Pattern of abnormalities on gray matter in patients with medial temporal lobe epilepsy and hippocampal sclerosis: An updated meta-analysis.

Temporal lobe epilepsy (TLE) is a prevalent form of epilepsy originating in the temporal lobes. A common pathological feature is hippocampal sclerosis (HS), characterized by the loss of neuronal cells, which is associated with the typical temporal mesial lobe epilepsy (MTLE). In this study, we aimed to analyze gray matter alterations in patients with MTLE with right and left hemisphere HS using voxel-based morphometry and compare them with control groups. A meta-analysis was performed based on the guidelines contained in the Protocol Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), using the MEDLINE database, with the keywords: "gray matter" AND "temporal lobe epilepsy " AND ("hippocampal sclerosis" OR "hippocampal abnormalities") AND ("voxel-based morphometry" OR "VBM" OR "voxel-wise"). Of the 14 articles included in the review, 8 were added by the method, in which the meta-analysis was performed. Our results indicate that in the right hemisphere, the hippocampus, caudate nucleus, parahippocampal gyrus, thalamus, dorsalis medial nucleus, insula, and right claustrum were most commonly implicated. In the left hemisphere, a significant pattern of gray matter loss was observed in the putamen, lentiform nucleus, uncus, Brodmann areas 20 and 23, cingulate gyrus, caudate nucleus, cerebellum, and cuneus compared to healthy controls.Our study highlights distinct patterns of gray matter alteration in MLTE-HS and suggests that these regions may contribute to changes in verbal memory and visuospatial impairment based on their anatomical and hemispheric locations. Our findings can be potentially helpful for future diagnostic markers, therapeutic targets, and insights into disease progression, better understanding of these findings.

Human RNA Polymerase II Segregates from Genes and Nascent RNA and Transcribes in the Presence of DNA-Bound dCas9.

RNA polymerase II (Pol II) dysfunction is frequently implied in human disease. Understanding its functional mechanism is essential for designing innovative therapeutic strategies. To visualize its supra-molecular interactions with genes and nascent RNA, we generated a human cell line carrying ~335 consecutive copies of a recombinant ß-globin gene. Confocal microscopy showed that Pol II was not homogeneously concentrated around these identical gene copies. Moreover, Pol II signals partially overlapped with the genes and their nascent RNA, revealing extensive compartmentalization. Using a cell line carrying a single copy of the ß-globin gene, we also tested if the binding of catalytically dead CRISPR-associated system 9 (dCas9) to different gene regions affected Pol II transcriptional activity. We assessed Pol II localization and nascent RNA levels using chromatin immunoprecipitation and droplet digital reverse transcription PCR, respectively. Some enrichment of transcriptionally paused Pol II accumulated in the promoter region was detected in a strand-specific way of gRNA binding, and there was no decrease in nascent RNA levels. Pol II preserved its transcriptional activity in the presence of DNA-bound dCas9. Our findings contribute further insight into the complex mechanism of mRNA transcription in human cells.

Senescent cell-derived vaccines: a new concept towards an immune response against cancer and aging?

Two recent seminal works have untangled the intricate role of tumor-associated senescent cells in cancer progression, or regression, by guiding our immune system against cancer cells. The characterization of these unique, yet diverse cell populations, should be considered, particularly when contemplating the use of senolytics, which are drugs that selectively eliminate senescent cells, in a cancer framework. Here, we will describe the current knowledge in this field. In particular, we will discuss how the presence of senescent cells in tumors could be used as a therapeutic target in immunogenic cancers and how we may hypothetically design an adaptive anti-aging vaccine.

A long-term prospecting study on giant viruses in terrestrial and marine Brazilian biomes.

The discovery of mimivirus in 2003 prompted the search for novel giant viruses worldwide. Despite increasing interest, the diversity and distribution of giant viruses is barely known. Here, we present data from a 2012-2022 study aimed at prospecting for amoebal viruses in water, soil, mud, and sewage samples across Brazilian biomes, using Acanthamoeba castellanii for isolation. A total of 881 aliquots from 187 samples covering terrestrial and marine Brazilian biomes were processed. Electron microscopy and PCR were used to identify the obtained isolates. Sixty-seven amoebal viruses were isolated, including mimiviruses, marseilleviruses, pandoraviruses, cedratviruses, and yaraviruses. Viruses were isolated from all tested sample types and almost all biomes. In comparison to other similar studies, our work isolated a substantial number of Marseillevirus and cedratvirus representatives. Taken together, our results used a combination of isolation techniques with microscopy, PCR, and sequencing and put highlight on richness of giant virus present in different terrestrial and marine Brazilian biomes.

Exploring the Interplay of RUNX2 and CXCR4 in Melanoma Progression.

Overexpression of the Runt-related transcription factor 2 (RUNX2) has been reported in several cancer types, and the C-X-C motif chemokine receptor 4 (CXCR4) has an important role in tumour progression. However, the interplay between CXCR4 and RUNX2 in melanoma cells remains poorly understood. In the present study, we used melanoma cells and a RUNX2 knockout (RUNX2-KO) in vitro model to assess the influence of RUNX2 on CXCR4 protein levels along with its effects on markers associated with cell invasion and autophagy. Osteotropism was assessed using a 3D microfluidic model. Moreover, we assessed the impact of CXCR4 on the cellular levels of key cellular signalling proteins involved in autophagy. We observed that melanoma cells express both RUNX2 and CXCR4. Restored RUNX2 expression in RUNX2 KO cells increased the expression levels of CXCR4 and proteins associated with the metastatic process. The protein markers of autophagy LC3 and beclin were upregulated in response to increased CXCR4 levels. The CXCR4 inhibitor WZ811 reduced osteotropism and activated the mTOR and p70-S6 cell signalling proteins. Our data indicate that the RUNX2 transcription factor promotes the expression of the CXCR4 chemokine receptor on melanoma cells, which in turn promotes autophagy, cell invasiveness, and osteotropism, through the inhibition of the mTOR signalling pathway. Our data suggest that RUNX2 promotes melanoma progression by upregulating CXCR4, and we identify the latter as a key player in melanoma-related osteotropism.

The Impact of Long Noncoding RNAs in Tissue Regeneration and Senescence.

Overcoming senescence with tissue engineering has a promising impact on multiple diseases. Here, we provide an overview of recent studies in which cellular senescence was inhibited through the up/downregulation of specific lncRNAs. This approach prevented senescence in the bones, joints, nervous system, heart, and blood vessels, with a potential impact on regeneration and the prevention of osteoarthritis and osteoporosis, as well as neurodegenerative and cardiovascular diseases. Senescence of the skin and liver could also be prevented through the regulation of cellular levels of specific lncRNAs, resulting in the rejuvenation of cells from these organs and their potential protection from disease. From these exciting achievements, which support tissue regeneration and are not restricted to stem cells, we propose lncRNA regulation through RNA or gene therapies as a prospective preventive and therapeutic approach against aging and multiple aging-related diseases.

New copper(II) and oxidovanadium(IV) complexes with a vitamin B6 Schiff base: mechanism of action and synergy studies on 2D and 3D human osteosarcoma cell models.

We report the synthesis, characterization and anticancer activity of a new Schiff base (H2L) derived from the condensation of pyridoxamine with pyridoxal and its novel copper(II) and oxidovanadium(IV) complexes: [Cu(HL)Cl] (1), [Cu(LH2)(phen)]Cl2 (2), [Cu(LH2)(amphen)]Cl2 (3), [VIVO(HL)Cl] (4), and [VIVO(LH2)(phen)]Cl2 (5), where phen is 1,10-phenanthroline and amphen is its 5-amino derivative. All compounds were characterized by analytical and spectroscopic techniques, namely FTIR, UV-vis and EPR spectroscopy. Their stability in aqueous media was evaluated, revealing that the presence of the phen co-ligand significantly increases the stability. The ternary Cu(II) complexes (2 and 3) impaired cell viability of osteosarcoma cells (MG-63) (IC50 values of 3.6 ± 0.6 and 7 ± 1.9 µM for 2 and 3), while 1 and the VIVO complexes did not show relevant anticancer activity. Complexes 2 and 3 are also more active than cisplatin (CDDP). Synergistic studies between 2 and sorafenib showed significant synergism on MG-63 cells for the following combinations: 2 (2.0 µM) + sorafenib (10.0 µM) and 2 (2.5 µM) + sorafenib (12.5 µM), whilst the combination of 2 and CDDP did not show synergy. Complex 2 interacts with DNA, inducing significant genotoxic effects on MG-63 cells from 1.0 to 2.5 µM and it increases the ROS levels 880% over basal. Moreover, 2 induces apoptosis at 1.0 and 2.0 µM, while its combination with sorafenib induces apoptosis and necrosis. Finally, compound 2 reduces the cell viability of MG-63 spheroids showing an IC50 value 7-fold lower than that of CDDP (8.5 ± 0.4 µM vs. 65 ± 6 µM). The combination of 2 and sorafenib also showed synergism on spheroids, suggesting that the combination of these drugs improves the anticancer effect against bone cancer cells.

The optimum level of meld to minimize the mortality on liver transplantation waiting list, and liver transplanted patient in são paulo state, brazil / Melhor nível do meld para minimizar a mortalidade em lista de transplante de fígado no estado de são paulo, brasil

ABSTRACT BACKGROUND: After validation in multiple types of liver disease patients, the MELD score was adopted as a standard by which liver transplant candidates with end-stage liver disease were prioritized for organ allocation in the United States since 2002, and in Brazil, since 2006. AIMS: To analyze the mortality profile of patients on the liver transplant waiting list correlated to MELD score at the moment of transplantation. METHODS: This study used the data from the Secretary of Health of the São Paulo State, Brazil, which listed 22,522 patients, from 2006 (when MELD score was introduced in Brazil) until June 2009. Patients with acute hepatic failure and tumors were included as well. We also considered the mortality of both non-transplanted and transplanted patients as a function of the MELD score at presentation. RESULTS: Our model showed that the best MELD score for patients on the liver transplant waiting list associated to better results after liver transplantation was 26. CONCLUSIONS: We found that the best score for applying to liver transplant waiting list in the State of São Paulo was 26. This is the score that minimizes the mortality in both non-transplanted and liver transplanted patients.

RESUMO RACIONAL: Desde 2002, após validação em múltiplos tipos de hepatopatias, o escore MELD foi adotado como padrão pelo qual os candidatos a transplante de fígado com doença hepática terminal têm sido priorizados para alocação de órgãos nos Estados Unidos, e em 2006 no Brasil. OBJETIVOS: Analisar a mortalidade de pacientes em lista de espera para transplante de fígado correlacionando com o MELD, no momento do transplante. MÉTODOS: Foram utilizados os dados da Secretaria de Saúde do Estado de São Paulo, Brasil, onde foram listados 22.522 pacientes, desde 2006 (quando o escore MELD foi introduzido no Brasil) até junho de 2009. Foram incluídos pacientes com falência hepática e tumores. A mortalidade de pacientes não transplantados e transplantados também foi considerada em função do escore MELD. RESULTADOS: Nosso modelo mostrou que o melhor valor do MELD, em pacientes em lista de espera para transplante e com melhores resultados, foi de 26. Este valor minimiza mortalidade em pacientes não transplantados bem comem pacientes na lista de espera para transplante de fígado. CONCLUSÕES: O escore MELD ótimo para entrar na lista de espera para transplante de fígado, no estado de São Paulo, é em torno de 26. Esse é o valor que minimiza a mortalidade tanto dos pacientes não transplantados em lista de espera, quanto dos submetidos à transplante de fígado.

Comparação do dispositivo termográfico FLIR ONE® versus avaliação clínica presencial e avaliação fotográfica na determinação da profundidade das queimaduras / Comparison of the FLIR ONE® thermographic device versus face-to-face clinical assessment and photographic assessment in determining the depth of burns

OBJETIVO: Comparar a avaliação clínica presencial, com fotos e imagens térmicas obtidas no dispositivo FLIR ONE® para o diagnóstico de profundidade das queimaduras, avaliar concordância intragrupos e descrever o perfil epidemiológico da população estudada. MÉTODO: Estudo transversal de acurácia. Foram incluídos pacientes adultos com queimaduras agudas, submetidos a balneoterapia, selecionados aleatoriamente e avaliados isoladamente por dois grupos de avaliadores (avaliação clínica presencial X fotos do dispositivo térmico), no período de 14 de fevereiro a 14 de março de 2018 no Centro de Tratamento de Queimados do Hospital Geral do Estado da Bahia. Nas análises estatísticas foi utilizado o programa IBM-SPSS-Statistics versão 23, realizando análises descritivas e distribuição de frequências. A significância estatística (p<0,05) foi avaliada pelo teste de Spearman. RESULTADOS: No total, 39 diferentes áreas de queimadura, e suas respectivas fotos em VGA. 19 pacientes foram incluídos no estudo, 57,9% pertenciam ao sexo masculino, com média de idade de 35 anos. A média de superfície corporal queimada foi de 16,32%. Das 39 áreas queimadas avaliadas, 14 (35,9%) foram classificadas como profundas e 25 (64,1%) como superficiais pelo FLIR ONE®. O grupo 1 apresentou percentual de concordância no diagnóstico de 89,8%. O grupo 2 apresentou percentual de concordância no diagnóstico de 48,7%. CONCLUSÕES: A avaliação clínica presencial apresentou melhor concordância intragrupos do que a avaliação fotográfica. Quando os grupos foram comparados com o dispositivo térmico FLIR ONE® não ocorreu correlação significativa, com taxa de concordância de 35,9%.

OBJECTIVE: To compare in-person clinical assessment with photos and thermal images obtained on FLIR ONE® device to diagnose burn depth, evaluate intragroup agreement and describe the epidemiological profile of the studied population. METHODS: Accuracy cross-sectional study. Adult patients with acute burns, undergoing balneotherapy, were included, randomly selected and evaluated separately by two groups of evaluators (in-person clinical assessment versus photos of the thermal device), from February 14 to March 14, 2018 at the Burn Treatment Center of the General Hospital of the State of Bahia. In statistical analyses, the IBM-SPSS-Statistics version 23 program was used, performing descriptive analyzes and frequency distribution, statistical significance (p<0.05) was assessed using Spearman's test. RESULTS: In total, 39 different burn areas, and their respective VGA photos. 19 patients were included in the study, 57.9% of whom were male, with an average age of 35 years. The average body surface area burned was 16.32%. Of the 39 burned areas evaluated, 14 (35.9%) were classified as deep and 25 (64.1%) as superficial by the FLIR ONE®. Group 1 had a percentage of agreement in the diagnosis of 89.8%. Group 2 had a percentage of agreement in the diagnosis of 48.7%. CONCLUSIONS: The in-person clinical assessment showed better intragroup agreement than the photographic assessment. When the groups were compared with the FLIR ONE® thermal device, there was no significant correlation with an agreement rate of 35.9%.

Avaliação do contrafluxo: Um novo conceito como indicador de qualidade de um serviço de atendimento a vítimas de queimadura / Evaluating counterflow: A new concept as a quality indicator for a burn care service

OBJETIVO: Descrever o perfil de pacientes adultos internados por queimaduras que passaram por contrafluxo, retorno do paciente para uma unidade de maior complexidade assistencial por complicações ou deterioração clínica, durante a internação hospitalar e avaliar a relação existente entre a sua ocorrência, o Abbreviated Burn Severity Index (ABSI) e óbito. MÉTODO: Estudo retrospectivo de coorte aberta com dados secundários de um Centro de Tratamento de Queimados (CTQ) na Bahia, de janeiro de 2022 a junho de 2023. Os dados foram organizados no Excel, exportados e analisados no Stata. A significância estatística foi avaliada pelo teste Qui-quadrado ou exato de Fisher para variáveis categóricas. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa. RESULTADOS: Das 658 internações no CTQ, 72 (10,9%) tiveram contrafluxo. Destas, 51,4% foram do sexo masculino, 68% estavam na faixa etária de 18 a 59 anos, predominando as queimaduras por calor/fogo. As unidades que mais receberam o contrafluxo foram a Unidade de Terapia Intensiva (UTI) para queimados (UAC), com 48 (66,7%), e UTIs Gerais, com 21 eventos (29,2%). Na população estudada, houve significância estatística na taxa de mortalidade, na taxa de contrafluxo segundo as faixas de gravidade e no contrafluxo e mortalidade segundo procedência, no qual foi identificado que os pacientes vindos da emergência sofreram contrafluxo e tiveram maior taxa de mortalidade. CONCLUSÕES: O contrafluxo representa um importante indicador a ser monitorado no CTQ em estudo, pois esteve relacionado com pior prognóstico em adultos grandes queimados, procedentes da emergência e vítimas de queimaduras térmicas.

OBJECTIVE: To describe the profile of adult patients hospitalized for burns that underwent contraflow, return the patient to a more complex care unit due to complications or clinical complications, during hospital stay and evaluate the relationship between their occurrence, the Abbreviated Burn Severity Index (ABSI) and death. METHODS: Retrospective open cohort study with secondary data from a Burn Treatment Center (BTC) in Bahia, from January 2022 to June 2023. Data were organized in Excel, exported and applied to Stata. Statistical significance was assessed using the Chi-square or Fisher's exact test for categorical variations. This study was approved by the Research Ethics Committee. RESULTS: Of the 658 admissions to the BTC, 72 (10.9%) had contraflow. Of these, 51.4% were male, 68% were aged between 18 and 59 years, with heat/fire burns predominating. The units that received the most contraflow were the burn ICU (UAC) with 48 (66.7%), and General ICUs with 21 events (29.2%). In the studied population, there was statistical significance in the mortality rate, in the contraflow rate according to the severity ranges and in the contraflow and mortality according to origin, where it was identified that patients coming from the emergency suffered contraflow and had higher mortality rates. CONCLUSIONS: Contraflow represents an important indicator to be monitored in the BTC under study, as it was related to worse prognoses in severely burned adults, those coming to emergencies and victims of thermal burns.

Experience of patients undergoing liver transplantation during the covid-19 pandemic / Experiencia del patients sometido a trasplante hepático durante la pandemia de covid-19 / Vivência do paciente submetido ao transplante hepático durante a pandemia da covid-19

ABSTRACT Objective: to understand the experience of patients undergoing liver transplantation during the COVID-19 pandemic. Method: exploratory and qualitative research, developed in a reference hospital in liver transplantation, in the city of Florianópolis, Brazil. Participants were liver transplant patients between the years 2011 and 2021. Data collection conducted through a semi-structured script and data analysis performed according to content analysis. Results: from the participation of 23 patients, two categories of analysis emerged: "Perceptions about social isolation", with results related to coping and feelings related to social isolation; and "Actions and information: patients, support network and health services", revealing the meanings of strategies and changes developed in life activities of daily living as well as challenges faced with information and health services during the pandemic period. Conclusion: the study was able to understand liver transplant patients' experience in the face of the challenges they face during the pandemic. It allowed to visualize coping strategies, feelings and meanings based on recipients' perspective. As a contribution, it presents possibilities for achieving improvements in services and attention to weaknesses in health services, providing opportunities for reflections to improve this care and considering the specificities and complexities of the postoperative period of liver transplantation.

RESUMEN Objetivo: comprender la experiencia de los pacientes sometidos a trasplante hepático en la pandemia de COVID-19. Método: investigación exploratoria, con abordaje cualitativo, desarrollada en un hospital de referencia para trasplante hepático, en la ciudad de Florianópolis, Brasil. Los participantes fueron pacientes trasplantados de hígado entre los años 2011 y 2021. La recolección de datos se realizó a través de un guión semiestructurado y el análisis de datos se realizó de acuerdo con el análisis de contenido. Resultados: de la participación de 23 pacientes surgieron dos categorías de análisis: "Percepciones sobre el aislamiento social", con resultados relacionados al afrontamiento y sentimientos relacionados al aislamiento social; y "Acciones e información: paciente, red de apoyo y servicios de salud", revelando los significados de las estrategias y cambios desarrollados en las actividades de la vida diaria, así como los desafíos enfrentados con la información y los servicios de salud durante el período de la pandemia. Conclusión: el estudio logró comprender la experiencia de los pacientes trasplantados de hígado frente a los desafíos que enfrentan durante la pandemia. Permitido visualizar estrategias de afrontamiento, sentimientos y significados basados ​​en la propia perspectiva del receptor. Como aporte, presenta posibilidades para lograr mejoras en los servicios y atención a las debilidades de los servicios de salud, brindando espacios de reflexión para mejorar esa atención, considerando las especificidades y complejidades del postoperatorio del trasplante hepático.

RESUMO Objetivo: compreender a vivência do paciente submetido ao transplante hepático na pandemia da COVID-19. Método: pesquisa exploratória, de abordagem qualitativa desenvolvida em hospital de referência em transplante hepático, na cidade de Florianópolis, Brasil; os participantes foram pacientes transplantados hepáticos entre os anos de 2011 e 2021. Coleta de dados conduzida por meio de roteiro semiestruturado e análise dos dados realizada conforme análise de conteúdo. Resultados: da participação dos 23 pacientes, duas categorias de análise emergiram: "percepções acerca do isolamento social" com resultados relacionados aos enfrentamentos e sentimentos referentes ao isolamento social e "e "ações e informações: paciente, rede de apoio e serviços de saúde" desvelando os significados das estratégias e mudanças desenvolvidas nas atividades de vida diária bem como os desafios em face das informações e dos serviços de saúde durante o período da pandemia. Conclusão: o estudo foi capaz de compreender a vivência dos pacientes transplantados hepáticos ante os desafios enfrentados por eles durante a pandemia. Permitiu visualizar estratégias de enfrentamento, sentimentos e significados com base na perspectiva do próprio receptor. Como contribuição, apresenta possibilidades de alcance de melhorias nos serviços e de atenção às fragilidades dos serviços de saúde, oportunizando reflexões para a melhoria desse cuidado, considerando as especificidades e complexidades do pós-operatório do transplante hepático.

Perfil de profissionais e organização do trabalho em centrais de transplantes / Perfil de los profesionales y organización del trabajo en los centros de trasplante / Profile of professionals and organization of work in transplant centers

Objetivo: identificar o perfil de profissionais e a organização do trabalho nas centrais nacional e estaduais de transplante. Método: pesquisa quantitativa, descritiva, realizada com 34 profissionais das centrais de transplantes. Realizou-se coleta de dados entre junho e setembro de 2020, por meio de questionário eletrônico. Os dados foram analisados pela estatística descritiva. Resultados: as equipes de transplantes são compostas principalmente por enfermeiros (73,5%), com tempo de formação entre 11 e 20 anos (41,2%) e atuação nas centrais entre cinco e 10 anos (44,1%). As atividades de gestão foram as mais citadas, seguida pelas de educação, e por fim atividades assistenciais. Conclusão: a partir deste estudo foi possível evidenciar quem são os profissionais atuantes nas Centrais de Transplantes. O enfermeiro destaca-se como integrante das equipes das centrais. A atuação do enfermeiro no processo de doação de órgãos é de extrema importância, visto que é o gestor do cuidado.(AU)

Objective: to identify the profile of professionals and the organization of work at national and state transplant centers. Method: quantitative, descriptive research carried out with 34 professionals from transplant centers. Data were collected between June and September 2020, through an electronic questionnaire. Data were analyzed using descriptive statistics. Results: the transplant teams are mainly composed of nurses (73.5%), with training time between 11 and 20 years (41.2%) and working in the centers between five and 10 years (44.1%). Management activities were the most cited, followed by education, and finally assistance activities. Conclusion: from this study it was possible to show who are the professionals working in the Transplant Centers. The nurse stands out as a member of the teams at the centers. The role of nurses in the organ donation process is extremely important, as they are the care managers.(AU)

bjetivo: identificar el perfil de los profesionales y la organización del trabajo en los centros de trasplante nacionales y estatales. Método: investigación cuantitativa, descriptiva, realizada con profesionales de centros de trasplante. La recolección de datos se realizó entre junio y septiembre de 2020, a través de un cuestionario electrónico. Los datos fueron analizados utilizando estadística descriptiva. Resultados: los equipos de trasplante están compuestos mayoritariamente por enfermeras (73,5%), con tiempo de formación entre 11 y 20 años (41,2%) y trabajando en los centros entre cinco y 10 años (44,1%). Las actividades de gestión fueron las más citadas, seguidas de las de educación y finalmente las de asistencia. Conclusión: fue posible evidenciar quiénes son los profesionales que actúan en los Centros de Trasplante. La enfermera tiene un papel destacado como miembro del equipo al ser la gestora de cuidados en el proceso de donación de órganos.(AU)

Validating potential organ and tissue donors in the middle of the COVID-19 pandemic: Scoping review and recommendations construction / Validación de los donantes potenciales de órganos y tejidos en medio de la pandemia de COVID-19: revisión del alcance y construcción de recomendaciones

Objective: To identify the available information to support registered nurses’ clinical decisions in assessing and validating potential organ and tissue donors during the COVID-19 pandemic.Method: This is a scoping review developed in six stages. The sixth stage was developed with registered nurses who work in the Brazil Organ Donation System. To consolidate the information and prepare all assumptions, the legislation in force in Brazil was followed.Results: Recommendations from 19 articles identified in the literature were analyzed; additionally, 52 professionals who work at Brazil Organ Donation System participated in the research. Four care assumptions were formed: investigation of community transmission, investigation of clinical situations, screening for COVID-19 signs and symptoms, and investigation of alterations presented in the physical examination. Such assumptions are formed by 34 care guidelines.Discussion: Care assumptions were prepared to guide and support registered nurses during assessment and validation of potential organ and tissue donors. From this perspective, assumptions certainly promote safety, effectiveness and quality in the service offered during the organ and tissue donation process in the midst of the COVID-19 pandemic, in addition to empowering registered nurses in this scenario. Quality and bio-surveillance through the donation stages have been discussed extensively in recent times, to improve donation and transplantations by valuing care, safety, and quality of life of recipients.Conclusion: The care assumptions presented in this study support and subsidize the daily practice of registered nurses who work in assessing and validating potential organ and tissue donors, enabling these professionals to make decisions based on secure information.

Objetivo: Identificar la información disponible para respaldar las decisiones clínicas de las enfermeras tituladas en la evaluación y validación de los donantes potenciales de órganos y tejidos durante la pandemia de COVID-19.Método:Se trata de una revisión del alcance, desarrollada en seis etapas. La sexta etapa se efectuó con las enfermeras tituladas que trabajan en el Sistema de Donación de Órganos de Brasil. Para consolidar la información y preparar todos los supuestos, el estudio se adaptó a la legislación vigente en Brasil.Resultados: Se analizaron las recomendaciones de 19 artículos identificados en la literatura; además, 52 profesionales que trabajan en el Sistema de Donación de Órganos de Brasil participaron en el estudio. Se formaron cuatro supuestos de cuidados: estudio de la transmisión comunitaria, estudio de las situaciones clínicas, cribado de los signos y síntomas de la COVID-19, y estudio de las alteraciones presentadas en el examen físico. Dichos supuestos están formados por 34 directrices sobre cuidados.Discusión: Se prepararon supuestos sobre cuidados para orientar y respaldar a las enfermeras tituladas durante la evaluación y validación de los donantes potenciales de órganos y tejidos. En esta perspectiva, los supuestos promovieron ciertamente la seguridad, efectividad y calidad del servicio ofrecido durante el proceso de donación de órganos y tejidos en medio de la pandemia de COVID-19, además de empoderar a este grupo de profesionales en este escenario. En los últimos tiempos, se ha debatido ampliamente sobre la calidad y bio-vigilancia a través de las etapas de la donación, a fin de mejorar esta y los trasplantes, valorando los cuidados, la seguridad y la calidad de vida de los receptores.Conclusión: Los supuestos sobre cuidados presentados en este estudio respaldan y subsidian la práctica diaria de las enfermeras tituladas que trabajan en la evaluación y validación de los donantes potenciales de órganos y tejidos,

Care actions in obtaining tissues and organs during the COVID-19 pandemic: a mixed methods study / Acciones de cuidado en la obtención de tejidos y órganos durante la pandemia de COVID-19: estudio de métodos mixtos / Ações de cuidados na obtenção de tecidos e órgãos durante a pandemia de COVID-19: estudo de métodos mistos

ABSTRACT Objective: to map health care actions in the organ and tissue donation process in Brazilian regions during the COVID-19 pandemic. Methods: a mixed methods study. Data collection was performed simultaneously through an online questionnaire with 72 nurses. Descriptive statistical analysis and content analysis. Results: a total of 34.7% of professionals work in the state of São Paulo. The largest number of responses was from the Southeast region. Four categories emerged. The first addresses triage care actions; the second involves guidelines for SARS-CoV-2 prevention in potential donors; the third relates to the epidemiological screening of professionals; the fourth presents the scenario of donation training in pandemic times. Conclusion: care actions are aimed at tracking the path taken until arrival at the hospital, assessing temperature and saturation curves, in addition to screening for signs and symptoms for SARS-CoV-2 contamination among professionals.

RESUMEN Objetivo: mapear las acciones de atención a la salud en el proceso de donación de órganos y tejidos en regiones brasileñas durante la pandemia de COVID-19. Métodos: estudio de métodos mixtos. La recolección de datos se realizó simultáneamente a través de un cuestionario en línea con 72 enfermeras. Análisis estadístico descriptivo y análisis de contenido. Resultados: 34,7% de los profesionales actúan en el estado de São Paulo. El mayor número de respuestas fue de la Región Sudeste. Se formaron cuatro categorías. La primera se refiere a las acciones de atención de clasificación; la segunda se trata de lineamientos para la prevención del SARS-CoV-2 en el potencial donante; la tercera se relaciona con el tamizaje epidemiológico de los profesionales; la cuarta presenta el escenario de la formación en donación en tiempos de pandemia. Conclusión: las acciones de cuidado tienen como objetivo rastrear el camino recorrido hasta la llegada al hospital, evaluar las curvas de temperatura y saturación, además del tamizaje de signos y síntomas de contaminación por SARS-CoV-2 entre los profesionales.

RESUMO Objetivo: mapear ações de cuidados em saúde no processo de doação de órgãos e tecidos nas regiões brasileiras durante a pandemia de COVID-19. Métodos: estudo de métodos mistos. Coleta de dados realizada de maneira simultânea através de questionário online com 72 enfermeiros. Análise por estatística descritiva e análise de conteúdo. Resultados: 34,7% dos profissionais atuam no estado de São Paulo. O maior número de respostas foi da Região Sudeste. Foram formadas quatro categorias. A primeira aborda ações de cuidados para triagem; a segunda envolve orientações para prevenção do SARS-CoV-2 no potencial doador; a terceira se relaciona com a triagem epidemiológica dos profissionais; a quarta apresenta o cenário das capacitações em doação em tempos de pandemia. Conclusão: as ações de cuidados direcionam-se para rastrear o caminho percorrido até a chegada do hospital, avaliar curva de temperatura e saturação, além da triagem de sinais e sintomas para contaminação do SARS-CoV-2 entre profissionais.

Brain death communication with parents of children and adolescents: care strategies / Comunicación de la muerte cerebral a los padres de niños y adolescentes: estrategias de atención / Comunicação da morte encefálica junto aos pais de crianças e adolescentes: estratégias de cuidados

ABSTRACT Objectives: to identify care strategies developed by professionals from critically ill patients' units in communicating BD with parents of children and adolescents. Methods: an exploratory and descriptive research with a qualitative approach, carried out in two health institutions between October and December 2019, through semi-structured interviews. Data analysis took place through content analysis. Results: twenty-one professionals participated. Three care strategies were identified: actual clinical situation in suspected brain death; sensitizing families to the real clinical situation after brain death diagnosis; and time to assimilate the death information. Final Considerations: the care strategies for communicating brain death to families identified in this study present the possibility of subsidizing health managers in training and support promotion for professionals in care practice. Moreover, they can be incorporated and validated in the care practice of the studied context.

RESUMEN Objetivos: identificar las estrategias de atención desarrolladas por profesionales de pacientes críticos en la comunicación de la muerte encefálica con los padres de niños y adolescentes. Métodos: investigación exploratoria y descriptiva con enfoque cualitativo, realizada en dos instituciones de salud entre octubre y diciembre de 2019, a través de entrevistas semiestructuradas. El análisis de los datos se llevó a cabo a través del análisis de contenido. Resultados: participaron 21 profesionales. Se identificaron tres estrategias de atención: situación clínica real ante la sospecha de muerte encefálica; sensibilizar a la familia sobre la situación clínica real tras el diagnóstico de muerte encefálica; y tiempo para asimilar la información de la muerte. Consideraciones Finales: las estrategias de cuidado para comunicar la muerte encefálica a las familias identificadas en este estudio presentan la posibilidad de subsidiar a los gestores de salud en la promoción de la formación y apoyo a los profesionales en la práctica del cuidado. Además, pueden ser incorporados y validados en la práctica asistencial del contexto estudiado.

RESUMO Objetivos: identificar estratégias de cuidados desenvolvidas pelos profissionais das unidades de pacientes críticos na comunicação da morte encefálica junto aos pais de crianças e adolescentes. Métodos: pesquisa exploratória e descritiva com abordagem qualitativa, realizada em duas instituições de saúde entre outubro e dezembro de 2019, por meio de entrevistas semiestruturadas. A análise dos dados ocorreu através da análise de conteúdo. Resultados: participaram 21 profissionais. Foram três estratégias de cuidados identificadas: real situação clínica na suspeita de morte encefálica; sensibilizando a família da real situação clínica após o diagnóstico de morte encefálica; e tempo para assimilar a informação da morte. Considerações Finais: as estratégias de cuidados para comunicação de morte encefálica às famílias identificadas neste estudo apresentam a possibilidade de subsidiar gestores de saúde na promoção de capacitações e apoio aos profissionais na prática assistencial. Além disso, podem ser incorporadas e validadas na prática assistencial do contexto estudado.

Biovigilância no processo de doação de órgãos e tecidos durante a pandemia: desafios para o enfermeiro / Biovigilance in the process of organ and tissue donation during the pandemic: challenges for nurses / Biovigilancia en el proceso de donación de órganos y tejidos durante la pandemia: desafíos para el enfermero

Objetivo: identificar as estratégias desenvolvidas pelo enfermeiro capazes de manter a biovigilância no processo de doação de órgãos e tecidos a fim de minimizar o risco de transmissão da COVID-19 entre doadores, receptores e equipes de saúde. Método: pesquisa exploratória, com abordagem qualitativa, apoiada no referencial teórico sobre a biovigilância da Agência Nacional de Vigilância Sanitária. Realizou-se a coleta de dados por meio de formulário on-line composto por questões abertas. Participaram 52 enfermeiros atuantes nas estruturas do Sistema Nacional de Transplantes. Os dados foram analisados pela Análise de Conteúdo. Resultados: identificou-se que o monitoramento e o controle no processo de doação, embasados na investigação clínica do potencial doador e na investigação familiar e comunitária, bem como a modificação da cultura de segurança na instituição, por meio da elaboração de protocolos e diretrizes para o cuidado do potencial doador, foram estratégias elaboradas pelo enfermeiro durante a pandemia com o objetivo de manter a segurança do paciente. Conclusão e implicações para a prática: as estratégias desenvolvidas pelos enfermeiros foram o monitoramento e o controle dos possíveis riscos relacionados com a contaminação do potencial doador pelo vírus SARS-CoV-2 e a modificação da cultura de segurança a partir da elaboração e implantação de protocolos, de modo a assegurar a continuidade da doação e o transplante de órgãos e tecidos, garantindo a segurança e a qualidade nesse processo

Objective: to identify the strategies developed by nurses capable of maintaining biovigilance in the process of organ and tissue donation in order to minimize the risk of transmission of COVID-19 among donors, recipients and health care teams. Method: an exploratory research, with a qualitative approach, supported by the theoretical framework on biovigilance of the Brazilian Health Regulatory Agency. Data were collected using an online form composed of open questions. Fifty-two nurses who work in the structures of the National Transplant System participated. The data was analyzed by Content Analysis. Results: it was identified that the monitoring and control of the donation process, based on the clinical investigation of the potential donor and on the family and community investigation, as well as the modification of the safety culture in the institution, through the development of protocols and guidelines for the care of the potential donor, were strategies developed by nurses during the pandemic in order to maintain patient safety. Conclusion and practice implications: the strategies developed by the nurses were the monitoring and control of possible risks related to the contamination of the potential donor by the SARS-CoV-2 virus and the modification of the safety culture through the development and implementation of protocols, in order to ensure the continuity of donation and transplantation of organs and tissues, ensuring safety and quality in this process

Objetivo: identificar las estrategias desarrolladas por el enfermero capaces de mantener la biovigilancia en el proceso de donación de órganos y tejidos para minimizar el riesgo de transmisión de COVID-19 entre donantes, receptores y equipos de salud. Método: investigación exploratoria con enfoque cualitativo, sustentada en el marco teórico sobre biovigilancia de la Agencia Nacional de Vigilancia Sanitaria. Los datos se recopilaron a través de un formulario en línea compuesto por preguntas abiertas. Participaron 52 enfermeros que laboran en las estructuras del Sistema Nacional de Trasplantes. Los datos se analizaron mediante análisis de contenido. Resultados: se identificó que el monitoreo y control en el proceso de donación, basado en la investigación clínica del potencial donante y en la investigación familiar y comunitaria, así como la modificación de la cultura de seguridad en la institución, mediante el desarrollo de protocolos y guías de el cuidado del donante potencial, fueron estrategias desarrolladas por el enfermero durante la pandemia con el fin de mantener la seguridad del paciente. Conclusión e implicaciones para la práctica: las estrategias desarrolladas por los enfermeros fueron el monitoreo y control de posibles riesgos relacionados con la contaminación del potencial donante por el virus SARS-CoV-2 y la modificación de la cultura de seguridad a partir del desarrollo e implementación de protocolos, con el fin de asegurar la continuidad de la donación y trasplante de órganos y tejidos, garantizando la seguridad y calidad en este proceso

Obtaining tissues and organs for transplantation and coronavirus infections: a scoping review / Obtención de tejidos y órganos para trasplante e infecciones por coronavirus: revisión de alcance / Obtenção de tecidos e órgãos para transplante e infecções por coronavírus: revisão de escopo

ABSTRACT Objectives: to map the care recommendations available in the literature capable of supporting health professionals' decision-making in the organ and tissue donation process before the COVID-19 pandemic. Methods: is a nine-step scoping review with searches performed in three databases and an electronic library (Science Direct). Results: 873 publications were retrieved, 15 selected for analysis. All were published in 2020, originating mainly on China, with predominance of original articles. The most frequent recommendations relate to testing to detect SARS-CoV-2 infection for deceased donors (52.6%) and clinical evaluation of potential donors and possible donors (31.6%). Final considerations: it is believed that the recommendations evidenced will support health professionals in the process of donation and organ transplantations to determine interventions for decision-making during the COVID-19 pandemic.

RESUMEN Objetivo: mapear las recomendaciones de atención disponibles en la literatura capaces de apoyar la toma de decisiones de los profesionales de la salud que trabajan en el proceso de donación de órganos y tejidos ante la pandemia de COVID-19. Métodos: es una revisión de alcance desarrollada en nueve etapas con búsquedas realizadas en tres bases de datos y una biblioteca electrónica (Science Direct). Resultados: se recuperaron 873 publicaciones, 15 seleccionadas para su análisis. Todos fueron publicados en 2020, originados principalmente en China, con predominio de artículos originales. Las recomendaciones más frecuentes están relacionadas con las pruebas para detectar la infección por SARS-CoV-2 en donantes fallecidos (52,6%) y la evaluación clínica del donante potencial y posible donante (31,6%). Consideraciones finales: se cree que las recomendaciones evidenciadas subsidiarán a los profesionales de la salud que trabajan en el proceso de donación y trasplante de órganos para determinar intervenciones para la toma de decisiones durante la pandemia de COVID-19.

RESUMO Objetivo: mapear as recomendações de cuidados disponíveis na literatura capazes de subsidiar a tomada de decisão de profissionais da saúde atuantes no processo de doação de órgãos e tecidos diante da pandemia de COVID-19. Métodos: trata-se de uma revisão de escopo desenvolvida em nove etapas com buscas realizadas em três bases de dados e uma biblioteca eletrônica (Science Direct). Resultados: foram recuperadas 873 publicações, 15 selecionadas para análise. Todas foram publicadas em 2020, tendo como origem principalmente a China, predominando artigos originais. As recomendações mais frequentes se relacionam com a realização de testes para detectar a infecção por SARS-CoV-2 para doadores falecidos (52,6%) e avaliação clínica do potencial doador e possível doador (31,6%). Considerações finais: acredita-se que as recomendações evidenciadas subsidiarão os profissionais de saúde atuantes no processo de doação e transplantes de órgãos a determinar intervenções para a tomada de decisão durante a pandemia de COVID-19.

Incidence of surgical and prosthetic complications in total edentulous patients rehabilitated by the All-on-Four® technique: a retrospective study

ABSTRACT: Objective: To analyze the level of survival and the main complications presented by total edentulous patients after the All-on-Four® treatment, through a retrospective analysis. Methods: The medical records of 32 rehabilitated patients, between 2010 to 2018 were selected, presenting a total of 128 implants with subsequent fixed prostheses. The following variables were analyzed: gender, age, patient's systemic condition, time of implant installation, number of implants, and surgical and prosthetic complications. Results: The procedures were performed over on average 5.9 years ago and were more prevalent in female patients(59.6%). Out of the 32 patients selected 75% presented some systemic alteration, with hypertension being the most frequent disease. Regarding the implant placement, the rehabilitation in the mandible was more prevalent(62.5%), while in the maxilla(31.2%), and in the bimaxillary region(6.25%). As for the complications, out of 128 implants installed, 13 presented loss of osseointegration, leading to a survival rate of 90.44% (94.3% mandible and 83.3% maxilla). Furthermore, 15 surgical and 20 prosthetic complications were diagnosed. Among the surgical complications, the most frequent were loss(5-33%) and bone fracture(3-20%), while the most frequent prosthetic complications included loosening and/or or fracture of the prosthetic component and prosthetic fracture (6-30%). Conclusion: All-on-Four® is a procedure that has a high survival rate.

Custo-efetividade do Stent Farmacológico na Intervenção Coronariana Percutânea no SUS / Cost-effectiveness of Drug-Eluting Stents in Percutaneous Coronary Intervention in Brazils Unified Public Health System (SUS)

Resumo Fundamento O uso do stent farmacológico (SF) comparado ao stent não farmacológico (SNF) na intervenção coronariana percutânea (ICP) reduziu o percentual de reestenose, porém sem impacto na mortalidade, com aumento no custo. A literatura carece de estudos randomizados que comparem economicamente esses dois grupos de stents na realidade do Sistema Único de Saúde (SUS). Objetivo Estimar a razão custo-efetividade incremental (RCEI) entre SF e SNF na coronariopatia uniarterial em pacientes do SUS Métodos Pacientes com coronariopatia uniarterial sintomática foram randomizados em 3 anos para uso de SF ou SNF durante a ICP, na proporção de 1:2, com seguimento clínico de 12 meses. Foram avaliados reestenose intrastent (RIS), revascularização da lesão-alvo (RLA), eventos adversos maiores e custo-efetividade (CE) de cada grupo. Os valores de p < 0,05 foram considerados significativos. Resultados No grupo SF, dos 74 pacientes (96,1%) que completaram o acompanhamento, ocorreu RIS em 1(1,4%), RLA em 1 (1,4%), óbito em 1 (1,4%), sem trombose. No grupo SNF, dos 141 pacientes (91,5%),ocorreu RIS em 14 (10,1%), RLA em 10 (7,3%), óbito em 3 (2,1%) e trombose em 1 (0,74%). Na análise econômica, o custo do procedimento foi de R$ 5.722,21 no grupo SF e de R$4.085,21 no grupo SNF. A diferença de efetividade a favor do grupo SF por RIS e RLA foi 8,7% e 5,9%, respectivamente, com RCEI de R$ 18.816,09 e R$ 27.745,76. Conclusões No SUS, o SF foi custo-efetivo, em concordância com o limiar de CE preconizado pela Organização Mundial da Saúde. (Arq Bras Cardiol. 2020; 115(1):80-89)

Abstract Background The use of drug-eluting stents (DESs), compared with bare-metal stents (BMSs), in percutaneous coronary intervention (PCI) has reduced the rate of restenosis, without an impact on mortality but with an increase in costs. Medical literature lacks randomized studies that economically compare these 2 stent types within the reality of the Brazilian Unified Public Health System (SUS). Objective To estimate the incremental cost-effectiveness ratio (ICER) between DES and BMS in SUS patients with single-vessel coronary artery disease. Methods Over a 3-year period, patients with symptomatic single-vessel coronary artery disease were randomized in a 1:2 ratio to receive a DES or BMS during PCI, with a 1-year clinical follow-up. The evaluation included in-stent restenosis (ISR), target lesion revascularization (TLR), major adverse events, and cost-effectiveness for each group. P-values <0.05 were considered significant. Results In the DES group, of 74 patients (96.1%) who completed the follow-up, 1 developed ISR (1.4%), 1 had TLR (1.4%), and 1 died (1.4%), with no cases of thrombosis. In the BMS group, of 141 patients (91.5%), ISR occurred in 14 (10.1%), TLR in 10 (7.3%), death in 3 (2.1%), and thrombosis in 1 (0.74%). In the economic analysis, the cost of the procedure was R$ 5,722.21 in the DES group and R$ 4,085.21 in the BMS group. The effectiveness by ISR and TLR was 8.7% for DES and 5.9% for BMS, with an ICER of R$ 18,816.09 and R$ 27,745.76, respectively. Conclusions In the SUS, DESs were cost-effective in accordance with the cost-effectiveness threshold recommended by the World Health Organization (Arq Bras Cardiol. 2020; 115(1):80-89)

Coronavirus infections: recommendations for good practice in obtaining tissues and organs for the transplantation / Infecciones por coronavirus: recomendaciones para buenas prácticas en la obtención de tejidos y órganos para el trasplante / INFECÇÕES POR CORONAVÍRUS: RECOMENDAÇÕES PARA BOAS PRÁTICAS NA OBTENÇÃO DE TECIDOS E ÓRGÃOS PARA TRANSPLANTE

Objective: To analyze care recommendations available in the literature that can subsidize the decision making of health professionals in organ and tissue donation during the COVID-19 pandemic. Method: Scoping review, developed in five steps and four databases. Results: 873 publications were found and 15 selected for analysis. All these studies were published in 2020, mainly from China and predominantly discussion articles. The main recommendations are: running of tests to detect SARS-Cov-2 infection in a deceased donor; complete clinical evaluation of past history for potential and possible donation. Final considerations: Recommendations evidenced in this study can support health professionals on the process of organ and tissue donation to decision making in more effective interventions during the pandemic and with the available resources.

Objetivo: Analisar recomendações de cuidados disponíveis na leitura capazes de subsidiar a tomada de decisão de profissionais da saúde atuantes no processo de doação de órgãos e tecidos diante da pandemia do COVID-19. Método: trata-se de uma Scoping rewiew, desenvolvida em cinco etapas, em quatro bases de dados. Resultados: Foram recuperados 873 publicações, 15 selecionadas para análise.  Todas publicadas em 2020, tendo como origem, principalmente, a China, predominando artigos de discussão. As principais recomendações relacionam-se com a realização de testes para detectar a infecção por SARS-CoV-2 para doadores falecidos; tempo de cura dos pacientes expostos ao COVID-19 para considerar a doação; realização minuciosa da avaliação clínica pregressa do potencial doador e possível doador. Considerações finais: Acredita-se que as recomendações evidenciadas subsidiarão os profissionais de saúde atuantes no processo de doação e transplantes de órgãos para determinar intervenções para a tomada de decisão mais efetiva frente aos recursos disponíveis.