Psychometric Validation of a Hearing Screening Questionnaire for Preschoolers based on language development evaluation by caregivers.

INTRODUCTION: This study aimed to validate three age-adjusted versions of a Hearing Screening Questionnaire for Preschoolers, in Brazilian Portuguese, based on parents' perception of their children's hearing and oral language. METHODS: Psychometric validation was conducted on three questionnaires, each comprising nine items with Yes/No responses. Three items focused on hearing screening at birth, and six assessed hearing and oral language. The study included 152 parents and their children, who attended day care centers in Belo Horizonte, Brazil. The children were categorized into three age bands: 12 to 18 months, 19 to 35 months, and 36 to 48 months. Audiological assessments, including tympanometry, transient-evoked otoacoustic emissions (TOAE) and pure-tone audiometry (when applicable), were performed on the children. In case of abnormal findings in the previous exams, auditory brainstem response (ABR) testing was conducted. Descriptive data, false alarm, and false-negative analyses were carried out. RESULTS: Considering any type of hearing loss, whether unilateral or bilateral, the questionnaires showed a false-negative rate of 41.17% (7/17 children). However, when considering only bilateral hearing loss, the questionnaire showed a false alarm rate of 31.69% (45/142) and a false-negative rate of 30.0% (3/10). When focusing exclusively on sensorineural hearing loss, the questionnaire identified two children (1.31%), with a false-negative rate of 0% but a false-positive rate of 33.33%. CONCLUSION: Language-development oriented questionnaires allowed quick screening of potential hearing loss in preschoolers. This study found a robust hit rate with these questionnaires. Their validation signifies a promising and cost-effective tool for conducting hearing screenings in preschool children, especially in nations lacking a comprehensive school screening policy.The validated questionnaire affords an easy-to-apply, low-cost and effective instrument for preschool hearing screening.

Relação do tipo de contacto físico com o aleitamento materno exclusivo na alta hospitalar / Association between the type of physical contact and exclusive breastfeeding at hospital discharge / Relación del tipo de contacto físico con la lactancia materna exclusiva en el momento del alta hospitalaria

Resumo Enquadramento: Promover o contacto físico, especialmente o pele a pele, de forma imediata ou precoce em recém-nascidos prematuros é ainda um desafio. Objetivo: Verificar a prevalência de contacto físico entre mãe e recém-nascido prematuro no nascimento e associar o tipo de contacto físico realizado pelo binómio na sala de parto com a prevalência do aleitamento materno exclusivo na alta hospitalar. Metodologia: Estudo transversal com amostra não probabilística de 78 mães e 79 prematuros. A colheita de dados foi efetuada de julho a novembro de 2017, por meio de entrevista e consulta em prontuário e os dados foram analisados conforme a estatística descritiva e Regressão de Poisson com variância robusta. Resultados: A prevalência de qualquer tipo de contacto físico realizado na sala de parto foi de 51,9%, sem diferença estatística entre o tipo de contacto físico realizado entre mãe e bebé com o aleitamento materno exclusivo na alta. Conclusão: O contacto físico pelo toque e beijo no momento do parto não influenciou na prevalência de aleitamento materno exclusivo na alta hospitalar.

Abstract Background: Promoting physical contact, especially skin-to-skin contact, immediately or as soon as possible in preterm newborns is still a challenge. Objective: To determine the prevalence of physical contact between mothers and preterm newborns at birth and to analyze the association between the type of physical contact between them in the delivery room and the prevalence of exclusive breastfeeding at hospital discharge. Methodology: Cross-sectional study with a nonprobability sample of 78 mothers and 79 preterm newborns. Data were collected from July to November 2017, through interviews and medical records, and analyzed through descriptive statistics and Poisson Regression with robust variance. Results: The prevalence of any type of physical contact in the delivery room was 51.9%, without statistical difference between the type of physical contact between mothers and infants and exclusive breastfeeding at discharge. Conclusion: Physical contact by touching and kissing after birth did not influence the prevalence of exclusive breastfeeding at hospital discharge.

Resumen Marco contextual: Promover el contacto físico, especialmente piel con piel, de forma inmediata o precoz en recién nacidos prematuros sigue siendo un desafío. Objetivo: Comprobar la prevalencia del contacto físico entre la madre y el recién nacido prematuro en el momento del nacimiento y asociar el tipo de contacto físico realizado por el binomio en la sala de partos con la prevalencia de la lactancia materna exclusiva en el momento del alta hospitalaria. Metodología: Estudio transversal con una muestra no probabilística de 78 madres y 79 recién nacidos prematuros. La recogida de datos se realizó de julio a noviembre de 2017, mediante entrevista y consulta en antecedentes clínicos, y los datos se analizaron según la estadística descriptiva y la regresión de Poisson con varianza robusta. Resultados: La prevalencia de cualquier tipo de contacto físico realizado en la sala de partos fue del 51,9%, sin diferencias estadísticas entre el tipo de contacto físico realizado entre la madre y el bebé, y la lactancia materna exclusiva en el momento del alta. Conclusión: El contacto físico mediante caricias y besos durante el parto no influyó en la prevalencia de la lactancia materna exclusiva en el momento del alta hospitalaria.

Machine Learning Algorithms to Predict Breast Cancer Recurrence Using Structured and Unstructured Sources from Electronic Health Records.

Recurrence is a critical aspect of breast cancer (BC) that is inexorably tied to mortality. Reuse of healthcare data through Machine Learning (ML) algorithms offers great opportunities to improve the stratification of patients at risk of cancer recurrence. We hypothesized that combining features from structured and unstructured sources would provide better prediction results for 5-year cancer recurrence than either source alone. We collected and preprocessed clinical data from a cohort of BC patients, resulting in 823 valid subjects for analysis. We derived three sets of features: structured information, features from free text, and a combination of both. We evaluated the performance of five ML algorithms to predict 5-year cancer recurrence and selected the best-performing to test our hypothesis. The XGB (eXtreme Gradient Boosting) model yielded the best performance among the five evaluated algorithms, with precision = 0.900, recall = 0.907, F1-score = 0.897, and area under the receiver operating characteristic AUROC = 0.807. The best prediction results were achieved with the structured dataset, followed by the unstructured dataset, while the combined dataset achieved the poorest performance. ML algorithms for BC recurrence prediction are valuable tools to improve patient risk stratification, help with post-cancer monitoring, and plan more effective follow-up. Structured data provides the best results when fed to ML algorithms. However, an approach based on natural language processing offers comparable results while potentially requiring less mapping effort.

Hospitalizations for ambulatory care-sensitive conditions in children, Rondônia, Brazil, 2008-2019. / Internações por condições sensíveis à atenção primária em crianças, Rondônia, Brasil, 2008-2019.

This study aimed to define the profile of hospitalizations of children in public hospitals of 52 municipalities of the state of Rondônia, Brazil. We performed an ecological time series study using secondary data provided by the Hospital Information System. The annual trend of Hospitalizations was presented by age group and health region. Linear regression was performed using the Prais-Winsten technique of the statistical package Stata, version 11.0. Hospitalizations for gastrointestinal diseases were found to be decreasing in all age groups, just as those for vaccine-preventable diseases in children aged between 1 and 9 years. Hospitalizations for skin and subcutaneous tissue diseases were increasing in all ages, as well as those caused by epilepsies in children aged 1 to 9 and those caused by diseases related to childbirth and puerperium. Health regions showed a varied hospitalization profile. A stable trend was found in the Cone Sul, Madeira-Mamoré, Café, Vale do Guaporé, and Vale do Jamari regions, whereas a declining trend was found in the Central and Zona da Mata regions. The high rates of hospitalizations for ambulatory care-sensitive conditions in children show how inefficient strategies and investments in primary care have been in the state of Acre, Brazil.

Objetivou-se caracterizar o perfil de internações de crianças na rede pública dos 52 municípios do estado de Rondônia, Brasil, no período de 2008 a 2019. Trata-se de um estudo de série temporal do tipo ecológico, com dados secundários do Sistema de Informações Hospitalares. A tendência anual das internações foi apresentada por faixa etária e regional de saúde. Foi realizada regressão linear aplicando a técnica de Prais-Winsten no pacote estatístico Stata, versão 11.0. As internações por doenças gastrointestinais tiveram declínio em todas as faixas etárias, assim como pelas doenças previníveis por imunizantes entre 1 a 9 anos. As internações por doenças de pele e tecido subcutâneo foram crescentes em todas as idades, as epilepsias em idades de 1 a 9 anos e pelas doenças relacionadas ao parto e puerpério foi crescente. As regiões de saúde apresentaram perfil de internações variável, com tendência estável nas regiões Cone Sul, Madeira-Mamoré, Café, Vale do Guaporé, Vale do Jamari; e em declínio nas regiões Central e Zona da Mata. As elevadas taxas de internações por condições sensíveis à atenção primária em crianças refletem a pouca efetividade das estratégias e dos investimentos na esfera da atenção primária no estado.

Internações por condições sensíveis à atenção primária em crianças, Rondônia, Brasil, 2008-2019 / Hospitalizations for ambulatory care-sensitive conditions in children, Rondônia, Brazil, 2008-2019

Resumo Objetivou-se caracterizar o perfil de internações de crianças na rede pública dos 52 municípios do estado de Rondônia, Brasil, no período de 2008 a 2019. Trata-se de um estudo de série temporal do tipo ecológico, com dados secundários do Sistema de Informações Hospitalares. A tendência anual das internações foi apresentada por faixa etária e regional de saúde. Foi realizada regressão linear aplicando a técnica de Prais-Winsten no pacote estatístico Stata, versão 11.0. As internações por doenças gastrointestinais tiveram declínio em todas as faixas etárias, assim como pelas doenças previníveis por imunizantes entre 1 a 9 anos. As internações por doenças de pele e tecido subcutâneo foram crescentes em todas as idades, as epilepsias em idades de 1 a 9 anos e pelas doenças relacionadas ao parto e puerpério foi crescente. As regiões de saúde apresentaram perfil de internações variável, com tendência estável nas regiões Cone Sul, Madeira-Mamoré, Café, Vale do Guaporé, Vale do Jamari; e em declínio nas regiões Central e Zona da Mata. As elevadas taxas de internações por condições sensíveis à atenção primária em crianças refletem a pouca efetividade das estratégias e dos investimentos na esfera da atenção primária no estado.

Abstract This study aimed to define the profile of hospitalizations of children in public hospitals of 52 municipalities of the state of Rondônia, Brazil. We performed an ecological time series study using secondary data provided by the Hospital Information System. The annual trend of Hospitalizations was presented by age group and health region. Linear regression was performed using the Prais-Winsten technique of the statistical package Stata, version 11.0. Hospitalizations for gastrointestinal diseases were found to be decreasing in all age groups, just as those for vaccine-preventable diseases in children aged between 1 and 9 years. Hospitalizations for skin and subcutaneous tissue diseases were increasing in all ages, as well as those caused by epilepsies in children aged 1 to 9 and those caused by diseases related to childbirth and puerperium. Health regions showed a varied hospitalization profile. A stable trend was found in the Cone Sul, Madeira-Mamoré, Café, Vale do Guaporé, and Vale do Jamari regions, whereas a declining trend was found in the Central and Zona da Mata regions. The high rates of hospitalizations for ambulatory care-sensitive conditions in children show how inefficient strategies and investments in primary care have been in the state of Acre, Brazil.

[Vaccination for Cirrhosis and Liver Transplant Patients]. / Inmunizaciones en cirrosis y trasplante hepático: Puesta al día.

Patients with cirrhosis and liver transplantation (LT) have a higher risk of infections, complications and death. Vaccines have historically been used to prevent and reduce the risk of complications from viral and bacterial infections. The population with cirrhosis and candidates for LT should be evaluated for immunity against the most relevant immuno-preventable infections, update corresponding immunizations according to the national vaccination program, and inoculate the missing vaccines based on these recommendations. In case of not reaching its inoculation prior to LT, in the post-LT period its vaccination status should be updated. All doctors involved in the health care of these patients must have knowledge about this important topic and be aware of the access and free availability for this population through the presentation of a special form incorporated into the National Immunization Program.

Interoperable Medical Application for CTC Counting.

In the present poster we will explain how the development of an interoperable AI-powered application for Circulating Tumor Cells (CTCs) counting is addressed. We will explain the selection of the most appropriate information for early detection of distant metastasis, local recurrence and the data structure definition to be compliant with international standards and ontologies.

Susceptibility of embryos of Biomphalaria tenagophila (Mollusca: Gastropoda) to infection by Pochonia chlamydosporia (Ascomycota: Sordariomycetes).

Schistosoma mansoni is a heteroxenous parasite, meaning that during its life cycle needs the participation of obligatory intermediate and definitive hosts. The larval development occurs in aquatic molluscs belonging to the Biomphalaria genus, leading to the formation of cercariae, which emerge to infect the final vertebrate host. For this reason, studies for control of the diseases caused by digenetic trematodes often focus on combating the snail hosts. Thus, the objective of this study was to evaluate the susceptibility of Biomphalaria tenagophila embryos to the fungus Pochonia chlamydosporia (isolate Pc-10). The entire experiment was conducted in duplicate, with five replicates for each repetition (five egg masses/replicate), utilizing a total of 100 egg masses, with 20-30 eggs/egg mass. At the end of 15 days, the egg masses were evaluated under a stereomicroscope to analyze the hatching of B. tenagophila embryos in both experimental groups. After days of interaction, the exposure to the fungal hyphae bodies significantly impaired the viability of the B. tenagophila eggs, inhibiting the embryogenesis process by 83.7% in relation to the control group. Transmission and scanning electron microscopic images revealed relevant structural alterations in the egg masses exposed to the hyphae action of the fungus, interfering in the development and hatching of the young snails under analysis. These results indicate the susceptibility of B. tenagophila embryos to the fungus P. chlamydosporia (isolate Pc-10) and suggest the potential of Pc-10 to be used in the control of intermediate host, for its ovicidal capacity and for being an ecologically viable option, but in vivo experiments become necessary.

Hepatobiliary manifestations in inflammatory bowel disease: A practical approach.

Inflammatory bowel diseases (IBD) are associated with various hepatobiliary disorders. They can occur at any moment in the course of the disease or associated with the treatment. The prevalence of liver dysfunction can reach up to 50% in different studies. Nonalcoholic fatty liver disease is considered the most common hepatobiliary complication in IBD, while primary sclerosing cholangitis is the most specific. Management of hepatic manifestations in IBD involves a multidisciplinary approach that includes a high index of suspicion and joint management with hepatologists. The medical confrontation with abnormal liver tests must include an exhaustive study to determine if these patterns can be related to IBD, associated diseases or to the therapies used.

Heterorhabditis bacteriophora (Rhabditida: Heterorhabditidae), isolate HP88, induces reproductive and physiological alterations in Biomphalaria glabrata (Gastropoda: Planorbidae): an alternative for biological control of schistosomiasis.

Heterorhabditis bacteriophora is an entomopathogenic nematode (EPN) that is mutually associated with Photorhabdus luminescens, utilized globally for biological control of numerous organisms. Freshwater snails of the species Biomphalaria glabrata have been incriminated as the main intermediate hosts of Schistosoma mansoni in Brazil, but virtually nothing is known about the susceptibility of these gastropod to EPNs. Information in this respect is relevant for control of these intermediate hosts, and thus of the helminthiases they transmit. This paper for the first time reports the susceptibility of B. glabrata to infective juveniles of H. bacteriophora (isolate HP88) under laboratory conditions. For that purpose, six groups were formed: three Control groups (not exposed) and three Treated groups, in which the snails were exposed to 300 juveniles infecting the nematode over three weeks. The entire experiment was conducted in triplicate, using a total of 270 snails. Significant physiological alterations in B. glabrata were observed in response to the infection by H. bacteriophora HP88, characterized by decreased levels of hemolymphatic glucose as well as reduced contents of glycogen stored in the host's digestive gland. In parallel, the hemolymphatic activity of lactate dehydrogenase increased in the infected snails, indicating that the infection induces breakdown of carbohydrate homeostasis in B. glabrata. Additionally, all the reproductive parameters analyzed were reduced as a consequence of the infection. The results indicate the occurrence of the phenomenon of parasitic castration in the B. glabrata/H. bacteriophora HP88 interface, probably due to the depletion of galactogen in the parasitized organism. Although the infection did not cause lethality in the population of infected snails, H. bacteriophora HP88 compromised the reproductive performance of B. glabrata, suggesting its applicability in programs for biological control of this planorbid.

CASIDE: A data model for interoperable cancer survivorship information based on FHIR.

Cancer survivorship has traditionally received little research attention although it is associated with a variety of long-term consequences and also many other comorbidities. There is an urgent need to increase research on this area, and the secondary use of healthcare data has the potential to provide valuable insights on survivors' health trajectories. However, cancer survivors' data is often stored in silos and collected inconsistently. In this study we present CASIDE, an interoperable data model for cancer survivorship information that aims to accelerate the secondary use of healthcare data and data sharing across institutions. It is designed to provide a holistic view of the cancer survivor, taking into account not just the clinical data but also the patient's own perspective, and is built upon the emerging Health Level Seven (HL7) Fast Healthcare Interoperability Resources (FHIR) standard. Advantages of adopting FHIR and challenges in information modelling using this standard are discussed. CASIDE is a generalizable approach that is already being used as a support tool for the development of downstream applications to support clinical decision making and can contribute to translational collaborative research on cancer survivorship.

Resumen ejecutivo: Enfermedad por hígado graso no alcohólico en sujetos con diabetes mellitus tipo 2: Postura conjunta de la Asociación Chilena de Hepatología (ACHHEP) y la Sociedad Chilena de Diabetología (SOCHIDIAB) / Non-alcoholic fatty liver disease in type 2 diabetes: a joint statement of the Chilean Hepatology and Diabetology Societies

Non-alcoholic fatty liver disease (NAFLD) has a high prevalence and risk of progression to cirrhosis and other complications in patients with type 2 diabetes mellitus (T2DM). Likewise, the presence of NAFLD implies a high risk of developing T2DM, determining a bidirectional relationship between them. The diabetology and hepatology societies, developed a joint initiative aiming to unify criteria, reviewing the definitions, diagnostic criteria, risk stratification, treatment, and follow-up of patients with NAFLD and T2DM. The key questions to be discussed were defined by a panel of specialists in diabetology and hepatology. The Delphi methodology was used to reach consensus on the respective recommendations. Based on the discussion generated among the experts, diagnostic and treatment algorithms were proposed, as well as an indication for referral and the role of the different specialists involved in the management of these patients. Strengthening multidisciplinary work with patients with NAFLD and T2DM will allow the early recognition of the disease, the prevention of the progression to cirrhosis, and reducing the associated complications.

Draft Whole-Genome Sequence of Bacillus paramycoides LB_RP2, a Putative Polyhydroxyalkanoate-Producing Bacterium Isolated from an Amazonian Blackwater River.

Bacteria of the genus Bacillus have been investigated due to the ability that many species have of accumulating polyhydroxyalkanoates (PHA) via a wide variety of raw materials as their carbon source. Herein, we report the draft whole-genome sequence of the putative PHA-accumulating strain Bacillus paramycoides LB_RP2, isolated from an Amazonian river.

Endopleura uchi - A review about its nutritional compounds, biological activities and production market.

Endopleura uchi (Huber) Cuatrec, known as uxi, is a native plant from the Amazon region, which has been used by locals for some pathology treatments. This review aimed to find the main uxi studies carried out in scientific literature. This compilation includes the biological activities that have been proven, parts of the plant that were exploited, as well as its nutritional properties. Uxi fruit has compounds, such as vitamins A and E, minerals, bioactive phenolic and organic acids, along with anti-inflammatory, antioxidant, antibacterial, antidiabetic, and anti-cholesterol actions. Some E. uchi extract activities have been reported, such as: α-glucosidase and cyclooxygenases (COX1/COX2) inhibitions, in addition to anti-bactericidal properties. The isocoumarin compound, bergenin is responsible for many of the reported biological activities of this species. E. uchi can be used for manufacturing products in food, pharmaceutical, and cosmetic industries, demonstrating its worth, regional economic growth, along the potential to dominate the worldwide market.

Liver transplantation in acute liver failure due to Hepatitis B. Two clinical cases.

Hepatitis B virus (HBV) related acute liver failure (ALF) is uncommon in our region, and there is limited HBV literature regarding the optimal management of these cases. In this article, we report two clinical cases of young men who have sex with men (MSM), both developed severe acute hepatitis caused by HBV, progressed to ALF and afterward required liver transplantation. Antiviral post-transplant treatment included entecavir without Hepatitis B Immunoglobulin (HBIG), and immunosuppression therapy with steroids, tacrolimus, and mycophenolate. Serologic follow-up showed early Hepatitis B surface Antigen (HBsAg) seroconversion, undetectable HBV viral load, and positive Anti-HBs titers. During later follow-up, Anti-HBs titers gradually fell (<10mUI/L after six months), with normal liver function. DISCUSSION: In cases of HBV-related ALF, the liver develops a robust immune response, leading to, an early undetectable viral load and seroconversion, with loss of HBsAg, and the appearance of Anti-HBs as a result of the inflammatory response. The management varies depending on whether this is a de novo acute infection or a reactivation of a previous chronic infection. In both cases, the use of antiviral therapy is recommended, with entecavir or tenofovir, among others, but the use of specific HBIG is supported only in ALF related to chronic HBV infection. The optimal length of the antiviral therapy after liver transplantation is still under discussion. CONCLUSION: These cases of HBV related ALF with an early HBsAg seroconversion demonstrates the relevance of requesting IgM antibody against hepatitis B core antigen (anti-HBc IgM) for the etiological study of ALF with negative HBsAg. Usage of HBIG does not seem essential during the post-transplantation period in these cases.

Actions of multiple doses of resveratrol on oxidative and inflammatory markers in plasma and brain of healthy and arthritic rats.

The actions of resveratrol in brain and plasma of rats with adjuvant-induced arthritis were investigated. Resveratrol was administered orally during a period of 23 days. A major concern of the present work was to explore an ample range of daily doses (10-200 mg/kg). Several oxidative and inflammatory markers were measured. Important effects of resveratrol treatment were the normalization of the plasma myeloperoxidase activity (inflammatory marker), the normalization of the brain xanthine oxidase activity (reactive oxygen species source) and the near-normalization of the catalase activity in the brain (antioxidant defence). These effects presented obvious dose dependencies in the range up to 200 mg/kg. Resveratrol also reduced protein and lipid damage within the lowest dose ranges investigated, and its action as a free radical scavenger activity was enhanced in brain mitochondria of arthritic rats. Resveratrol failed in restoring the diminished albumin levels and plasma protein thiols in arthritic rats. The latter, however, were substantially increased in healthy rats at low doses (up to 50 mg/kg), a sign of antioxidant action. This increase was reversed at higher doses, a sign of pro-oxidant action. The observations agree with the notion that low doses of resveratrol might be useful as an adjuvant to the conventional antirheumatic drugs.

Evaluating the Impact of Mobile Phone Technology on Health Outcomes for Latinos with Type 2 Diabetes.

OBJECTIVES: To assess whether a Spanish-language text messaging program helps Latinos with diabetes better manage their disease. METHODS: Spanish-speaking Latinos with type 2 diabetes and HbA1c ≥ 8% (N = 38) were recruited January 1, 2016-May 31, 2016, at a large integrated healthcare delivery system. Participants received 1-3 Spanish-language text messages about diabetes self-care per day for 3 months with an optional 3-month extension. The Wilcoxon signed-rank test for paired data was used to compare pre-post intervention HbA1c. The Wilcoxon-Mann-Whitney nonparametric test was used to compare changes in HbA1c across groups. RESULTS: After 3 months, the median HbA1c reduction overall was 1.4 percentage points (IQR: 0.5-3.3, p < 0.01). Latinos having pre-intervention HbA1c > 10.0% had a greater reduction in median HbA1c (3.8, IQR: 0.5-5.3) compared with those having pre-intervention HbA1c ≤ 10.0% (0.9, IQR: 0.1-1.9, p < 0.05). This reduction in median HbA1c persisted after 6 months (1.3, IQR: 0.2-2.9, p < 0.01). CONCLUSION: A Spanish-language text messaging program was an effective way to improve glycemic control for Latinos with type 2 diabetes. POLICY IMPLICATIONS: Culturally and linguistically tailored text messaging programs for managing diabetes should be considered.

Análisis del sistema de alistamiento y priorización para trasplante hepático de adultos en Chile

Background: In Chile, organ allocation for liver transplantation (LT) in adults is prioritized according to the MELD-Na score. Exceptions such as Hepatocellular Carcinoma (HCC) and other non-HCC exceptions receive a score called Operational MELD score. Aim: To evaluate the effectiveness of the MELD-Na score and the operational MELD score as a prioritization system for LT in Chile. Material and Methods: Retrospective analysis of the waiting list (WL) of adult candidates (≥ 15 years) for elective LT in Chile from 2011 to 2017. The probability of leaving the WL, defined by death or contraindication for LT was compared in three groups: 1) Cirrhotic patients prioritized according to their real MELD-Na score (CPM), 2) HCC and 3) other non-HCC exceptions. Results: We analyzed 730 candidates for LT, with a median age of 57 years, 431 (56%) were men. In the study period, 352 LT were performed (48%). The annual exit rate was significantly higher in the CPM group (45.5%) compared to HCC (33.1%) and non-HCC (29.3%), (p < 0.001). Post LT survival was 86% at 1 year and 85% at 5 years, without significant differences between groups. In the CPM group, post-transplant survival was significantly lower (p < 0.05) in patients with MELD-Na ≥ 30 at transplant (81% per year) compared to patients with patients with MELD-Na < 30 (91% per year). Conclusions: MELD-Na score can discriminate very well patients who have a higher risk of death in the short and medium term. However, the assignment of operational scores for situations of exception produces inequities in the allocation of organs for LT and must therefore be carefully adjusted.