Einstein-Sao Paulo最新文献

Background: This study analyzed 22,824 organ offers made to Brazil's National Transplant Center. Of these, 37% were accepted and 63% were refused. Among the accepted organs, 76% were transplanted. Understanding reasons for refusal may help improve national organ use and guide the developmentof effective strategies.

Background: Logistical factors were not responsible for most organ rejections in the single national waiting list.

Background: Refusal information was operator dependent, as the reason for refusal was generic in most cases.

Background: It is possible to increase the use of organs offered to the National Transplant Center by converting more offers into transplants performed through a more detailed study of the reasons for refusal.

Objective: To investigate the outcomes and reasons for the refusal of organs offered on a single national list managed by the National Transplant Center.

Methods: This retrospective cohort study was conducted with a quantitative approach, using data from offers of organs not used in the states and the Federal District, but offered to the National Transplant Center for national distribution.

Results: Of the 22,824 offers of unused organs in the states to the National Transplant Center, 8,483 (37%) were accepted and 14,341 (63%) refused. Of the accepted organs, 6,433 (76%) were implanted and 2,050 (24%) were not used.

Conclusion: The use of organs at the interstate (national) level could be improved, and ascertaining the reasons for refusal could contribute to intervention strategies.

Background: This study aimed to explore membrane transporter gene expression as a predictive biomarker of chemoradiotherapy response in cervical cancer. The differential expression of ATP1B3 and SLCO1B3 accurately classified patients as responders or non-responders with 90% accuracy, highlighting their potential for personalized treatment strategies.

Background: Two gene groups with contrasting expression profiles were identified.

Background: The ATP1B3 and SLCOB3 gene profiles classified patients with 90% accuracy.

Background: The ATP1B3 and SLCOB3 gene signature is a potential predictor of treatment response.

Introduction: Cervical cancer is the fourth most common cancer in women worldwide. Resistance to chemoradiotherapy in cervical cancer has been widely associated with membrane transport-related genes, particularly those encoding efflux transport proteins, such as the ATP-binding cassette family members (including P-glycoprotein), which act by expelling chemotherapeutic agents from tumor cells, as well as solute carrier proteins, whose expression impairs the uptake of antineoplastic drugs by cancer cells.

Objective: This study aimed to identify specific membrane transport-related gene expression profiles as potential biomarkers for predicting chemoradiotherapy response in cervical cancer.

Methods: Cervical biopsies were collected from 31 patients (21 responders and 10 non-responders) at Hospital Luxemburgo - Instituto Mário Penna. Fluorescence-activated cell sorting was used to separate non-stem cancer cells from cervical cancer biopsies. cDNA libraries from the 21 responders and 10 non-responders were sequenced using the Illumina platform. Expression analysis was performed using R and the DESeq2 package, with differentially expressed genes identified based on log fold change >1 or <-1 and padj ≤0.05. WEKA software and decision tree methods were used to analyze membrane transporters.

Results: The results revealed two major gene groups with contrasting differentially expressed genes profiles. The first group, comprising SLC35 and ATP13, was overexpressed in non-responders, while the second group, consisting of SLC25 and ATP6, was overexpressed in responders. Decision tree analysis revealed that ATP1B3 and SLCOB3 expression profiles accurately classified patients into responder and non-responder groups with 90% accuracy, indicating that ATP1B3 and SLCOB3 are potential predictors of chemoradiotherapy response.

Conclusion: Our results strongly suggest the presence of a candidate gene signature comprising ATP1B3 and SLCO1B3 that holds predictive value for chemoradiotherapy response in cervical cancer.

Background: The PEACE-Q was translated into Brazilian Portuguese and validated for use with medical residents. The Brazilian version of the instrument showed acceptable consistency, moderate reliability, and appropriate validity for assessing palliative care knowledge among this population.

Background: Performance was < 70% in 10 of the 33 items.

Background: Lowest performance domains were Oncologic Pain and Opioid Side Effects.

Background: Residents in clinical specialties outperformed those in surgical or mixed specialties.

Background: Residents with ≥3 years of training outperformed those on their first 2 years.

Objective: To translate, cross-culturally adapt, and validate the Palliative Care Knowledge Questionnaire for PEACE (PEACE-Q) in Brazilian Portuguese.

Methods: This study followed five steps: translation, back-translation, cultural adaptation, pre-test, and test-retest. Pre-test (n=20) and test-retest (n=63) were conducted on medical residents from Santa Casa Hospital in Belo Horizonte, Brazil. We determined the content validity index, Kuder-Richardson-20 (KR-20) value, and intraclass correlation coefficient. The performances of residents with different years of training and specialty areas were compared using the Kruskal-Wallis and Mann-Whitney tests.

Results: The translated version of the instrument comprised 33 items divided into nine domains, with a content validity index of 0.95. The test-retest on medical residents showed an internal consistency (KR-20) of 0.60 (95% confidence interval (95%CI)=0.54-0.66) and intraclass correlation coefficient of 0.71 (95%CI=0.51-0.82). Medical residents of clinical specialties showed better overall scores than those of surgical or mixed specialties (median scores [IQR]: 27.0 [25.0-28.0], 26.0 [23.0-28.0], and 23.5 [21.5-25.5], respectively; [p=0.013]). Regarding year of training, medical residents on year three or beyond had higher scores in the "Opioid Side Effects" domain than those on the first 2 years [median scores (IQR): 2.0 (2.0-3.0) versus 2.0 (1.0-2.0); p=0.03].

Conclusion: The Brazilian version of the PEACE-Q demonstrated acceptable internal consistency and moderate reliability and appears appropriate for assessing the palliative care knowledge of Brazilian medical residents.

Background: This micro-costing study assessed hospital admissions for maternal near miss in a high-complexity maternity referral center in Brazil. The findings revealed an average cost of US$ 1,427.70 per admission, with personnel costs being the main driver. The estimated national economic burden reached US$ 86 million in 2019. As most cases are preventable, this underscores the systemic gaps in maternal healthcare delivery and reinforces the need for targeted policy interventions to improve quality and prevent avoidable complications.

Background: Micro-costing showed high per-admission costs (US$ 1,427.70) for maternal near miss.

Background: Reimbursement values (US$ 973) underestimate true hospital costs.

Background: Brazil's economic burden estimated at US$ 86 million (2019).

Background: Most maternal near miss events stem from preventable causes.

Objective: This study aimed to estimate the hospital costs of maternal near miss cases from both the institutional and Brazilian Public Health System perspectives in a reference maternitiy hospital.

Methods: This cost-of-illness study used primary data collected from 128 patients admitted to the obstetric intensive care unit of a reference hospital in 2019 who met the maternal near-miss criteria. Two costing methods were used: micro-costing assessment through reviewing medical records and micro-costing assessment derived from reimbursement data of the Brazilian Public Health System. The resources used were assigned costs in reais (R$) that were converted into US dollars (US$) based on 2019 values.

Results: The average cost of a hospital stay for patients treated for maternal near miss was US$ 1,427.70 per medical record review and US$ 973.00 per Brazilian Public Health System reimbursement. The costs estimated by reimbursement were significantly lower than those estimated by reviewing medical records (p<0.0001). Considering the estimated incidence of maternal near miss among women treated in the Brazilian Public Health System, the projected national economic burden was US$ 86,055,130.50 in 2019.

Conclusion: Through using a micro-costing methodology, this study established that, for the Brazilian Public Health System, hospital admissions due to maternal near misses had resulted in high costs, although this condition is considered to involve a large number of preventable cases. The cost estimates derived from the institution's medical records were significantly higher than the estimated reimbursement costs.

Background: This study reveals elevated levels of MMP-1, MMP-2, and MMP-3 in endometriotic lesions, potentially reflecting a senescenceassociated secretory phenotype. No corresponding increase was observed in peritoneal fluid, possibly due to technical or sample-related limitations. These findings support the potential of MMPs as biomarkers and therapeutic targets in endometriosis.

Background: MMP-1, MMP-2, and MMP-3 are upregulated in endometriotic lesions.

Background: The study findings suggest a senescence-associted secretory phenotype in endometriosis.

Background: The study findings support targeting senescence pathways in endometriosis.

Objective: To investigate the roles of cellular senescence and dysfunctional extracellular matrix metalloproteinases (MMPs) in perpetuating chronic inflammation and facilitating the establishment of endometriotic lesions. By analyzing the MMP activity in the endometrial tissue and peritoneal fluid, we aimed to obtain novel insights into the molecular mechanisms underlying endometriosis-related pathophysiology.

Methods: The endometrial tissue and peritoneal fluid samples were collected laparoscopically from 12 women with endometriosis and 16 healthy controls. Gelatin zymography was performed to assess the activity of MMP-2, and multiplex assays were performed to determine the concentrations of MMP-1 and MMP-3 proteins. Statistical analyses were performed using Generalized Linear Models (GzLM) and SPSS software.

Results: Gelatin zymography revealed higher pro-MMP-2 activity in endometriotic lesions than in eutopic and control endometrium. However, no differences were observed in peritoneal fluid samples. Additionally, MMP-1 and MMP-3 protein levels were elevated in endometriotic lesions compared with those in the eutopic endometrium, whereas only MMP-3 was increased compared with that in the control. No statistical significance was observed for MMP-2, MMP-1, and MMP-3 in the peritoneal fluid samples.

Conclusion: Increased levels of MMP-1, MMP-2, and MMP-3 in endometriotic lesions indicate that endometriosis may have a unique metabolomic signature linked to cell cycle arrest and inflammation. This may contribute to the pathogenesis of endometriosis by facilitating implantation of ectopic endometrium-like tissue in a disturbed immune environment.

Objective: This study compared the productivity of prison oral health teams during the COVID-19 crisis (2020-2022) with the previous three-year period (2017-2019) to identify the number and type of dental procedures performed.

Methods: We employed an ecological and retrospective study using Primary Care Health Information System data. We analyzed data from all municipalities that reported the productivity of Prison Primary Care Teams from 2017 to 2022, totaling 418 municipalities distributed across all five Brazilian regions. Data pertaining to 15 oral health procedures were collected and subsequently grouped into five categories: preventive, urgent, extraction, periodontics, and restorative. The data revealed a non-normal distribution and were evaluated using the Wilcoxon test.

Results: The findings revealed inequality between regions, with the productivity of several municipalities being close to or equal to zero. Although the number of restorative procedures reduced in both periods (2017-2019 and 2020-2022), it was not statistically significant. However, statistically significant increases were observed, with the exception of restorative and periodontal procedures. Urgent and extraction procedures prevailed over restorative and periodontal treatments.

Conclusion: Access to Brazilian oral health procedures for inmates is low and remained unaffected by the pandemic, maintaining similar characteristics with increased productivity during that period.

Background: The use of long-term devices for chemotherapy in neoplastic diseases is very common. The CAVA trial was an extensive study that prospectively evaluated more than 1000 patients undergoing chemotherapy and randomly allocated them to three groups based on the type of catheters used: peripherally inserted central catheters, Port, or Hickmann. For this study, the Quality of Life Vascular Access Device (QoLVAD) questionnaire was administered to assess the impact of these devices (abovementioned catheters) on the patients' daily lives. routine However, no Brazilian Portuguese version of the questionnaire exists, hindering its use among Brazilian patients.

Objective: To translate the CAVA trial QoLVAD to Brazilian Portuguese and validate it so that it can be used in the Brazilian population.

Methods: A total of 167 patients with long term vascular access devices for chemotherapy participated in the study. After translation and retranslation, construct validity was analyzed by identifying the correlation between QoLVAD and the European Quality of Life Questionnaire (EuroQol). To determine the reliability, internal consistency and test-retest analysis with at least a 7-day interval between two administrations of the questionnaire were calculated.

Results: The results revealed good internal and external consistency of the QoLVAD. Significant correlations were found between the QoLVAD and EuroQol (r -0,658 and p<0.001).

Conclusion: The Brazilian Portuguese version of the QoLVAD exhibited good clinimetric properties and proved to be applicable to the Brazilian population.

Objective: To analyze the immediate analgesic effects of Aussie Current on chronic low back pain using different parameters.

Methods: A total of 105 patients (aged 18-80 years, of both sexes, with chronic low back pain) were randomized into five groups: AG1kHz/100Hz, AG1kHz/2Hz, AG4kHz/100Hz, AG4kHz/2Hz, and placebo. All participants underwent a single application of the Aussie Current for 30 min. The assessments were conducted before and immediately after the intervention, with the following outcomes: pain intensity using the numerical pain rating scale, McGill Pain Questionnaire, mechanical pain threshold, and five-times-sit-to-stand test before and immediately after the intervention. The Start-Back Questionnaire was administered before the intervention to analyze the physical and psychosocial factors related to chronic lower back pain.

Results: In the intragroup analysis, all groups showed significant differences in the numerical pain rating scale and total McGill Pain Questionnaire index. For the mechanical pain threshold, a significant difference was observed in the AG1kHz/100Hz Group at three points in the lumbar region and in the five-times-sit-to-stand test at AG1kHz/100Hz, AG1kHz/2Hz, and AG4kHz/100Hz. In the intergroup comparison, there was a significant difference in the numerical pain rating scale scores between the AG1kHz/100Hz and AG1kHz/2Hz Groups in the Placebo Group.

Conclusion: Aussie Current provides an immediate analgesic effect in individuals with chronic low back pain; however, there is no consensus on the ideal parameters.ClinicalTrials.gov Identifier: RBR-98HJ9X.

Objective: To identify the costs pertaining to the preparation and administration process of each chemotherapy treatment session in a public oncology hospital belonging to the Brazilian Unified Health System.

Methods: This prospective, observational, and descriptive study employs the bottom-up micro-costing method through Time-Driven Activity-Based Costing, from the perspective of the facilities of a chemotherapy department within a public oncology hospital.

Results: A comprehensive overview of the flow related to outpatient antineoplastic therapy was elaborated through process mapping, which included each step required for a treatment session. Total personnel costs were calculated at R$ 287,66, distributed among the nursing (48.81%), pharmacy (18.66%), clinical analysis (16.27%), and clinical oncology (16.27%) sectors. The total cost of one intravenous antineoplastic therapy session per patient, excluding the cost of the antineoplastic drug, was R$ 470,35. Nursing care accounted for 49.88% (R$ 234,61) of the financial resources used per session, while pharmacy, clinical analysis, and clinical oncology accounted for 24.47%, 15.70%, and 9.95% of the costs, respectively.

Conclusion: Employing the Time-Driven Activity-Based Costing method in health services not only facilitates resource optimization, providing quality and efficient care within constrained budgets, but also enhances control over processes and their financing.