Abstract in English:

ABSTRACT BACKGROUND: Understanding the lingering effects of child abuse may improve healthcare pathways with preventive and supportive strategies. OBJECTIVE: To compare adverse outcomes between survivors of child abuse and non-exposed subjects. DESIGN AND SETTING: This is a cohort study conducted at the Pediatric Emergency Department of the Nuevo Hospital Civil de Guadalajara, Guadalajara, Mexico. METHODS: This cohort study of Mexicans compared adverse outcomes between survivors of child abuse and non-exposed individuals from 2011 to 2018. Additionally, we contacted survivors in 2020 to collect additional data, including sociodemographic and study variable-related information. RESULTS: This study included 300 survivors of child abuse, paired by age with 300 non-exposed subjects. Neglect and sexual abuse were the most frequent types of abuse. Among the survivors, there was a higher risk of hyperactivity with attention deficit [Relative Risk (RR) = 4.65(2.06–10.51); P = 0.0001], drug abuse [RR = 3.09(1.25–7.63); P = 0.0001], mood disorders [RR = 2.97(1.81–4.86); P = 0.0001], tobacco use [RR = 2.79(1.60–4.88); P = 0.0001], and engagement with substance abuse and sexual intercourse at a younger age. Non-exposed subjects had a higher level of education [RR = 0.65(0.49–0.87); P = 0.0001] and were more engaged in sports [RR = 0.31(0.18–0.52); P = 0.0001]. CONCLUSION: Survivors of child abuse are at risk for psychological problems and substance abuse. Increasing sports engagement and school attendance may protect against adverse outcomes.

Abstract in English:

ABSTRACT BACKGROUND: Polycystic ovary syndrome (PCOS) is a common endocrine–metabolic disorder. Irisin is an exercise-related myokine involved in energy homeostasis; however, prior studies have reported inconsistent associations between irisin and PCOS. OBJECTIVES: To compare serum irisin levels between women with PCOS and non-PCOS controls and to assess the discriminatory performance of irisin for PCOS. DESIGN AND SETTING: Cross-sectional, case–control study conducted at a tertiary referral center. METHODS: We enrolled 144 women, 72 with PCOS and 72 non-PCOS as controls. Serum irisin levels were measured using an enzyme-linked immunosorbent assay. Adjusted comparisons were performed using a general linear model, and the association between irisin and PCOS was further evaluated using multivariable binary logistic regression. Receiver operating characteristic (ROC) analysis was used to assess the diagnostic performance of irisin. RESULTS: Serum irisin levels in the PCOS group were significantly lower than those in the control group (p = 0.006). In the age and body mass index (BMI) adjusted ANCOVA model, PCOS status remained significantly associated with lower log-transformed irisin (p = 0.002). In a multivariable logistic regression analysis adjusted for age and BMI, log-transformed irisin levels remained independently associated with PCOS (p = 0.006). In ROC analysis, the area under the ROC curve for irisin was 0.632; an irisin cut-off of ≤ 16.2 ng/mL resulted in 87.5% sensitivity and 38.89% specificity. CONCLUSIONS: Women with PCOS had lower circulating irisin levels than controls, and this association persisted after adjusting for age and BMI. Discriminatory performance was modest, and specificity was low at the selected cutoff. Larger studies are warranted to validate these findings.

Abstract in English:

ABSTRACT BACKGROUND: Vitamin D deficiency is common among individuals with obesity; however, the association between low 25-hydroxyvitamin D [25(OH)D] concentrations and adiposity remains unclear. Shift workers are at increased risk for both vitamin D deficiency and metabolic disorders, making this population particularly relevant for investigating this relationship. OBJECTIVES: This study aimed to evaluate the effect of cholecalciferol supplementation on central adiposity, assessed by waist circumference (WC) and waist-to-height ratio (WHtR), among male shift workers. DESIGN AND SETTING: Randomized, double-blind, placebo-controlled clinical trial involving 198 male shift workers employed by an iron ore extraction company in Minas Gerais, Brazil. METHODS: Participants with 25(OH)D concentrations <30 ng/mL and at least one metabolic abnormality, including metabolic syndrome, impaired fasting glucose, dyslipidemia, elevated blood pressure, or increased WC, were randomly assigned to receive placebo, cholecalciferol 14,000 IU/week, or cholecalciferol 28,000 IU/week for 4 months. Plasma 25(OH)D concentrations, WC, and WHtR were evaluated at baseline and post-intervention. RESULTS: After 4 months, no significant differences in WC or WHtR were observed between the vitamin D supplementation groups (14,000 IU/week and 28,000 IU/week) and the placebo group. Nevertheless, serum 25(OH)D concentrations increased significantly in the supplementation groups: +6.23 ng/mL (p25 = 0.58; p75 = 10.61) in the 14,000 IU/week group and +15.25 ng/mL (p25 = 10.57; p75 = 19.68) in the 28,000 IU/week group. In contrast, the placebo group showed a decrease of −0.50 ng/mL (p25 = −1.03; p75 = 2.71). Despite these increases, supplementation produced no significant effect on central adiposity outcomes (p > 0.05). CONCLUSION: Although vitamin D supplementation effectively increased serum 25(OH)D concentrations, it did not reduce central adiposity among male shift workers. These findings indicate that vitamin D supplementation alone is unlikely to improve obesity-related outcomes in this high-risk occupational population and underscore the need for comprehensive strategies targeting metabolic health in shift workers. CLINICAL TRIAL OR SYSTEMATIC REVIEW REGISTRATION: This study was registered in the Brazilian Registry of Clinical Trials (ReBEC) under identifier RBR-6CS352 on October 25, 2017.

Abstract in English:

ABSTRACT BACKGROUND: Familial Mediterranean fever (FMF) is a hereditary autoinflammatory disorder characterized by recurrent febrile episodes and serositis. OBJECTIVES: The aim of this study was to assess the impact of FMF on sleep quality in children and adolescents and to explore the relationship between depressive symptoms and sleep disturbances in this patient population. DESIGN AND SETTING: A prospective case-control study was conducted at a secondary hospital in Istanbul between July 2024 and January 2025. METHODS: Children and adolescents diagnosed with FMF who were followed at a pediatric rheumatology clinic were included. Sleep disturbances were assessed using the Sleep Disturbance Scale for Children (SDSC), and depressive symptoms were evaluated using the Beck Depression Inventory (BDI). Correlations between these scores were analyzed. RESULTS: The mean age of the patient group (n = 97) was significantly higher than that of the control group (n = 90) (10.6 ± 2.9 years vs. 9.3 ± 2.4 years; p < 0.001). The median SDSC and BDI scores were significantly higher in the patient group than in the control group (p < 0.05). Analysis of the SDSC subscales indicated that patients with FMF experienced difficulties in sleep initiation and maintenance, sleep-related breathing problems, hyperhidrosis, arousal disturbances, sleep-wake transitions, and excessive daytime somnolence (p < 0.05). No significant differences were found between patient subgroups categorized by MEFV gene mutations in total BDI scores, total SDSC scores, all SDSC subscale scores, or depression severity classes (p > 0.05). Furthermore, no significant correlations were observed between total BDI scores and total SDSC scores or any of the SDSC subscale scores (p > 0.05).. CONCLUSION: Children and adolescents with FMF had significantly higher levels of depressive symptoms and sleep disturbances than controls.

Abstract in English:

ABSTRACT BACKGROUND: Many scolicidal agents are used to treat hydatid cysts. However, most of these have been discontinued because of complications. Currently, no safe, effective, and useful scolicidal agent are available for the treatment of hydatid cysts in humans. Therefore, novel agents with greater efficacy, fewer side effects, and lower costs are required. In this study, we evaluated the effects of aminomix-1 solution on the liver and bile ducts of rats. MATERIALS AND METHODS: Twenty-two male Wistar-Albino rats were divided into two groups. A 0.5 mL solution of aminomix-1 was injected into the common bile duct with a 27-gauge syringe without pressure in the experimental group and normal saline (0.9% isotonic) in the control group. Blood samples for hepatic function tests and liver and bile duct tissues were examined histopathologically 4 weeks after the procedure. All statistical analyses were performed using IBM SPSS Statistics for Windows, version 21.0. Statistical significance was set at p < 0.05. RESULTS: The aminomix-1 group showed significantly higher aspartate aminotransferase and alkaline phosphatase levels than the control group. No significant differences were observed in the alanine aminotransferase and amylase levels. Total and direct bilirubin and gamma-glutamyl transferase levels were below the detection limits. No fibrosis or confluent necrosis was observed in either group. The aminomix-1 group showed moderate necrosis in the spotty (focal) necrosis analysis, which was borderline significant (p ≈ 0.08). CONCLUSION: Although aminomix-1 caused mild biochemical and histopathological changes, it did not cause advanced or irreversible liver damage or sclerosing cholangitis.

Abstract in English:

ABSTRACT BACKGROUND: Long-term metabolic complications in childhood are associated with birthweight. OBJECTIVES: This study aimed to examine trends in the prevalence of low and high birthweight over a 16-year period and to investigate the association between birthweight and overweight/obesity among schoolchildren aged 7 to 10 years. DESIGN AND SETTING: The analyses included four school-based cross-sectional surveys conducted in Florianópolis. METHODS: The probabilistic panels were conducted in 2002, 2007, 2012–2013, and 2018–2019. Multiple logistic regression models were used to assess the associations between low and high birthweight and childhood overweight/obesity. Adjusted models included biological, socioeconomic, survey-period, and dietary-intake variables. RESULTS: Over the 16-year period, low birthweight showed a progressive and statistically significant increase, rising by 58.3% from 2002 to 2018–2019. In contrast, the prevalence of high birthweight was 9.1% in 2002 and declined significantly over the ten-year period from 2002 to 2012–2013, decreasing by 40.7%. In the adjusted model, high birthweight was significantly associated with overweight/obesity across all study waves (OR = 1.63; 95% CI = 1.32–2). CONCLUSION: A statistically significant upward trend in the prevalence of low birthweight was observed among schoolchildren in Florianópolis from 2002 to 2018–2019. Despite a reduction in high birthweight over time, high birthweight remained directly associated with overweight/obesity, independently of food intake and other confounding factors.

Abstract in English:

ABSTRACT BACKGROUND: Brain death is the essential condition for organ procurement, yet donation rates in Brazil remain insufficient to meet national transplant needs. Understanding both the clinical determinants of brain death and the social or institutional barriers to organ donation is crucial for improving donation outcomes and informing public health strategies. OBJECTIVES: To identify the main causes of brain death and analyze the factors associated with organ non-donation at a university hospital in São Paulo State. DESIGN AND SETTING: This cross-sectional study with a quantitative approach was conducted at a university hospital in São Paulo State, using data from the Organ Procurement Organization affiliated with the Universidade de São Paulo. METHODS: The medical records of all patients diagnosed with brain death between 2001 and 2015 were reviewed. Sociodemographic variables, clinical causes of brain death, and factors related to donation outcomes were assessed using descriptive statistics and chi-square tests. RESULTS: In total, the data of 1,688 cases were analyzed, including those of 574 donors (34%) and 1,114 non-donors. Traumatic brain injury and hemorrhagic stroke were the predominant neurological causes of brain death. No significant association was observed between sex or cause of brain death and donation outcome. Public initiatives such as the 2001 consent law and the 2014 “Green September” campaign showed limited short-term impact on donation rates. CONCLUSION: Although neurological causes account for most cases of brain death, donation outcomes are strongly influenced by social and institutional factors-particularly family refusal and trust in the healthcare system.

Abstract in English:

ABSTRACT BACKGROUND: Thyroid nodules are common, and although most are benign, a proportion may be malignant. Fine-needle aspiration biopsy (FNAB), interpreted using the Bethesda System, is the standard diagnostic method. However, in euthyroid patients, the predictive value of thyroid function tests and their derived ratios in relation to Bethesda categories remains unclear. OBJECTIVES: To evaluate thyroid function parameters and their association with Bethesda classification in euthyroid patients with thyroid nodules, and to identify potential predictors of malignancy. DESIGN AND SETTING: This retrospective cross-sectional study was conducted at the University of Health Sciences Haydarpaşa Numune Training and Research Hospital and included a convenience sample of eligible euthyroid patients who underwent FNAB between January 2020 and December 2023. METHODS: A total of 828 euthyroid patients were included. Demographic data, pre-biopsy TSH, fT3, fT4, and derived ratios (TSH/T4, TSH/T3, and T3/T4) were analyzed for correlations with Bethesda categories and compared between the benign and malignant groups. RESULTS: The mean age was 52.85 ± 12.53 years, and 80.8% of participants were female. Benign cytology was found in 54.6% of cases, and malignant cytology was found in 2.8%. Cases with malignant cytology were younger (p = 0.003) and more frequently male (p = 0.021). No significant differences were observed in hormone levels or ratios between the benign and malignant groups. However, TSH and the TSH/T4 ratio showed positive correlations with Bethesda category (p = 0.034 and p = 0.033, respectively). CONCLUSION: The TSH level and TSH/T4 ratio were correlated with Bethesda categories; however, thyroid function tests and derived ratios showed no diagnostic value for predicting malignancy in euthyroid nodules.

Abstract in English:

ABSTRACT BACKGROUND: Adverse outcomes associated with potentially inappropriate medication (PIM) use are prevalent among older adults. OBJECTIVES: This study aimed to determine the frequency of PIM use older outpatients and assess its association with chronic comorbidities and geriatric syndromes using the screening tool of older persons’ prescriptions (STOPP) and screening tool to alert to right treatment (START) version 3 criteria. DESIGN AND SETTING: This retrospective study included patients aged 65 years or older who attended geriatric outpatient clinics between January and June 2024. METHODS: PIM use was evaluated using the STOPP/START version 3 criteria. Polypharmacy was defined as the use of five or more medications. RESULTS: Among the 107 patients (median age, 77 years; range, 65-91), 71% (n = 76) used PIM, with a median of two PIMs per patient (range, 0-6). PIM use was significantly more prevalent among patients with polypharmacy (odds ratio [OR] = 3.986; 95% CI: 1.493-10.639; p = 0.006). Analyses based on the STOPP criteria also revealed significant associations of PIM use with dementia (OR = 13.240; 95% CI: 1.504-116.529; p = 0.02), polypharmacy (OR = 4.352; 95% CI: 1.476-12.827; p = 0.008), and a history of falls (OR = 3.131; 95% CI: 1.017-9.634; p = 0.047). CONCLUSION: Polypharmacy was significantly associated with greater odds of PIM use among older adults. Based on the STOPP version 3 criteria, dementia and a history of falls were also associated with increased PIM use in this population.

Abstract in English:

ABSTRACT BACKGROUND: Intermediate temperatures (10°C) better preserve mitochondrial function and extend ischemic time, which are fundamental for lung preservation during transplantation. The EMAIS-SR device was developed as a reusable, cost-effective alternative to maintain the 10°C set-point, thereby overcoming logistical and economic barriers in organ transport. OBJECTIVE: This study aimed to validate the thermal stability of the EMAIS-SR system in a swine model by evaluating the organ-cooling curve and the time spent within the target temperature range. DESIGN AND SETTING: Validation study using experimental surgery on porcine organs. METHODS: Lung blocks were harvested from two Landrace swine in independent experiments (P1, P2). The organs were placed in triple sterile packaging. Thermal stability was monitored for 48 h by using four negative temperature coefficient (NTC) thermistors (three intrapulmonary and one extrapulmonary) with data acquisition at a 0.1-s interval. Another datalogger (Hantek ® HTM208B) was used for control and validation. Thermal distribution was further characterized by infrared thermography (FLIR C3-X). RESULTS: In Experiment 1 (P1), intrapulmonary temperatures reached the predefined target range (≤ 12°C) approximately 1.4 h after lung extraction, and the mean temperature recorded in the container was 8.01 °C (standard deviation, 2.88°C). In Experiment 2 (P2), a mean temperature reduction of 6.6°C was observed, bringing the intrapulmonary temperature to the target range (≤ 12°C) within approximately 2 h post-extraction. CONCLUSION: The EMAIS-SR device effectively maintained lung-preservation temperatures within the target 8°C–12°C range over 48 h. These results demonstrate the system’s technical feasibility and its capacity to provide consistent thermal stability across intrapulmonary compartments.

Abstract in English:

ABSTRACT BACKGROUND: Although miniaturized percutaneous nephrolithotomy (mini-PCNL) is a less invasive alternative to standard percutaneous nephrolithotomy (PCNL), its comparative outcomes in pediatric patients remain unclear. OBJECTIVES: To compare the efficacy and safety of mini-PCNL versus standard PCNL in children with nephrolithiasis. DESIGN AND SETTING: Systematic review and meta-analysis conducted according to PRISMA guidelines, including randomized controlled trials (RCTs) and retrospective cohort studies of pediatric patients undergoing mini-PCNL or standard PCNL. METHODS: Major databases (Cochrane Library, PubMed/MEDLINE, and Embase) were searched through August 2024. The primary endpoint was the stone-free rate. Secondary endpoints included operative time, postoperative fever, and complications classified by the Clavien–Dindo system. RESULTS: Five studies (two RCTs and three retrospective cohort studies) involving 490 patients (46% underwent mini-PCNL) were included. Stone-free rates were comparable between the groups (relative risk [RR], 0.98; 95% confidence interval [CI], 0.929–1.041; p = 0.56; I2 = 0%). Mini-PCNL was associated with longer operative times (mean difference [MD], 7.5 min; 95% CI, 0.2–14.9; p = 0.04; I2 = 78%) but a lower risk of Clavien–Dindo grade I complications (RR 0.464; 95% CI 0.442–0.944; p < 0.05; I2 = 0%). No significant differences were observed in postoperative fever or Clavien–Dindo grade II–IV complications. CONCLUSION: Mini-PCNL and standard PCNL achieve comparable stone-free rates in pediatric patients. Mini-PCNL is associated with fewer minor complications, whereas standard PCNL is associated with shorter operative times. Both techniques demonstrate similar safety profiles with respect to major complications. CLINICAL TRIAL OR SYSTEMATIC REVIEW REGISTRATION: PROSPERO: CRD42024618399; available at: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024567890.