Exploring factors and trends in place of death by cancer: a population-based study in Brazil.

Background: The place of death profoundly affects end-of-life care quality, particularly in cancer. Assisting individuals at home enhances support, privacy, and control, reducing healthcare costs. This study seeks to elucidate factors associated and trends in place of death by cancer in Brazil. Methods: Using data obtained from the National Mortality Information System, this study extracted tumour topography, sociodemographic characteristics, and the place of death (outcome classified into hospital or home death) by cancer in Brazil from 2002 to 2021. Findings: The analysis included 3,677,415 cases, with 82.3% of deaths occurring in hospitals and 17.7% at home. Most participants were male (53.1%), had gastrointestinal tumours (32.2%), and resided in the Southeastern region (48.7%). Home deaths were more frequent in the Northeastern (30.2%) and Northern (24.8%) regions compared to the Southern (17.1%) and Southeastern (12.2%) regions. A strong inverse correlation was found between home deaths and the Human Development Index of the region. Over the years, there was a reduction in home deaths, followed by a recent increase. Individuals with no formal education, indigenous individuals, and patients from the North, Northeast, and Central-West regions had higher rates of home deaths, while patients with haematological malignancies had lower rates compared to those with gastrointestinal tumours. Interpretation: The minority of deaths by cancer in Brazil occur at home, with distinct trends over time. Home death was associated with regional, racial and educational level differences. Funding: No funding.

Ethnic disparities in breast cancer patterns in Brazil: examining findings from population-based registries.

PURPOSE: To investigate breast cancer (BC) incidence and mortality rates among specific racial groups in Brazil. METHODS: BC incidence was evaluated from 2010 to 2015, using Brazilian Population-Based Cancer Registries, incorporating crude ratios and annual average percentage change (AAPC). Clinical and sociodemographic data from 2000 to 2019 were obtained from Hospital-Based Cancer Registries. Mortality data from 2000 to 2020 were sourced from the National Mortality Information System, comparing White women and Black women. RESULTS: Across 13 Brazilian registries, 70,896 new BC cases were reported from 2010 to 2015. The median BC incidence rate was notably higher for White women (101.3 per 100,000) compared to Black women (59.7 per 100,000). In the general population, non-significant decrease in annual BC incidence was observed (AAPC = - 1.2; p = 0.474). Black women were more likely to live in underdeveloped areas, have lower education levels, live without a partner, and have higher alcohol consumption as compared to White women. A higher proportion of Black women received advanced-stage diagnoses (60.1% versus 50.6%, p < 0.001). BC-related mortality analysis showed 271,002 recorded deaths, with significant increase in BC-specific mortality rates in both racial groups. Black women displayed an AAPC of 2.3% (p < 0.001), while White women demonstrated a moderately elevated AAPC of 0.6% (p < 0.001). CONCLUSION: This study underscores the need for targeted policies to address disparities in access to early detection and proper treatment, particularly for Black women in underprivileged regions, aiming to improve the survival rates of Brazilian women grappling with BC.

Performance of intraoperative neurocognitive tests during awake surgery for patients with diffuse low-grade glioma.

Despite great advancements and the diffusion of awake surgery for brain tumors, the literature shows that the tests applied during the procedure are heterogeneous and non-standardized. This prospective, observational, descriptive study collected data on intraoperative brain mapping and the performance of multiple neurocognitive tests in 51 awake surgeries for diffuse low-grade glioma. Frequency of use and rate of intraoperative findings of different neurocognitive tests were analyzed. Patients mean age at the time of surgery was 35.1 (20-57) years. We performed 26 (51.0%) surgeries on the left hemisphere (LH) and 25 (49.0%) on the right hemisphere (RH). Significant differences were observed between the total number of functional findings (cortical and subcortical) identified in the LH and RH (p = 0.004). In subcortical findings alone, the differences remained significant (p = 0.0004). The RH subcortical region showed the lowest number of intraoperative findings, and this was correlated with functional outcome: Karnofsky performance scale at five days (p = 0.022), three months (p = 0.002) and one year (p = 0.002) post-surgery. On average, more tests were used to map the RH, with a lower frequency of both cortical and subcortical functional findings. Even though subcortical findings were less frequent than cortical findings, they were crucial to defining the resection margins. Based on the intraoperative findings, frequency of use, and rate of findings per use of the tests analyzed, the most relevant tests for each hemisphere for awake brain mapping were identified.

Ibrutinib topical delivery for melanoma treatment: The effect of nanostructured lipid carriers' composition on the controlled drug skin deposition.

Melanoma is responsible for more than 80% of deaths related to skin diseases. Ibrutinib (IBR), a Bruton's tyrosine kinase inhibitor, has been proposed to treat this type of tumor. However, its low solubility, extensive first-pass effect, and severe adverse reactions with systemic administration affect therapeutic success. This study proposes developing and comparing the performance of two compositions of nanostructured lipid carriers (NLCs) to load IBR for the topical management of melanomas in their early stages. Initially, the effectiveness of IBR on melanoma proliferation was evaluated in vitro, and the results confirmed that the drug reduces the viability of human melanoma cells by inducing apoptosis at a dose that does not compromise dermal cells. Preformulation tests were then conducted to characterize the physical compatibility between the drug and the selected components used in NLCs preparation. Sequentially, two lipid compositions were used to develop the NLCs. Formulations were then characterized and subjected to in vitro release and permeation tests on porcine skin. The NLCs containing oleic acid effectively controlled IBR release over 24 h compared to the NLCs composed of pomegranate seed oil. Furthermore, the nanoparticles acted as permeation enhancers, increasing the fluidity of the lipids in the stratum corneum, as determined by EPR spectroscopy, which stimulated the IBR penetration more profoundly into the skin. However, the NLCs composition also influenced the permeation promotion factor. Thus, these findings emphasize the importance of the composition of NLCs in controlling and increasing the skin penetration of IBR and pave the way for future advances in melanoma therapy.

Expansive Spinal Cord Injury After Autologous Olfactory Mucosal Transplantation: Case Report and Systematic Review.

OBJECTIVE: To present strategies for managing tumor mass formation and their corresponding postoperative outcomes. METHODS: We conducted a systematic literature review following the guidelines and protocol of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched the PubMed and EMBASE databases, screened titles and abstracts, and further evaluated full-text publications to select relevant studies. Additionally, a narrative review of other pertinent articles on PubMed was performed. Case reports, cohort studies, and clinical trials were included. Animal studies were excluded. RESULTS: Of 6 patients enrolled in this study, most had American Spinal Injury Association Impairment Scale grade A (66.7%) following intramedullary injury, and 1 patient had American Spinal Injury Association Impairment Scale grade D (16.65%). The discovery time of the intramedullary mass formation ranged from approximately 5 to 14 years. Surgical intervention was performed in most cases (66.7%), with improvement reported in 3 of the surgical cases (75%). The majority of cases (83.3%) involved cervical lesions, while only 1 case (16.7%) involved a thoracic lesion. CONCLUSIONS: Due to the scarcity of described cases, there is no specific treatment for this tumor. Although our patient remained stable after conservative treatment, other studies have shown improvement in symptoms after mass resection. It is essential that the management of this complication be researched further due to the variety of clinical characteristics presented.

Factors influencing COVID-19 mortality among cancer patients: A Brazilian multi-institutional study.

PURPOSE: This study aimed to describe the demographic and clinical characteristics of cancer patients with COVID-19, exploring factors associated with adverse outcomes. PATIENTS AND METHODS: This retrospective cohort study methodically extracted and curated data from electronic medical records (EMRs) of numerous healthcare institutions on cancer patients diagnosed with a confirmed SARS-CoV-2 infection between May 2020 and August 2021, to identify risk factors linked to extended hospitalization and mortality. The retrieved information encompassed the patients' demographic and clinical characteristics, including the incidence of prolonged hospitalization, acute complications, and COVID-19-related mortality. RESULTS: A total of 1446 cancer patients with COVID-19 were identified (mean [Standard deviation] age, 59.2 [14.3] years). Most patients were female (913 [63.1%]), non-white (646 [44.7%]), with non-metastatic (818 [56.6%]) solid tumors (1318 [91.1%]), and undergoing chemotherapy (647 [44.7%]). The rate of extended hospitalization due to COVID-19 was 46% (n = 665), which was significantly impacted by age (p = 0.012), sex (p = 0.003), race and ethnicity (p = 0.049), the presence of two or more comorbidities (p = 0.006), hematologic malignancies (p = 0.013), metastatic disease (p = 0.002), and a performance status ≥ 2 (p = 0.001). The COVID-19-related mortality rate was 18.9% (n = 273), and metastatic disease (<0.001), performance status ≥2 (<0.001), extended hospitalization (p = 0.028), renal failure (p = 0.029), respiratory failure (p < 0.001), sepsis (p = 0.004), and shock (p = 0.040) significantly and negatively influenced survival. CONCLUSION: The rate of extended hospitalization and COVID-19-specific death in cancer patients was notably high and could be influenced by comorbidities, cancer treatment status, and clinical fragility. These observations may aid in developing risk counseling strategies regarding COVID-19 in individuals diagnosed with cancer.

The state of art of awake craniotomy in Latin American countries: a scoping review.

BACKGROUND AND OBJECTIVE: Awake craniotomy (AC) is a valuable technique for surgical interventions in eloquent areas, but its adoption in low- and middle-income countries faces challenges like limited infrastructure, trained personnel shortage, and inadequate funding. This scoping review explores AC techniques in Latin American countries, focusing on patient characteristics, tumor location, symptomatology, and outcomes. METHODS: A scoping review followed PRISMA guidelines, searching five databases in English, Spanish, and Portuguese. We included 28 studies with 258 patients (mean age: 43, range: 11-92). Patterns in AC use in Latin America were analyzed. RESULTS: Most studies were from Brazil and Mexico (53.6%) and public institutions (70%). Low-grade gliomas were the most common lesions (55%), most of them located in the left hemisphere (52.3%) and frontal lobe (52.3%). Gross-total resection was achieved in 34.3% of cases. 62.9% used an Asleep-Awake-Asleep protocol, and 14.8% used Awake-Awake-Awake. The main complication was seizures (14.6%). Mean post-surgery discharge time was 68 h. Challenges included limited training, infrastructure, and instrumentation availability. Strategies discussed involve training in specialized centers, seeking sponsorships, applying for awards, and multidisciplinary collaborations with neuropsychology. CONCLUSION: Improved accessibility to resources, infrastructure, and adequate instrumentation is crucial for wider AC availability in Latin America. Despite disparities, AC implementation with proper training and teamwork yields favorable outcomes in resource-limited centers. Efforts should focus on addressing challenges and promoting equitable access to this valuable surgical technique in the region.

Intimate Partner Violence among women living in families with children under the poverty line and its association with common mental disorders during COVID-19 pandemics in Ceará, Brazil.

BACKGROUND: Intimate partner violence (IPV) is a pervasive public health issue that affects millions of women worldwide. Women living below the poverty line experience higher rates of violence and fewer resources to escape or cope with the abuse, and the COVID-19 pandemic has significantly impacted women's economic well-being worldwide. We conducted a cross-sectional study in Ceará, Brazil, on women in families with children living below the poverty line at the peak of the second wave of COVID to assess the prevalence of IPV and its association with common mental disorders(CMD). METHODS: The study population comprised families with children up to six years of age who participated in the cash transfer program "Mais Infância". The families selected to participate in this program must meet a poverty criterion: families must live in rural areas, in addition to a monthly per capita income of less than US$16.50 per month. We applied specific instruments to evaluate IPV and CMD. To access IPV, we used the Partner Violence Screen (PVS). The Self-Reporting Questionnaire (SRQ-20) was used to assess CMD. To verify the association between IPV and the other evaluated factors with CMD, simple and hierarchical multiple logistic models were used. RESULTS: Of the 479 participant women, 22% were positively screened for IPV (95% CI 18.2-26.2). After multivariate adjustment, the chances of CMD are 2.32 higher in women exposed to IPV than in those not exposed to IPV ((95%CI 1.30-4.13), p value = 0.004). CMD was also associated with job loss during the COVID-19 pandemic (ORa 2.13 (95% CI 1.09-4.35), p-value 0.029). In addition to these, separate or single marital status, as well as non-presence of the father at home and food insecurity were associated with CMD. CONCLUSION: We conclude that the prevalence of intimate partner violence in families with children up to six years of age living below the poverty line in Ceará is high and is associated with greater chances of common mental disorders in mothers. Also, job loss and reduced access to food caused by the Covid 19 pandemic exacerbated both phenomena, constituting a double burden generator factor on mothers.

Awake Craniotomy for Diffuse Low Grade Gliomas in a Resource Limited Setting: Lessons Learned with a Consecutive Series of 51 Surgeries.

OBJECTIVE: Despite benefits of awake craniotomy (AC) many centers do not have access to it. We demonstrated the oncological and functional results of our initial experience in implementing AC in a context of resource limited setting. METHODS: This prospective, observational, and descriptive study collected the first 51 AC for diffuse low-grade glioma, classified according to the 2016 World Health Organization. RESULTS: Mean age was 35.09 ± 9.91 years old. The most common clinical presentation was seizure (89.58%). The average segmented volume was 69.8 cc; with 51% of lesions with more than 6 cm in the largest diameter. Resection of more than 90% of the lesion was achieved in 49% of cases, and greater than 80% in 66.6% of cases. The mean follow-up was 835 days (2.29 years). Satisfactory Karnofsky performance status (KPS) (80 to 100) was observed in 90.1% presurgery, 50.9% at 5 days, 93.7% at 3 months, and 89.7% at 1-year postoperation. At multivariate analysis, tumor volume, new postoperative deficit, and extent of resection were related to KPS at 1 year of follow up. CONCLUSIONS: Functional decline was clearly observed in the immediate postoperative period, but excellent recovery of functional status was observed in the medium and long term. The data presented indicate the benefits of this mapping in both cerebral hemispheres, addressing several cognitive functions in addition to motricity and language. The proposed AC model is a reproducible technique and resource sparing that can be performed safely and with good functional outcomes.

ACW-02 an Acridine Triazolidine Derivative Presents Antileishmanial Activity Mediated by DNA Interaction and Immunomodulation.

The present study proposed the synthesis of a novel acridine derivative not yet described in the literature, chemical characterization by NMR, MS, and IR, followed by investigations of its antileishmanial potential. In vitro assays were performed to assess its antileishmanial activity against L. amazonensis strains and cytotoxicity against macrophages through MTT assay and annexin V-FITC/PI, and the ability to perform an immunomodulatory action using CBA. To investigate possible molecular targets, its interaction with DNA in vitro and in silico targets were evaluated. As results, the compound showed good antileishmanial activity, with IC50 of 6.57 (amastigotes) and 94.97 (promastigotes) µg mL-1, associated with non-cytotoxicity to macrophages (CC50 > 256.00 µg mL-1). When assessed by flow cytometry, 99.8% of macrophages remained viable. The compound induced an antileishmanial effect in infected macrophages and altered TNF-α, IL-10 and IL-6 expression, suggesting a slight immunomodulatory activity. DNA assay showed an interaction with the minor grooves due to the hyperchromic effect of 47.53% and Kb 1.17 × 106 M-1, and was sustained by docking studies. Molecular dynamics simulations and MM-PBSA calculations propose cysteine protease B as a possible target. Therefore, this study demonstrates that the new compound is a promising molecule and contributes as a model for future works.

Association of Sociodemographic Factors and Maternal Educational Attainment with Child Development among Families Living below the Poverty Line in the State of Ceará, Northeastern Brazil.

Maternal educational attainment has been identified as relevant to several child health and development outcomes. This study aimed to evaluate the association of sociodemographic and maternal education factors with child development in families living below the poverty line. A cross-sectional study was conducted through telephone contact from May to July 2021 in Ceará, a state in Northeastern Brazil. The study population comprised families with children up to six years of age participating in the cash transfer program "Mais infância". The families selected to participate in this program must have a monthly per capita income of less than US$16.50. The Ages and Stages Questionnaire version 3 was applied to assess the children's development status. The mothers reported maternal educational attainment as the highest grade and or degree obtained. The final weighted and adjusted model showed that maternal schooling was associated with the risk of delay in all domains except for the fine motor domain. The risk of delay in at least one domain was 2.5-fold higher in mothers with a lower level of schooling (95% CI: 1.6-3.9). The findings of this study suggest that mothers with higher educational attainment have children with better child development outcomes.

Exploring biomarkers and prognostic factors in uterine carcinosarcoma: An insight into L1CAM, CDX2, p53, and MSI status.

BACKGROUND: Uterine Carcinosarcomas (UCS) are a rare type of cancer composed of an admixture of high-grade carcinomatous and sarcomatous elements. Clinicopathological prognostic factors in UCS are well established, but studies that approach the impact of biomarkers in this unusual disease are scarce. The study objective was to evaluate the prevalence and prognostic impact of a panel of prominent biomarkers in uterine carcinosarcoma (UCS) using an immunohistochemical characterization with four biomarkers. METHODS AND FINDINGS: The internal database of a single Brazilian institution was carefully explored to select women diagnosed with UCS who were submitted to surgery and postoperative chemotherapy with carboplatin and paclitaxel between January 2012 and December 2017. Tissue microarrays containing UCS samples were evaluated by immunohistochemistry for L1CAM, CDX2, p53 and microsatellite instability markers. A total of 57 cases were included. The mean age was 65.3 years (standard deviation, SD 7.0). L1CAM was negative (score 0, no staining) in 27 (47.4%) patients. Of L1CAM-positive, 10 (17.5%) showed weak (score 1, <10%), 6 (10.5%) showed moderate (score 2, between 10-50%), and 14 (24.6%) showed strong L1CAM staining (score 3, ≧50%). dMMR occurred in 3 (5.3%) cases. The p53 was aberrantly expressed in 15 (26.3%) tumors. CDX2 was positive in 3 (5.3%) patients. The three-year progression-free survival (PFS) rate in the general population of the study was 21.2% (95% CI: 11.7-38.1) and the three-year overall survival (OS) rate was 29.4% (95% CI: 18.1-47.6). By multivariate analysis, the presence of metastases and CDX2-positive were significantly associated with poorer PFS (p < 0.001 and p = 0.002, respectively) and OS (p < 0.001 and p = 0.009, respectively). CONCLUSION: The strong influence of CDX2 on prognosis requires further investigation. Biological or molecular variability may have impaired the assessment of the impact of the other markers on survival.

Exploring Real-World HER2-Low Data in Early-Stage Triple-Negative Breast Cancer: Insights and Implications.

Purpose: This study aimed to compare the clinical behavior, clinicopathological and sociodemographic characteristics of patients with early-stage triple-negative breast cancer (TNBC) who belong to the HER2-low and HER2-zero subgroups. Patients and Methods: This study involved a thorough search in the internal database of a single Brazilian institution to identify women with TNBC who underwent neoadjuvant chemotherapy (NACT) followed by curative surgery within the period from January 2010 to December 2014. HER2 analysis through immunohistochemistry (IHC) and, if required, amplification by in situ hybridization, was conducted using core biopsy samples. The study assesses outcomes of residual cancer burden (RCB), event-free survival (EFS), and overall survival (OS). Results: A total of 170 cases were analyzed, with a mean age of 51.4 years (standard deviation, SD 11.2). The HER2 status was categorized as IHC 0, 1+, or 2+ in 80 (47.1%), 73 (42.9%), and 17 (10%) patients, respectively. No significant differences were observed in the prevalence of clinical pathological characteristics among the subgroups. The absence of significant results for clinicopathological and demographic features hindered the multivariate analysis of HER2 subgroups. Similarly, no significant differences were found in the RCB, EFS, and OS outcomes between HER2 subgroups. Conclusion: The findings of this study suggest that, in early-stage TNBC, the clinical behavior and survival outcomes of the HER2-low subgroup may not differ significantly from those of the HER2-zero subgroup.

Prevalence of long-term opioid use after radiotherapy for cervical cancer in a Brazilian cancer center.

PURPOSE: This study aimed to describe the clinical and demographic profile of cervical cancer patients exploring risk factors for prolonged use of opioids. METHODS: The database of the Brazilian National Cancer Institute was queried out and 214 women with cervical cancer diagnosed between January 2014 and December 2015 who underwent isolated external beam radiation therapy (EBRT) or chemoradiotherapy (CRT) with complete response were included. Patients who no longer used opioids 6 months after completion of radiation therapy were classified as stoppers; patients who continued using opioids were non-stoppers. Variables were comparatively evaluated as risk factors for prolonged use of opioids. RESULTS: The median age was 49.4 years. Most women were non-white (64.5%) and had ECOG Performance Status (PS) ≥ 1 (76.6%), International Federation of Gynecology and Obstetrics (FIGO) stage II-III (84.1%), and squamous cell carcinoma (82.7%). Smoking and alcohol consumption rates were, respectively, 44.9% and 39.7%. The median time from diagnosis to the onset of EBRT was 111 days (interquartile range 66.2). Most patients underwent CRT (88.8%). The rate of non-stoppers was 65.0%. By multivariate analysis, prescription of strong opioids (p = 0.005) and disease recurrence (p < 0.001) were suggested as independent factors for prolonged use of opioids. CONCLUSION: The rate of prolonged use of opioids after radiotherapy is alarming. Prescription of strong opioids and disease recurrence might be independent risk factors for its persistent use. IMPLICATIONS FOR CANCER SURVIVORS: These results reveal an unmet and urgent need to implement public multiprofessional support programs with well-established protocols for dependence withdrawal, as well as stricter national measures of control in opioid prescription.

Antioxidant and Neuroprotective Effects of the First Tryptophyllin Found in Snake Venom (Bothrops moojeni).

In this study, we report the isolation, characterization, and synthesis of the peptide BmT-2 belonging to the tryptophyllins family, isolated from the venom of the snake Bothrops moojeni. This is the first time a tryptophyllin is identified in snake venom. We tested whether BmT-2 had cytotoxic effects and antioxidant activity in a set of experiments that included both in vitro and cell-based assays. BmT-2 presented a radical scavenging activity toward ABTS• and AAPH-derived radicals. BmT-2 protected fluorescein, DNA molecules, and human red blood cells (RBCs) from free radicals generated by the thermal decomposition of AAPH. The novel tryptophyllin was not toxic in cell viability tests, where it (up to 0.4 mg/mL) did not cause hemolysis of human RBCs and did not cause significant loss of cell viability, showing a CC50 > 1.5 mM for cytotoxic effects against SK-N-BE(2) neuroblastoma cells. BmT-2 prevented the arsenite-induced upregulation of Nrf2 in Neuro-2a neuroblasts and the phorbol myristate acetate-induced overgeneration of reactive oxygen species and reactive nitrogen species in SK-N-BE(2) neuroblastoma cells. Electronic structure calculations and full atomistic reactive molecular dynamics simulations revealed the relevant contribution of aromatic residues in BmT-2 to its antioxidant properties. Our study presents a novel peptide classified into the family of the tryptophyllins, which has been reported exclusively in amphibians. Despite the promising results on its antioxidant activity and low cytotoxicity, the mechanisms of action of BmT-2 still need to be further elucidated.

Positive Parenting Behaviors and Child Development in Ceará, Brazil: A Population-Based Study.

Parenting practices have been identified as a key determinant of children's developmental outcomes. The aim of this study was to evaluate the association of parenting practices with child development in a cross-sectional population-based study in a low-income state in northeastern Brazil. The study included data on 3566 caregiver−child pairs, and the children were aged 0−66 months. Positive parenting behaviors (PPBs) were conceptualized in areas of interactive play, social development, and speech and language interactions. Child development was evaluated using the Brazilian Ages and Stages Questionnaire. Linear regression analysis was used to assess the relationships. We found that a greater number of PPBs was associated with better child development domain scores. Among infants < 1 year, each additional PPB was associated with a 0.32 standardized mean difference (SMD) greater communication (95% CI: 0.24−0.41) and 0.38 SMD greater problem-solving scores (95% CI: 0.24−0.52). Among children aged 4−6 years old, each additional PPB was associated with improved communication (SMD: 0.22; 95% CI: 0.13−0.32), problem solving (SMD: 0.21; 95% CI: 0.10−0.32) and personal−social domain scores (SMD: 0.26; 95% CI: 0.17−0.36). Our findings indicate that PPB were robustly associated with better outcomes across developmental domains among Brazilian children. Programs and interventions that support PPB can contribute to improvements in development outcomes.

Alterations in innate immune responses of patients with chronic rhinosinusitis related to cystic fibrosis.

The role of phagocytes of children with cystic fibrosis (CF) associated with different phenotypes of chronic rhinosinusitis (CRS) is unclear. The aim of this study was to evaluate the phagocytic capacity of blood neutrophils and monocytes and production of superoxide anion by phagocytes in patients with CF with or without chronic rhinosinusitis and with or without nasal polyps (NP). This cross-sectional study was established in 2015-2017 in a tertiary reference center to the CF treatment, Brasilia, Brazil. Sample included 30 children volunteers with CRS related to CF (n = 16) and control subjects (n = 14). Epidemiological and clinical data were compared. Collection of 15 mL of peripheral blood and nasal endoscopy to identify the presence or absence of nasal polyps (NP) were performed. Phagocytosis of Saccharomyces cerevisiae by pathogen-associated molecular pattern receptors and opsonin receptors was assessed. Superoxide anion production was evaluated. The control group showed a higher phagocytic index to monocytes and neutrophils than to the CF or CF+CRS with NP groups [Kruskal-Wallis p = 0.0025] when phagocytosis were evaluated by pathogen-associated molecular pattern receptors (5 yeasts/cell). The phagocytic index of the CF+CRS without NP group was higher than in the CF+CRS with NP group (Kruskal-Wallis p = 0.0168). In the control group, the percentage of phagocytes involved in phagocytosis and superoxide anion production (74.0 ± 9.6%) were higher in all CF groups (p < 0,0001). The innate immune response, represented by phagocytic activity and superoxide anion production by monocytes and neutrophils was more impaired in patients with CF related or not related to CRS than in the control group. However, the phagocytic function of patients without NP showed less impairment.

Assembly and use of a low-cost paracentesis simulator for the teaching of puncture and drainage of ascites.

OBJECTIVES: to describe the assembly of a low-cost paracentesis simulator and evaluate its effectiveness, acceptance and impact on the learning of medical students. METHODOLOGY: a paracentesis simulator was built using a mannequin and materials such as plastic bottles, Velcro, polyvinyl chloride sheets and silicone were used. A cross-sectional and experimental study was carried out with undergraduate medical students without previous practical experience with paracentesis, which sought to validate the model, evaluating its benefits in learning and obtaining technical skills. RESULTS: after using the simulator there was an increase of 82.4% in the level of confidence in performing paracentesis in a patient, with 98% of respondents considering that the model fulfilled the simulator function with satisfaction, and 100% considering it useful as a teaching tool. CONCLUSION: the built simulator was effective as an educational resource, serving as an alternative to high-cost commercial models, allowing for greater accessibility in the use of this tool in medical education.

Unusual bifrontal cerebral infarction related to pituitary apoplexy. An uncommon presentation and literature review.

Background: Pituitary apoplexy (PA) is a syndromic condition described in 1950. The main symptoms are headache, visual impairment, ophthalmoplegia, and hypopituitarism. The relationship between stroke and PA is uncommon and two mechanisms are described: vascular compression and vasospasm. Case Report: A 65-old-year man presented with severe headache, vomiting, ophthalmoplegia, and somnolence. Radiological examinations showed an expansive sellar and suprasellar lesion with a heterogeneous signal, besides Diffusion-weighted imaging (DWI) restriction in the bifrontal area was present. The findings were compatible with PA and stroke. Conclusion: PA leading to cerebral infarction is a rare condition that presents high morbidity and mortality levels. There are two main mechanisms related: direct arterial compression and arterial vasospasm. The cases must be conducted as neuroendocrinological emergencies and surgical management is a key point to better the prognosis of patients.

Assembly and use of a low-cost paracentesis simulator for the teaching of puncture and drainage of ascites / Montagem e uso de simulador de paracentese de baixo custo - aplicabilidade no ensino de punção e drenagem de ascite

ABSTRACT Objectives: to describe the assembly of a low-cost paracentesis simulator and evaluate its effectiveness, acceptance and impact on the learning of medical students. Methodology: a paracentesis simulator was built using a mannequin and materials such as plastic bottles, Velcro, polyvinyl chloride sheets and silicone were used. A cross-sectional and experimental study was carried out with undergraduate medical students without previous practical experience with paracentesis, which sought to validate the model, evaluating its benefits in learning and obtaining technical skills. Results: after using the simulator there was an increase of 82.4% in the level of confidence in performing paracentesis in a patient, with 98% of respondents considering that the model fulfilled the simulator function with satisfaction, and 100% considering it useful as a teaching tool. Conclusion: the built simulator was effective as an educational resource, serving as an alternative to high-cost commercial models, allowing for greater accessibility in the use of this tool in medical education.

RESUMO Objetivos: descrever a montagem de simulador de paracentese de baixo custo e avaliar eficácia, aceitação e impacto no aprendizado de acadêmicos do curso de medicina. Método: um simulador de paracentese foi construído a partir de manequim e de materiais como garrafas plásticas, velcro, folhas de policloreto de vinila e silicone. Foi feito estudo transversal com estudantes da graduação do curso de medicina sem experiência real prévia com paracentese, que buscou validar o modelo, por meio da análise de benefícios no aprendizado e na obtenção de habilidades técnicas. Resultados: após o uso do simulador, observou-se aumento de 82,4% no nível de segurança na realização da paracentese em paciente, 98% dos pesquisados consideraram que o uso do modelo cumpriu com satisfação a função de simulador e 100% definiram-no útil como ferramenta de ensino. Conclusão: a montagem do simulador mostrou-se factível e eficaz como recurso educacional. Serviu como alternativa aos modelos comerciais de alto custo e permitiu maior acessibilidade do uso dessa ferramenta na educação médica.