Simulation in pediatric minimally invasive surgery: adaptation of a simple series of exercises as part of the process of an initial implementation of a resident training program.

INTRODUCTION: the simulation in minimally invasive surgery is fundamental for surgeon in training to learning and training skills, especially in pediatrics, due to the particularities, reduced spaces, specific and rare procedures. The aim of this study was to propose an adapted series of exercises and to simply evaluate the performance of pediatric surgery residents in the initial implementation of a training program. METHOD: seven basic skills exercises in video surgery, based on series and programs already published and using low-cost materials, were performed by six residents in 2 moments, with an interval of 15 days and evaluated by simple instrument. RESULTS: there was no difficulty with models. Considering the individual averages of the seven exercises together in the two moments, five of the six residents increased the score in the second moment. The average score per exercise increased in five of the seven tasks. Despite the small number of participants and repetition, it has already been possible to observe a trend of better performance with decreased time of all residents after a single repetition. All considered the exercises capable of training essential skills of the specialty, with simple and inexpensive materials. CONCLUSION: given the challenges of simulated training in pediatric video surgery, it is known the benefit of a continuous program, with exercises that can simulate real situations. A pre-established schedule, more participants and repetitions, supervision of experienced surgeons and validated instruments are fundamental to evaluate surgeons in training and show statistical benefits of simulated exercises in this series.

Simulation in pediatric minimally invasive surgery: adaptation of a simple series of exercises as part of the process of an initial implementation of a resident training program / Simulação em cirurgia minimamente invasiva pediátrica: adaptação de uma série de exercícios simples e de fácil aplicação como parte do processo de implementação inicial de um programa de treinamento de residentes

ABSTRACT Introduction: the simulation in minimally invasive surgery is fundamental for surgeon in training to learning and training skills, especially in pediatrics, due to the particularities, reduced spaces, specific and rare procedures. The aim of this study was to propose an adapted series of exercises and to simply evaluate the performance of pediatric surgery residents in the initial implementation of a training program. Method: seven basic skills exercises in video surgery, based on series and programs already published and using low-cost materials, were performed by six residents in 2 moments, with an interval of 15 days and evaluated by simple instrument. Results: there was no difficulty with models. Considering the individual averages of the seven exercises together in the two moments, five of the six residents increased the score in the second moment. The average score per exercise increased in five of the seven tasks. Despite the small number of participants and repetition, it has already been possible to observe a trend of better performance with decreased time of all residents after a single repetition. All considered the exercises capable of training essential skills of the specialty, with simple and inexpensive materials. Conclusion: given the challenges of simulated training in pediatric video surgery, it is known the benefit of a continuous program, with exercises that can simulate real situations. A pre-established schedule, more participants and repetitions, supervision of experienced surgeons and validated instruments are fundamental to evaluate surgeons in training and show statistical benefits of simulated exercises in this series.

RESUMO Introdução: a simulação em cirurgia minimamente invasiva é fundamental para treinamento e aprendizagem de habilidades ao cirurgião em formação, especialmente na pediatria, devido às particularidades da especialidade, espaços reduzidos, procedimentos específicos e raros. O objetivo deste estudo foi propor uma adaptação de uma série de exercícios em simulador e avaliar o desempenho dos residentes de cirurgia pediátrica na implementação inicial de um programa de treinamento. Método: sete exercícios de habilidades básicas em videocirurgia, baseados em séries e programas já publicados e utilizando materiais de baixo custo, foram realizados por seis residentes em 2 momentos, com intervalo de 15 dias e avaliados por instrumento simples. Resultados: não houve dificuldade em relação aos modelos. Considerando- se as médias individuais dos sete exercícios juntos nos dois momentos, cinco dos seis residentes aumentaram a pontuação no segundo momento. A pontuação média por exercício aumentou em cinco das sete tarefas. Apesar do pequeno número de participantes e repetição, já foi possível observar uma tendência de melhor desempenho com diminuição do tempo de todos os residentes após uma única repetição. Todos consideraram os exercícios capazes de treinar habilidades essenciais da especialidade, de maneira acessível e com materiais simples e baratos. Conclusão: diante dos desafios do treinamento simulado em videocirurgia pediátrica, sabe-se do benefício de um programa contínuo, com exercícios que simulam situações reais. Um cronograma pré-estabelecido, mais participantes e mais repetições, supervisão de cirurgiões experientes e instrumentos validados são fundamentais para avaliar a evolução dos cirurgiões em formação e permitir demonstrar resultados com significância estatística.

Comparative effectiveness of telesimulation versus standard simulation for pediatric Minimally Invasive Surgery (MIS) essential skills training.

BACKGROUND: Proctored on site simulation-based surgical education has been integrated in our residents curricula since 2012. Due to COVID-19 pandemic and social distance protocols, we developed a Tele-assisted Essential Skills Training Module (T-ESTM). The aim of this study is to evaluate comparative effectiveness between Telesimulation (T) versus Standard Simulation (S) for minimally invasive surgery (MIS) essential skills training. METHODS: ESTM includes academic lectures, tutorials for ergonomics and 7 hands-on tasks scheduled into 2 sessions of 3 hours. Initial and final assessment scoring (adapted from GOALS) as well as timing for 3 of the tasks were registered. Telesimulation (T) group accessed the content online and completed their Hands-On practice through a digital communication platform. Standard Simulation (S) group attended conferences and Hands-On practice at the simulation center. Both groups were proctored by the same educators with summative and formative feedback and debriefing. Data was analyzed with the R-studio software program. RESULTS: Each group had 20 participants with a mean age of 28 ± 5 years. 67.5% were surgeons in training, 47.5% had performed low complexity procedures and 40% had previous experience with simulation training. We observed a significant improvement in scoring and time reduction for all assessed tasks in S and T groups (p < 0.001), with no statistically significant differences when comparing both groups. Similar performance could be achieved with both strategies. CONCLUSION: Telesimulation is a reproducible and effective educational tool for remote MIS essential skills training, and should be considered as an alternative to on-site simulation programs. LEVEL OF EVIDENCE: Level II. TYPE OF STUDY: Clinical Research.

Mercantilização do ensino superior: uma análise de cursos de Serviço Social a distância / Mercantilization of higher education: an analysis of online social service courses

O artigo analisa as páginas dos sites de sete instituições brasileiras que oferecem cursos de Serviço Social a distância e que são acessíveis à população de Viçosa, Minas Gerais, Brasil. Os dados revelam que as principais estratégias de promoção dos cursos centram-se em aspectos econômicos como valor da mensalidade, oportunidades de bolsas de estudo e oferecimento de descontos. O pouco espaço para apresentação do currículo e da formação profissional sinaliza um distanciamento do projeto ético-político do Serviço Social brasileiro, comprometido com uma educação laica, gratuita, crítica e de qualidade

The paper aims at examining the pages of the websites of seven Brazilian institutions that offer online Social Work courses, which are available to the population of Viçosa, Minas Gerais, Brazil. The data show that the main strategies for promoting the courses focus on economic aspects such as tuition fees, discounts and scholarship opportunities. The little space for the presentation of the curriculum and professional training signals a distance from the ethical-political project of the Brazilian Social Service, committed to a secular, free, critical and quality education

Ecotoxicological responses of Daphnia magna and Eisenia andrei in landfill leachate.

Leachate toxicity using bioindicators such as microcrustaceans and earthworms has not been fully elucidated. These bioindicators are traditionally determined through physicochemical and microbiological analyses. The ecotoxicological assessment of leachate using indicator organisms from different environments is a technique to ensure the treatment and safe disposal of this effluent with minimum impact on human health and the environment. The current study aimed to evaluate the ecotoxicological responses of Daphnia magna and Eisenia andrei in landfill leachate, identifying which organism was more sensitive to this effluent. The leachate used in ecotoxicological tests was collected at the Campina Grande Sanitary Landfill (ASCG), Paraíba, Brazil. The leachate sample contained a high content of organic matter in the form of chemical oxygen demand (19496.86 mg.L-1) and ammoniacal nitrogen (2198.00 mg.NL-1), in addition to metals with carcinogenic potential, such as Cr (0.64 mg.L-1) and Fe (1.16 mg.L-1). The exposure of Daphnia magna to the leachate showed that the effluent is harmful to aquatic organisms, obtaining an EC 50, 48 h = 1.22%, FT of 128 and a TU of 81.96%. Among the contaminant concentrations tested in Eisenia andrei, 57% (59.28 mL.kg-1) caused the highest lethality, causing the death of 21 earthworms within 72 hours of exposure. The avoidance test showed that exposure to leachate concentrations between 10.38 and 39.86 mL.kg-1 led to the leakage of earthworms, and habitat loss was observed at a concentration of 55.80 mL.kg-1, in which leak response (LR) ≥80% was obtained. This study demonstrates that the mentioned organisms are suitable for ecotoxicological tests in landfill leachate. Moreover, the microcrustacean Daphnia magna showed the most significant sensitivity, presenting a rapid ecotoxicological response to the leachate.

Panorama das notificações de eventos adversos e queixas técnicas em máscaras / Panorama of notifications about adverse events and technical complaints related to facemasks

Introdução: No cotidiano dos profissionais de saúde, principalmente no enfrentamento à pandemia do SARS-CoV-2, as máscaras são artigos de suma importância, porém não existe programa de controle de pós-comercialização para tais produtos. Objetivo: Avaliar os eventos adversos (EA) e as queixas técnicas (QT) de máscaras dos tipos cirúrgicas e respiradores, a fim de elencar e categorizar os problemas de saúde pública envolvendo o produto. Método: Estudo transversal, descritivo, retrospectivo, documental com abordagem quantitativa, englobando dados de janeiro de 2010 a maio de 2020 disponibilizados no sistema Notivisa. Os dados analisados tiveram abrangência nacional que foram reclassificados, quando necessário, acerca da sua categoria (EA ou QT). Resultado: Incluiu-se 443 notificações no estudo, que continham no total 519 reclamações (EA e QT). A distribuição dos dados na década analisada apresentou acentuado decréscimo, sendo a Região Sudeste do país a com maior prevalência de notificações no Brasil. A maior parte das empresas notificantes foram estabelecimentos de saúde, valendo destacar que a maior prevalência de eventos de saúde encontrados para este produto foram EA relacionados a problemas que afetavam o usuário nas tiras de fixação e clipe nasal dos produtos (como desprendimento do clipe nasal e rompimento das tiras de fixação durante o uso) indicando graves indícios de problemas de biossegurança em sua utilização. Conclusões: A pesquisa caracterizou os EA e as QT de máscaras com enfoque na promoção da saúde, indicando a necessidade da implantação do monitoramento sanitário dos produtos.

Introduction: In the daily routine of Health Professionals, mainly in the midst of the Sars-CoV-2 pandemic, facemasks are important devices; however, there is no post market control for these products. Objective: Evaluate the Adverse Events (AE) and Technical Complaints (TC) related to facemasks and respirators, to list and categorize the public health problems involving these products. Method: Cross-sectional, descriptive, retrospective and documental study with a quantitative approach, including data from January 2010 to May 2020 available in the Notivisa system. The analyzed data had national coverage and were reclassified, when necessary, according to their category (EA or QT). Results: 443 notifications were included in the study containing 519 claims (AE and TC). The data distribution on the analized decade presented an accentuated decrease; the Southeast region had the highest prevalence of claims in Brazil. Most of the notifying companies were health establishments and the highest prevalence of health events found were Adverse Events that affected the user when fixing strips and nose clips (such as detachment of the nose clip and breaking of the fixation straps during use), indicating serious biosecurity problems. Conclusions: This study characterized the Adverse Events and the Technical Complaints in facemasks focusing on health promotion and indicating the necessity of sanitary monitoring improvement of the products.

Primary Malignant Liver Tumors: eight-year experience in a Pediatric Hospital in Brazil. A cross-sectional study.

INTRODUCTION: liver tumors are rare neoplasms in childhood (1-2%), and about 2/3 are malignant. Hepatoblastoma (HB) is the most frequent, followed by hepatocellular carcinoma (HCC). In both, the main treatment is surgical resection. Currently, chemotherapy and liver transplantation have improved outcomes. OBJECTIVE: study of the epidemiological profile and evolution of liver cancer cases in a referral pediatric hospital. METHODOLOGY: a retrospective survey of medical records of patients aged up to 18 years with a diagnosis of primary malignant hepatic neoplasm between 2012 and 2020, carried out in the largest exclusively pediatric hospital in Brazil. RESULTS: a total of 13 patients with malignant liver tumors (HB 12, HCC 1) were treated. Of the HB cases, 66,7% were male, with a mean age of 2 years and the main alteration in the palpable abdominal mass. Tumors involved an average of 3 liver segments, more in the right lobe (54%). Only one patient was treated with surgery without neoadjuvant therapy, another one underwent transplantation like the first treatment, and another 2 required liver transplantation as a rescue. The middle follow-up time of patients with HB was 39 months and only 1 case died due to febrile neutropenia. The 5-year overall and disease-free survival was 91.7% and 81.5%, respectively. CONCLUSION: Advanced staging at the time of diagnosis has always been a poor prognostic factor in patients with primary malignant liver tumors. However, the results and survival have improved with the advancement of chemotherapy, surgical technique, and liver transplantation.

Vascular endothelial growth factor (VEGF) and interleukin-1 receptor antagonist (IL-1Ra) as promising biomarkers for distinguishing active from latent tuberculosis in children and adolescents.

Since distinguishing pulmonary (PTB) from latent tuberculosis (LTBI) in pediatric patients remains a challenge, we aimed to investigate the efficacy of immune mediators in diagnosing PTB and LTBI in this population. In this cross-sectional study performed with children and adolescents, serum levels of 20 biomarkers were assessed and data were analyzed according to age groups. We included 65 participants (PTB, n = 28 and LTBI, n = 37). Overall, levels of TNF-α, IL-1Ra, IL-6, IL-17A, VEGF, MMP-1, and procalcitonin were significantly higher (P < 0.05) in adolescents and children <10 years-old with PTB. Also, principal component analysis (PCA) showed that immune mediators were able to distinguish PTB from LTBI. VEGF and IL-1Ra presented the highest area under the curve (AUC) values, both separately (AUC 0.890 and 0.785) and combined (AUC 0.99). Taken together, we showed that VEGF and IL-1Ra are promising biomarkers to distinguish PTB from LTBI in pediatric patients, especially in children <5 years-old.

Immunological and virological aspects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and hepatitis C virus.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can generate a systemic inflammatory response, characterized by a cytokine storm and associated with an exaggerated release of proinflammatory cytokines, including tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and IL-17, all of which can affect the liver. Here, we aimed to evaluate the cytokine profiles of patients suffering from coronavirus disease (COVID)-19 and/or hepatitis. We subjected 87 patients to serology and/or polymerase chain reaction analysis for the hepatitis C virus. They were also tested for TNF-α, IL-6, and IL-17 using commercial immunoassay kits. The test results of the COVID-19/hepatitis C patients (n = 8) were compared with that of the negative controls (n = 28), hepatitis C patients (n = 29), and COVID-19 patients (n = 22). All COVID-19 patients (mono- and coinfected) expressed high levels of cytokines. The COVID-19/hepatitis patients exhibited higher levels of IL-6 (6.33 ± 3.9 pg/ml) and IL-17 (102.23 ± 2.7 pg/ml); however, TNF-α values were lower (68.08 ± 15.88 pg/ml), as compared with that of the hepatitis patients (p < 0.001), and lower than that of the COVID-19 patients and exceptionally for TNF-α (p < 0.05). These data highlight the importance of monitoring patients with hepatitis and COVID-19.

Expression profile of the Kisspeptin/Kiss1r system and angiogenic and immunological mediators in the ovary of cyclic and pregnant cats.

The Kisspeptin/Kiss1r system has been studied in mammalian ovaries. However, there are still no studies on the modulation of this system and its relationship with angiogenic and immunological mediators in the ovary of domestic cats, especially during pregnancy. We evaluated the expression of Kisspeptin/Kiss1r and angiogenic and immunological mediators during folliculogenesis, luteogenesis and luteal regression of cyclic and pregnant cats. The ovary exhibited moderate to intense expression for Kiss1, VEGF, Flk-1, INFγ and MIF in oocytes and the follicular wall, while Kiss1r expression was low in granulosa cells. In these cells, there was also a greater expression of Kiss1, INFγ and MIF, mainly in secondary follicles, while tertiary and preovulatory follicles exhibited greater expression of VEGF and Flk-1 in this layer. In luteogenesis, Kiss1 immunostaining was higher in mature corpora lutea (MCL) of pregnant cats compared to vacuolated CL (VCL) and corpus albicans (CA). Pregnancy also increased the luteal gene expression of Kiss1 as well as Kiss1, Kiss1r, Flk-1, and MIF immunostaining in MCL, while reduced the area of VEGF expression in VCL and luteal mRNA expression of Mif when compared to non-pregnant animals. In addition, positive gene correlation between Kiss1r and Mif was observed in the CL. Kiss1, Kiss1r, Vegf and Mif expression were lower in the CA of cats in anestrus. These findings reveal that the expression of Kisspeptin/Kiss1r and angiogenic and immunological mediators, in the ovary of domestic cats, depend on the follicular and luteal stage, and the luteal expression of these mediators is influenced by pregnancy.

Clinical, laboratory, and radiographic aspects of patients with pulmonary tuberculosis and dysglycemia and tuberculosis treatment outcomes / Aspectos clínicos, laboratoriais e radiográficos de pacientes com tuberculose pulmonar e disglicemia e desfechos do tratamento da tuberculose

ABSTRACT Objective: To analyze the association of dysglycemia with clinical, laboratory, and radiographic characteristics of patients with pulmonary tuberculosis (PTB), as well as with their tuberculosis treatment outcomes. Methods: This was a longitudinal study involving 140 patients diagnosed with PTB (positive cultures for Mycobacterium tuberculosis or positive Xpert MTB/RIF results from sputum samples). Patients were evaluated at diagnosis (M0), after completing the second month of treatment (M2), and at the end of treatment (MEND). At M0, the patients were classified into three groups: normoglycemia+PTB (NGTB); pre-diabetes mellitus+PTB (PDMTB), and diabetes mellitus+PTB (DMTB), in accordance with glycated hemoglobin levels (< 5.7%, 5.7%-6.4%, and ≥ 6.5%, respectively). Treatment outcomes were classified as favorable (cure or treatment completion) and unfavorable (death, loss to follow-up, or treatment failure). Results: In our sample, 76 patients (61.4%) had dysglycemia, 20 of whom (14.3%) had DM at M0. The patients with dysglycemia, in comparison with those in the NGTB group, more frequently presented with positive sputum smear microscopy (94.2% vs. 75.9%; p = 0.003); cavities (80.2% vs. 63.0%; p = 0.03); bilateral lesions (67.4% vs. 46.0%; p = 0.02); and higher median of affected thirds of the lungs (3.0 vs. 2.0; p = 0.03) on chest radiography. No significant differences regarding outcomes were found among the groups, but tuberculosis lethality was higher in the DMTB group than in the PDMTB and NGTB groups (20% vs. 2.2%). Conclusions: PTB patients with dysglycemia had laboratory and radiographic manifestations indicative of more advanced disease, and the risk of death was higher in the DMTB group. These findings reinforce the recommendation for early screening for DM in patients with newly diagnosed tuberculosis in order to reduce the risk of death during treatment.

RESUMO Objetivo: Analisar a associação de disglicemia e características clínicas, laboratoriais e radiográficas em pacientes com tuberculose pulmonar (TBP), bem como a associação de disglicemia e desfechos do tratamento da tuberculose. Métodos: Estudo longitudinal com 140 pacientes com diagnóstico de TBP (culturas de escarro positivas para Mycobacterium tuberculosis ou resultados positivos do teste Xpert MTB/RIF em amostras de escarro). Os pacientes foram avaliados no momento do diagnóstico (M0), após dois meses de tratamento (M2) e no fim do tratamento (MFIM). Em M0, os pacientes foram divididos em três grupos: normoglicemia+TBP (NGTB); pré-diabetes mellitus+TBP (PDMTB) e diabetes mellitus+TBP (DMTB), de acordo com os níveis de hemoglobina glicada (< 5,7%, 5,7%-6,4% e ≥ 6,5%, respectivamente). Os desfechos do tratamento foram classificados em favoráveis (cura ou conclusão do tratamento) e desfavoráveis (óbito, perda de seguimento ou falência do tratamento). Resultados: Em nossa amostra, 76 pacientes (61,4%) apresentavam disglicemia, 20 (14,3%) dos quais apresentavam DM em M0. Os pacientes com disglicemia, em comparação com os do grupo NGTB, apresentaram mais frequentemente baciloscopia de escarro positiva (94,2% vs. 75,9%; p = 0,003); cavidades (80,2% vs. 63,0%; p = 0,03); lesões bilaterais (67,4% vs. 46,0%; p = 0,02) e maior mediana de terços pulmonares acometidos (3,0 vs. 2,0; p = 0,03) na radiografia de tórax. Não foram observadas diferenças significativas entre os grupos quanto aos desfechos, mas a letalidade da tuberculose foi maior no grupo DMTB do que nos grupos PDMTB e NGTB (20% vs. 2,2%). Conclusões: Pacientes com TBP e disglicemia apresentaram manifestações laboratoriais e radiográficas indicativas de doença mais avançada, e o risco de óbito foi maior no grupo DMTB. Esses achados reforçam a recomendação de detecção precoce de DM em pacientes com tuberculose recém-diagnosticada, a fim de reduzir o risco de óbito durante o tratamento.

Teste de Progresso como ferramenta de intervenção curricular na implementação de um curso de Medicina / Progress Test as a curricular interventional tool in the implementation of a medical course

Resumo: Introdução: O Teste de Progresso (TP) é uma modalidade de avaliação longitudinal composta por questões de múltipla escolha que permite a avaliação do estudante com realização do feedback individual e a análise do processo de ensino-aprendizagem institucional. O presente estudo relata a experiência do uso do TP como ferramenta de gestão e aprendizado na implementação de um curso de Medicina de currículo integrado e baseado em metodologias ativas. Relato de experiência: Desde 2014, o curso de Medicina de uma capital do país utiliza o TP como ferramenta de avaliação para estimular a autonomia do estudante, baseado em seu desempenho longitudinal, possibilitar ao docente a reflexão e ação adequadas ao processo de ensino-aprendizagem e fornecer elementos significativos para a tomada de decisão institucional relacionada à adequação curricular e à implementação do curso. Com diversas estratégias, como a formação de uma Comissão de Avaliação do Estudante e do Curso (Caec), oficinas com professores e estudantes e consórcios interinstitucionais, os atores que compõem o curso refletem seu papel na consolidação do conhecimento para o futuro profissional médico e se engajam nesse processo em diferentes momentos e de diferentes formas. Discussão: O TP é uma ferramenta com potenciais e limites que devem considerar a segurança, a confiabilidade e validade da avaliação, utilizando-se de estratégias qualificadoras, incluindo o ambiente virtual. O TP possibilita a autodeterminação e o autoaperfeiçoamento do estudante, do docente e do curso ao estabelecer comparações entre médias de desempenho longitudinais dos discentes em diversos estágios de aprendizado e instituições. Conclusão: A experiência demonstrou a importância do TP como ferramenta de avaliação e trouxe vantagens e benefícios na implantação do curso e orientação de intervenções para a melhoria do processo de ensino-aprendizagem.

Abstract Introduction: The Progress Test (PT) is a longitudinal assessment modality composed of multiple-choice questions and allows the assessment of the student with individual feedback and the analysis of the institutional teaching-learning process. The present study aims at reporting the experience of using the progress test as a management and learning tool in the implementation of a medical course with an integrated curriculum based on active methodologies. Experience report: Since 2014, a medical school in a capital of the country uses the PT as an assessment tool to stimulate student autonomy, based on their longitudinal performance, allowing the teacher to reflect on and take the appropriate actions aimed at the teaching and learning process and providing significant elements for institutional decision-making related to curricular adequacy and course implementation. Using several strategies, such as the formation of a student and course evaluation committee (CAEC), workshops with teachers and students and inter-institutional consortia, the actors that make up the course reflect on their role in consolidating knowledge for the future medical professional and engage in this process at different times and in different ways. Discussion: The progress test is a tool with potentials and limits that must consider the safety, reliability and validity of the evaluation, using qualifying strategies, including the virtual environment. The PT enables the students, the faculty and the course self-determination and self-improvement by establishing comparisons between longitudinal performance averages of students at different stages of learning and institutions. Conclusion: The experience demonstrated the importance of the PT as an evaluation tool, brought advantages and benefits in the course implementation and guidance on interventions aimed at improving the teaching-learning process.

Serological and molecular characterization of hepatitis B virus infection in chronic kidney disease patients from Rio de Janeiro, Brazil

ABSTRACT Chronic kidney disease (CKD) patients undergoing hemodialysis (HD) are more vulnerable to blood-borne viral infections due to frequent invasive procedures. Hepatitis B virus (HBV) infection in this cohort of patients has been a matter of concern worldwide. The objective of this cross-sectional study was to evaluate the frequency of serological markers for hepatitis B, and the occurrence of overt and occult HBV infection (OBI) and its molecular characterization in serum samples from 644 CKD patients in HD units located in Rio de Janeiro, Brazil, from 2013 to 2017. HBV DNA was investigated in HBsAg reactive and "anti-HBc alone" samples to determine infecting genotypes and genetic relatedness between sequences. The prevalence of serological markers HBsAg+, anti-HBc alone, anti-HBc+/anti-HBs+, anti-HBs+, anti-HBc/anti-HBs/HBsAg were 5.9%, 2.8%, 30.7%, 26.6%, 34.0%, respectively. HBV DNA was detected in 39.5% (15/38) of the HBsAg+ and in 5/18 (27.8%) of the "anti-HBc alone" individuals, indicating a high prevalence of OBI within this group. We found a higher prevalence of HBV/A1 (65%), followed by HBV/D3 (20%), and HBV/A2 (15%). Bayesian MCC tree with a highly supported clade, genetic distance comparison, and identical nucleotide sequences suggested a nosocomial spread of HBV in some units. The high prevalence of HBV infection and low number of individuals immune to infection reinforces the need for vaccination in this group. The presence of closely related strains in the same HD unit reinforces the importance of continuous improvement of safety control measures and laboratory surveillance of serological markers to prevent the risk of infection and transmission of HBV.

Primary Malignant Liver Tumors: eight-year experience in a Pediatric Hospital in Brazil. A cross-sectional study / Neoplasias Malignas Primárias do Fígado: experiência de oito anos de um Hospital Pediátrico no Brasil. Estudo transversal

ABSTRACT Introduction: liver tumors are rare neoplasms in childhood (1-2%), and about 2/3 are malignant. Hepatoblastoma (HB) is the most frequent, followed by hepatocellular carcinoma (HCC). In both, the main treatment is surgical resection. Currently, chemotherapy and liver transplantation have improved outcomes. Objective: study of the epidemiological profile and evolution of liver cancer cases in a referral pediatric hospital. Methodology: a retrospective survey of medical records of patients aged up to 18 years with a diagnosis of primary malignant hepatic neoplasm between 2012 and 2020, carried out in the largest exclusively pediatric hospital in Brazil. Results: a total of 13 patients with malignant liver tumors (HB 12, HCC 1) were treated. Of the HB cases, 66,7% were male, with a mean age of 2 years and the main alteration in the palpable abdominal mass. Tumors involved an average of 3 liver segments, more in the right lobe (54%). Only one patient was treated with surgery without neoadjuvant therapy, another one underwent transplantation like the first treatment, and another 2 required liver transplantation as a rescue. The middle follow-up time of patients with HB was 39 months and only 1 case died due to febrile neutropenia. The 5-year overall and disease-free survival was 91.7% and 81.5%, respectively. Conclusion: Advanced staging at the time of diagnosis has always been a poor prognostic factor in patients with primary malignant liver tumors. However, the results and survival have improved with the advancement of chemotherapy, surgical technique, and liver transplantation.

RESUMO Introdução: tumores hepáticos são neoplasias raras na infância (1-2%), sendo que cerca de 2/3 são malignos. O hepatoblastoma (HB) é o mais frequente, seguido do carcinoma hepatocelular (CHC). Em ambos, o principal tratamento é a ressecção cirúrgica completa. Atualmente, a quimioterapia e o transplante hepático têm melhorado os resultados. Objetivo: estudo do perfil epidemiológico e evolução dos casos de cânceres hepáticos em um hospital pediátrico de referência. Método: Levantamento retrospectivo de prontuários de pacientes até 18 anos com diagnóstico de neoplasia maligna primária hepática entre 2012 e 2020 realizado no maior hospital exclusivamente pediátrico do Brasil. Resultados: foram atendidos 13 pacientes com tumores malignos hepáticos (HB 12, CHC 1). Dos casos de HB, 66,7% eram do sexo masculino, com idade média de 2 anos e a principal alteração foi massa abdominal palpável. Os tumores envolviam em média 3 segmentos hepáticos, mais em lobo direito (54%). Um paciente foi tratado com cirurgia sem neoadjuvância, um foi submetido a transplante inicialmente e outros 2 necessitaram de transplante hepático como resgate. O tempo de seguimento dos pacientes com HB foi de 39 meses e apenas 1 caso foi a óbito por neutropenia febril. A sobrevida geral e livre de doença em 5 anos foi de 91,7% e 81,5% respectivamente. Conclusão: o estadiamento avançado no momento do diagnóstico sempre foi um fator de mau prognóstico em pacientes com tumores hepáticos malignos primários. Entretanto, os resultados e a sobrevida têm melhorado significativamente com o avanço da quimioterapia, da técnica cirúrgica e do transplante hepático.

Lessons Learned from Implementation of an Interferon Gamma Release Assay to Screen for Latent Tuberculosis Infection in a Large Multicenter Observational Cohort Study in Brazil.

The interferon gamma release assay (IGRA) has emerged as a useful tool for identifying latent tuberculosis infection (LTBI). This assay can be performed through testing platforms such as the QuantiFERON-TB Gold Plus (QFT-Plus) assay. This in vitro test has been incorporated into several guidelines worldwide and has recently been considered by the World Health Organization (WHO) for the diagnosis of LTBI. The possibility of systematically implementing IGRAs such as the QFT-Plus assay in centers that perform LTBI screening has been accelerated by the decreased availability of the tuberculin skin test (TST) in several countries. Nevertheless, the process to implement IGRA testing in routine clinical care has many gaps. The study utilized the expertise acquired by the laboratory teams of the Regional Prospective Observational Research in Tuberculosis (RePORT)-Brazil consortium during study protocol implementation of LTBI screening of tuberculosis (TB) close contacts. RePORT-Brazil includes clinical research sites from Brazilian cities and is the largest multicenter cohort of TB close contacts in the country to date. Operational and logistical challenges faced during IGRA implementation in all study laboratories are described, as well as the solutions that were developed and led to the successful establishment of IGRA testing in RePORT-Brazil. The descriptions of the problems identified and resolved in this study can assist laboratories implementing IGRAs, in addition to manufacturers of IGRAs providing effective technical support. This will facilitate the implementation of IGRA testing in countries with large TB burdens, such as Brazil. IMPORTANCE The IGRA has emerged as a useful tool for identifying persons with LTBI. Although the implementation of IGRAs is of utmost importance, to our knowledge there is scarce information on the identification of logistical and technical challenges for systematic screening for LTBI on a large scale. Thus, the descriptions of the problems identified and resolved in this study can assist laboratories implementing IGRAs, in addition to manufacturers of IGRAs providing effective technical support. This will facilitate the implementation of IGRA testing in countries with large TB burdens, such as Brazil.

Antinociceptive and analgesic effect of continuous intravenous infusion of maropitant, lidocaine and ketamine alone or in combination in cats undergoing ovariohysterectomy.

BACKGROUND: Multimodal analgesia consists of the combination of analgesic drugs at low doses to act in different places along the path of pain. Studies with continuous infusion of analgesic drugs in cats are not common. This study aimed to evaluate the analgesic effect of maropitant, lidocaine and ketamine alone or in combination (intravenous bolus + subsequent continuous intravenous infusion) in the management of acute postoperative pain in cats undergoing ovariohysterectomy. Seventy healthy cats undergoing an ovariohysterectomy received a standard anesthetic protocol consisting of acepromazine and morphine, propofol (anesthesia induction), and isoflurane (anesthesia maintenance). The animals were stratified into seven groups (n = 10 in each group): control (CG), maropitant (MG), lidocaine (LG), ketamine (KG), maropitant + lidocaine (LMG), maropitant + ketamine (KMG), and maropitant + lidocaine + ketamine (LKMG). All drugs were injected first as an intravenous bolus and then by continuous intravenous infusion. During surgery, esophageal temperature, respiratory rate, heart rate, oxygen saturation, expired isoflurane concentration, and partial pressure of carbon dioxide at the end of expiration were evaluated at 7 time points. Postoperative pain was evaluated for 6 h after extubation using the visual analogue scale and the UNESP-Botucatu multidimensional composite pain scale for assessing postoperative pain in cats. RESULTS: Adverse effects related to maropitant, lidocaine and ketamine infusion were not observed. Pain scores were lower in the MG, KG and LG groups when compared to the CG group using both scales. Although pain scores were also lower in all combination groups than CG, more animals in these groups required rescue analgesia compared to MG. This indicates that the postoperative analgesic effect of all drugs, either alone or in combination, confers analgesia, although the combinations did not promote greater analgesia. CONCLUSIONS: Continuous intravenous infusion of maropitant, lidocaine, and ketamine alone induces postoperative analgesic effect in cats undergoing ovariohysterectomy, but combinations of these drugs did not increase the analgesic effect. No adverse effect was observed with any drug or their combination.

Tratamento de ferida cirúrgica cutânea em ratos com óleo-resina de copaíba (copaíba reticulata) / Treatment of surgical wounds in rats with copaiba oil-resin (copaiba reticulata)

Foi avaliada a atividade cicatrizante do óleo-resina de copaíba "in natura" em feridas cirúrgicas cutâneas induzidas em ratos. Setenta e dois ratos foram distribuídos em três grupos: Grupo Controle Negativo (GCN), Grupo Controle Positivo (GCP) e Grupo Óleo-resina de Copaíba (GOC). A avaliação da hiperemia por escore na macroscopia mostrou que a chance de um animal apresentar um grau de hiperemia baixo quando tratado com o óleo-resina de copaíba é 1,46 vezes maior que um animal tratado com ácidos graxos essenciais e 2,14 vezes maiores que a chance de um animal tratado com óleo mineral. Com relação ao infiltrado inflamatório na microscopia a probabilidade de ser menor ocorre no GOC em comparação com os GCN e GCP. Em relação ao tempo de reepitelização, a chance de um animal apresentar uma reepitelização mais lenta tratado com ácidos graxos essenciais é de 1,2 vezes a chance de um animal tratado com óleo-resina de copaíba. A análise histológica mostrou que o tecido cicatricial após o tratamento com óleo-resina de copaíba apresentou maior contração da ferida e consequentemente redução do tamanho da ferida visto pela aproximação de anexos da pele no corte histológico. Concluiu-se que o tratamento com óleo-resina de copaíba proporciona maior contração da ferida e aproximação dos anexos da pele.

The healing activity of "in natura" oil-resin of copaíba resin was evaluated in cutaneous surgical wounds induced in rats. Seventy-two rats were divided into three groups: Negative Control Group (GCN), Positive Control Group (GCP) and Copaíba Oil-Resin Group (GOC). Evaluation of hyperemia by macroscopic score showed that the chance of an animal presenting a low degree of hyperemia when treated with copaiba oil-resin is 1.46 times higher than an animal treated with essential fatty acids and 2.14 times greater than the chance of an animal treated with mineral oil. With regard to inflammatory infiltrate under microscopy the probability of being smaller occurs in GOC compared to GCN and GCP. Regarding the time of re-epithelialization, the chance of an animal having a slower reepithelization treated with essential fatty acids is 1.2 times the chance of an animal treated with copaiba oil-resin. Histological analysis showed that cicatricial tissue after treatment with copaiba oil-resin presented greater contraction of the wound due to the approximation of skin attachments. It was concluded that the treatment with copaiba oil-resin provides greater contraction of the wound and approximation of the skin attachments.

Extracellular vesicles cargo from head and neck cancer cell lines disrupt dendritic cells function and match plasma microRNAs.

Extracellular vesicles (EVs) are mediators of the immune system response. Encapsulated in EVs, microRNAs can be transferred between cancer and immune cells. To define the potential effects of EVs originated from squamous cell carcinoma cells on immune system response, we performed microRNA profiling of EVs released from two distinct cell lines and treated dendritic cells derived from circulating monocytes (mono-DCs) with these EVs. We confirmed the internalization of EVs by mono-DCs and the down-regulation of microRNA mRNA targets in treated mono-DCs. Differences in surface markers of dendritic cells cultivated in the presence of EVs indicated that their content disrupts the maturation process. Additionally, microRNAs known to interfere with dendritic cell function, and detected in EVs, matched microRNAs from squamous cell carcinoma patients' plasma: miR-17-5p in oropharyngeal squamous cell carcinoma, miR-21 in oral squamous cell carcinoma, miR-16, miR-24, and miR-181a circulating in both oral and oropharyngeal squamous cell carcinoma, and miR-23b, which has not been previously described in plasma of head and neck squamous cell carcinoma, was found in plasma from patients with these cancer subtypes. This study contributes with insights on EVs in signaling between cancer and immune cells in squamous cell carcinoma of the head and neck.

Protective action of N-acetyl-L-cysteine associated with a polyvalent antivenom on the envenomation induced by Lachesis muta muta (South American bushmaster) in rats.

In this study, we examined the potential use of N-acetyl-L-cysteine (NAC) in association with a polyvalent antivenom and as stand-alone therapy to reduce the acute local and systemic effects induced by Lachesis muta muta venom in rats. Male Wistar rats (300-350 g) were exposed to L. m. muta venom (1.5 mg/kg - i.m.) and subsequently treated with anti-Bothrops/Lachesis serum (antivenom:venom ratio 1:3 'v/w' - i.p.) and NAC (150 mg/kg - i.p.) separately or in association; the animals were monitored for 120 min to assess changes in temperature, locomotor activity, local oedema formation and the prevalence of haemorrhaging. After this time, animals were anesthetized in order to collect blood samples through intracardiac puncture and then euthanized for collecting tissue samples; the hematological-biochemical and histopathological analyses were performed through conventional methods. L. m. muta venom produced pronounced local oedema, subcutaneous haemorrhage and myonecrosis, with both antivenom and NAC successfully reducing the extent of the myonecrotic lesion when individually administered; their association also prevented the occurrence of subcutaneous haemorrhage. Venom-induced creatine kinase (CK) release was significantly prevented by NAC alone or in combination with antivenom; NAC alone failed to reduce the release of hepatotoxic (alanine aminotransferase) and nephrotoxic (creatinine) serum biomarkers induced by L. m. muta venom. Venom induced significant increase of leucocytes which was also associated with an increase of neutrophils, eosinophils and monocytes; antivenom and NAC partially reduced these alterations, with NAC alone significantly preventing the increase of eosinophils whereas neither NAC or antivenom prevented the increase in monocytes. Venom did not induce changes in the erythrogram parameters. In the absence of a suitable antivenom, NAC has the potential to reduce a number of local and systemic effects caused by L. m. muta venom.

Kisspeptin/Kiss1r system and angiogenic and immunological mediators at the maternal-fetal interface of domestic cats.

The Kisspeptin/Kiss1r system is a key regulator of reproduction by stimulating gonadotrophin-releasing hormone and luteinizing hormone release, and in vitro studies have shown that Kisspeptin can modulate angiogenesis and immune function, factors that are also essential for reproduction However, there are no studies on the expression of Kisspeptin/Kiss1r at the maternal-fetal interface in domestic cats and its relationship with angiogenic and immunological mediators. Thus, our objective was to evaluate the spatiotemporal expression profile of Kisspeptin/Kiss1r and angiogenic and immunological mediators in the uterus and placenta of domestic cats during pregnancy. Uterus and placenta samples were collected from cats in mid pregnancy (N = 6) and late pregnancy (N = 6), in addition to uterus from non-pregnant cats in diestrus (N = 7), to evaluate protein and gene expression of kisspeptin (Kiss1), kisspeptin receptor (Kiss1r), vascular endothelial growth factor (VEGF), tyrosine kinase receptor (Flk-1), placental growth factor (PLGF), interferon gamma (INFγ), migration inhibiting factor (MIF), tumor necrosis factor (TNFα), interleukins (IL6 and IL10) by immunohistochemistry and quantitative polymerase chain reaction. Pregnancy increased the uterine expression of Kiss1 and Kiss1r, especially at the late pregnancy, in addition to upregulating INFy, MIF, Vegf, Il10, and Tnf and downregulating Plgf. Higher placental expression of Kiss1r and Plgf mRNA occurred at the late pregnancy, while the expression of Kiss1, VEGF, Flk-1, INFy, TNFα, Il6, and IL10 was higher in the mid of pregnancy. A positive correlation between Kiss1 and Tnf was observed in the placenta, while Kiss1r had a negative correlation with Infγ, Il6, and Il10. The findings reveal that Kisspeptin/Kiss1r and angiogenic and immunological mediators at the maternal-fetal interface of pregnant cat have a gene correlation and are modulated by the gestational age. These data suggest possible functional links of Kisspeptin in placental angiogenesis and immunology.