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SUMMARY OBJECTIVE: The aim of this study was to reveal the histopathological results of Prostate Imaging Reporting and Data System 3 lesions and to investigate whether targeted biopsy is essential in these lesions. METHODS: One hundred and twenty-seven patients with 176 lesions, being categorized as Prostate Imaging Reporting and Data System 3 according to Prostate Imaging Reporting and Data System version 2.1, who underwent transrectal ultrasound-magnetic resonance imaging fusion biopsy were included in the study. RESULTS: The mean age of the patients was 62.4 years. The median of prostate-specific antigen, prostate-specific antigen density, free prostate-specific antigen, and free/total prostate-specific antigen were 6.64 ng/mL, 0.10 ng/mL2, 1.24 ng/mL, and 0.18 ng/mL, respectively. In patient- and lesion-based analysis, the prevalence of adenocarcinoma was 12.7 and 9%, and clinically significant prostate cancer was 2.3 and 1.7%, respectively. The rate of prostate cancer detected by systematic biopsy alone was 7.8%, and 1.5% of these were clinically significant. There was no significant difference in prostate-specific antigen or prostate-specific antigen density between patients with histopathologically malignant and benign Prostate Imaging Reporting and Data System 3 lesions (p≥0.233). prostate-specific antigen density was higher in malignant patients, considering only 89 patients with index lesion P3 (p=0.046). Family history was significantly higher in malignant patients (p=0.028). CONCLUSION: Since clinically significant prostate cancer is very low in Prostate Imaging Reporting and Data System 3 lesions, clinical findings and risk factors should be considered in the biopsy decision in patients with index lesion Prostate Imaging Reporting and Data System 3. However, in patients with index lesions Prostate Imaging Reporting and Data System 4 and 5, targeting these Prostate Imaging Reporting and Data System 3 areas might be important with regard to the extent of the disease.

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SUMMARY OBJECTIVE: The aim of this study was to examine the risk of falls and associated factors among hospitalized pregnant women and to evaluate the measurement consistency between the Itaki II Fall Risk Scale and the Assessment Scale for Risk of Falling in Pregnant Women. METHODS: This descriptive, correlational study was performed in the obstetrics ward of a university hospital between March and August 2024. A total of 165 pregnant women were included in the study. Data were collected using the Assessment Scale for Risk of Falling in Pregnant Women questionnaire and the Itaki II Fall Risk Scale. For data analysis, the Mann-Whitney U test, Kruskal-Wallis H test, Spearman's correlation, linear regression, and Bland-Altman analysis were employed. RESULTS: The prevalence of falls during pregnancy was 10.3%. The median total Assessment Scale for Risk of Falling in Pregnant Women score was 9, whereas the median Itaki II Fall Risk Scale score was 2. Gestational weight gain, gestational age, spouse's education level, and the presence of chronic diseases were significantly associated with fall risk (p<0.05). A low-level significant correlation was found between the scales, and Bland-Altman analyses indicated that there was no measurement coherence between the two scales. CONCLUSION: Early identification of pregnant women at risk of falls and implementation of appropriate preventive strategies are critical for patient safety. Therefore, it is recommended to develop a reliable fall risk assessment tool tailored for hospitalized pregnant women and to provide education programs and environmental modifications.

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SUMMARY OBJECTIVE: Endometrial cancer is the most common gynecologic malignancy in developed countries. Currently, there are no reliable screening methods available for the early diagnosis or prognostic evaluation of the disease. MicroRNAs are small non-coding ribonucleic acid molecules primarily involved in the regulation of gene expression. The aim of this study was to evaluate and compare serum levels of microRNA-204 and microRNA-652-3p between patients diagnosed with endometrial cancer and healthy controls in order to determine their potential diagnostic and prognostic value as candidate biomarkers. METHODS: Serum samples were collected from a total of 226 participants, comprising 150 patients diagnosed with endometrial cancer and 76 healthy controls. Relative expression levels of microRNA-204 and microRNA-652-3p were measured using quantitative real-time polymerase chain reaction. RESULTS: The present study demonstrated that serum levels of microRNA-204 and microRNA-652-3p were significantly elevated in patients with endometrial cancer compared with healthy controls. Overexpression of these microRNAs was significantly associated with disease stage and adverse prognosis. Moreover, patients with high microRNA-204 and microRNA-652-3p expression exhibited significantly shorter survival than those with low expression. Elevated expression of both microRNAs was also significantly associated with an increased risk of disease recurrence. CONCLUSION: Serum levels of microRNA-204 and microRNA-652-3p distinguished patients with endometrial cancer from healthy controls. In addition, both microRNAs were associated with prognosis, including an increased risk of disease recurrence. These findings require confirmation in larger, independently validated cohorts.

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SUMMARY OBJECTIVE: Primary spontaneous pneumothorax is characterized by the accumulation of air within the pleural space in the absence underlying lung diseases. This study aims to evaluate the clinical characteristics, treatment modalities, and recurrence rates of child and adolescent patients diagnosed with primary spontaneous pneumothorax in our clinic. METHODS: Patients under the age of 18 diagnosed with primary spontaneous pneumothorax via chest X-ray and thoracic computed tomography were included in the study. Patients’ age, gender, presenting complaints, side of pneumothorax, treatment method, complication status, history of recurrence, smoking status, body mass index, and Haller index were recorded. The pneumothorax ratio was calculated radiologically according to the British Thoracic Society guidelines and using the Kircher-Swartzel formula. RESULTS: Total of 33 patients were included in the study. During follow-up, 15 recurrent episodes occurred, yielding a total of 48 pneumothorax episodes for analysis. No patient experienced more than two total episodes. A statistically significant relationship was identified between the pneumothorax percentage and the development of recurrence. No statistically significant difference was found between body mass/Haller/gender index and the development of recurrence. No significant association was found between the side of pneumothorax (left, right, or bilateral) and the development of either recurrence or complications. CONCLUSION: Although management strategies similar to adult protocols are applied in childhood pneumothorax, individualized treatment planning based on patient characteristics is of paramount importance. Large-scale studies are required to establish a standardized treatment protocol.

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SUMMARY OBJECTIVE: The response to neoadjuvant therapy in patients with locally advanced rectal cancer varies considerably among individuals. While some patients achieve a complete pathological response, others may even experience disease progression during treatment. The aim of the study was to investigate the predictive value of serum adipokines in determining the response to neoadjuvant therapy. METHODS: This prospective study included patients diagnosed with rectal cancer and scheduled for neoadjuvant therapy at our institution between September 2020 and September 2022. Before the treatment, blood samples were collected from the patients, and levels of serum adipokines (adiponectin, leptin, resistin, and adipsin) were measured. Following surgical resection, the Modified Ryan Scoring System was used to assess the response to neoadjuvant chemoradiotherapy. Patients were then divided into two groups according to the response to the treatment (Group 1: tumor regression grade 0; Group 2: tumor regression grade 1–3). RESULTS: In the 58 patients included, no significant differences were observed in terms of demographics, tumor characteristics, or serum biochemical parameters. However, levels of adiponectin (p=0.039) and resistin (p=0.017) were significantly lower in the pathologic complete response group. CONCLUSION: Adiponectin and resistin might contribute to anticipating response to neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer. The incorporation of these markers into personalized therapy approaches has the potential to improve correct decision-making in the management of locally advanced rectal cancer.

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SUMMARY OBJECTIVE: The aim of this study was to describe sexual life and determine the prevalence of erectile dysfunction in men with chronic obstructive pulmonary disease. METHODS: A multicenter cross-sectional study was conducted with 120 male patients diagnosed with chronic obstructive pulmonary disease for 2 years since 2021. Participants completed a comprehensive questionnaire that included the International Index of Erectile Function, selected items from the Questionnaire on Changes in Sexual Function, and additional questions about sexual health. Erectile dysfunction was considered clinically significant with an International Index of Erectile Function score ≤16. No formal a priori sample size calculation was performed because participant recruitment was based on consecutive inclusion during a 2-year study period. RESULTS: In total, 113 participants (94.2%) reported experiencing changes in their sex life and 42 (36%) were dissatisfied. The main factors contributing to these changes were the underlying disease (53.3%), medication use (20.8%), and psychological problems (20%). The mean International Index of Erectile Function score was 13.8 (7.0), with an erectile dysfunction prevalence of 87.5%. Erectile dysfunction was mild in 33 patients (27.5%), mild-to-moderate in 26 (21.7%), moderate in 21 (17.5%), and severe in 25 (20.8%). Multivariate analysis identified dyslipidemia (odds ratio: 4.028; 95%CI 1.428–11.361; p=0.008) and %pFEV1 (OR 0.937; 95%CI 0.906–0.968; p<0.001) as independent predictors of clinically significant erectile dysfunction. CONCLUSION: Poor sexual health and erectile dysfunction are highly prevalent among men with chronic obstructive pulmonary disease. Dyslipidemia and impaired airflow are associated with the presence of clinically significant erectile dysfunction.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate the association between lower limb strength and symptoms of anxiety and depression in communitydwelling older adults. METHODS: This cross-sectional study included 99 community-dwelling older adults (69.5±6.6 years; 81.8% women) assessed between 2021 and 2023 in Minas Gerais, Brazil. Inclusion criteria were age ≥60 years, independent mobility, and medical clearance. Participants were excluded if they had uncontrolled chronic or cardiovascular diseases, a history of stroke, unmanaged neurodegenerative disorders, active psychiatric comorbidities that could interfere with psychological assessments, or musculoskeletal injuries preventing safe participation in testing. Anxiety and depressive symptoms were assessed using the Geriatric Anxiety Inventory and Geriatric Depression Scale. Lower limb strength was measured using the 30-Second Chair Stand test and classified according to age- and sex-specific normative values. RESULTS: Participants with below-average lower limb strength had higher odds of anxiety symptoms (OR 10.90; 95%CI 1.97–60.33; p=0.006). Lower limb strength was also associated with depressive symptoms, although with a smaller effect size (OR 3.96; 95%CI 1.06–14.74; p=0.040). Age was positively associated with anxiety (p=0.019), while no significant associations were observed for sex. CONCLUSION: The 30-Second Chair Stand test may have potential as a complementary screening indicator to identify older adults at elevated psychosocial risk.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate the participation of obstetric nurses in care provided during labor and delivery within the Brazilian private health system. METHODS: This cross-sectional observational study included women admitted for delivery in six private hospitals—five in São Paulo and one in Santos, Brazil. Data were obtained through structured interviews conducted during the postpartum period and included information on hospital admission, labor and delivery care, healthcare professionals involved, and obstetric interventions. Women with live births during the study period were included. RESULTS: A total of 2,435 postpartum women were interviewed. Among them, 48.2% were in their first pregnancy, and 56.4% were primiparous. Only 14.9% had a previous vaginal delivery, while 31.2% had undergone a previous cesarean section. Labor was attended by a physician in 99.3% of cases. Although 52.3% of women had the presence of an obstetric nurse during labor, only 0.7% received delivery assistance from this professional. Among women with labor onset, 58.3% had a vaginal delivery, and only 3.2% were assisted exclusively by obstetric nurses during labor and delivery. Overall, 76.6% of participants underwent cesarean section. CONCLUSION: Obstetric nurses were frequently present during labor but rarely performed delivery care in private hospitals. Their limited participation suggests underutilization of this professional group within the studied setting.

Resumo em Inglês:

SUMMARY BACKGROUND: Cardiac risk stratification protocols are widely used in cardiac rehabilitation programs, but divergent classifications limit their applicability. In 2020, the Brazilian Society of Cardiology updated its protocol; however, its agreement with established protocols and inter-rater reliability in cardiac rehabilitation programs remain unclear. OBJECTIVE: The aim of this study was to evaluate the agreement between the 2020 Brazilian Society of Cardiology cardiac risk stratification protocol and protocols used in clinical practice and to assess inter-rater agreement in its application. DESIGN AND SETTING: Cross-sectional observational study conducted in a cardiac rehabilitation program at a public university in Brazil. METHODS: Medical records of 51 cardiac rehabilitation programs participants were independently analyzed by two cardiovascular physical therapists using the 2020 Brazilian Society of Cardiology, American Association of Cardiovascular and Pulmonary Rehabilitation, American College of Sports Medicine, Pashkow, and 2013 Brazilian Society of Cardiology protocols. Agreement between protocols and inter-rater reliability was assessed using the Kappa coefficient. RESULTS: The 2020 Brazilian Society of Cardiology protocol showed moderate agreement with Pashkow (k=0.544; 95%CI 0.340–0.748; p<0.001) and the 2013 Brazilian Society of Cardiology protocol (k=0.708; 95%CI 0.498–0.918; p<0.001), good-to-excellent agreement with American Association of Cardiovascular and Pulmonary Rehabilitation (k=0.780; 95%CI 0.604–0.956; p<0.001), and weak, nonsignificant agreement with American College of Sports Medicine (k=0.003; 95%CI -0.015 to 0.021 p=0.866). Inter-rater analysis demonstrated excellent agreement between evaluators (k=0.843; 95%CI 0.672–1.014; p<0.001). CONCLUSION: The findings provide preliminary evidence regarding the agreement and reproducibility of the 2020 Brazilian Society of Cardiology protocol compared with established cardiac rehabilitation programs protocols; however, further studies are needed to evaluate its predictive validity for exercise-related events.