this analysis for kidney transplantation outcomes and other clinical applications.

Prevalence of Bone Fractures in Women with Breast Cancer: A Systematic Review of the Impact of the Use of Aromatase Inhibitors

Adriele Godgienski, Emanuela Lando, Julia Pastorello, Rosana Martins — Mon, 28 Apr 2025 00:00:00 -0400

The prevalence of bone fractures in patients with breast cancer undergoing treatment with aromatase inhibitors (AIs) is associated with a substantial increase in the risk of osteoporotic fractures and loss of bone mineral density (BMD), due to suppression of bone mineral levels, estrogen in the body, especially in postmenopausal patients. In essence, the present study aims to evaluate the prevalence and severity of bone fractures in breast cancer patients who are being treated with AIs, as well as identify the related risk factors. A systematic literary review was conducted using the scientific databases PubMed and Scielo, the keywords aromatase inhibitors, breast cancer, bone mineral density and fractures were used. Included were publications between June 2002 and February 2021. A total of 176 studies were identified (PubMed: n = 120; Scielo: n = 56), of which 126 were excluded for not meeting the eligibility criteria. Ultimately, 15 studies were included in the analysis, comprising 13 from PubMed and 2 from Scielo. The AIs has a significant impact on BMD in postmenopausal patients, especially compared to patients treated with tamoxifen, and is evident in studies that analyzed the transition from tamoxifen to AI. This negative effect on BMD is related to the increased risk of fractures in patients with hormone receptor-positive breast cancer, especially patients with BMD T-scores less than -1,5. It is relevant that different AIs have varying effects on bone health; anastrozole is associated with a more pronounced reduction in BMD than letrozole and exemestane. In addition to preserving bone health, the inclusion of biphosphonate agentes and vitamin D supplementation demonstrated efficiency in reducing the risk of BMD.