Translation, transcultural adaptation, and validation of PedsQL 3.0 Sickle Cell Disease Module into Brazilian Portuguese.

INTRODUCTION: Despite the high prevalence of sickle cell disease (SCD) in Brazil, no studies have described the validation of an SCD-specific health-related quality-of-life (HRQoL) instrument in children. We validated PedsQL 3.0 Sickle Cell Disease Module (PedsQL-SCD) for Brazilian Portuguese, and cross-validated it with PedsQL 4.0 Generic Core Scale (PedsQL-GCS) in children with SCD. METHODS: PedsQL-SCD was translated and culturally adapted using forward and reverse translations. PedsQL-SCD and PedsQL-GCS were tested in children and adolescents with SCD aged 2-18 years and their caregivers. Validity was assessed using the Pearson and intraclass correlation coefficients, and reliability measured with Cronbach's alpha. RESULTS: PedsQL-SCD was validated in 206 children with SCD (median age 14 years, range: 8-18) and 201 caregivers. Among patients and caregivers, the mean total score for PedsQL-SCD was 65.7 and 64.1, respectively. The mean total score for PedsQL-GCS was 73.1 and 68.9 among patients and caregivers, respectively. The internal consistency for PedsQL-SCD and PedsQL-GCS was good; Cronbach's alpha coefficients ranged from .59-.93 to .64-.83 among patients and from .60-.95 to .65-.85 among caregivers, respectively. Most intercorrelations between PedsQL-SCD and PedsQL-GCS, for patients and caregivers, had medium to large effect sizes (range: .23-.63 and .27-.64, respectively). Pain and pain impact domains of PedsQL-SCD and physical dimension of PedsQL-GCS had the highest cross-correlation (.63 and .6 for patients; .63 and .64 for caregivers, respectively), confirming convergent construct validity. CONCLUSION: PedsQL-SCD is a valid, culturally appropriate measure to assess HRQoL in children with SCD in Brazil and is well-correlated PedsQL-GCS.

Treatment patterns and outcomes for Hodgkin Lymphoma patients aged 60 and older: a report from the Brazilian Prospective Hodgkin Lymphoma Registry.

The treatment of older patients with Hodgkin lymphoma (HL) remains a challenge. We sought to identify the treatment patterns and outcomes in older HL patients included in the Brazilian HL registry (NCT02589548). A total of 136 patients with HIV-negative classic HL, aged ≥ 60 years, diagnosed between 2009 and 2018, were analyzed. The median age was 66 years old (60-90), 72% had advanced disease, 62% had a high IPS, and 49% had a nodular sclerosis subtype. Median follow-up was 64 months for alive patients. ABVD was the front-line treatment in 96% of patients. Twenty-one patients (15%) died during front-line treatment. The 5-year PFS and 5-year OS rates were 55% and 59%, respectively. The 5-year OS rates in localized and advanced disease were 81% and 51% (p=0.013). Lung toxicity developed in 11% of the patients treated with ABVD. Bleomycin was administered for > 2 cycles in 65% of patients. Compared with 2009-2014, there was a decrease in the use of bleomycin for > 2 cycles in 2015-2018 (88% × 45%, p<0.0001). The impact of socioeconomic status (SES) on outcomes was studied in patients treated with ABVD. After adjusting for potential confounders, lower SES remained independently associated with poorer survival (HR 2.22 [1.14-4.31] for OS and HR 2.84 [1.48-5.45] for PFS). Treatment outcomes were inferior to those observed in developed countries. These inferior outcomes were due to an excess of deaths during front-line treatment and the excessive use of bleomycin. SES was an independent factor for shorter survival.

Perceptions of Gender Stereotypes among Women Residents in Surgical and Nonsurgical Specialties.

OBJECTIVE: The objective of this study was to determine whether and to what degree residents experience stereotype perception by gender and specialty type (surgical vs nonsurgical). METHODS: A cross-sectional survey was sent to resident physicians across all specialties at a single academic institution in February 2021. The survey items asked whether participants believe residents, faculty, and the public expect men or women to be better physicians on a numerical scale from 1 to 7. A χ2 test compared the calculated mean and standard error for each survey item. This study took place at Washington University School of Medicine in St. Louis, Missouri, a large academic tertiary care center. RESULTS: A total of 411 (46% of total) residents participated; 13 were excluded because of nonbinary gender or missing demographic information, for a final sample of 398. Participants perceived all three groups to expect men to be better physicians than women. Regression analysis showed a significant effect of gender on stereotype perception, with women reporting stronger stereotype perceptions than men. There were no significant differences in stereotype perceptions by specialty type. CONCLUSIONS: Women resident physicians in both surgical and nonsurgical fields reported higher levels of gender stereotype perception compared with men, making it imperative that graduate medical education leadership support changes to the current learning environment.

Shave Excision Versus Elliptical Excision of Nonpigmented Intradermal Melanocytic Nevi: Comparative Assessment of Recurrence and Cosmetic Outcomes.

BACKGROUND: Nonpigmented intradermal melanocytic nevi (IMN) are benign lesions often removed for cosmetic reasons. There is no consensus as to the best technique for IMN excision. OBJECTIVE: To compare cosmetic outcomes and risk of recurrence after shave excision versus elliptical excision of IMN. MATERIALS AND METHODS: In this randomized clinical trial, patients underwent shave excision or elliptical excision with sutured closure of IMN of the face or back. Recurrence, patient satisfaction, cosmetic outcome, postoperative discomfort, scar size, discoloration, and presence of hypertrophic or keloid scars were evaluated at 3, 6, and 9 months. RESULTS: Overall, 145 nevi were removed from 45 patients (86.7% women, mean age 52.1 ± 12.5 years). The recurrence rate was 11.7%, occurring only after shave excision; 94.1% of recurrences were observed at 3-month follow-up. Shave excision was associated with less discomfort 48 hours after intervention but a greater likelihood of involved lateral and deep margins (p < .001). Scars were larger after elliptical excision and suture than after shave excision (p < .01). The mean patient satisfaction was higher in the shave excision group (p < .004). CONCLUSION: Shave excision of IMN is associated with higher rates of involved surgical margins and recurrence than elliptical excision but provides superior cosmesis and patient satisfaction.

Genotoxic and cytotoxic effects of mobile phone use on the oral epithelium: a systematic review with meta-analysis.

The use of mobile phones is based on radiofrequency (RF) waves, and the devices act as transmitters and receivers of non-ionizing energy. The micronucleus test was developed to identify increases in the occurrence of mutations in cells exposed to various agents. This systematic review with meta-analysis adhered to the following protocol: defining the objective, outlining the search method (PICO model), conducting the search, identifying literature, selecting articles, and extracting data. The study aimed to answer the following research question: Does non-ionizing radiation emitted by mobile phones have genotoxic and/or cytotoxic effects on the oral epithelium? The search for evidence published 2009-2019 was conducted in the MEDLINE, PubMed, Scopus, LILACS, Google Scholar, PROSPERO, and Cochrane Library databases. The following inclusion criteria were defined: investigations of effects on the oral mucosa related to RF; investigations of cytotoxic and/or genotoxic effects; investigations involving humans; and investigations using cells exfoliated from the oral epithelium. Investigations related to the parotid gland were excluded. The search strategy found 464 articles; after application of the eligibility criteria, 358 abstracts were analyzed and 351 abstracts excluded. After 7 full texts were reviewed, 1 study was excluded. The 6 included studies were classified as level 5 quality of evidence (observational studies). The meta-analysis included 2 studies that compared the frequency of micronuclei on the side exposed to RF electromagnetic fields (RF-EMFs) to that on the unexposed side. The studies evaluated presented a low degree of evidence, but the meta- analysis indicated that no genotoxic effects are associated with mobile phone use. However, observations of other nuclear abnormalities in some studies suggest the occurrence of cytotoxic effects caused by exposure to the RF-EMFs emitted by mobile phones. More studies are necessary to prove or refute this association.

Intraoperative Awareness With Recall: A Descriptive, Survey-Based, Cohort Study.

BACKGROUND: Unintended intraoperative awareness with recall (AWR) is a potential complication of general anesthesia. Patients typically report recollections of (1) hearing sounds or conversations, (2) being unable to breathe or move, (3), feeling pain, and/or (4) experiencing emotional distress. The purpose of the current study was to identify and further characterize AWR experiences identified through postoperative surveys of a large unselected adult surgical cohort. METHODS: This is a substudy of a prospective registry study, which surveys patients on their health and well-being after surgery. Responses to 4 questions focusing on AWR were analyzed. Patients who reported AWR with pain, paralysis, and/or distress were contacted by telephone to obtain more information about their AWR experience. The interview results for patients who received general anesthesia were sent to 3 anesthesiologists, who adjudicated the reported AWR episodes. RESULTS: Of 48,151 surveys sent, 17,875 patient responses were received. Of these respondents, 622 reported a specific memory from the period between going to sleep and waking up from perceived general anesthesia and 282 of these reported related pain, paralysis, and/or distress. An attempt was made to contact these 282 patients, and 149 participated in a telephone survey. Among the 149 participants, 87 endorsed their prior report of AWR. However, only 22 of these patients had received general anesthesia, while 51 received only sedation and 14 received regional anesthesia. Three anesthesiologists independently adjudicated the survey results of the 22 general anesthesia cases and assigned 6 as definite AWR, 8 as possible AWR, and 8 as not AWR episodes. Of the 65 patients who confirmed their report of AWR after regional or sedation anesthesia, 37 (31 with sedation and 6 with regional anesthesia) had not expected to be conscious during surgery. CONCLUSIONS: The complication of AWR continues to occur during intended general anesthesia. Many reports of AWR episodes occur in patients receiving sedation or regional anesthesia and relate to incorrect expectations regarding anesthetic techniques and conscious experiences, representing a potential target for intervention.

Lower socioeconomic status is independently associated with shorter survival in Hodgkin Lymphoma patients-An analysis from the Brazilian Hodgkin Lymphoma Registry.

Socioeconomic status (SES) is a well-known determinant of outcomes in cancer. The purpose of this study was to analyze the impact of the SES on the outcomes of Hodgkin lymphoma (HL) patients from the Brazilian Prospective HL Registry. SES stratification was done using an individual asset/education-based household index. A total of 624 classical HL patients with diagnosis from January/2009 to December/2014, and treated with ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine), were analyzed. The median follow-up was 35.6 months, and 33% were classified as lower SES. The 3-year progression- free survival (PFS) in higher and lower SES were 78 and 64% (p < 0.0001), respectively. The 3-year overall survival (OS) in higher and lower SES were 94 and 82% (p < 0.0001), respectively. Lower SES patients were more likely to be ≥ 60 years (16 vs. 8%, p = 0.003), and to present higher risk International Prognostic score (IPS) (44 vs. 31%, p = 0.004) and advanced disease (71 vs. 58%, p = 0.003). After adjustments for potential confounders, lower SES remained independently associated with poorer survival (HR = 3.12 [1.86-5.22] for OS and HR = 1.66 [1.19-2.32] for PFS). The fatality ratio during treatment was 7.5 and 1.3% for lower and higher SES (p = 0.0001). Infections and treatment toxicity accounted for 81% of these deaths. SES is an independent factor associated with shorter survival in HL in Brazil. Potential underlying mechanisms associated with the impact of SES are delayed diagnosis and poorer education. Educational and socio-economic support interventions must be tested in this vulnerable population.

Treatment outcomes for Hodgkin lymphoma: First report from the Brazilian Prospective Registry.

Data about Hodgkin lymphoma (HL) in developing countries are scarce and suggest the existence of substantial disparities in healthcare and outcomes in large areas of the world. In 2009, a prospective registry of HL was implemented in Brazil. Web-based data were contributed by 20 institutions across the country participating in the Brazilian Prospective Hodgkin's Lymphoma Registry. The aim of this study was to present the clinical features and outcomes of newly diagnosed patients with HL aged 13 to 90 years. Multivariate Cox regression models were used to estimate progression-free (PFS) and overall survival (OS) by clinical factors. A total of 674 patients with classical HL were analysed, with a median follow-up of 37 months. Median age was 30 years (13-90). The median time from the onset of symptoms to diagnosis was 6 months (0-60). Only 6% of patients had early favourable disease, while 65% had advanced disease. Stage IVB was present in 26% and a high-risk International Prognostic Score in 38%. Doxorubicin, bleomycin, vinblastine, and dacarbazine was used in 93%. The median dose of radiotherapy was 36 Gy for localized disease and 32 Gy for advanced disease. The 3 year PFS in early favourable, early unfavourable, and advanced disease were 95%, 88%, and 66%, respectively. High-risk International Prognostic Score, advanced disease, and age greater than or equal to 60 were independently associated with poorer PFS and OS; performance status greater than or equal to 2 was also associated with a poorer OS. Poor-risk patients predominated. Radiation doses for localized disease appear higher than current recommendations. Outcomes appear inferior in developing countries than in developed countries. Delayed diagnosis is probably a major factor underlying these findings. Scattered reports from developing nations suggest that many aspects of standard care in developed countries remain unmet needs for populations living in developing countries. The present report contributes to this body of data, with a proper description of what is currently achieved in urban areas in Brazil.

Development of an Internet-based system to guide and telemonitor hearing aid users. / Desenvolvimento de sistema baseado na internet para orientação e telemonitoramento de usuários de prótese auditiva.

PURPOSE: To develop and verify the usability of an internet-based system for telemonitoring and guidance of the hearing aid user as well as monitoring the long-term performance in a pilot group. METHODS: The system "I can hear, but I can't understand" was developed based on recommendations in the literature regarding layout, design, and content for guidance and advice. Three stages were followed: planning, design and content development, and pilot testing. The sample consisted of 43 adults and older adults with any type and degree of hearing loss, who had been regularly using a hearing aid for at least 30 days and at most 24 months, with reading skills and no evidence of cognitive impairments. The individuals were followed up for 8 to 12 months. The users' performance was monitored with the Speech, Spatial and Qualities of Hearing Scale. The usability of this material was assessed with the System Usability Scale. RESULTS: Improved performance and increased self-reported daily use of the hearing aid were observed after the period of guidance and telemonitoring via the system for all research participants. In all analyzes of the SUS scale, it was possible to observe a performance superior to 70 points, demonstrating good usability of the system. In the analysis of the performance of the SSQ, in the three moments of the research, a positive response was observed in all domains, thus showing progress in the use of hearing aids, with significant data for the domain of Hearing Speech. CONCLUSION: The system "I can hear, but I can't understand" proved to be an easy-to-use and effective tool to telemonitor hearing aid users.

OBJETIVO: Desenvolver e verificar a usabilidade de um sistema baseado na internet para telemonitoramento e orientação do usuário de prótese auditiva bem como monitorar o desempenho de longo prazo em um grupo piloto. MÉTODO: O sistema Escuto, mas não entendo foi desenvolvido baseado em recomendações de literatura para layout, design e conteúdo de orientação e aconselhamento. Seguimos três etapas: planejamento, elaboração do design e conteúdo e teste piloto. A amostra foi formada por 43 adultos e idosos, com perda auditiva, de qualquer tipo e grau, uso regular de prótese auditiva de no mínimo 30 dias e no máximo 24 meses; com habilidade de leitura e sem evidências de comprometimentos cognitivos. Os indivíduos foram acompanhados por um período de oito a 12 meses. O desempenho dos usuários foi monitorado por meio do questionário Speech Spatial and Qualities of Hearing Scale. A usabilidade deste material foi avaliada com o questionário System Usability Scale. RESULTADOS: Foi observada melhora de desempenho e aumento de uso diário autorrelatado das próteses auditivas após o período de orientação e telemonitoramento via sistema para todos os participantes da pesquisa. Em todas as análises da escala SUS foi possível observar o desempenho superior a 70 pontos, demonstrando a boa usabilidade do sistema. Na análise do desempenho do SSQ, nos três momentos da pesquisa, observou-se resposta positiva em todos os domínios, mostrando assim uma evolução com o uso das próteses auditivas, com dados significantes para o domínio Audição para a fala. CONCLUSÃO: A usabilidade do sistema foi considerada adequada pelos indivíduos participantes do estudo.

Comparative evaluation of mutagenic effects of two cone-beam computed tomography in oral mucosa cells.

BACKGROUND: This pilot study aimed to evaluate the mutagenic effects in cells of the oral mucosa after exposure to two different cone beam computed tomography (CBCT). METHODS: Eighteen adults were submitted to the different CBCT (Carestream CS8100 3D and I-CAT). The cells were collected immediately before the CBCT exposure and 10 days later, when the material was placed on a slide and stained using the Feulgen/Fast Green technique. Microscopic analysis counted micronuclei and other nuclear alterations, which are indicative of cytotoxicity such as pyknosis, karyolysis, karyorrhexis, and binucletion. 2000 cells were analyzed. The statistical analysis was performed with the Wilcoxon Signed-Rank test to compare the frequency of cellular alterations, and the Mann-Whitney U test to compare different CBCTs, both with a significance level of 5%. RESULTS: There was no statistically significant difference in the micronucleated cell count before and after the exposition to the ionizing radiation from I-CAT (p = .298) and CS8100 3D (p = .203) A significate increase of pyknosis (p < .001), karyolysis (p < .001), karyorrhexis (p < .001), and binucletion (p < .001) were noted on I-CAT CBCT. There was no statistically significant difference in cellular alterations in CS8100 3D CBCT. CONCLUSION: Despite the increase in micronuclei after exposure, this study indicates that there is no evidence of genotoxicity. On the other hand, the I-CAT CBCT produced cytotoxic effects.

Validation of the Brazilian Portuguese version of the Medical Outcomes Study-Social Support Survey in Hodgkin's lymphoma survivors.

PURPOSE: The aim of this study was to assess the psychometric properties of the Brazilian Portuguese version of the "Medical Outcomes Study-Social Support Survey (MOS-SSS)" in Hodgkin's lymphoma (HL) survivors. METHODS: The MOS-SSS is a 19-item questionnaire with five scales covering different aspects of social support (affection, positive social interaction, emotional, informational, and material). A sample of 200 HL survivors completed a self-administered questionnaire at the treatment center or at home. RESULTS: The median age of the patients at diagnosis was 29 years (16­77), and the median follow-up since diagnosis was 7 years (3.6-12.7). Item-corrected Pearson correlation coefficients between items and their dimensions varied from 0.57 to 0.76. Internal consistency, evaluated using Cronbach's alpha, was 0.95 for the overall scale, ranging from 0.78 to 0.87 for the five subscales proposed by the original instrument. An exploratory factor analysis yielded a three-factor solution, aggregating affection and positive social interaction, and emotional and informational dimensions of social support. Higher socioeconomic status and higher social network were associated with higher levels of all kinds of support. CONCLUSION: Results show good general psychometric properties of the Brazilian version of the MOS-SSS when applied to HL survivors. The three-factor structure identified in this study is in line with a previous validation among Brazilian healthy civil servants. The Brazilian Portuguese version will now be used to evaluate social support and its association with long-term disease outcomes and quality of life of Hodgkin's lymphoma survivors.

Myeloproliferative Neoplasm Symptom Assessment Form - Total Symptom Score (MPN-SAF TSS) questionnaire: translation, cultural adaptation and validation to Brazilian Portuguese.

INTRODUCTION: Constitutional symptoms and thrombohemorrhagic events are common in patients with myeloproliferative neoplasms (MPNs). Hence, the treatment's primary goal is to control symptoms and improve the quality of life (QoL). In order to assess response to therapy, symptom burden, and QoL among patients with MPN, the "Myeloproliferative Neoplasm Symptom Assessment Form - Total Symptom Score (MPN-SAF TSS)" questionnaire was developed in the USA in 2012. Herein, we translated and validated the MPN-SAF TSS questionnaire to Brazilian Portuguese. METHODS: The ten-item questionnaire was translated from the English language and its psychometric properties (reliability, convergent and construct validities) were evaluated in 101 MPN patients. RESULTS: There were 41 patients with essential thrombocythemia, 39 with myelofibrosis and 21 with polycythemia vera. The median age of all patients at diagnosis was 68 years and 59% were female. The Cronbach's alpha coefficient for the overall questionnaire was 0.78, ranging from 0.73 to 0.79, if each item was deleted. Validity analyses showed that the strongest item-item correlation were between early satiety and abdominal discomfort. Strong correlations were also found between physician and patient perceptions of itching (r=0.81) and fatigue (r=0.70). The Pearson coefficient correlation between the MPN-SAF TSS global score and the EORTC QLQ-C30 functional scales ranged from 0.51 to 0.64. The exploratory factor analysis showed that seven of the ten symptoms loaded into one single factor. CONCLUSION: The Brazilian Portuguese version of the MPN-SAF-TSS showed good psychometric properties and can be an available tool to assess symptom burden in this group of patients.

Self-Perception of Hearing Difficulties and Quality of Life in Individuals with Hearing Loss.

OBJECTIVES: To characterize the results of the Short Form Health Survey-36 (SF-36), Abbreviated Profile of Hearing Aid Benefit (APHAB), and the Hearing Handicap Inventory for Adults (HHIA) questionnaires in individuals with mild to moderate sensorineural hearing loss and compare them with brainstem auditory evoked potentials (BAEPs). METHODS: There were 26 individuals with mild to moderate bilateral symmetrical sensorineural hearing loss who participated in the study. They were aged between 13 and 59 years old, right-hand preference, of both sexes, and were assigned to one of two groups according to the result of a BAEP test: normal (n = 16) or altered (n = 10). All subjects underwent a brief, cognitive screening battery and answered the SF-36, APHAB, and HHIA self-assessment questionnaires. For analysis of results, descriptive measures and inferential analysis were used. RESULTS: On the SF-36 questionnaire, scores below 80 points were found in both groups, signifying minimal impact in the domains of pain, general health, vitality, and mental health compared to the other domains. The results of the APHAB questionnaire showed worse scores on the environmental noise subscale, and evaluation with the HHIA revealed a perception of severe restriction in participation in daily life activities. In a comparison between the groups, normal or abnormal BAEPs, no significant differences were found for any of the questionnaires. CONCLUSIONS: The results of the self-assessment questionnaires indicate that individuals with hearing loss can experience reduced quality of life, with limitations and restrictions for participation in daily living. The use of BAEPs as a criterion for dividing the groups was not effective in isolating the central component in the results of the self-assessment questionnaires.

Detection and Quantification of the Hypersensitive Response Cell Death in Arabidopsis thaliana.

In plants, the hypersensitive response (HR) is a programmed cell death modality that occurs upon recognition of harmful non-self. It occurs at the site of pathogen infection, thus preventing pathogens to live off plant tissue and proliferate. Shedding light on the molecular constituents underlying this process requires robust and quantitative methods that can determine whether plants lacking functional genes are defective in HR execution compared to wild-type controls. In this chapter, we provide two quantitative protocols in which we measure cell death from Arabidopsis thaliana leaves infected with avirulent HR-causing bacterial strains. Firstly, we use trypan blue staining to quantify the stained area of leaves upon bacterial infection using a personalized macro in the Image J (Fiji) software. Alternately, we incorporate an electrolyte leakage protocol in order to measure HR caused by different avirulent bacterial strains at different bacterial titers. We encourage users to perform a combination of both methods when assessing HR in different plant genotypes.

The Impact of COVID-19 on Dual-Physician Couples: A Disproportionate Burden on Women Physicians.

Background: Currently, physicians face an unprecedented crisis with the novel coronavirus disease 2019 (COVID-19) pandemic. The impact of the pandemic on dual-physician households remains unknown. In this survey study, we examined the impact of the COVID-19 pandemic on dual-physician families and described gendered differences related to the impact of the pandemic. Methods: This was a cross-sectional survey distributed via e-mail and social media, with results collected from April 30, 2020 until May 26, 2020. Respondents were members of a dual-physician couple. Respondents provided information on demographic characteristics and the impact of the pandemic on their professional lives, personal lives, and well-being. Categorical variables were compared using chi-squared or Fisher's exact test. Ordinal variables were compared between genders using Cochran-Armitage trend test. Feeling emotionally and physically drained compared to pre-pandemic was analyzed as a binary outcome in a multivariable logistic model. Results: Of the 1799 physicians who completed the survey, 52% were between 30 and 39 years old, 81% self-identified as women, and 62% were white. Women were more likely to report increased worry about their job security, finances, personal health, partner's health, and children's health (p = 0.02, p = 0.01, p < 0.001, p < 0.001, and p < 0.001, respectively). Seventy-eight percent of respondents reported feeling more drained during the pandemic. Multivariable analysis revealed that female gender (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.7-3.3, p < 0.001), and having children younger than 5 years of age (OR 1.43, 95% CI 1.05-1.95, p = 0.02) were associated with an increased risk of feeling more drained. Conclusions: Women were more likely to report increased worry about job security, finances, and health and had an increased risk of feeling more drained during the pandemic. While the COVID-19 pandemic is a significant stress for all physicians, women in dual-physician families were disproportionately affected, demonstrating the need for increased support from hospital administrations.

Death and Myocardial Infarction Following Initial Revascularization Versus Optimal Medical Therapy in Chronic Coronary Syndromes With Myocardial Ischemia: A Systematic Review and Meta-Analysis of Contemporary Randomized Controlled Trials.

Background In chronic coronary syndromes, myocardial ischemia is associated with a greater risk of death and nonfatal myocardial infarction (MI). We sought to compare the effect of initial revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) plus optimal medical therapy (OMT) with OMT alone in patients with chronic coronary syndrome and myocardial ischemia on long-term death and nonfatal MI. Methods and Results Ovid Medline, Embase, Scopus, and Cochrane Library databases were searched for randomized controlled trials of PCI or CABG plus OMT versus OMT alone for patients with chronic coronary syndromes. Studies were screened and data were extracted independently by 2 authors. Random-effects models were used to generate pooled treatment effects. The search yielded 7 randomized controlled trials that randomized 10 797 patients. Median follow-up was 5 years. Death occurred in 640 of the 5413 patients (11.8%) randomized to revascularization and in 647 of the 5384 patients (12%) randomized to OMT (odds ratio [OR], 0.97; 95% CI, 0.86-1.09; P=0.60). Nonfatal MI was reported in 554 of 5413 patients (10.2%) in the revascularization arms compared with 627 of 5384 patients (11.6%) in the OMT arms (OR, 0.75; 95% CI, 0.57-0.99; P=0.04). In subgroup analysis, nonfatal MI was significantly reduced by CABG (OR, 0.35; 95% CI, 0.21-0.59; P<0.001) but was not reduced by PCI (OR, 0.92; 95% CI, 0.75-1.13; P=0.43) (P-interaction <0.001). Conclusions In patients with chronic coronary syndromes and myocardial ischemia, initial revascularization with PCI or CABG plus OMT did not reduce long-term mortality compared with OMT alone. CABG plus OMT reduced nonfatal MI compared with OMT alone, whereas PCI did not.

Therapist-oriented home rehabilitation for adults with sickle cell anemia: effects on muscle strength, functional capacity, and quality of life.

OBJECTIVES: Considering the advances in functional rehabilitation in recent decades, therapist-oriented home rehabilitation (TOHR) has been increasingly used in the field of physical therapy because it increases patient compliance and reduces health system costs. The objective of this study was to investigate the effects of TOHR on functional capacity, muscle strength, and quality of life (QoL) in adults with sickle cell anemia (SCA). METHODS: Forty adults with SCA underwent manually guided TOHR for 12 weeks. Before and at the end of training, the following variables were assessed in the participants: distance covered in the 6-min walk test (6MWD); maximal inspiratory pressure (MIP); maximal expiratory pressure (MEP); handgrip strength (HGS); quadriceps strength (QS); and QoL using the Short Form-36 physical component summary (SF-36PCS) and the Short Form-36 mental component summary (SF-36MCS). RESULTS: After TOHR, significant increases were observed in the mean values for the 6MWD, MIP, MEP, HGS, QS, and SF-36PCS and SF-36MCS scores. The relative delta between the pre- and post-TOHR 6MWDs correlated significantly with the relative deltas of MIP (rs = 0.640, p < 0.0001), MEP (rs = 0.587, p < 0.0001), HGS (rs = 0.360, p = 0.022), and QS (rs = 0.351, p = 0.026). When the participants were separated according to their use of hydroxyurea, significant increases were observed in the relative deltas of the 6MWD, MIP and MEP values. CONCLUSIONS: This study shows that TOHR can potentially increase functional capacity, muscle strength, and QoL in adults with SCA. Furthermore, there appears to be a relationship between 6MWD gains and muscle strength gains with TOHR.Trial registration: ClinicalTrials.gov identifier: NCT04705792.

Bone morphogenetic protein-2/4 and bone morphogenetic protein receptor type IA expression in metastatic and nonmetastatic oral squamous cell carcinoma.

PURPOSE: The study aimed to analyze the expression of bone morphogenetic protein-2/4 (BMP-2/4) and its receptor BMPR-IA (BMP receptor type IA) in metastatic and nonmetastatic oral squamous cell carcinoma (OSCC) and its implications for disease prognosis. MATERIALS AND METHODS: The experimental group included 16 cases of OSCC without metastasis and 7 cases of OSCC with metastasis. The presence or absence of nodal metastasis was used as a parameter for the evaluation of disease prognosis. Ten cases of oral fibroepithelial hyperplasia were selected as the control group. The expression of BMP-2/4 and BMPR-IA was analyzed by immunohistochemistry. RESULTS: In the experimental group with metastasis, strong expression of BMP-2/4 was observed in most cases (71.4%), whereas BMPR-IA exhibited weak expression (85.7%). In the experimental group without metastasis, there was strong expression of BMP-2/4 (62.5%) and BMPR-IA (100%). A significant association was observed between the prognosis of OSCC and the intensity of BMP-2/4 staining (P = .002). Weak immunoreactivity to BMP-2/4 and BMPR-IA was observed in all control specimens. CONCLUSIONS: The results suggest that strong expression of BMP-2/4, associated with low expression of BMPR-IA, observed in metastatic OSCC has a prognostic value, with the loss of responsiveness to BMPs through the loss of expression of their receptors being indicative of the development of metastasis.

Diaphragm ultrasonography in adults with sickle cell anemia: evaluation of morphological and functional aspects.

OBJECTIVES: To assess morphological and functional aspects of the diaphragm by ultrasonography (US) in adults with sickle cell anemia (SCA) and evaluate if the diaphragmatic musculature can play a role in changes found in pulmonary function tests (PFTs) of these patients. METHODS: This is a cross-sectional observational and single-center study involving 40 adults with SCA who underwent diaphragm US and PFTs with a maximum of 1 month between the two tests. Diaphragm US was performed in B and M modes, and echogenicity, thickness and movement of the muscle was assessed in different respiratory maneuvers. RESULTS: Diaphragms had preserved echogenicity and the thickness was not significantly different between the groups. The SCA group exhibited significantly higher movement of the right hemidiaphragm during deep breathing (p = 0.004) and the sniff test (p = 0.0008) and lower movement of the left hemidiaphragm during quiet breathing (p = 0.009). There was a predominance of restrictive pattern (65%) and a global reduction in respiratory muscle strength (RMS) (70%). CONCLUSIONS: This study shows that adults with SCA had normal morphostructural aspects and absence of diaphragm dysfunction. Otherwise, they presented greater movement of the right hemidiaphragm during deep breathing and sniff test maneuvers. Despite the restrictive pattern and the reduction in RMS found in PFTs, the diaphragm of young adults with SCA did not have weakness or paralysis.

Desenvolvimento de sistema baseado na internet para orientação e telemonitoramento de usuários de prótese auditiva / Development of an Internet-based system to guide and telemonitor hearing aid users

RESUMO Objetivo Desenvolver e verificar a usabilidade de um sistema baseado na internet para telemonitoramento e orientação do usuário de prótese auditiva bem como monitorar o desempenho de longo prazo em um grupo piloto. Método O sistema Escuto, mas não entendo foi desenvolvido baseado em recomendações de literatura para layout, design e conteúdo de orientação e aconselhamento. Seguimos três etapas: planejamento, elaboração do design e conteúdo e teste piloto. A amostra foi formada por 43 adultos e idosos, com perda auditiva, de qualquer tipo e grau, uso regular de prótese auditiva de no mínimo 30 dias e no máximo 24 meses; com habilidade de leitura e sem evidências de comprometimentos cognitivos. Os indivíduos foram acompanhados por um período de oito a 12 meses. O desempenho dos usuários foi monitorado por meio do questionário Speech Spatial and Qualities of Hearing Scale. A usabilidade deste material foi avaliada com o questionário System Usability Scale. Resultados Foi observada melhora de desempenho e aumento de uso diário autorrelatado das próteses auditivas após o período de orientação e telemonitoramento via sistema para todos os participantes da pesquisa. Em todas as análises da escala SUS foi possível observar o desempenho superior a 70 pontos, demonstrando a boa usabilidade do sistema. Na análise do desempenho do SSQ, nos três momentos da pesquisa, observou-se resposta positiva em todos os domínios, mostrando assim uma evolução com o uso das próteses auditivas, com dados significantes para o domínio Audição para a fala. Conclusão A usabilidade do sistema foi considerada adequada pelos indivíduos participantes do estudo.

ABSTRACT Purpose To develop and verify the usability of an internet-based system for telemonitoring and guidance of the hearing aid user as well as monitoring the long-term performance in a pilot group. Methods The system "I can hear, but I can't understand" was developed based on recommendations in the literature regarding layout, design, and content for guidance and advice. Three stages were followed: planning, design and content development, and pilot testing. The sample consisted of 43 adults and older adults with any type and degree of hearing loss, who had been regularly using a hearing aid for at least 30 days and at most 24 months, with reading skills and no evidence of cognitive impairments. The individuals were followed up for 8 to 12 months. The users' performance was monitored with the Speech, Spatial and Qualities of Hearing Scale. The usability of this material was assessed with the System Usability Scale. Results Improved performance and increased self-reported daily use of the hearing aid were observed after the period of guidance and telemonitoring via the system for all research participants. In all analyzes of the SUS scale, it was possible to observe a performance superior to 70 points, demonstrating good usability of the system. In the analysis of the performance of the SSQ, in the three moments of the research, a positive response was observed in all domains, thus showing progress in the use of hearing aids, with significant data for the domain of Hearing Speech. Conclusion The system "I can hear, but I can't understand" proved to be an easy-to-use and effective tool to telemonitor hearing aid users.