Use of ChatGPT in Urology and its Relevance in Clinical Practice: Is it useful?

ABSTRACT Purpouse: One of the many artificial intelligence based tools that has gained popularity is the Chat-Generative Pre-Trained Transformer (ChatGPT). Due to its popularity, incorrect information provided by ChatGPT will have an impact on patient misinformation. Furthermore, it may cause misconduct as ChatGPT can mislead physicians on the decision-making pathway. Therefore, the aim of this study is to evaluate the accuracy and reproducibility of ChatGPT answers regarding urological diagnoses. Materials and Methods: ChatGPT 3.5 version was used. The questions asked for the program involved Primary Megaureter (pMU), Enuresis and Vesicoureteral Reflux (VUR). There were three queries for each topic. The queries were inserted twice, and both responses were recorded to examine the reproducibility of ChatGPT's answers. Afterwards, both answers were combined. Finally, those rwere evaluated qualitatively by a board of three specialists. A descriptive analysis was performed. Results and Conclusion: ChatGPT simulated general knowledge on the researched topics. Regarding Enuresis, the provided definition was partially correct, as the generic response allowed for misinterpretation. For VUR, the response was considered appropriate. For pMU it was partially correct, lacking essential aspects of its definition such as the diameter of the dilatation of the ureter. Unnecessary exams were suggested, for Enuresis and pMU. Regarding the treatment of the conditions mentioned, it specified treatments for Enuresis that are ineffective, such as bladder training. Therefore, ChatGPT responses present a combination of accurate information, but also incomplete, ambiguous and, occasionally, misleading details.

The effectiveness of parasacral transcutaneous electrical nerve stimulation in the treatment of monosymptomatic enuresis in children and adolescents: a systematic review

ABSTRACT Background: Parasacral Transcutaneous Electrical Nerve Stimulation (PTENS) is a treatment used in enuresis refractory to first-line treatment. This review aimed to evaluate the effectiveness of PTENS in treating monosymptomatic enuresis (MNE) in children and adolescents. Methods: The study followed the Preferred Reporting Items for Systematic (PRISMA) guidelines. The search was carried out in the following databases: MEDLINE (via PubMed), Web of Science, SCOPUS, Central Cochrane Library and Physiotherapy Evidence Database (PEDro). The selected studies were randomized clinical trials (RCTs). The "Risk of Bias tool for randomized trials" and the "Risk of Bias VISualization" were used to analyze the risk of bias. Results: Of the 624 studies selected, four RCTs were eligible. Three included 146 children and adolescents aged between six and 16.3 years and used similar PTENS protocols with a frequency of 10 Hz, pulse duration of 700 µs and 20 minutes three times/week. One study enrolled 52 patients aged seven to 14 years used PTENS at home, with a pulse duration of 200 µs and 20 to 60 minutes twice/day. Risk of bias was observed in three studies due to results' randomization and measurement. Two studies showed a partial response with a reduction in wet nights, one a complete response in 27% of patients, and one showed no improvement. Conclusion: PTENS reduces wet nights' frequency but does not cure them, except in 27% of patients in one study. Limited RCTs and data heterogeneity are limitations.

The landscape of biomedical research funding in Brazil: a current overview

ABSTRACT Objective: The objective of this narrative review is to discuss the current state of research funding in Brazil. Materials and Methods: This study is based on the most recent edition of the course Funding for Research and Innovation in the University of Sao Paulo School of Medicine which was a three-day course with 12 hours of instruction. The course brought together leading experts in the field to comprehensively discuss the current state of research funding in Brazil. Each speaker provided a presentation on a specific topic related to research funding. After the workshop, speakers assembled relevant topics in this manuscript. Results: collaborative research is critical for securing research funding. It optimizes proposal competitiveness, amplifies societal impact, and manages risks effectively. As such, fostering and supporting these collaborations is paramount for both researchers and funding agencies. To maintain the highest integrity in research, investigators involved in these collaborations must disclose any relationships that could potentially influence the outcomes or interpretation of their projects. Conclusions: In Brazil, the mainstay of research funding stems from public entities, with agencies such as CNPq, CAPES, and state bodies like FAPESP, FAPERJ, FAPEMIG and others at the forefront. Concurrently, industry funding offers viable pathways, especially through industry-sponsored studies, investigator-led projects, and collaborative initiatives. The Brazilian funding landscape is further enriched by innovative platforms, including crowdfunding and the contributions of institutions like the Serrapilheira Institute. Internationally, esteemed organizations such as the National Institutes of Health (NIH) and the Bill & Melinda Gates Foundation stand out as potential funders.

Dynamic and static ultrasound features predictive of vesicoureteral reflux and renal damage in children and adolescents with neurogenic bladder

ABSTRACT Purpose: This study aimed to analyze the diagnostic accuracy of dynamic and static ultrasound (DSUS) in detecting vesicoureteral reflux (VUR) and renal scarring in a cohort of children with neurogenic bladder (NB). Materials and Methods: A retrospective, longitudinal, observational study was conducted using the Reporting Diagnostic Accuracy Studies guideline. The DSUS (index test) data were compared with voiding cystourethrography (VCUG) and renal scintigraphy 99mTc-dimercaptosuccinic (reference tests). Overall performance for predicting VUR and renal scarring was assessed using renal pelvic diameter (RPD)/distal ureteral diameter and renal parenchymal thinning on DSUS, respectively. Results: A total of 107 patients (66 girls, median age 9.6 years) participated. Seventeen patients (15.9%) presented VUR, eight bilateral. For overall reflux grade, the AUC was 0.624 for RPD and 0.630 for distal ureteral diameter. The diagnostic performance for detecting high-grade VUR was slightly better for DSUS parameters. The AUC was 0.666 for RPD and 0.691 for distal ureteral diameter. The cut-offs of 5 mm for RPD and 6.5 mm for distal ureteral diameter presented the best diagnostic odds ratio (DOR) to identify high-grade VUR. The increase of RPD during detrusor contractions showed an accuracy of 89.2%. The thinness of renal parenchyma presented an accuracy of 88% for renal scarring. Conclusion: DSUS predicts VUR and renal scarring in children with NB with fair to good accuracy, and all measurements exhibited a high negative predictive value (NPV). The increase in RPD during voiding or detrusor contractions proved to be the most accurate parameter for indicating the presence of VUR in this study.

Aposentadoria e depressão: perspectiva para clínica ampliada / Retirement and depression: perspective for enlarged clinic / Jubilación y depresión: perspectiva para la clínica ampliada

RESUMO Objetivo O objetivo do estudo foi discutir a relação entre aposentadoria e depressão em idosos promovendo uma reflexão teórica na perspectiva da clínica ampliada diante dessa transição. Métodos Reflexão teórica, baseada em artigos científicos que discutem sobre aposentadoria e depressão, enfatizando as percepções e significados do trabalho na velhice, a transição para a aposentadoria, as relações entre aposentadoria e depressão na terceira idade e as contribuições da clínica ampliada na vida do idoso pré e pós-aposentadoria. Resultados O presente trabalho foi construído por evidências cientificas, os quais foram selecionados obedecendo os critérios de inclusão e exclusão entre os anos 2012 a 2017, resultando em 15 artigos para discussão dessa reflexão. Conclusão Dessa forma, a literatura aponta a necessidade do preparo continuado ao trabalhador e não somente nas vésperas da aposentadoria. Portanto, estas ações de intervenção serão essenciais para que o sujeito idoso possa desfrutar de uma aposentadoria bem sucedida e sem grandes impactos na sua saúde.

ABSTRACT Objective The objective of the study was to discuss the relationship between retirement and depression in the elderly and promoting theoretical reflection from the perspective of the expanded clinic in the face of this transition. Method Theoretical reflection, based on scientific articles that discuss retirement and depression, emphasizing the perceptions and meanings of work in old age, the transition to retirement, the relationships between retirement and depression in old age and the contributions of the expanded clinic in the life of the elderly pre and post-retirement. Results This work was built on scientific evidence, which were selected following the inclusion and exclusion criteria between 2012 and 2017, resulting in 15 articles to dis-cuss this reflection. Conclusions In this way, the literature points out the necessity of continuous preparation for the worker and not only on the eve of retirement. Therefore, these intervention actions will be essential so that the elderly subject can enjoy a successful retirement without major impacts on their health.

RESUMEN Objetivo El objetivo del estudio fue discutir la relación entre jubilación y depresión en ancianos y promover la reflexión teórica desde la perspectiva de la clínica ampliada ante esta transición. Método Reflexión teórica, basada en artículos científicos que discuten jubilación y depresión, enfatizando las percepciones y significados del trabajo en la vejez, la transición a la jubilación, las relaciones entre jubilación y depresión en la vejez y los aportes de la clínica ampliada en la vida del Ancianos pre y post-jubilación. Resultados Este trabajo se basó en evidencia científica, que fueron seleccionados siguiendo los criterios de inclusión y exclusión entre 2012 y 2017, resultando 15 artículos para discutir esta reflexión. Conclusión La literatura apunta a la necesidad de una preparación continua para el trabajador y no solo en la víspera de la jubilación. Por lo tanto, estas acciones de intervención serán esenciales para que las personas de edad avanzada puedan disfrutar de una jubilación exitosa y sin mayores impactos en su salud.

Validation of the Vancouver Symptom Score Questionnaire for bladder and bowel dysfunction for Brazilian children and adolescents

ABSTRACT Objective: This study aimed to translate, and perform a cross-cultural adaptation, and validation of the Vancouver Symptom Score (VSS) for bladder and bowel dysfunction (BBD) for Brazilian children and adolescents Materials and Methods: Six steps were performed for the translation and cross-cultural adaptation: (1) translation, (2) synthesis of translations, (3) back-translation, (4) pre-final version of the translated instrument, (5) pilot test and degree of comprehensibility and (6) elaboration of the Brazilian version of the VSS. For validation, the Brazilian Dysfunctional Voiding Score (DVSS) questionnaire was used. Results: Validation was performed on a sample of 107 children and adolescents with a mean age of 9.2 ± 2.84 years, presenting BBD and 107 without BBD (control group-CG). There was a positive correlation (r = 0.91, 95% CI 0.88 to 0.93, p < 0.0001) between total VSS score and total DVSS score. VSS was higher in patients with BBD (p < 0.0001). The internal consistency estimated by Cronbach's alpha was 0.87 for patients with BBD. The VSS showed excellent diagnostic accuracy in detecting cases, with an area under the ROC curve of 98% (95% CI 0.96 to 0.99, p < 0.001). A cut-off value of >11 points produced a sensitivity of 100% (95% CI 96.4% to 100%) and a specificity of 91.8% (95% CI 85.1% to 95.6%). Conclusion: The translated, cross-culturally adapted, and validated VSS for the Brazilian population is a reliable and valid tool to identify symptoms of BBD in children and adolescents aged five to 16 years, whose first language is Brazilian Portuguese.

Handgrip strength as a diagnostic tool for frailty risk in elderly patients with moderate to severe asthma / Força de preensão manual como ferramenta diagnóstica de risco de fragilidade em pacientes idosos com asma moderada a grave

ABSTRACT Objective: To evaluate handgrip strength (HGS) as a diagnostic tool for frailty risk in elderly patients with asthma, as well as to investigate the prevalence of frailty in this population. Methods: This was a cross-sectional study including 96 patients ≥ 60 years of age diagnosed with moderate to severe asthma and treated at a tertiary referral center in Brazil. We measured HGS using a calibrated hydraulic hand dynamometer. We used a frailty scale and the AUC to assess the diagnostic accuracy of the HGS test. Results: The median age of participants was 67 years. Most (78%) were women and non-White (91%) of low socioeconomic status. HGS identified those at risk for frailty, with an AUC of 71.6% (61.5-80.4%; p < 0.002), as well as a sensitivity of 73.58% and a specificity of 67.53%, on the basis of a cutoff of ≤ 19 kgf. Conclusions: HGS appears to be a simple, reliable tool for clinicians to determine frailty risk in older asthma patients in a point-of-care setting.

RESUMO Objetivo: Avaliar a força de preensão manual (FPM) como ferramenta diagnóstica de risco de fragilidade em pacientes idosos com asma e investigar a prevalência de fragilidade nessa população. Métodos: Estudo transversal com 96 pacientes com idade ≥ 60 anos e diagnóstico de asma moderada a grave, atendidos em um centro terciário de referência no Brasil. Medimos a FPM com um dinamômetro hidráulico manual calibrado. Usamos uma escala de fragilidade e a ASC para avaliar a precisão diagnóstica do teste de FPM. Resultados: A mediana da idade dos participantes foi de 67 anos. A maioria eram mulheres (78%) não brancas (91%) cujo nível socioeconômico era baixo. O ponto de corte de FPM ≤ 19 kgf identificou os participantes que apresentavam risco de fragilidade, com ASC = 71,6% (61,5-80,4%; p < 0,002), sensibilidade = 73,58% e especificidade = 67,53%. Conclusões: A FPM parece ser uma ferramenta simples e confiável para determinar, no próprio local de atendimento médico, o risco de fragilidade em pacientes idosos com asma.

Desempenho do Escore Pediátrico de Alerta (EPA) de deterioração clínica / Desempeño del Sistema de Alerta Precoz Infantil (SAPI) de deterioración clínica / Pediatric Alert Score (EPA) performance in clinical deterioration

Resumo Objetivo Avaliar a acurácia, utilidade, reprodutibilidade e aplicabilidade do Escore Pediátrico de Alerta (EPA) na identificação da deterioração clínica em crianças e adolescentes hospitalizados. Métodos Estudo de teste diagnóstico, prospectivo, realizado entre outubro/2018 a outubro/2019, para medir a acurácia diagnóstica do EPA em uma amostra de 240 crianças, e sua reprodutibilidade e aplicabilidade em uma amostra de 60 crianças. Os dados foram processados e analisados no MedCalc e VassarStats.net. Resultados No ponto de corte ≥ 3, o escore apresentou sensibilidade de 73,6%, especificidade de 95,7%, valor preditivo positivo de 83%, valor preditivo negativo de 92,7, área sob a curva ROC de 93,6%, prevalência estimada pelo teste de 19,6%, razão de probabilidade positiva 17,1, probabilidade pós-teste positivo de 77,8%, kappa simples de 0,946. Conclusão O estudo fornece evidências sobre a elevada acurácia, utilidade e reprodutibilidade do EPA na identificação da deterioração clínica em um cenário hospitalar pediátrico brasileiro, e considerou o instrumento aplicável no contexto da pesquisa.

Resumen Objetivo Evaluar la precisión, utilidad, reproducibilidad y aplicabilidad del Sistema de Alerta Precoz Infantil (SAPI) en la identificación del deterioro clínico en niños y adolescentes hospitalizados. Métodos Estudio de prueba diagnóstica, prospectiva, realizada entre octubre de 2018 y octubre de 2019, para medir la precisión diagnóstica del SAPI en una muestra de 240 niños y su reproducibilidad y aplicabilidad en una muestra de 60 niños. Los datos fueron procesados y analizados en MedCalc y VassarStats.net. Resultados En el punto de corte ≥ 3, el puntaje presentó una sensibilidad del 73,6 %, especificidad del 95,7 %, valor predictivo positivo del 83 %, valor predictivo negativo de 92,7, área bajo la curva ROC del 93,6 %, prevalencia estimada por la prueba del 19,6 %, razón de probabilidad positiva 17,1, probabilidad posprueba positiva del 77,8 %, kappa simple de 0,946. Conclusión El estudio presenta evidencias sobre la elevada precisión, utilidad y reproducibilidad del SAPI en la identificación del deterioro clínico en un escenario hospitalario pediátrico brasileño, por lo que el instrumento se consideró aplicable en el contexto de la investigación.

Abstract Objective To assess the Pediatric Alert Score (EPA) accuracy, usefulness, reproducibility and applicability in identifying clinical deterioration in hospitalized children and adolescents. Methods This is a prospective diagnostic test study, carried out between October/2018 and October/2019, to measure EPA diagnostic accuracy in a sample of 240 children, and its reproducibility and applicability in a sample of 60 children. Data were processed and analyzed on MedCalc and VassarStats.net. Results At cut-off point ≥ 3, the score had a sensitivity of 73.6%, specificity of 95.7%, positive predictive value of 83%, negative predictive value of 92.7, area under the ROC curve of 93.6%, estimated prevalence of 19.6%, positive probability ratio of 17.1, positive post-test probability of 77.8%, simple Kappa of 0.946. Conclusion The study provides evidence on EPA high accuracy, usefulness and reproducibility in identifying clinical deterioration in a Brazilian pediatric hospital setting, and considered the instrument applicable in the context of the research.

Relationship between primary monosymptomatic enuresis and process toilet training: a case-control

ABSTRACT Objective: Primary monosymptomatic nocturnal enuresis (PMNE) is a prevalent condition in childhood, and the pathophysiology is multifactorial. This study investigated the relationship between the toilet training process (TT) and PMNE in children and adolescents. Patients and Methods: A case-control study was carried out from 2015 to 2020. The presence of PMNE was identified according to International Children's Continence Society criteria. A semi-structured questionnaire was applied to assess TT. Results: The study included 103 children and adolescents with PMNE and 269 participants with normal psychomotor development without PMNE (control group [CG]). Readiness signals were more remembered and less frequent in participants with PMNE (p=0.001) when compared to control group. No differences were found between the groups regarding the onset age of the daytime TT (p= 0.10), the nocturnal TT (p=0.08), the acquisition of daytime continence (p=0.06), and the type of equipment used for the TT (p=0.99). The use of Child-Oriented approach in group of children with enuresis was lower than in controls [87.4% (90/103) versus 94% (250/266)], respectively (OR= 0.44, 95% CI 0.21-0.94, p = 0.039). Conclusions: The age of onset of TT, acquisition of daytime continence, and the type of equipment were not associated with higher occurrence of PMNE. On the other hand, the Child-Oriented approach was a protective factor for the occurrence of PMNE.

Evaluating TIMP-2 and IGFBP-7 as a predictive tool for kidney injury in ureteropelvic junction obstruction

ABSTRACT A major challenge in the management of ureteropelvic junction obstruction (UPJO) is the selection of patients who would benefit from surgical treatment. Tissue inhibitor metalloproteinase-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) indicate renal cell stress and are associated with cell cycle arrest. The [TIMP-2] [IGFBP7] ratio (Nephrocheck®) has been recently applied in patients in intensive care units patients to predict the development of acute kidney injury. In this study, we evaluated the performance of these biomarkers performance to distinguishing obstructive hydronephrosis (HN) from non-obstructive HN. Materials and Methods: Consecutive patients with UPJO were enrolled in this study. Urinary [TIMP-2] [IGFBP7] and clinical characteristics (hydronephrosis grade, differential renal function, and drainage half-time) were measured in the following groups: 26 children with obstructive HN at initial diagnosis (group 1A) and after six months of dismembered pyeloplasty (group 1B); 22 children with non-obstructive HN (group 2), and 26 children without any urinary tract condition, as the control group (group 3). Results: Comparing the initial samples, [TIMP-2] [IGFBP7] had higher levels in the HN groups and lower levels in the control group; however, no difference was observed between the HN groups (obstructive vs. non-obstructive). After six months of follow-up, patients who underwent dismembered pyeloplasty showed stability in the urinary concentration of [TIMP-2] [IGFBP7]. All patients with [TIMP-2] [IGFBP7] higher than 1.0 (ng/mL)2/1000 had diffuse cortical atrophy on ultrasonography. Conclusions: We showed that urinary levels of urinary [TIMP-2] [IGFBP7] are higher in children with HN than controls. Nephrocheck® is not reliable in predicting the need for surgical intervention for pediatric patients with UPJO.

Calf circumference is an independent predictor of postoperative complications in the surgical treatment of head and neck cancer

INTRODUCTION: The prevalence of malnutrition is high among head and neck cancer (HNC) patients and negatively impacts their quality of life, treatment, and survival rates. OBJECTIVE: To identify preoperative nutritional variables capable of predicting postoperative complications in surgically treated HNC patients. METHODS: This was a prospective cohort study of HNC patients referred for surgery as initial treatment. RESULTS: Sixty patients were included in the study; they had a median age of 65.5 years, were mostly me n (85%), and most had low education levels (90%) and low household income (78.3%). The incidence rate of severe postoperative complications (grades II, III, IV, and V according to the Clavien-Dindo grading system) was found to be 50%. The nutritional variables under investigation, namely calf circumference (CC), triceps skinfold, body mass index, and adductor pollicis muscle thickness were shown to predict postoperative complications in HNC patients, especially CC, which was found to be an independent predictor of complications (OR=0.8; 95%CI: 0.65­0.96). Each 1-cm increase in calf circumference was associated with a 20% decrease in the risk of postoperative complications. CONCLUSION: Our findings show the nutritional variables studied are useful in the prognostic assessment of HNC surgery.

Early postoperative serum albumin levels as predictors of surgical outcomes in head and neck squamous cell carcinoma / Níveis de albumina sérica no pós‐operatório imediato como preditivo de resultados cirúrgicos em carcinoma de células escamosas de cabeça e pescoço

Abstract Background Malnutrition is a common issue in patients with head and neck squamous cell carcinoma and has a negative effect on surgical outcomes. Objective We attempted to determine which malnutrition diagnostic variables can be used as predictors of postoperative complications in patients with head and neck squamous cell carcinoma. Methods Forty-one patients undergoing surgery for head and neck squamous cell carcinoma were submitted to a prospective evaluation. Biochemical data, anthropometric measurements and evaluation of body composition were used in the nutritional analysis. Results Twenty-two patients (53.6%) developed complications. Serum albumin measured on the first postoperative day was the only variable that significantly differed between groups. A cut-off value of 2.8 g/dL distinguished between patients with a complicated and uncomplicated postoperative course. Normalization of albumin levels occurred more frequently and more rapidly in the noncomplicated group. Conclusion Serum albumin measured on the first postoperative day was the only variable that was a predicter of postoperative complications after major head and neck squamous cell carcinoma surgery.

Resumo Introdução A desnutrição é um problema comum em pacientes com carcinoma de células escamosas de cabeça e pescoço e tem um efeito negativo nos resultados cirúrgicos. Objetivo Tentamos determinar quais variáveis diagnósticas de desnutrição podem ser usadas como preditivos de complicações pós‐operatórias em pacientes com carcinoma de células escamosas de cabeça e pescoço. Método Quarenta e um pacientes submetidos à cirurgia de carcinoma de células escamosas de cabeça e pescoço foram submetidos a uma avaliação prospectiva. Dados bioquímicos, medidas antropométricas e avaliação da composição corporal foram usados na análise nutricional. Resultados Vinte e dois pacientes (53,6%) desenvolveram complicações. A dosagem de albumina sérica no primeiro dia pós‐operatório foi a única variável que diferiu significantemente entre os grupos. Um valor de corte de 2,8 g/dL distinguiu os pacientes com uma evolução pós‐operatória complicada e não complicada. A normalização dos níveis de albumina ocorreu mais frequentemente e mais rapidamente no grupo sem complicação pós‐operatória. Conclusão A albumina sérica medida no primeiro dia pós‐operatório foi a única variável capaz de predizer complicações pós‐operatórias após cirurgia de carcinoma de células escamosas de cabeça e pescoço de grande porte.

Arterial lactate as a predictor of postoperative complications in head and neck squamous cell carcinoma / Lactato arterial como preditor de complicações pós‐operatórias no carcinoma epidermoide de cabeça e pescoço

Abstract Introduction Surgery is one of the most frequently used options in the treatment of head and neck squamous cell carcinoma. In surgical patients, the use of arterial lactate to assess hypoxemia and severe inflammatory states is well-founded. However, there are few studies on its use in patients with head and neck squamous cell carcinoma. The aim of this study was to investigate whether the serum arterial lactate level on the 1st postoperative day would be a predictor of postoperative complications in head and neck squamous cell carcinoma surgeries. Methods This is a prospective cohort, which evaluated 44 adult patients of both genders, with HNSCC, who underwent surgery associated with monobloc neck dissection as an initial treatment. Patients were divided into two groups, according to the presence or absence of postoperative complications: with complication (Clavien-Dindo II-V) and without complications (Clavien-Dindo 0-I). Student's t-test and its variants were used to compare continuous data. Pearson's or Spearman's test was used to correlate the data and p values ​​<0.05 were considered statistically significant. Results A total of 59% of the patients (n = 26/44) developed postoperative complications. Serum lactate was significantly higher in the group with complications when compared to patients without complications, respectively 2.15 mmoL/L (1.10-3.90) and 1.59 mmoL/L (0.70-3.44); p = 0.03. The prognostic accuracy of arterial lactate was 69% (95% CI: 54%-82%; p = 0.03), estimated by the ROC curve. A cut-off >1.7 mmoL/L was identified, with a sensitivity of 65.38% and specificity of 66.67%. Conclusion Arterial lactate measured on the first postoperative day is a good predictor of postoperative complications in patients with head and neck squamous cell carcinoma.

Resumo Introdução A cirurgia é uma das opções mais usadas no tratamento do carcinoma epidermoide de cabeça e pescoço. Nos pacientes cirúrgicos, o uso do lactato arterial para avaliação de hipoxemia e de quadros inflamatórios graves é bem fundamentado. Entretanto, existem poucos estudos sobre o seu uso em pacientes com carcinoma epidermoide de cabeça e pescoço. O objetivo deste estudo foi investigar se o lactato arterial sérico no 1° dia de pós‐operatório seria um preditor de complicações pós‐operatórias nas cirurgias do carcinoma epidermoide de cabeça e pescoço. Método Trata‐se de uma coorte prospectiva, que avaliou 44 pacientes adultos, de ambos os gêneros, com carcinoma epidermoide de cabeça e pescoço, submetidos a cirurgia associada ao esvaziamento cervical em monobloco como tratamento inicial. Os pacientes foram divididos em dois grupos, segundo a presença ou não de complicações pós‐operatórias: complicados (Clavien‐Dindo II a V) e sem complicações (Clavien‐Dindo 0-I). Na comparação dos dados contínuos, foi usado o teste t de Student e as suas variantes. Na correlação dos dados, usou‐se o teste de Pearson ou Spearman. Valores de p inferiores a 0,05 (p < 0,05) foram considerados estatisticamente significativos. Resultados Dos pacientes, 59% (n = 26/44) desenvolveram complicações pós‐operatórias. O lactato sérico foi significantemente maior no grupo com complicações em relação aos pacientes sem complicações, respectivamente 2,15 mmoL/L (1,10-3,90) e 1,59 mmoL/L (0,70-3,44); p = 0,03. A acurácia prognóstica do lactato arterial foi de 69% (95% IC 54%-82%; p = 0,03), estimada pela curva ROC. Foi identificado um cut‐off> 1,7 mmoL/L, com sensibilidade de 65,38% e especificidade de 66,67%. Conclusão O lactato arterial do primeiro dia de pós‐operatório é um bom preditor de complicações pós‐operatórias nos pacientes com carcinoma epidermoide de cabeça e pescoço.

Association between Attention Deficit Hyperactivity Disorder and lower urinary tract symptoms in children and adolescents in a community setting

ABSTRACT Introduction: The present study aims to investigate the prevalence of lower tract urinary symptoms (LUTS) and symptoms of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents and their association in a community setting using validated scoring instruments. Materials and Methods: A cross-sectional study was carried out from February 2015 to December 2019, during which the parents or guardians of 431 children and adolescents from 5 to 13 years of age, attending a general pediatric outpatient clinic were interviewed. Results: The prevalence of ADHD symptoms and LUTS were 19.9% and 17.9%, respectively. Of the 82 children and adolescents with ADHD, 28% (23) had LUTS (OR 2.31, 95% CI 1.28 to 3.75, p=0.008). Mean total DVSS score in children in the group of children presenting ADHD symptom was significantly higher than those without ADHD symptom (10.2±4.85 vs. 4.9±2.95, p=0.002). Urgency prevailed among LUTS as the most frequent symptom reported by patients with ADHD symptoms (p=0.004). Analyzing all subscales of the DVSS, the items "When your child wants to pee, can't he wait? "Your child holds the pee by crossing his legs, crouching or dancing?" were higher in those with ADHD symptoms (p=0.01 and 0.02, respectively). Functional constipation was present in 36.4% of children with LUTS and 20.7% without LUTS (OR 4.3 95% CI 1-5.3 p=0.001). Conclusion: Children and adolescents with ADHD symptoms are 2.3 times more likely to have LUTS. The combined type of ADHD was the most prevalent among them.

Luts-V: A new simplified score for assessing lower urinary tract symptoms in men

ABSTRACT Objectives: Develop and validate a new and simplified score for evaluating the lower urinary tract symptoms in men. Materials and methods: We modified the existing visual prostate symptom score, including changes in the images, sequence, and new alternatives, resulting in a new visual score (LUTS visual score-LUTS-V). For the validation of the new tool, we used the International Prostatic Symptom Score as the gold-standard and the new LUTS-V to 306 men. The total IPSS score and the total LUTS-V score of each subject were evaluated to determine the agreement between the two instruments. ROC curve was used to evaluate the diagnostic accuracy and best cut-off of LUTS-V. Sensitivity, specificity, and diagnostic odds ratios were used to describe the diagnostic properties. Results: The mean age of the participants was 59 [52-87] years. There was a significant correlation between LUTS-V and IPSS. (r=0.72 (p <0.0001). The Bland-Altman analyzes demonstrate good agreement between the two questionnaires (bias=5.6%). LUTS-V demonstrated excellent diagnostic accuracy in detecting the most serious cases with an area under the ROC curve of 83% [78-87%] 95% CI. p <0.001). LUTS-V >4 was the best threshold, with a sensitivity of 74% and specificity of 78%. Conclusions: LUTS-V is a simple, self-administered tool with a significant discriminatory power to identify subjects with moderate to severe LUTS and may represent a useful instrument for the diagnosis and follow-up of men with urinary symptoms.

Breastfeeding technique and the incidence of nipple traumas in puerperal women attended in a city hospital: intervention study / Técnica de amamentar e a incidência de traumas mamilares em puérperas atendidas em um hospital municipal: estudo de intervenção

Abstract Objectives: to evaluate the effect of an intervention on the incidence of nipple trauma and the quality of breastfeeding technique in the first month of postpartum. Methods: this is a quasi-randomized intervention study with 180 puerperal women equally distributed between experimental and control groups. The intervention was performed at a maternity and consisted of an educational session on breastfeeding technique. A descrip-tive analysis of the groups' characteristics was performed, comparing the frequencies of unfa-vorable parameters related to breastfeeding technique between groups. Pearson's chi-square test and Fisher's test were used, and p≤0.05 was adopted as the critical level of significance. Results: at 30 days, 64% and 15% of the mothers used the technique correctly, respec-tively, in the experimental and control groups with RR=4.87 (CI95%=2.93-8.34); NNT=1.96 (CI95% =1.61-2.72); p<0.001. In the experimental group, a decrease was observed in the unfavorable parameters of the breastfeeding technique (p≤0.05). The incidence of nipple trauma was 30% in the experimental group and 38.9% in the control group (p=0.21). Conclusions: the intervention was insufficient to prevent nipple trauma in the experi-mental group, but significantly improved the quality in the breastfeeding technique.

Resumo Objetivos: avaliar o efeito de uma intervenção na incidência de traumas mamilares e na qualidade da técnica de amamentar no primeiro mês pós-parto. Métodos: trata-se de um estudo de intervenção quasi randomizado com 180 puérperas distribuídas entre os grupos experimental e controle. A intervenção foi realizada na mater-nidade e consistiu de sessão educativa sobre a técnica de amamentar. Foi realizada análise descritiva das características dos grupos, comparadas as frequências dos parâmetros desfa-voráveis da técnica de amamentar. O teste do qui-quadrado de Pearson e teste de Fisher foram utilizados, sendo adotado p≤ 0,05 como nível crítico de significância. Resultados: aos 30 dias, 64% e 15%, das mães apresentaram técnica correta, respectiva-mente, nos grupos experimental e controle com RR= 4,87 (IC95%=2,93-8,34); NNT= 1,96 (IC95%=1,61-2,72); p<0,001.No grupo experimental percebeu-se que houve diminuição dos parâmetros desfavoráveis da técnica de amamentar (p≤0,05). A incidência de trauma mamilar foi de 30% no grupo experimental e 38,9% no grupo controle (p=0,21). Conclusão: no grupo experimental a intervenção realizada não foi suficiente para prevenir a ocorrência de traumas mamilares, porém melhorou significantemente a qualidade da técnica de amamentar.

Effect of an educational intervention on the breastfeeding technique on the prevalence of exclusive breastfeeding / Efeito de uma intervenção educativa sobre a técnica de amamentação na prevalência do aleitamento materno exclusivo

Abstract Objectives: to evaluate the effect of an intervention directed to the breastfeeding technique in the prevalence of exclusive breastfeeding in the first month of life. Methods: this is a quasi-randomized intervention study conducted in a public maternity ward accredited in the Baby-Friendly Hospital Initiative. The intervention consisted of individual orientations on the breastfeeding technique in the first 48 hours after delivery, with the help of a breast model, doll, and movie. The control group was oriented by researchers about the importance of breastfeeding, and received hospital orientations. Data were collected in the maternity ward, and at the end of the first month in the hospital's outpatient service by implementing a questionnaire, observing the baby's breastfeeding technique and examining breasts. Results: the prevalence of exclusive breastfeeding in the first month of life of the infant was 76.6% in the experimental group, and 52.2% in the control group. RR=1.46 (CI95%=1.16-1.84); NNT=4.09; p=0.001. The trained women presented a correct breast-feeding technique in 64.04%, much higher when compared to those who did not receive training (15.11%;RR=4.87[CI95%=2.93-8.34]; NNT=1.96;p<0.001). Conclusions: the use of audiovisual resources, use of instruments (model breast and doll), and type of individualized approach contributed to an increased prevalence of exclusive breastfeeding up to 30 days after delivery.

Resumo Objetivos: avaliar o efeito de uma intervenção direcionada à técnica de amamentação na prevalência de aleitamento materno exclusivo no primeiro mês de vida. Métodos: foi realizado um estudo de intervenção quasi randomizado em uma maternidade pública, credenciada como Amigo da Criança. A intervenção consistiu em orientações individuais sobre a técnica de amamentação nas primeiras 48 horas após o parto, com ajuda de seio cobaia, boneca e filme. O grupo controle foi orientado sobre a importância do aleitamento materno pelas pesquisadoras, além das orientações fornecidas pelo hospital. A coleta de dados ocorreu na maternidade e ao final do primeiro mês em serviço ambulatorial do hospital, mediante a aplicação de um questionário, observação da mamada e exame das mamas. Resultados: a prevalência do aleitamento materno exclusivo, no primeiro mês de vida do lactente, foi de 76,6% no grupo experimental e 52,2% no grupo controle. RR=1,46 (IC95%=1,16-1,84); NNT=4,09; p=0,001. As mulheres que sofreram a intervenção, apresentaram técnica correta de amamentação em proporção significativamente maior que os controles: 64,04% vs 15,11%, RR= 4,87 [IC95%= 2,93-8,34] NNT= 1,96; p<0,001. Conclusões: a utilização de recursos audiovisuais, uso de instrumentos (seio cobaia e boneca) e tipo de abordagem individualizada contribuíram para o aumento da prevalência do aleitamento materno exclusivo até 30 dias pós parto.

Prevalência de Sintomas Depressivos em Estudantes de Medicina com Currículo de Aprendizagem Baseada em Problemas / Prevalence of Depressive Symptoms in Medical Students Following a Problem-Based Learning Curriculum

Resumo: Introdução: A depressão é um distúrbio heterogêneo, com etiologia, evolução e resposta terapêutica variadas, com relatos de aumento crescente na incidência entre os jovens. Dois objetivos nortearam este estudo: estimar a prevalência de sintomas depressivos entre acadêmicos de Medicina de uma universidade com métodos ativos de aprendizagem e investigar possíveis associações com variáveis sociodemográficas. Métodos: Trata-se de um estudo transversal descritivo. Aplicaram-se um questionário eletrônico com variáveis sociodemográficas e o Inventário de Depressão de Beck (BDI). Foram realizadas análise univariada e regressão logística multivariada. Resultados: Avaliamos 173 discentes, com discreta predominância de rapazes (n = 93, 53,7%) e idade mediana de 24 (22-26) anos. Verificaram-se sintomas depressivos em 46,2% (n = 80), dos quais 33,5% (n = 58) leves, 9,2% (n = 16) moderados e 3,4% (n = 6) graves. Sexo feminino (p = 0,032) e insatisfação com a Aprendizagem Baseada em Problemas - ABP (p < 0,001) se associaram de forma independente aos sintomas depressivos em regressão logística multivariada, com aumento na chance de sintomas depressivos de 2 e 3,5 vezes, respectivamente. Os fatores morar com os pais, ter outros diagnósticos psiquiátricos e praticar regularmente atividade física se associaram aos sintomas depressivos apenas em análise univariada. Conclusão: Os acadêmicos de Medicina apresentaram significativa prevalência de sintomas depressivos. A associação dos sintomas depressivos com insatisfação com o método ABP pode fomentar reflexões sobre a conduta pedagógica e as deficiências na aplicação da metodologia ABP na referida universidade. Ressaltamos a importância da implementação da atividade física no projeto pedagógico e curricular do curso de Medicina como estratégia para a promoção de saúde mental e física nos discentes.

Abstract: Introduction: Depression is a heterogenous disorder of diverse etiology, progression and therapeutic response. Increasing incidence of depression in young adulthood has been reported. The purpose of this paper was to evaluate the prevalence of depressive symptoms among medical students at a university which adopts an active learning method and to investigate possible associations to sociodemographic variables. Methods: Descriptive, cross-sectional study. An electronic questionnaire was applied to evaluate sociodemographic variables and depressive symptoms using the Beck Depression Inventory. Univariate and multivariate logistic regression analysis were performed. Results: A slight male predominance (n=93, 53.7%) was found among 173 students, along with an average median age of 24 [22-26]. Depressive symptoms were identified in 46.2% of the students (n=80): 33.5% (n=58) with mild symptoms, 9.2% (n=16) moderate, and 3.4% (n=6) severe. Female gender (p=0.032) and dissatisfaction with the active learning method (p<0.001) were independently associated with depressive symptoms in a multivariate logistic regression analysis with the chance of suffering from depressive symptoms increasing 2 and 3.5 fold, respectively. Living with one's parents, additional psychiatric diagnosis, and lack of regular physical exercise were associated with depressive symptoms only in univariate analysis. Conclusion: The medical students presented a high prevalence rate of depressive symptons. Association between dissatisfaction with the active learning method and depressive symptoms may offer some insight regarding the pedagogical practices and deficiencies in the application of this method at the university in question. It is important to implement strategies that incorporate physical exercise into the pedagogical and curricular project to promote the mental and physical health of the students.