Fundação Técnico Educacional Souza Marques

Cardiovascular events are the main cause of mortality in individuals with type 2 diabetes mellitus (T2DM) and also in those with metabolic dysfunction-associated steatotic liver disease (MASLD). In this editorial, we comment on the results of a meta-analysis published by Shetty et al that shows an addictive risk for cardiovascular events when both pathologies are together. Patients with MASLD and T2DM have the worst prognosis related to liver disease since they have a higher risk for metabolic dysfunction-associated steatohepatitis, disease progression, and hepatocarcinoma. The meta-analysis included 370013 participants and showed that, although with high heterogeneity, there is a higher prevalence of cardiovascular events in patients with T2DM when MASLD is diagnosed compared to those without MASLD. Hence, MASLD and T2DM may have a new interplay regarding cardiovascular outcomes in addition to the already known liver-related outcomes.

Valproic acid (AVP) is widely used in the treatment of epilepsy and mood disorders, but recent studies suggest that its epigenetic action may negatively interfere in tissue regeneration and healing processes. Repair of the abdominal wall, essential for the success of procedures such as herniorrhaphy and laparotomy, depends on a cascade of inflammatory, cellular and molecular events that can be modulated by systemic drugs such as AVP. The aim of this study was to analyze the interference of valproic acid in abdominal wall healing, considering its possible effects on collagen synthesis, fibroblast proliferation and the integrity of the extracellular matrix, and to discuss its clinical implications in abdominal surgery. This is a literature review with a qualitative and exploratory approach. The studies were selected using the PubMed, SciELO, ScienceDirect and Scopus databases, with full articles published in peer-reviewed scientific journals addressing the use of valproic acid in the context of tissue healing, especially in patients undergoing surgical procedures. The time frame of the research considered the period from 2018 to 2022, based on the oldest article (Costa et al., 2018) and the most recent (Santos et al., 2022; Alves et al., 2022; Moura et al., 2022). The findings indicate that AVP, by acting as a histone deacetylase (HDAC) inhibitor, can alter the gene expression of key proteins in the healing process, such as type I and III collagen, metalloproteinases and growth factors. In experimental models, delayed granulation tissue formation and collagen matrix organization were observed, suggesting an increased risk of dehiscence, incisional hernia and abdominal wall fragility in patients taking the drug continuously. We conclude that valproic acid may represent an underestimated risk factor in surgical repair of the abdominal wall. Preoperative assessment of the use of this drug should be considered in clinical practice, especially in elective surgeries. New clinical studies are needed to validate these experimental findings and guide safer therapeutic approaches.

Sedation in outpatient procedures requires agents with a favorable pharmacokinetic profile, cardiovascular safety, and rapid recovery. Propofol, traditionally used, is effective but can cause hypotension and respiratory depression. Remimazolam, an ultra-short-acting benzodiazepine, emerges as a promising alternative, combining controllable sedation with an improved safety profile. This study aimed to compare the efficacy, safety, and recovery time of remimazolam versus propofol in patients undergoing outpatient procedures, to assess its clinical feasibility as a substitute or complement to propofol. This is a literature review with a qualitative and exploratory approach. The selection of studies was performed by consulting the PubMed, SciELO, ScienceDirect, and Scopus databases, considering full articles published in peer-reviewed scientific journals that analyze aspects related to the use of remimazolam and propofol in outpatient procedures. The time frame considered publications between 2020 and 2023, based on the oldest articles (da Silva, 2020; Melo, 2020; Rodrigues et al., 2020) and the most recent (Gomes et al., 2023; Carvalho et al., 2023). The data analyzed showed that remimazolam has sedative efficacy comparable to propofol, but with a lower incidence of hypotension, bradycardia, and respiratory depression. In addition, it showed greater predictability in recovery, especially in the elderly and patients with comorbidities. The time to cognitive function recovery and hospital discharge was similar between groups, with a slight advantage for remimazolam in some studies. Its reversibility with flumazenil also offers an additional margin of safety. It is concluded that remimazolam is a safe and effective alternative to propofol for sedation in outpatient procedures, with advantages in specific risk profiles. Despite its higher costs, its use may be preferred in vulnerable populations or in protocols that require rapid recovery and less hemodynamic instability.

Introduction: Congenital toxoplasmosis is one of the most serious forms of Toxoplasma gondii infection, acquired by the fetus when pregnant women are infected, at the beginning of pregnancy or close to conception. Therefore, diagnosis, monitoring, and guidance during prenatal care are essential factors to help reduce the number of cases of this disease and its consequences. Objectives: To evaluate the serological monitoring of gestational toxoplasmosis during prenatal care based on data collected from medical records of postpartum women treated at a public hospital in Petrópolis city, Rio de Janeiro state, Brazil, between 2020 and 2022. Methods: Pregnant women were divided into four groups, according to the number of serological tests they were subjected to during prenatal care. Variables related to mother, pregnancy, and prenatal care were analyzed and compared between groups. Results: In total, 240 (39.9%) of the 602 analyzed medical records presented IgG antibodies, whereas eight (1.3%) of them showed IgM antibodies; 16 (2.7%) of patients were subjected to four serological tests during pregnancy; 115 (19.1%) of them were subjected to three tests; 214 (35.5%), to two tests; and 257 (42.7%) of patients only underwent one test. Group 4 was the only group in which all susceptible pregnant women underwent all three serological tests following the initial test. Consequently, the number of toxoplasmosis tests conducted decreased as pregnancy progressed. Conclusions: Based on the analyzed data, approximately 60% of pregnant women were susceptible to infection caused by Toxoplasma gondii, and many were not monitored as recommended by the Ministry of Health."*

More than 200 000 pregnant people fall ill with tuberculosis (TB) annually. Little is known about the impact of pregnancy on TB outcomes. This study used surveillance data from Brazil's Ministry of Health. We included women aged 11-49 years newly diagnosed with drug-susceptible TB disease between 2016 and 2022, treated with a first-line anti-TB regimen, and with a known treatment outcome. Using multivariable regression, we estimated the age-stratified effect of pregnancy on (1) loss to follow-up and (2) death during TB treatment. Of 96 868 women with TB, 1870 (1.9%) were pregnant, 79 361 (81.9%) were not pregnant, and 15 637 (16.1%) had unknown pregnancy status. Among pregnant women, 1432 (76.6%) experienced treatment success, 358 (19.1%), lost to follow-up, and 80 (4.3%) died. Among nonpregnant women, 79 262 (83.4%) experienced treatment success, 11 582 (12.2%) were lost to follow-up, and 4154 (4.4%) died. In adolescents, pregnancy conferred higher odds of loss to follow-up (adjusted odds ratio [aOR], 1.78; 95% confidence interval [CI]: 1.29-2.44) and death (aOR, 2.35; 95% CI: 1.27-4.37). Compared to nonpregnant women of the same age, pregnant women aged 20-29 and 30-39 years experienced more loss to follow-up (respectively: aOR, 1.39; 95% CI: 1.17-1.66 and aOR 1.79; 95% CI, 1.42-2.25), while those aged 40-49 years were more likely to die (aOR, 1.66; 95% CI: 1.04-2.66). Our analysis revealed a significant association between pregnancy and poor TB treatment outcomes, highlighting the need for care providers to offer enhanced support and monitoring for pregnant women undergoing TB treatment. Further research is needed to identify the underlying reasons for these findings.

A inteligência artificial (IA) tem transformado a medicina cardiovascular, oferecendo novas possibilidades para o diagnóstico, prognóstico e tratamento de doenças cardiovasculares (DCV), que continuam a ser a principal causa de mortalidade global. Tradicionalmente, a estratificação de risco baseia-se em fatores clínicos como hipertensão, diabetes e tabagismo, mas as diferentes manifestações desses fatores sugerem a necessidade de abordagens mais precisas e personalizadas. A imagem cardiovascular, incluindo tomografia computadorizada (TC), ressonância magnética (RM) e ecocardiografia, tem se destacado ao fornecer informações detalhadas sobre a estrutura e função cardíaca, bem como sobre a aterosclerose coronariana. A TC, por exemplo, permite a quantificação do cálcio coronariano e a identificação de placas vulneráveis, como as de baixa atenuação e remodelamento positivo, que estão associadas a maior risco de eventos cardiovasculares. A integração de dados clínicos e de imagem por meio de modelos de fusão multimodal tem se mostrado promissora para melhorar a predição de eventos adversos. Esses modelos combinam informações de múltiplas fontes, como registros eletrônicos de cada paciente, dados de imagem e eletrocardiograma para criar predições mais precisas e personalizadas. No entanto, a extração manual desses dados é demorada e sujeita a viéses, limitando sua aplicação clínica. A automação desse processo por meio de técnicas de inteligência artificial tem sido explorada para facilitar a extração de dados, permitindo a criação de modelos de fusão mais eficientes e aplicáveis em larga escala. Além disso, a IA tem sido aplicada para a análise automática de estruturas cardíacas, quantificação de volumes e função ventricular, e detecção de características fenotípicas de placas ateroscleróticas de alto risco. Essas aplicações não apenas melhoram a eficiência do fluxo de trabalho clínico, mas também têm o potencial de identificar padrões sutis que podem passar despercebidos na análise humana tradicional. Este artigo explora o estado atual da IA na imagem cardiovascular, destacando a aplicação de modelos de fusão multimodal e as perspectivas futuras para a implementação clínica dessas tecnologias, visando uma medicina mais personalizada e precisa.

Complex brachial plexus injuries represent a major challenge in medicine, as they can result in severe motor and sensory deficits, significantly impacting patients’ quality of life. Microsurgery and nerve reconstruction techniques have evolved to restore upper limb function, but they still have limitations in terms of full recovery of functionality. The prognosis varies according to the severity of the injury, the time elapsed before the intervention and the surgical approaches used. This study aims to analyze the advances in microsurgery in brachial plexus reconstruction, assessing the prognosis and limitations of these approaches in patients with complex injuries. This is a bibliographic review with qualitative premises, using the SciELO, PubMed and Google Scholar databases to search for scientific articles. To refine the search, the health descriptors “brachial plexus”, “microsurgery”, “nerve reconstruction” and “nerve transfers” were used, applying Boolean operators to optimize the results. The time frame covers the years 2019 to 2023, according to the date of the first and last reference selected. Advances in microsurgery have allowed for better functional recovery rates, especially with techniques such as nerve grafts, nerve transfers and neurotizations. Nerve transfers have stood out for reducing reinnervation time, favoring better motor results. However, factors such as the chronicity of the injury, surgical time and the patient’s neural plasticity significantly influence outcomes. Limitations include the need for prolonged rehabilitation, variability in functional results and difficulty in restoring fine movements and adequate muscle strength. It is concluded that microsurgery and nerve reconstruction are fundamental strategies in the rehabilitation of patients with complex brachial plexus injuries, providing partial or significant recovery of upper limb function. Despite advances, challenges such as prolonged recovery time and limitations in complete nerve regeneration still persist. New approaches, including regenerative therapies and tissue engineering, may contribute to better prognoses in the future.