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Vacuum-assisted biopsy in the era of low-risk ductal carcinoma in situ active monitoring: real world data and implications
(2025) Couto, Henrique Lima; Neves, Carolina Nazareth Valadares; Soares, Aleida Nazareth; Ricardo, Bernardo Ferreira de Paula; Toppa, Paola Hartung; Coelho, Bertha Andrade; Pessoa, Eduardo Carvalho; Resende, Vivian; Oliveira, Tereza Cristina Ferreira de; Mattar, Andre; Amorim, Andressa Gonçalves; Clarke, Paula; Freitas Junior, Ruffo de; Rahal, Rosemar Macedo Sousa
Background: The short-term oncological safe of active monitoring for ductal carcinoma in situ (DCIS) with low risk (LR-DCIS) of progression to invasive cancers (IC) has been demonstrated. This study evaluates vacuum assisted biopsy (VAB) as diagnostic test for LR-DCIS active monitoring (AM) in real-world clinical practice.Methods: Database analysis of 116 cancers [both invasive breast cancers (IC) and ductal carcinoma in situ (DCIS)] diagnosed by VAB submitted to standard surgical treatment with complete histological data from VAB and surgery from 04/13/2017 to 11/28/2020. The VAB results matched the surgical pathology, considered the gold standard, and AM criteria. The pathological diagnoses were grouped into malignancies requiring guideline surgical treatment [DCIS with high risk (HR-DCIS) of progression to IC or IC] versus those eligible to alternative AM (LR-DCIS). HR-DCIS/IC were considered positive while LR-DCIS negative results. VAB sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were obtained.Results: Mean age 55.6 [± 12.27]; mean IC size 7.14 [± 5.17]mm and 12.6 [± 11.63]mm for DCIS. Out of 116 malignancies diagnosed by VAB, 15 (12.9%) resulted LR-DCIS in the biopsy, 10 (8.6%) confirmed LR-DCIS in surgery, and 5 (4.3%) upgraded to HR-DCIS/IC in surgery. VAB showed 95.28% (89.3–98.5; 95% CI) sensitivity, 100% (69.2–100; 95% CI) specificity, PPV was 100% (96.4–100; 95% CI), and NPV 66.67% (38.4–88.2; 95% CI). VAB LR-DCIS AM was 6.9% (8/116) and underdiagnoses 2.6% (2 pT1a-bN0 hormone receptor positive and 1 HR-DCIS).Conclusion: VAB LR-DCIS AM would lead to a moderate (6.9%) overall reduction of short-term breast cancer surgical overtreatment counterbalanced by a low rate (2.6%) of underdiagnosed HR-DCIS/IC potentially treatable by adjuvant hormone therapy.
COVID-19 case fatality ratio and survival among hospitalized adults in Goiás, 2020: a cohort study
(2025) Borges, Moara Alves Santa Bárbara; Zara, Ana Laura de Sene Amâncio; Tomich, Lísia Gomes Martins de Moura; Guilarde, Adriana Oliveira; Oliveira, Cacilda Pedrosa de; Carvajal, Deborah Lopes Mota; Pedrosa, Marina Mascarenhas Roriz; Costa, Paulo Sérgio Sucasas da; Turchi, Marília Dalva
Objective: To describe clinical-epidemiological and therapeutic aspects and to estimate case fatality ratio and risk factors for lower in-hospital survival due to COVID-19. Methods: This is a retrospective cohort study conducted in the state of Goiás, Brazil, in 2020, with data obtained from the Influenza Epidemiological Surveillance Information System and through a review of clinical records and hospital. Relative risk for in-hospital death was estimated and Poisson multiple regression and Cox regression analyses were performed. Survival functions were compared using the log-rank test and represented by Kaplan-Meier curves. Results: The sample consisted of 651 adults, whose median age was 59 years, 57.0% were admitted to public hospitals, 61.1% had severe acute respiratory syndrome on admission and 72.0% had at least one comorbidity, the most frequent being hypertension , diabetes and obesity. The overall case fatality ratio was 17.5% (95% confidence interval, 95%CI 14.7; 20.6), with no significant difference between public and private hospitals. The case fatality ratio was higher in the ≥60 years age group (prevalence ratio, PR 1.26; 95%CI 1.01; 1.58), in hypertensive patients (PR 1.41; 95%CI 1.14; 1 .74) and in those undergoing intensive care (PR 2.68; 95%CI 1.13; 6.32) and mechanical ventilation (PR 11.15; 95%CI 5.53; 22.46). The median time between hospital admission and death was 10 days (interquartile range, 6-18). Survival was lower in the ≥60 years age group (adjusted hazard ratio, HR 1.93; 95%CI 1.26; 2.95) and in those undergoing mechanical ventilation (HR 10.13; 95%CI 6.03; 17. 02). Conclusion: Factors related to comorbidities and severity were independent predictors of shorter in-hospital survival among patients with COVID-19.
Electrocardiographic left ventricular mass trajectories and the effects of treatment in patients at different stages of hypertension
(2025) Fuchs, Flavio Danni; Valter, Leonardo Krause; Tavares, Arthur Lacerda; Camilo, Beatriz Padoin; Whelton, Paul Kieran; Scala, Luiz Cesar Nazario; Martin, Jose Fernando Vilela; Figueiredo, Carlos Eduardo Poli de; Silva, Ricardo Pereira; Gus, Miguel; Jardim, Paulo Cesar Brandão Veiga
Background: The comparison of left ventricular mass (LVM) at different BP levels and the effects of antihypertensive drug treatment on LVM are unknown. Objective: To compare the LVM of individuals with prehypertension and Stage 1 hypertension and assess the effects of treatment on LVM at these stages of hypertension. Methods: We estimated LVM in the PREVER-Prevention trial using Sokolow–Lyon and Cornell voltage and voltage–duration products before and after randomization to 18 months of treatment with low doses of chlorthalidone and amiloride or placebo in adults with JNC 7 “prehypertension” (systolic BP [SBP] of 120–139 mm Hg and diastolic BP [DBP] of 80–89 mm Hg). Similarly, in the PREVER-Treatment trial, we assessed these indices before and after randomization to 18 months of treatment with the chlorthalidone/amiloride combination or losartan in adults with JNC 7 “stage 1” hypertension (140–159 mm Hg or DBP of 90–99 mm Hg). Results: At baseline, the participants in the stage I hypertension trial exhibited higher mean LVM indices than those in the prehypertension trial. In the PREVER-Prevention trial, those randomized to the chlorthalidone/amiloride combination experienced a significant reduction in Sokolow–Lyon LVM indices compared to placebo (p = 0.02). In the PREVERTreatment trial, those randomized to the chlorthalidone/amiloride combination or losartan experienced a similar reduction in electrocardiographic LVM during the 18 months of treatment (p < 0.01). Conclusions: The institution of low-dose antihypertensive drug therapy in prehypertension and treatment of patients with stage 1 hypertension has the potential to interrupt the progress of hypertensive cardiomyopathy.
Comparação dos valores de pressão arterial e dos medicamentos anti-hipertensivos utilizados por brasileiros não afrodescendentes e afrodescendentes com hipertensão
(2025) Euzébio, Maicon Borges; Vitorino, Priscila Valverde de Oliveira; Brandão, Andréa Araujo; Barbosa, Eduardo Costa Duarte; Amodeo, Celso; Feitosa, Audes Diógenes de Magalhães; Malachias, Marcus Vinicius Bolivar; Gomes, Marco Antônio Mota; Povoa, Rui Manuel dos Santos; Lopes, Renato Delascio; Jardim, Paulo Cesar Brandão Veiga
Background: The prevalence of hypertension (HTN) is high in ethnic communities, particularly among Afro-descendant adults in the United States. Moreover, there is a lack of studies addressing this issue in the Brazilian Afro-descendant population. Objective: To analyze blood pressure control and the use of antihypertensive medications among Afro-descendant and non-Afro-descendant Brazilians. Methods: This cross-sectional study evaluated data from the First Brazilian Registry of Hypertension, which included individuals over 18 years of age, self-identified as Afro-descendant or non-Afro-descendant, with HTN for at least four weeks or using antihypertensive medication. Comparisons were performed using t-tests or the Mann-Whitney test. A significance level of p < 0.05 was adopted. Results: A total of 2,643 participants were included, of whom 82.8% were non–Afro-descendant and 17.1% were Afro-descendant. The rates of uncontrolled HTN were 44.68% among non–Afro-descendants and 54.64% among Afro-descendants. Median values of systolic blood pressure (SBP), diastolic blood pressure (DBP), and body mass index (BMI) were higher in Afro-descendants compared to non–Afro-descendants (p < .001). The distribution of antihypertensive medication classes varied between the populations. No significant differences in HTN control were observed between beta-blocker users in the Afro-descendant and non–Afro-descendant groups, even when stratified by sex. Conclusion: The Afro-descendant population in Brazil demonstrated a higher prevalence of uncontrolled HTN and higher SBP, DBP, and BMI values compared to the non–Afro-descendant population. The choice of antihypertensive medications differed between groups, with thiazides more commonly prescribed for Afro-descendants and ARBs for non–Afro-descendants. However, no significant differences in blood pressure control were observed between groups using beta-blockers, regardless of sex.
Effects of eye closure on the spiking activity of human lateral geniculate neurons
(2025) Self, Matthew W.; Garcia Filho, Osvaldo Vilela; Neuenschwander, Sergio; Silva Filho, Helio Fernandes da; Goulart, Lissa Carrilho; Roelfsema, Pieter Roelf
The lateral geniculate nucleus (LGN) of the thalamus is a key link between the retina and visual cortex but our understanding of the properties of neurons in the human LGN is based on recordings in animal models. Here we recorded spiking activity of cells in the LGN of two patients who had electrodes implanted in the LGN as part of their treatment for epilepsy. Human LGN cells responded to strong visual stimulation with high-frequency bursts of spikes. The cells had receptive-field properties resembling those of monkeys with circular ON-OFF sub-fields, red-green opponency in the dorsal layers and preferences for high temporal frequencies in the ventral layers. Responses were largelymonocular and the closure of one eye decreased the spontaneous activity of broad-spiking neurons preferring this eye while increasing the activity of neurons with narrower spikes, suggesting that interneurons might gate LGN activity during eye closure.
A rare presentation of terminal myelocystocele associated with cervical dermal sinus tract: case report and literature review
(2026) Lino Filho, Adriano Martins; Amorim, Jonas Borges Santos; Morais, Bárbara Albuquerque; Paranhos, Matheus Carneiro; Campos, Fillipe Thiago Xavier de; Faria, Viviane Ribeiro; Ribeiro, Paulo Ronaldo Jubé; Garcia Filho, Osvaldo Vilela
Purpose Terminal myelocystocele (TMC) and dermal sinus tract (DST) are uncommon forms of skin-covered spinal dysraphism, each arising from distinct embryological mechanisms. The objective of this report is to present, for the first time in the literature to our knowledge, the clinical features, diagnostic evaluation, surgical management, and detailed imaging description of this uncommon association. Case presentation We present the case of a female neonate with concomitant TMC and DST. Magnetic resonance imaging demonstrated a trumpet-shaped TMC associated with sacral osseous dysraphism and a DST extending from C7–T1 to the skin surface. Both malformations were surgically treated in a single session. The malformed distal neural tissue of the TMC was resected, and the DST was excised completely. Postoperatively, the patient developed a transient lumbar cerebrospinal fluid leak, which resolved with conservative management, and she remained neurologically intact at discharge. Histopathology confirmed malformed neural proliferation in the TMC and squamous-lined tract tissue in the DST. Discussion From an embryological perspective, the dual occurrence of TMC and DST highlights that neural tube formation can be disrupted at different stages of development in the same individual. Timely diagnosis and surgical management are critical to prevent complications. Addressing both anomalies in a single operative setting proved feasible and yielded a favorable short-term outcome. Further studies are needed to elucidate the intricate mechanisms involved.
Comparison of neuropsychological side effects between contemporary radiofrequency ablative neurosurgery for psychiatric disorders and conventional neurosurgical procedures: systematic review and meta-analysis
(2026) Bannach, Osvaldo Vilela; Bannach, Matheus de Andrade; Lino Filho, Adriano Martins; Hamani, Clement; Nuttin, Bart; Hariz, Marwan I.; Schulder, Michael; Greenberg, Benjamin David; Cosgrove, Garth Rees; Souza, Ricardo de Oliveira
Background Psychiatric disorders are increasingly contributing to global disability. Despite advances in conservative management, the prevalence of treatment-resistant cases remains high. Meanwhile, neurosurgery for psychiatric disorders (NPD) remains underused, largely due to strict regulations and historical concerns, particularly those related to neuropsychological side effects (NPSE). Objective To address this issue, we conducted a systematic review with meta-analysis to compare NPSE associated with radiofrequency ablative NPD to those observed in neuro-oncological, neurovascular and epilepsy surgeries. Methods PubMed, Embase and LILACS databases were searched in April 2024 for articles published in English/Spanish from 1990 to 2022, following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Results A total of 48 articles with 2678 participants were included. The frequency of transient and permanent NPSE in the NPD group ranged from 0.94% to 11.50% and 0.94% to 2.03%, respectively, comparable to the other surgical groups (epilepsy: 0.31–11.70%; vascular: 0.52–22.90%; oncology: 0.94–17.60% for transient NPSE; epilepsy: 0.31–12%; vascular: 0.40– 1.96% and oncology: 0.84–1.48% for permanent NPSE). Regarding permanent NPSE, arguably the most critical consideration, the NPD group showed better outcomes in memory, language and social cognition than the epilepsy group, but worse outcomes in executive and perceptual-motor functions. Compared with the vascular group, the NPD group had better executive function but worse complex attention. Finally, the NPD group had fewer permanent deficits than the oncology group in executive function, complex attention and perceptual-motor domains, although language performance was lower. Conclusions Contemporary NPD apparently carries a similar risk of NPSE as other conventional neurosurgical procedures, challenging misconceptions and this unjustified barrier to its broader use.
Risk factors and clinical outcomes of post-extubation stridor in pediatric intensive care
(2025) Fonseca, Jakeline Godinho; Cunha, Cristiane Fernandes de Moura; Rézio, Geovana Sôffa; Silva, Laís Aparecida da; Deus, Mayara Moreira de; Rodrigues, Amanda Elis; Caixeta, Juliana Alves de Sousa; Ferri, Luiza Avelino; Ferri, Melissa Ameloti Gomes Avelino
Objectives: To assess risk factors for post-extubation stridor in children and its impact on clinical outcomes. Methods: Prospective cohort study with children aged from 0 to 13 years who were intubated or underwent orotracheal intubation in the pediatric intensive care units (PICU) of two tertiary public hospitals. The outcome of interest was the occurrence of post-extubation stridor. The information collected included patient characteristics, comorbidities, history of airway manipulation, and factors related to orotracheal intubation. A logistic regression was used to identify potential risk factors for post-extubation stridor; data were analyzed until hospital discharge, death, or referral to another facility. Results: A total of 239 children were included, with a median age of 1.3 years and a duration of intubation of three days. Post-extubation stridor was observed in 57.3% of children. A multivariate analysis included prehospital or non-specialized hospital intubation, trauma or complications during intubation, and orotracheal intubation longer than seven days as risk factors for stridor. Children with stridor had a longer PICU length of stay, longer duration of invasive mechanical ventilation, and were often managed with non-invasive ventilation (p < 0.05). Most children with extubation failure (p = 0.001) and cardiorespiratory arrest (p = 0.03) presented with stridor. Conclusions: Risk factors for post-extubation stridor included intubation performed in prehospital or non-specialized hospitals, orotracheal intubation longer than seven days, and trauma or complications during intubation. Children with stridor had a worse prognosis, with longer stays in the PICU and on mechanical ventilation and higher rates of extubation failure.
Brazilian Academy of Paediatric Otorhinolaryngology Task Force - lingual frenulum disorders in childhood - evidence-based recommendations
(2026) Caixeta, Juliana Alves de Sousa; Pazinatto, Débora Bressan; Padoin, Rita Carolina Pozzer Krumenauer; Lubianca Neto, José Faibes; Ferri, Melissa Ameloti Gomes Avelino; Chen, Vitor Guo; Vassoler, Tríssia Maria Farah; Castellano, Leticia Teixeira; Pirana, Sulene
Objective: To provide evidence-based recommendations for the diagnosis, assessment of functional impact, and management of altered lingual frenulum in children. Methods: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on ankyloglossia, or lingual frenotomy were eligible for inclusion. The American College of Physicians’ guideline grading system was used for critical appraisal of evidence and recommendations for therapeutic interventions. Results: There are several methods described in the literature for the evaluation of the lingual frenulum, and most of them lack internal or external validation. There are no data supporting a relationship between altered lingual frenulum and dysphagia, orofacial alterations, malocclusion, social limitations, obstructive sleep apnoea, or gastroesophageal reflux. According to the studies, an altered lingual frenulum does not cause speech delay; however, some studies with very low levels of evidence show that an altered lingual frenulum may make the pronunciation of some phonemes more difficult. In children with an altered lingual frenulum, lingual frenotomy may reduce maternal pain during breastfeeding. Therefore, in children with an altered lingual frenulum, lingual frenotomy may be a good therapeutic option when there is a complaint of pain during breastfeeding. There are several surgical techniques described in the literature for the release of the lingual frenulum, as well as different instruments that can be used for this purpose. There is no scientific evidence that one method is superior to another. Conclusion: Lingual frenectomy may improve maternal pain during breastfeeding and may be an option in selected cases of phonetic alterations.
Computed tomography imaging features of major pulmonary and extrapulmonary complications of fibrotic lung diseases
(2026) Torres, Pedro Paulo Teixeira e Silva; Amaral, Paula Terra Martins Almeida; Hummel, Alan Diniz; Fonseca, Eduardo Kaiser Ururahy Nunes; Chate, Rodrigo Caruso; Szarf, Gilberto; Velasco, Flávia Castro; Escuissato, Dante Luiz; Rabahi, Marcelo Fouad; Marchiori, Edson dos Santos
Patients diagnosed with fibrosing interstitial lung disease are at risk of several complications, some of which may be life-threatening. Computed tomography imaging plays an important role in diagnosing these overlapping conditions. This article summarizes the computed tomography imaging features of the most common conditions associated with fibrosing interstitial lung diseases, categorized by involvement of the lung parenchyma or extra-pulmonary compartments. Some steps may help to recognize such complications, such as having knowledge of the underlying fibrotic lung disease, being aware of potentially immunosuppressive treatments in use, noting new relevant symptoms, checking previous imaging examinations to detect subtle changes, and considering the exam technique, for example, to avoid false perception of ground-glass opacities in exams with insufficient inspiration. Unenhanced computed tomography may be enough to diagnose most situations, but in specific cases, for example, in the clinical suspicion of pulmonary embolism, dedicated computed tomography angiography may be warranted. Careful comparison with previous exams is advised, especially to detect subtle opacities suspicious for lung cancer, underscoring that its detection may be difficult owing to the baseline morphological lung changes. Radiologists must be aware of such possible complications to perform early diagnosis and ensure proper management.
Effects of Bacillus Calmette Guérin (BCG Moscow) vaccination on white blood cell count: results of a randomized clinical trial
(2025) Cardoso, Amanda da Rocha Oliveira; Conte, Marcus Barreto; Anjos, Laura Raniere Borges dos; Kipnis, Ana Paula Junqueira; Rabahi, Marcelo Fouad
Introduction: Bacillus Calmette-Guérin (BCG) vaccination induces innate and specific responses that protect against some severe forms of tuberculosis and have nonspecific effects against other infections. Objective: To evaluate whether revaccination with BCG Moscow is associated with serum increase in total and differential leukocytes. Methods: We conducted an analytical study on the white blood cell count of 156 participants (BCG revaccination group: 80; Control group: 76) of a randomized clinical trial investigating BCG revaccination for the prevention or reduction of complications associated with COVID-19. Blood samples were collected before randomization and after 15 days of intervention. Values were expressed as mean (μ) and standard deviation, using paired t-tests and Student’s t-test. Results: BCG revaccination did not alter leukocyte levels between revaccinated (μ, 6019.74±1865.33) and non revaccinated groups (μ, 6278.75±1823.87), p=0.94. Stratification by sex, obesity, and age did not significantly affect white blood cell levels. Conclusion: Revaccination with BCG Moscow did not stimulate leukocyte production.
Influence of teaching a structured and humanizedmethodofcareontheperception of medical student attitudes in the doctor patient relationship
(2025) Cardoso, Hígor Chagas; Pereira, Edna Regina Silva; Soares, Viviane; Rabahi, Marcelo Fouad
Introduction Thehumanization of care can be defined, in a generic way, as the act of making an empa thetic and respectful approach to patients. This study proposed to evaluate the perception of attitudes of medical students regarding the doctor-patient relationship, after implementation of teaching a humanized and structured care method. Materials and methods Single-blind, randomized controlled experimental study that evaluated medical students in relation to patient care, based on a pre-post design, using the Patient-Practitioner Orienta tion Scale (PPOS). This scale has been validated to assess patient-centered attitudes, as the prime outcome measure. The intervention, with a group of randomized students, included teaching the structured and humanized method of patient care, denominated the SEAGULL(Subjective, Exams, Analysis, Goal, Ultimate Action), and was carried out at the university outpatient clinic. Results Fifty-nine medical students participated in the study, with a mean age of 21.3 years (SD = 2.8) and a higher prevalence of female students (71.2%). The increase in the final scores wasgreater in the intervention group (p = 0.025) when comparing means of the total PPOS scores. The intervention group presented a larger effect size and higher mean scores (d = 0.49, Δ =+0.38, p<0.001) than the control group (d = 0.21, Δ = + 0.10, p = 0.004). It is note worthy that the analysis of the initial and final means of the PPOS scores of the sharing domain revealed larger effect sizes in the intervention group compared to the control group (Δ =+0.42, d=0.63; p<0.001). Discussion andconclusion Thefindings showed that training in the use of the SEAGULL structured method led to a sig nificant increase in PPOS scores related to the humanization of care by these students, with emphasis on the domain ofsharing information, power, and responsibility with patients.
Nerandomilast in patients with idiopathic pulmonary fibrosis
(2025) Richeldi, Luca; Arata, Azuma; Cottin, Vincent; Kreuter, Michael; Maher, Toby Michael; Martinez, Fernando J.; Oldham, Justin M.; Valenzuela, Claudia; Clerisme-Beaty, Emmanuelle; Gordat, Maud; Rabahi, Marcelo Fouad
Background Nerandomilast (BI 1015550) is an orally administered preferential inhibitor of phosphodiesterase 4B with antifibrotic and immunomodulatory effects. In a phase 2 trial involving patients with idiopathic pulmonary fibrosis, treatment with nerandomilast stabilized lung function over a period of 12 weeks. Methods In this phase 3, double-blind trial, we randomly assigned patients with idiopathic pulmonary fibrosis in a 1:1:1 ratio to receive nerandomilast at a dose of 18 mg twice daily, nerandomilast at a dose of 9 mg twice daily, or placebo, with stratification according to background antifibrotic therapy (nintedanib or pirfenidone vs. none). The primary end point was the absolute change from baseline in forced vital capacity (FVC), measured in milliliters, at week 52. Research Summary Nerandomilast in Patients with Idiopathic Pulmonary Fibrosis Results A total of 1177 patients underwent randomization, of whom 77.7% were taking nintedanib or pirfenidone at enrollment. Adjusted mean changes in FVC at week 52 were −114.7 ml (95% confidence interval [CI], −141.8 to −87.5) in the nerandomilast 18-mg group, −138.6 ml (95% CI, −165.6 to −111.6) in the nerandomilast 9-mg group, and −183.5 ml (95% CI, −210.9 to −156.1) in the placebo group. The adjusted difference between the nerandomilast 18-mg group and the placebo group was 68.8 ml (95% CI, 30.3 to 107.4; P<0.001), and the adjusted difference between the nerandomilast 9-mg group and the placebo group was 44.9 ml (95% CI, 6.4 to 83.3; P=0.02). The most frequent adverse event in the nerandomilast groups was diarrhea, reported in 41.3% of the 18-mg group and 31.1% of the 9-mg group, as compared with 16.0% in the placebo group. Serious adverse events were balanced across trial groups. Conclusions In patients with idiopathic pulmonary fibrosis, treatment with nerandomilast resulted in a smaller decline in the FVC than placebo over a period of 52 weeks. (Funded by Boehringer Ingelheim; FIBRONEER-IPF ClinicalTrials.gov number, NCT05321069.)
Scalloped tongue: an additional, accessible and useful tool to detect severe obstructive sleep apnea?
(2025) Guimarães, Francisca Nieto; Canadas, Joana; Cunha, Maria Gonçalves; Durão, Vera; Rosa, Paula; Rabahi, Marcelo Fouad; Ding, Zou; Silveira, Flávio José Magalhães da
The anatomy of the upper airway can influence the risk of obstructive sleep apnea (OSA). However, there is limited evidence supporting the link between scalloped tongue (ST) and nocturnal intermittent hypoxia. This study aimed to investigate if ST could serve as a clinical indicator of OSA, particularly severe OSA. Over a 4-month period from October 2023 to January 2024, 160 patients underwent level 1 polysomnography at a sleep laboratory in Brazil. Demographics, body mass index (BMI), neck circumference (NC), presence of ST, Epworth Sleepiness Scale score, apnea hypopnea index, oxygen desaturation index (ODI) and time under 90% of oxygen saturation were included in a database. Logistic and multiple linear regression models were performed. A p-value <0.05 was considered as the lower threshold of significance. Most (90%) patients had OSA, 41% classified as severe. Older age and a wider NC significantly increased the risk of OSA. Older age, higher BMI, wider NC, and ST significantly increased the risk of severe OSA, and there was a statistically significant positive correlation between the presence of ST and ODI (p = 0.001). The presence of ST increased ODI by 6.723/h, adjusted for age, BMI, and NC. The combined presence of NC ≥ 40 cm and ST significantly increased the risk of severe OSA (OR 4.210, p < 0.001), and significantly impacted ODI estimates. Incorporating tongue and NC assessment in OSA screening, both objective and easily observable clinical signs, may help physicians in the prompt identification of severe cases that benefit from early positive airway pressure therapy.
Nerandomilast in patients with progressive pulmonary fibrosis
(2025) Maher, Toby M.; Assassi, Shervin; Arata, Azuma; Cottin, Vincent; Hoffmann-Vold, Anna-Maria; Kreuter, Michael; Oldham, Justin M.; Richeldi, Luca; Valenzuela, Claudia; Wijsenbeek, Marlies S.
Background Nerandomilast (BI 1015550) is an orally administered preferential inhibitor of phosphodiesterase 4B with antifibrotic and immunomodulatory properties. Nerandomilast has been shown to slow the progression of idiopathic pulmonary fibrosis, but an assessment of its effects in other types of progressive pulmonary fibrosis is needed. Methods In a phase 3, double-blind trial, we randomly assigned patients with progressive pulmonary fibrosis in a 1:1:1 ratio to receive nerandomilast at a dose of 18 mg twice daily, nerandomilast at a dose of 9 mg twice daily, or placebo, with stratification according to background therapy (nintedanib vs. none) and fibrotic pattern on high-resolution computed tomography (usual interstitial pneumonia-like pattern vs. other patterns). The primary end point was the absolute change from baseline in the forced vital capacity (FVC), measured in milliliters, at week 52. Research Summary Nerandomilast in Patients with Progressive Pulmonary Fibrosis Results A total of 1176 patients received at least one dose of nerandomilast or placebo, of whom 43.5% were taking background nintedanib therapy at baseline. The adjusted mean change in the FVC at week 52 was −98.6 ml (95% confidence interval [CI], −123.7 to −73.4) in the nerandomilast 18-mg group, −84.6 ml (95% CI, −109.6 to −59.7) in the nerandomilast 9-mg group, and −165.8 ml (95% CI, −190.5 to −141.0) in the placebo group. The adjusted difference between the nerandomilast 18-mg group and the placebo group was 67.2 ml (95% CI, 31.9 to 102.5; P<0.001), and the adjusted difference between the nerandomilast 9-mg group and the placebo group was 81.1 ml (95% CI, 46.0 to 116.3; P<0.001). The most frequent adverse event was diarrhea, reported in 36.6% of the patients in the nerandomilast 18-mg group, 29.5% of those in the nerandomilast 9-mg group, and 24.7% of those in the placebo group. Serious adverse events occurred in similar percentages of patients in the trial groups. Conclusions In patients with progressive pulmonary fibrosis, treatment with nerandomilast led to a smaller decline in the FVC than placebo over a period of 52 weeks. (Funded by Boehringer Ingelheim; FIBRONEER-ILD ClinicalTrials.gov number, NCT05321082.)
The association of ICU acuity and organizational factors with outcomes of low-risk patients
(2025) Salgueiro, Emmanuel Santos; Kurtz, Pedro Martins Pereira; Borges, Lunna Perdigão; Bastos, Leonardo dos Santos Lourenço; Zampieri, Fernando Godinho; Burghi, Gaston; Melo, Ulisses de Oliveira; Corrêa, Thiago Domingos; Rabahi, Marcelo Fouad
OBJECTIVE: Outcomes of low-risk patients may be affected by the overall acuity of the ICU to which they were admitted. Studies addressing this topic are very scarce and the underlying mechanisms supporting this association remain incompletely understood. Here, we investigated the effects of ICU acuity (defined as the mean Simplified Acute Physiology Score 3 of all admitted patients in the bimester in which a given patient was admitted) and organizational factors on the outcomes of patients with a low risk of dying admitted to ICUs. DESIGN: Retrospective cohort study. SETTING: One hundred and thirty-four ICUs from Brazil and Uruguay. PATIENTS: All low-risk (defined as a Simplified Acute Physiology Score 3 probability of death < 3%) patients admitted between 2016 and 2018. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcome was hospital mortality; secondary outcomes were ICU mortality, and ICU and hospital lengths of stay (LOS). ICU acuity was evaluated as a continuous variable. Multilevel multivariable regression analyses were used to explore the association between ICU acuity, organizational characteristics, and outcomes. Of 285,553 patients, 69,675 (24.4%) were considered low risk. Elective surgeries (66.2%) were the main admission reason. In the models adjusted for patient- and ICU-level characteristics, ICU acuity was not associated with hospital mortality (odds ratio [OR] = 1.095 [0.942–1.274]) and all secondary outcomes. These results were consistent in sensitivity analyses. The presence of dedicated pharmacists in the ICU (OR = 0.531 [0.365–0.773]) and the number of implemented clinical protocols (OR = 0.817 [0.688–0.970]) were independently associated with lower hospital mortality. Clinical protocols were also associated with shorter ICU and hospital LOS. CONCLUSIONS: ICU acuity was not associated with outcomes in low-risk patients. Appropriate multidisciplinary staffing coupled with adherence to best clinical practices are essential to optimize efficiency and minimize variability of care for this population.
Anxiety and depression in patients with primary glomerulopathies
(2025) Borges, Marcela Oliveira Faria Braga; Pereira, Edna Regina Silva; Barbosa, Maria Alves; Fernandes, Marcos Rassi
Objective: The objective of this study was to evaluate the anxiety and depression domains of patients with primary glomerulopathies from the patients’ perspective via patient-reported outcome measurements and to identify the factors associated with worse scores. Materials and methods: This was a cross-sectional study involving 46 patients in which a patient-reported outcome measurement instrument was applied to evaluate the domains of anxiety and depression in patients with primary glomerulopathies. Exploratory univariate statistical analyses were performed, followed by multiple linear regression analyses. Results: 46 patients participated in the study. The mean age was 38.5 ± 16.4 years. The anxiety T score was 58.6%, and the depression T score was 54.7%. Female patients had worse anxiety scores (p = 0.044) and depression scores (p = 0.040). Patients under 60 years of age had worse anxiety scores (p = 0.041). A lower educational level was related to a worse depression score (p = 0.010). The concomitant presence of diabetes mellitus and a diagnosis time ≥ 9 months were associated with worse anxiety scores (p = 0.015 and p = 0.014) and depression (p = 0.012 and p = 0.007). Conclusion: Patients with primary glomerulopathies have more anxiety and depression, and the variables associated with worse scores are female sex, age under 60 years, lower educational level, time since diagnosis, and diabetes mellitus.
Adhesive capsulitis: current concepts
(2026) Fernandes, Marcos Rassi
Adhesive capsulitis, commonly known as frozen shoulder, is a condition characterized by pain and progressive loss of shoulder motion. This condition typically affects individuals between 40 and 60 years of age and can severely impact daily functioning and quality of life. The etiology of adhesive capsulitis is multifactorial, with contributions from systemic conditions such as diabetes and thyroid disorders, as well as idiopathic factors. This review provides an overview of current concepts in the diagnosis and management of adhesive capsulitis, highlighting advancements in both conservative and surgical treatments. Conservative management remains the first-line approach, emphasizing pain relief and restoration of shoulder mobility through physical therapy, analgesics, and corticosteroid injections. Techniques such as the suprascapular nerve block have gained prominence for their effectiveness in reducing pain and facilitating rehabilitation. Recent studies underscore the importance of early intervention and individualized treatment plans tailored to the patient’s needs. Surgical intervention, including arthroscopic capsular release, is considered when conservative measures fail to yield satisfactory results. While effective in restoring shoulder function, surgery carries risks and necessitates a comprehensive rehabilitation program to prevent recurrence of stiffness. This review also addresses potential complications associated with both conservative and surgical treatments, and the role of emerging techniques and technologies in improving patient outcomes. The integration of evidence-based practices and personalized care strategies is crucial for optimizing treatment efficacy and enhancing the quality of life for individuals affected by adhesive capsulitis.
Suprascapular nerve blocks with 5 mL × 10 mL in the treatment of primary adhesive capsulitis: pilot study of clinical trial
(2025) Fernandes, Marcos Rassi
Purpose To assess whether 5 mL would not be less effective than 10 mL when performing a suprascapular nerve block, regarding shoulder function and quality of life in primary adhesive capsulitis. Methods This is a pilot study of a randomized, controlled, double-blind clinical trial conducted at a single center. Patients with AC characterized by constant pain and restricted movements in anterior elevation, 0°/90° external rotation, and internal rotation were selected. Two groups were randomly selected. In group I, a dose of 10 mL of bupivacaine was applied, while in group II, only 5 mL, in four weekly blocks. Sealed and sequentially numbered envelopes were used. The SF-36 and DASH questionnaires were applied in five moments. The t-Student test was used to compare the means, with a probability of rejecting null hypothesis of 5%. Results There were 17 participants with primary AC, seven in group I and 10 in group II. The average age was 54.30 and 50.43 years in the 5 mL and 10 mL groups, respectively. There were no differences when the means were compared by DASH: T0 (p = 0.074); T2 (p = 0.285); T4 (p = 0.333); T8 (p = 0.392), and T12 (p = 0.453). As for the SF-36, there were sparse differences in T2 in the domains of vitality (p = 0.006) and social aspects (p = 0.036) in favor of group I, and in the general health status domain in T8, in favor of group II (p = 0.033). Conclusion The volume of 5 mL is not less effective than 10 mL when performing SSNB in the treatment of primary adhesive capsulitis.
Assessment of cognitive functions in individuals with systemic lupus erythematosus
(2025) Vieira, Juliana Rosa Pires; Rezende, Andréa Toledo de Oliveira; Dias, Danilo Rocha; Silva, Nilzio Antonio da; Fernandes, Marcos Rassi
Introduction Neurocognitive changes may hinder the autonomy and independence of patients diagnosed with Systemic Lupus Erythematosus (SLE), being considered as one of the main negative outcomes. Objectives To evaluate the cognitive functions of patients diagnosed with active SLE and in remission at the Rheumatology Outpatient Clinic of the Hospital das Clínicas, School of Medicine, Universidade Federal de Goiás. Methodology This was a cross-sectional study, non-probabilistic sample and consecutive type. MiniMental State Examination (MMSE), Five Digits Test (FDT), and Rey’s Complex Figures (FCR) were used in 83 patients in the period from November 2021 to May 2022. Patients with depressive disorders and users of alcohol and other drugs were excluded. Results The assessed cognitive functions - attention, memory, language, and executive functions - showed mild impairments, corroborating previous studies. There was a significant difference (p > 0,05) concerning cognitive performance when comparing patients with active SLE and in remission groups. Cognitive function was not associated with time of diagnosis. Conclusion In this sense, cognitive dysfunctions were present in patients with active SLE and remission. The results showed mild cognitive impairment in patients diagnosed with SLE.

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