Nevin Manimala

Rev Assoc Med Bras (1992). 2025 Aug 8;71(7):e20250075. doi: 10.1590/1806-9282.20250075. eCollection 2025.

ABSTRACT

OBJECTIVE: The aim of this study was to investigate the relationship between anticholinergic drug burden and clinical frailty in patients with urinary incontinence.

METHODS: This prospective cross-sectional study included 197 patients who were aged ≥60 years old and admitted to Family Medicine and Urology Departments of Kırıkkale Faculty of Medicine between May 2024 and August 2024. Anticholinergic burden was calculated using anticholinergic burden calculator, frailty was assessed using the clinical frailty scale, and these patients were assigned a frailty score ranging from 1 (very fit) to 9 (terminally ill).

RESULTS: The mean age of the 197 participants in our study was 67.71±6.85 and 92 (46.7%) were female. The mean anticholinergic burden score was 2.43±1.77 and clinical frailty scale score was 4.75±1.05. There was a statistically significant difference between age groups, gender, marital status, educational status, anticholinergic burden status, and clinical frailty scale score (p<0.001, p=0.001, p=0.033, p<0.001, and p<0.001, respectively). There was also a statistically significant distance between age groups, gender, marital status, educational status, and anticholinergic aurden score (p=0.001, p=0.023, p=0.013, p=0.042, respectively). A strong, positive, and significant correlation was found between anticholinergic burden and frailty (r=0.728, p<0.01).

CONCLUSION: The findings of this study highlighted that it is useful to evaluate the anticholinergic burden and reconsider treatment options when prescribing to elderly patients with urinary incontinence.

PMID:40802409 | DOI:10.1590/1806-9282.20250075

Rev Assoc Med Bras (1992). 2025 Aug 8;71(7):e20242031. doi: 10.1590/1806-9282.20242031. eCollection 2025.

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate serum B-type natriuretic peptide levels in pregnant women with hyperemesis gravidarum and compare them with healthy pregnant women.

METHODS: In this prospective cross-sectional study, sample size calculation using G*Power determined a minimum of 40 participants per group, totaling 80 participants. The study included 43 pregnant women with hyperemesis gravidarum and 43 healthy pregnant controls. Hyperemesis gravidarum diagnosis was based on clinical and laboratory criteria, including weight loss, ketonuria, and electrolyte imbalance. Exclusion criteria included pre-existing cardiovascular or systemic diseases, multiple pregnancies, and smoking. Serum B-type natriuretic peptide levels and various biochemical parameters were measured using standard laboratory techniques. Statistical analyses were performed using the Statistical Package for the Social Sciences software, with a p-value of <0.05 considered statistically significant.

RESULTS: B-type natriuretic peptide levels were significantly higher in the hyperemesis gravidarum group compared to the control group (HG: 9.6±2.5 pg/mL [95%CI 8.9-10.3]; control: 8.1±1.8 pg/mL [95%CI 7.5-8.6]; Cohen’s d=0.70, p=0.016). No significant differences were found between the groups in terms of age, body mass index, and other biochemical parameters, including hemoglobin, electrolytes, and inflammatory markers. B-type natriuretic peptide levels were not significantly correlated with gestational week, maternal age, body mass index, or hemoglobin levels.

CONCLUSION: In this study, we found that B-type natriuretic peptide levels are elevated in hyperemesis gravidarum, and we believe that this may be associated with increased cardiac stress. B-type natriuretic peptide may serve as a potential biomarker for monitoring cardiovascular changes in hyperemesis gravidarum. Further research is warranted to validate these findings and explore the role of B-type natriuretic peptide in the clinical management of hyperemesis gravidarum.

PMID:40802403 | DOI:10.1590/1806-9282.20242031

Rev Assoc Med Bras (1992). 2025 Aug 8;71(7):e20242017. doi: 10.1590/1806-9282.20242017. eCollection 2025.

ABSTRACT

OBJECTIVE: Findings in the literature indicate that women often have incorrect or incomplete knowledge about the concepts of microbiota, microbiome, probiotics, prebiotics, and their relationship with women’s health, pregnancy, childbirth methods, and breast milk. In this regard, designing educational programs that contribute to preventing reproductive system infections, achieving positive fertility outcomes, and supporting the health processes of women and newborns through the microbiota of the female body can contribute to the current situation. In line with this aim, in this study, the development and evaluation of a microbiota education program for women were conducted.

METHODS: The research was conducted with 151 female participants in a pre-test and post-test, single-group, quasi-experimental design. The trainings were conducted for 2 days, with a total of 4 h for each group, 2 h each day. The microbiota knowledge test applied before the training was repeated as a post-test after 4 weeks. SPSS 25.0 was used for data analysis.

RESULTS: It was determined that there was a statistically significant difference between the pre-training and post-training knowledge scores of the participants, with the post-training knowledge scores being higher than the pre-training scores (p<0.05). It was found that there was an increase in intra-group means for age, education level, occupation, number of pregnancies, number of births, and method of delivery after the training.

CONCLUSION: As a result of the evaluations, it was concluded that the microbiota education program developed and implemented for women addressed all female participants.

PMID:40802401 | DOI:10.1590/1806-9282.20242017

Rev Assoc Med Bras (1992). 2025 Aug 8;71(7):e20241870. doi: 10.1590/1806-9282.20241870. eCollection 2025.

ABSTRACT

OBJECTIVE: Zonulin is a protein, synthesized in intestinal cells, that reversibly regulates the permeability of the intestinal epithelium. Elevated levels of zonulin are associated with increased intestinal permeability. It is shown that some neurological disorders are related to zonulin. We aim to research the possible associations between the zonulin levels and the symptom intensity in restless legs syndrome.

METHOD: Demographic data of 43 patients with restless legs syndrome were recorded, and plasma zonulin levels were compared with 43 healthy controls using the enzyme-linked immunosorbent assay test. In the study, 66% of all participants were female and 20% were male. The mean age of the study group was 57.4±14.3 years. The average duration of the disease was 9.3±7.4 years, while the severity of the disease was 24.3±7.6. A p<0.05 was considered statistically significant.

RESULTS: There was no significant difference between plasma zonulin levels in the control group and patients, but there were more individuals in the patient group in the high category of Zonulin levels, while the control group was dominant in the low level. In the patient group, zonulin levels were higher in the overweight and obese groups according to body mass index.

CONCLUSION: Our study indirectly supports the hypothesis that central factors play a more significant role in the pathophysiology of restless legs syndrome rather than immunoresponsiveness in the gut and intestinal permeability.

PMID:40802396 | DOI:10.1590/1806-9282.20241870

Rev Assoc Med Bras (1992). 2025 Aug 8;71(7):e20241460. doi: 10.1590/1806-9282.20241460. eCollection 2025.

ABSTRACT

OBJECTIVE: The aim of the study was to assess the predictive value of the triglyceride-glucose index and atherogenic indices for infertility in women with polycystic ovary syndrome.

METHODS: This prospective, single-center, non-randomized observational study was conducted on 279 women diagnosed with polycystic ovary syndrome from May to December 2023. Women with polycystic ovary syndrome were grouped into two groups: those with infertility and those without infertility. Demographic, hormonal, and clinical parameters were studied. The statistical study employed IBM SPSS (Statistical Package for the Social Sciences) Statistics 22 to analyze the distribution of variables, assessing normality and comparing categorical and continuous data. Descriptive statistics were computed, with categorical and continuous data compared using appropriate tests (chi-square, Student’s t-test, and Mann-Whitney U). Multivariable logistic regression identified independent predictors of infertility, with a significance level set at 0.05.

RESULTS: Infertile women with polycystic ovary syndrome had significantly higher plasma levels of dehydroepiandrosterone sulfate (p=0.001), testosterone (p=0.005), insulin (p=0.041), Homeostasis Model Assessment of Insulin Resistance (p=0.029), prolactin (p=0.018), triglycerides (p<0.001), triglyceride/high-density lipoprotein (p=0.001), atherogenic index of plasma (p=0.011), triglyceride-glucose index (p=0.001), and lipoprotein combine index (p=0.007) compared to the fertile women with polycystic ovary syndrome. Correlation analysis showed that the triglyceride-glucose index correlated with the Homeostasis Model Assessment of Insulin Resistance (r=0.402, p<0.001) and total testosterone (r=0.191, p=0.001). Multivariable analysis identified age (OR 1.189, 95%CI 1.122-1.263, p<0.001), prolactin (OR 1.040, 95%CI 1.004-1.077, p=0.029), and triglyceride-glucose index (OR 2.473, 95%CI 1.404-4.177, p<0.001) as independent predictors of infertility.

CONCLUSION: This study suggests a more atherogenic lipid profile in infertile women with polycystic ovary syndrome, suggesting a significant link between dyslipidemia and infertility. The triglyceride-glucose index proves to be a reliable, non-invasive marker of insulin resistance and may aid in identifying women at higher risk for infertility, facilitating earlier, targeted interventions.

PMID:40802395 | DOI:10.1590/1806-9282.20241460

Braz J Biol. 2025 Aug 8;85:e293174. doi: 10.1590/1519-6984.293174. eCollection 2025.

ABSTRACT

The food crisis in Peru has intensified due to the increase in the costs of raw materials, such as energy sources, fertilizers, and other industrial inputs, as a result of global socioeconomic instability. For this reason, research was conducted on the antioxidant in relation to nutrition, stomatal density, and yield in cilantro nourished with compost leachate based on vegetable waste (CLPW). The objective was to analyze the antioxidants in relation to nutrition, stomatal density, and the yield of cilantro nourished with CLPW. The methodology was based on an applied experimental approach, so the statistical model of completely randomized block design was employed, which consisted of 3 blocks and 5 treatments: T1 with 0, T2 with 2, T3 with 3, T4 with 4, and T5 with 5 liters of CLPW per 200 liters of water. The doses were applied 15 and 30 days after planting. The data obtained from the physical characteristics of cilantro, such as total length, plant weight, number of leaves, and commercial yield, were processed using analysis of variance and the Duncan test. Additionally, the concentration of nutrients (nitrogen, potassium, phosphorus, calcium, magnesium, sulfur, molybdenum, iron, manganese, copper, zinc, boron, chlorides, and sodium), antioxidant capacity, stomatal density in leaves, and profitability were evaluated. The results determined that T5 stood out in total length with 55.23 cm, plant weight with 79.63 g, number of leaves with 162, and commercial yield with 27.017 t/ha. Regarding nutrient concentration, T5 stood out in calcium, magnesium, iron, boron, and chlorides, with a profitability of 334%. T4 stood out in antioxidant capacity with 4638.1 μmol Trolox/100 g sample, while T1 showed the highest stomatal density with 143 stomata/mm2. In conclusion, T4, with 4638.1 μmol Trolox/100 g sample, exhibited the highest antioxidant capacity. However, T5, with 4212.8 μmol Trolox/100 g sample, promoted greater nutrient absorption, lower stomatal density, and other biochemical reactions, which resulted in strengthening against environmental stress and, consequently, higher yield.

PMID:40802391 | DOI:10.1590/1519-6984.293174

Epidemiol Serv Saude. 2025 Aug 11;34:e20240665. doi: 10.1590/S2237-96222025v34e20240665.en. eCollection 2025.

ABSTRACT

OBJECTIVE: To investigate morbidity and mortality rates from severe acute respiratory syndrome in pregnant women and newborns in the first two years of the COVID-19 pandemic.

METHODS: This was a descriptive-analytical study in which data on cases and deaths in pregnant women and newborns with a positive diagnosis of severe acute respiratory syndrome, regardless of the etiological agent, were collected from the Influenza Epidemiological Surveillance Information System and data on the number of live births from the Live Birth Information System. The frequencies of cases and deaths and the morbidity and mortality rates among pregnant women and newborns in the state of Rio de Janeiro were calculated using the Kruskal-Wallis test to compare the periods 2018-2019 and 2020-2021.

RESULTS: During the pandemic, there was a statistically significant increase in morbidity rates in pregnant women (24.49/100,000 to 537.39/100,000; p-value<0.001) and newborns (69.97/100,000 to 200.82/100,000; p-value 0.022) and mortality rates in pregnant women (1.87/100,000 to 48.08/100,000; p-value<0.001) and newborns (1.87/100,000 to 9.26/100,000; p-value 0.008).

CONCLUSION: This study identified a statistically significant increase in morbidity and mortality rates due to severe acute respiratory syndrome in pregnant women and newborns in the state of Rio de Janeiro during the pandemic. There is a clear need for greater investment to reduce harm to these groups, such as vaccination and access to the healthcare system, as well as highly complex infrastructure throughout the state.

PMID:40802384 | DOI:10.1590/S2237-96222025v34e20240665.en

Einstein (Sao Paulo). 2025 Aug 11;23:eAO1476. doi: 10.31744/einstein_journal/2025AO1476. eCollection 2025.

ABSTRACT

OBJECTIVE: This study compared the productivity of prison oral health teams during the COVID-19 crisis (2020-2022) with the previous three-year period (2017-2019) to identify the number and type of dental procedures performed.

METHODS: We employed an ecological and retrospective study using Primary Care Health Information System data. We analyzed data from all municipalities that reported the productivity of Prison Primary Care Teams from 2017 to 2022, totaling 418 municipalities distributed across all five Brazilian regions. Data pertaining to 15 oral health procedures were collected and subsequently grouped into five categories: preventive, urgent, extraction, periodontics, and restorative. The data revealed a non-normal distribution and were evaluated using the Wilcoxon test.

RESULTS: The findings revealed inequality between regions, with the productivity of several municipalities being close to or equal to zero. Although the number of restorative procedures reduced in both periods (2017-2019 and 2020-2022), it was not statistically significant. However, statistically significant increases were observed, with the exception of restorative and periodontal procedures. Urgent and extraction procedures prevailed over restorative and periodontal treatments.

CONCLUSION: Access to Brazilian oral health procedures for inmates is low and remained unaffected by the pandemic, maintaining similar characteristics with increased productivity during that period.

PMID:40802374 | DOI:10.31744/einstein_journal/2025AO1476

JMIR Hum Factors. 2025 Aug 13;12:e71912. doi: 10.2196/71912.

ABSTRACT

BACKGROUND: Bring your own device (BYOD) adoption in health care improves clinician productivity, but introduces cybersecurity risks due to weak security controls, human error, and policy circumvention. Existing security frameworks and models are technocentric, while overlooking sociotechnical factors such as clinician behavior, workflow integration, and organizational culture. This misalignment reduces their effectiveness in health care settings. In addition, hospitals vary in structure, resources, and BYOD use, necessitating a flexible yet structured approach to assess security maturity and prioritize improvements, which is lacking in existing models.

OBJECTIVE: This study aims to develop and pilot a hospital BYOD security maturity model that integrates technical, policy, and human factors for a structured assessment and improvement of BYOD security in health care.

METHODS: This study used mixed methods action research to design and pilot a hospital BYOD security maturity model. Surveys and interviews with IT managers and clinicians shaped the model, which was trialed at a public metropolitan hospital in Victoria, Australia. Participants completed a maturity assessment and joined a 90‑minute co‑design workshop that prioritized 6 key domains and proposed improvements. Descriptive statistics and thematic analysis guided refinements to improve clarity and usability.

RESULTS: The model was initially developed with 22 domains across 3 key dimensions: technology, policy, and people, each structured across 5 maturity levels to support systematic progression in hospital BYOD security. On the basis of participant feedback during the refinement process, 2 training-related domains were merged, resulting in a final model with 21 domains. The technology dimension includes domains such as identity, access, and authentication management; device security; and clinical communication, ensuring technical controls align with hospital policies and workflows. The policy dimension focuses on governance, covering areas such as BYOD strategy, regulatory compliance, and incident response, to establish clear security guidelines and enforcement mechanisms. The people dimension addresses human factors, including security awareness training, stakeholder involvement, and security culture, fostering staff engagement and adherence to security protocols. A maturity assessment survey conducted at a public metropolitan hospital in Victoria, Australia, revealed an overall maturity level of 2.04. Key areas for improvement included identity and access management, clinical communication security, and governance transparency. A 90-minute co-design workshop identified challenges and proposed solutions for the top 6 priority domains. Recommendations included implementing single sign-on, defining a formal BYOD strategy, enhancing secure communication tools, and improving stakeholder engagement.

CONCLUSIONS: The model can serve as a valuable tool for hospitals and policy makers, offering actionable recommendations to strengthen BYOD security. The pilot implementation demonstrated its practical applicability, helping the hospital identify security gaps and develop a road map for structured enhancements. Further validation across diverse health care settings will enhance its adaptability and long-term impact.

PMID:40802372 | DOI:10.2196/71912

Cad Saude Publica. 2025 Aug 8;41(7):e00153623. doi: 10.1590/0102-311XEN153623. eCollection 2025.

ABSTRACT

This study aims to evaluate the impact of the search for internet health information by patients on the doctor-patient relationship and satisfaction of both physicians and patients. In total, 200 patients of a tertiary hospital in Brazil and a convenience sample of 92 physicians were included. The questionnaires applied consisted of statements concerning the study’s objective; answers were given on a 5-point Likert scale. We conducted a descriptive analysis and used nonparametric tests to verify statistical differences in perception between subgroups of interest. In this study, 85.6% of internet users searched for internet health information but were skeptical about the information they found. They were mostly positive about the doctor-patient relationship; however, they desired greater engagement in health decisions. Overall, physicians tended to have a slightly positive view about internet health information impact on patients’ health despite some possible harmful effects. However, they believe that search for internet health information causes unnecessary fear and concern in patients, reduces doctor’s work efficiency, and that internet health information is not accurate or reliable. The massive search for internet health information has led to significant changes in the doctor-patient communication model. Both parties have demands to be addressed: patients need more reliable information; and physicians must adapt to these changes in a way that neither diminishes their autonomy as healthcare providers nor worsens the doctor-patient relationship. Hopefully, physicians could play a central role in educating patients and indicating adequate sources of information.

PMID:40802358 | DOI:10.1590/0102-311XEN153623