Faculdade de Medicina de Jundiaí

Introdução: A sífilis é uma doença infecciosa sistêmica causada por uma bactéria do gênero Spirochaeta e da família espitoquetácea, denominada Treponema pallidum que, quando não tratada ou tratada inadequadamente, pode apresentar evolução crônica. A infecção pode ser assintomática, nesse caso, seu diagnóstico somente é possível por meio de sorologia específica. Objetivo: Determinar o perfil de sífilis na gestação e a taxa de sífilis congênita em grávidas admitidas na maternidade do Hospital Universitário Professor Alberto Antunes (HUPAA). Métodos: Estudo transversal, de caráter retrospectivo, descritivo, analisando 93 prontuários de gestantes portadoras de sífilis e 304 de recém-nascidos com sífilis congênita internados no setor de neonatologia do hospital da Universidade Federal de Alagoas, no período de 2013 a 2016. Resultados: A incidência de sífilis em gestantes atendidas no HUPAA foi de 13 casos em 2013, 23 em 2014, 32 em 2015 e 25 em 2016, totalizando 93 casos em quatro anos de estudo. Das gestantes estudadas, todas realizaram consultas de pré-natal, entretanto, 40 obtiveram o diagnóstico de sífilis fora dessas consultas, isto é, no ato da internação hospitalar, enquanto 53 receberam o diagnóstico por ocasião da consulta pré-natal. Considerando a escolaridade, 67,7% das mães com sífilis tinham baixa escolaridade, isto é, cursado da 5a à 8a série incompleta, enquanto 8,6% não tinham escolaridade. Analisando a sífilis congênita no setor de neonatologia, foram observados 73 casos em 2013, 109 em 2014, 72 em 2015 e 50 em 2016, totalizando 304 casos de sífilis adquirida por transmissão vertical. Em relação ao tratamento do parceiro sexual, do total das 93 grávidas com sífilis, a ausência de tratamento foi verificada na maioria dos casos (77); os demais 16 receberam tratamento. Conclusão: No presente estudo, o número de recém-nascidos com sífilis congênita no período de quatro anos foi cerca de 3,2 vezes superior ao das gestantes com sífilis no mesmo período, justificado pela presença de recém-nascidos na casuística que nasceram em outras maternidades da rede pública e foram encaminhados para tratamento no setor de neonatologia. Chama a atenção a taxa alarmante de crianças que nasceram com sífilis no período deste estudo (31,7/1.000 nascidos vivos). As falhas determinantes para as referidas taxas elevadas de sífilis estão bem estabelecidas: diagnóstico tardio (durante a admissão hospitalar), parceiro não tratado e falha no sistema de saúde (desconhecendo a situação de tratamento do parceiro das gestantes).

Objectives To identify the variables at baseline, including physical frailty, that might predict cognitive and functional deficits in a 9‐year follow‐up. Methods This investigation included participants from the FIBRA study in Campinas city and Ermelino Matarazzo, subdistrict of São Paulo city, with complete data collected at baseline and follow‐up for the variables sex, age, education, frailty phenotype, number of chronic diseases, and tobacco and alcohol use. Of the initial 1284 participants at baseline, 98 that exhibited cognitive impairment were excluded. At follow‐up, 451 participants were located and reinterviewed and 85 scored below the cut‐off on the Mini‐Mental State Exam (MMSE), of which 45 also presented functional deficit. Results The follow‐up subsample comprised predominantly participants that were female (68.1%), aged 65–74 years (71.6%), and had low education (0–4 years of education, 75.6%). At baseline, 35.5% were non‐frail, 57.0% pre‐frail and 7.5% frail, whereas at follow‐up, 29.4% were non‐frail, 62.3% pre‐frail and 8.3% frail. Logistic regression showed that age and education but not frailty at baseline were associated with cognitive and functional deficits at follow‐up. Conclusions Higher age and lower education at baseline were predictors of cognitive and functional deficits after 9 years, whereas frailty was not. Further longitudinal studies should be conducted to elucidate the factors predicting cognitive and functional decline in low‐and middle‐income countries.

In 2015, the Zika virus (ZIKV) outbreak in Brazil caught the attention of the global community, as public health emergency. ZIKV, an Orthoflavivirus transmitted by Aedes mosquitoes, initially identified in 1947, has evolved from a historically inconspicuous pathogen to a significant public health concern. Beyond mild symptoms resembling Dengue fever, severe conditions such as microcephaly and Guillain-Barré syndrome have been linked to ZIKV. In regions already burdened by arboviruses such as dengue virus (DENV), the co-circulation of these pathogens has created challenges for diagnosis and clinical management. Studies highlighted the simultaneous circulation of DENV and ZIKV, often following one another in both time and space. Pandemic strains of ZIKV have shown evidence of codon usage adaptations enhancing replication efficiency in human hosts, contributing to the virus's rapid global spread. Furthermore, the arbovirus outbreaks in Brazil were characterized by a wave-like pattern, where viral transmission appears to follow a coordinated sequence. Despite the critical public health implications of ZIKV, studies focusing on the detailed epitope mapping of ZIKV proteins remain scarce. This study aims to investigate the epitope mapping patterns of ZIKV polyprotein in IgG ZIKV-positive individuals, correlating with newborns’ maternal immune interaction by SPOT-synthesis. Notably, regions in proteins C, E, NS1, and NS5 exhibited high membrane reactivity and epitope recognition patterns. Additionally, C, E, NS1, and NS5 proteins displayed immunogenic potential with differential responses in newborns. The study enhances the understanding of ZIKV humoral immune response and suggests further investigations for epitope validation and potential vaccine development.

Background Plerixafor combined with granulocyte colony‐stimulating factor (G‐CSF) has shown superior efficacy in mobilizing hematopoietic stem cells (HSCs). However, its widespread use is constrained by high costs, and there is ongoing debate regarding the effectiveness of mobilization strategies. This study evaluated the cost‐effectiveness of preemptive versus rescue plerixafor in patients from the Brazilian Public Health Care System with multiple myeloma or lymphoma eligible for autologous stem cell transplantation (ASCT). Methods This observational study assessed the costs and clinical outcomes of preemptive and rescue plerixafor strategies. The incremental cost‐effectiveness ratio (ICER) was calculated for the percentage of patients with successful optimal or minimal HSC collections, who underwent ASCT and the number of leukapheresis sessions. Results The study included 285 patients, 82 in the preemptive and 203 in the rescue group. Preemptive plerixafor resulted in a lower mobilization failure rate, a decreased need for remobilization, a higher proportion of patients progressing to ASCT, and a shorter interval between the beginning of mobilization and ASCT. The incremental cost of preemptive versus rescue plerixafor was US$1532.44. The incremental effectiveness observed was 10.1$ 151.28), 4.7% for optimal harvest (ICER US$326.05), and 13.1$ 116.18). Regarding the number of leukapheresis sessions, preemptive plerixafor was dominated. Summary Preemptive plerixafor is a cost‐effective strategy compared to rescue plerixafor, offering higher efficacy and lower ICER values, making it a clinically beneficial option despite its higher cost.

Objective: To identify gaps in healthcare professionals’ understanding and management of geriatric anorexia. Methods: Mixed methods, including discussions with experts through focus-group interviews and a digital survey distributed to healthcare professionals. Results: A total of 192 healthcare professionals completed the survey. Of these, 65.1% acknowledged a uniform definition of geriatric anorexia, defining it as a reduction in appetite and/or food intake; 93.2% identified depression as the most significant risk factor, and 91.1%, cognitive changes or dementia; 64.9% of respondents expressed confidence in providing nutritional recommendations, 57.8% in suggesting physical activity and 81.8% in involving caregivers (family members) in supporting older adults with anorexia; 76% of clinicians assessed appetite during each visit; the tools most often used to screen older adults for appetite loss included informal clinical interview (52.6%) and the Mini-Nutritional Assessment Short Form (40.1%); management focused primarily on recommending oral nutritional supplements (75%) and prescribing nutritional counseling (74.5%). Conclusion: Our findings highlight the challenges in caring for older adults with or at risk of geriatric anorexia. Identifying differences in practices among healthcare professionals and within healthcare teams can inform future healthcare education efforts.

IMPORTANCE This is the first Brazilian study evaluating the performance of Pediatric Risk of Mortality (PRISM) IV and the first to use the calibration belt technique. OBJECTIVES This study aimed to evaluate the performance of PRISM IV in a large cohort of patients admitted to Brazilian PICUs. DESIGN, SETTING AND PARTICIPANTS This is a longitudinal, prospective, multicenter study conducted in 36 Brazilian PICUs with children between 29 days and 18 years old admitted from March 2020 to March 2022. MAIN OUTCOMES AND MEASURES PRISM IV’s performance was assessed using the standardized mortality ratio (SMR), the area under the receiver operating characteristic curve (AUROC) with 95% CI, and the calibration belt with 80% and 95% CI. RESULTS A total of 12,046 patients from 36 PICUs were included. Observed overall in-hospital mortality was higher than predicted: observed = 249 (2.1%) × predicted = 188.1 (1.56%) (SMR = 1.32 [95% CI, 1.16–1.50]); discrimination was good (AUROC = 0.86 [95% CI, 0.83–0.89]), and calibration was poor, underestimating mortality over a wide range of predicted mortality (2–61%). To explore the impact of the COVID-19 pandemic on PRISM IV’s performance, we divided the study period into prevaccine and postvaccine. In the prevaccine period, the SMR was 1.38 (95% CI, 1.17–1.62), the AUROC was 0.84 (95% CI, 0.80–0.88), and the range of miscalibration was broader than in the total cohort (underestimation in the 2–98% range). In the postvaccine period, the SMR was 1.26 (95% CI, 1.03–1.51), the AUROC was 0.90 (95% CI, 0.86–0.94), and the calibration belt underestimated mortality in a narrower range of 3–46% of predicted mortality. CONCLUSIONS AND RELEVANCE PRISM IV showed good discrimination but miscalibration across a wide range of predicted mortality and different COVID-19 pandemic periods in a large cohort. Further research with subgroup analyses are needed to develop strategies to improve the performance of PRISM IV in different and heterogeneous Brazilian healthcare contexts.

Background High prevalence of depressive symptoms among primary care workers has been pointed out in previous studies. However, the relationship of leadership aspects and the mental health of nursing workers in Primary Health Care (PHC) has been overlooked. We aimed to estimate the prevalence of depressive symptoms among nursing workers and to investigate the associations between interactional justice, supervisor support, and depressive symptoms among nurses and nursing-assistants in PHC. Methods we conducted a cross-sectional study, with a representative sample of professionals from the Family Health Strategy (FHS) in the city of São Paulo, Brazil. Sixty-six UBS were randomly selected, including 351 teams and 953 nursing professionals (306 nurses and 647 technicians). The Patient Health Questionnaire (PHQ-9) was used to assess, with scores ≥ 10 being classified as probable major depression. We used the Brazilian version of the Organizational Justice Perception Scale to assess interactional justice and the Job Stress Scale to address support from supervisor. The associations between sociodemographic variables, stressful life events, work characteristics, and depressive symptoms were analyzed using Poisson regression with robust variance. Results The prevalence of probable major depression was 25.6%. The variables associated with the risk of probable major depression were being women, having reported low interactional justice (prevalence ratio = 1.53), and low supervisor support (prevalence ration = 1.96). Conclusion Reporting low interactional justice and receiving insufficient support from supervisors might jeopardize nursing workers’ mental health. Leadership training could be a strategy to mitigate depressive symptoms among PHC nursing.

Objective The current study aimed to describe risk factors for adverse perinatal outcomes (APOs) among pregnant women nonvaccinated for COVID‐19 who had respiratory symptoms. Methods A nested case–control study was performed within the REBRACO (in Portuguese, the Brazilian Network of COVID‐19 During Pregnancy) initiative. Women were recruited during pregnancy in 15 maternity hospitals in Brazil from February 1, 2020, to February 28, 2021, while seeking medical care for respiratory symptoms, and were followed up until childbirth regardless of confirmation of COVID‐19. For this analysis, women were divided into two groups: (1) those with APOs, defined as the occurrence of fetal or neonatal death, preterm delivery, 5‐min Apgar score <7, neonatal respiratory distress, neonatal mechanical ventilation, admission to the neonatal intensive care unit, small‐for‐gestational‐age newborn, or any neonatal morbidity; and (2) those without APOs. Results The total number of women included in this analysis was 481, with 210 having APOs (43.7%). The characteristics independently associated with APOs were a composite outcome of severe acute respiratory syndrome, maternal admission at the intensive care unit, or maternal death (relative risk [RR], 3.30 [95% confidence interval (CI), 1.38–7.89]), living in the North and Northeastern regions of Brazil (RR, 3.09 [95% CI, 1.13–8.41]), and pre‐eclampsia (RR, 2.77 [95% CI, 1.19–6.43]). Conclusion Severe maternal illness was strongly associated with APO regardless of COVID‐19 confirmation. It is essential to provide sufficient and timely health care for women who have respiratory symptoms compatible with COVID‐19.

Background Telemedicine has enhanced medical practice by increasing accessibility for patients in remote areas. In orthopedics, its use in shoulder surgery is recent but promising. However, there is still a need for studies that evaluate its effectiveness specifically in the setting of rotator cuff disorders. To evaluate reliability and reproducibility of treatment indications using telemedicine for patients with rotator cuff syndrome. Secondary objectives were assessment of physical examination accuracy and level of patient satisfaction. Methods This diagnostic accuracy study included patients diagnosed with rotator cuff syndrome, who were randomized into two groups as follows: telemedicine and in-person consultations. Both groups underwent two appointments conducted by different orthopedic surgeons. The agreement between treatment indications (nonsurgical, surgical, or conservative, with the possibility of switching to surgery) was assessed using the Kappa coefficient. Additionally, physical examination tests and patient satisfaction were also evaluated. Results A total of 64 patients were evaluated, with 32 in each group. The reproducibility of teleconsultation for treatment indication was high in both groups, with Kappa values ranging from 0.82 to 0.93. For physical examination tests, reproducibility was high in the in-person group (Kappa between 0.63 and 1) but varied in the telemedicine group (Kappa between 0.11 and 1). The accuracy of the tests in the in-person group was high (sensitivity between 0.94 and 1; specificity between 0.66 and 1), whereas the telemedicine group showed greater variability (sensitivity between 0.60 and 1; specificity between 0.16 and 1). Patient satisfaction was high in both groups, with no significant differences (P > .676). Conclusion Teleconsultation is a reliable tool for indicating treatment in patients with rotator cuff syndrome, demonstrating high reproducibility and high patient satisfaction. However, the variability in the accuracy of tests that require strength assessment highlights the need for improvements in telemedicine protocols to ensure more robust and accurate evaluations.

Men who have sex with men are a target group for HIV prevention and control. HIV testing is part of a broader combination prevention strategy. This study aimed to analyze the predictors for adherence to HIV infection testing among Brazilian men who have sex with men. A cross-sectional study was conducted with 1438 participants, online selected for convenience in all regions of Brazil. Binary logistic regression analysis was used to identify independent predictors of HIV testing in the study population. Adherence to the HIV test was high (80.1%). Had condomless anal intercourse in the last 12 months (Adjusted Odds Ratio [AOR]: 1,659; 95% Confidence Interval [CI]:1,12 − 2,43; p = 0,010), knew one place to seek HIV testing (AOR 6,158 [IC95%: 4,27 − 8,86]; p < 0,001), Received counselling on HIV testing by a health professional (AOR 3,389 [IC95%: 2,28 − 5,02]; p < 0,001), Have been diagnosed with STI (AOR 2,266 [IC95%: 1,41 − 3,62]; p < 0,001) and Knew someone living with HIV (AOR 1,86 [IC95%: 1,29 − 2,67]; p < 0,001) were independently associated with higher chances of HIV testing. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-024-21018-2.

Background: There is a lack of information from Brazil regarding therapies used and outcomes in patients with acute coronary syndrome with ST elevation (STEMI). Objectives: To evaluate evidence-based therapies, occurrence of outcomes, reperfusion use, and predictors of not receiving reperfusion in patients with STEMI in a national multicenter registry. Methods: Patients with STEMI from the ACCEPT registry, with up to 12 hours of symptoms, were followed for 1 year for the occurrence of major adverse cardiovascular events. A significance level of p < 0.05 was applied for all analyses. Results: In the analysis of 1553 patients, the reperfusion rate was 76.8%, ranging from 47.5% in the North Region to 80.5% in the Southeast Region. The rate of major adverse cardiovascular events was 12.5% at 1 year. The prescription of evidence-based therapies at hospital admission was 65.6%. The presence of hypertension (odds ratio [OR] 1.47; 95% confidence interval [CI] 1.11 to 1.96; p < 0.01); prior acute myocardial infarction (OR 1.81; 95% CI 1.32 to 2.48; p < 0.001); and the North (OR 4.65; 95% CI 2.87 to 7.52; p < 0.001), Central-West (OR 4.02; 95% CI 1.26 to 12.7; p < 0.05), and Northeast Regions (OR 1.70; 95% CI 1.17 to 2.46; p < 0.01) were independent predictors of not receiving reperfusion therapy. Conclusion: In the 1-year follow-up of the ACCEPT Registry, we were able to verify a wide variation within Brazilian geographical regions regarding adherence to best care practices. The following were independent predictors of not receiving reperfusion therapy: being treated in the North, Central-West, and Northeast Regions; having systemic arterial hypertension; and prior infarction. Keywords: Myocardial Infarction; Acute Coronary Syndrome; Medical Record Linkage

Background and Objective This study aimed to assess the prevalence of urinary incontinence (UI) and lower urinary tract symptoms (LUTS) in five selected low and middle‐income countries to provide appropriate evidence for other related studies. Materials and Methods In this multinational population‐based cross‐sectional survey between August 2019 and April 2021, validated questionnaires were used to assess LUTS in adults over 18 years from Iran, Egypt, Bangladesh, Brazil, and Cameroon. Results A total of 1477 participants from five countries completed the questionnaires. The mean age of participants was 43.5 ± 15.7 years. 37.1% reported at least one episode of UI per week. UUI prevalence in different countries analysis showed that the commonest prevalence was reported in Cameron (40.0%; n = 30), while the lowest was 15.0% ( n = 31) in Brazil. Stress UI was common in Iran (38.7%; n = 338), and Bangladesh had the lowest rate (7.8%; n = 16). Urinary urgency was the common LUTS among participants (59.9%, n = 818 out of 1477 participants). Nocturia was the other prevalent symptom among cases (50.6%; 748 out of 1477 cases), and this symptom had a higher rate in elderly populations. Men reported voiding and postmicturition symptoms more frequently than women. Storage symptoms except for nocturia, including frequency, urgency, and UI were common in women while voiding symptoms, including straining, and intermittency were reported more frequently in men than women. Conclusion A high prevalence of urinary symptoms was reported in low to middle‐income countries.

Resumo Introdução: Práticas Integrativas e Complementares em Saúde ampliam o cuidado em saúde. Objetivo: avaliar a satisfação dos usuários atendidos na Atenção Básica e a oferta de Práticas Integrativas e Complementares em Saúde no Sistema Único de Saúde. Método: Foram utilizadas questões do 3° ciclo do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica do qual participaram 140.121 usuários de 36.808 equipes de saúde. A variável desfecho foi mensurada por meio da questão "Na sua opinião, o cuidado que o(a) senhor(a) recebe da equipe de saúde é:". Resultados: Apresentaram menor chance de satisfação os usuários que moravam mais distantes das Unidades de Saúde; cujo horário de funcionamento não atendia suas necessidades ou atendiam às vezes; com os profissionais que quase nunca/nunca perguntavam sobre outras questões da sua vida; que se sentiam algumas vezes ou não se sentiam respeitados pelos profissionais; que acreditavam que a forma como foram acolhidos foi regular, ruim ou muito ruim; em locais cujas equipes não participaram de ações de educação permanente e que não ofereciam Práticas Integrativas e Complementares em Saúde. Conclusão: o oferecimento de Práticas Integrativas e Complementares em Saúde foi um fator que contribuiu favoravelmente para a satisfação dos usuários atendidos na atenção básica.