Anomalía de Ebstein: a propósito de un caso

La anomalía de Ebstein es una cardiopatía congénita rara y poco frecuente caracterizada por el adosamiento de los velos valvulares tricuspídeos; en la etapa prenatal se estima que su incidencia corresponde a un 3% de todas las cardiopatías diagnosticadas. Se presenta el caso de un feto con diagnóstico de anomalía de Ebstein a quien se le realizó un diagnóstico prenatal adecuado, lo que permitió planificar el nacimiento neonatal con un equipo multidisciplinario integral. Debido a la rareza del diagnóstico prenatal de esta entidad, se describe el caso clínico y los hallazgos imagenológicos representativos.

Ebsteins anomaly is a rare and infrequent congenital heart disease characterized by the attachment of the tricuspid valve leaflets; in the prenatal stage it is estimated that its incidence corresponds to 3% of all diagnosed heart diseases. We present the case of a fetus diagnosed with Ebsteins anomaly who underwent an adequate prenatal diagnosis, which made it possible to plan the neonatal birth with a comprehensive multidisciplinary team. Due to the rarity of the prenatal diagnosis of this entity, the clinical case and the representative imaging findings are described.

Liver transplantation for end-stage hepatic alveolar echinococcosis / 器官移植

Hepatic alveolar echinococcosis (HAE) is a common zoonotic endemic parasitic disease in western China. It lacks of typical clinical manifestations in the early stage, and symptoms become prominent during the end stage, with an alarmingly high mortality rate. Among the treatment of end-stage HAE (es-HAE), orthotopic liver transplantation is almost the only radical treatment due to insufficient remnant liver volume, uncontrollable bleeding and difficulty in vascular reconstruction in vivo. However, the shortage of donor liver and long-term postoperative use of immunosuppressants limit its application. The introduction of ex vivo liver resection and autotransplantation (ELRA) resolves this dilemma and significantly broadens the indications of es-HAE. In addition, multiple centers in China have optimized and modified ELRA to further improve the treatment system of es-HAE. At present, liver transplantation (including ELRA) of es-HAE remains a hot topic for clinicians. In this article, orthotopic liver transplantation, ELRA, auxiliary ELRA and other surgical treatment of es-HAE were reviewed, aiming to further enhance the diagnosis and treatment of es-HAE and improve clinical prognosis of the patients.

Mitochondria-specific near-infrared photoactivation of peroxynitrite upconversion luminescent nanogenerator for precision cancer gas therapy

Gas therapy is emerging as a highly promising therapeutic strategy for cancer treatment. However, there are limitations, including the lack of targeted subcellular organelle accuracy and spatiotemporal release precision, associated with gas therapy. In this study, we developed a series of photoactivatable nitric oxide (NO) donors NRh-R-NO (R = Me, Et, Bn, iPr, and Ph) based on an N-nitrosated upconversion luminescent rhodamine scaffold. Under the irradiation of 808 nm light, only NRh-Ph-NO could effectively release NO and NRh-Ph with a significant turn-on frequency upconversion luminescence (FUCL) signal at 740 nm, ascribed to lower N-N bond dissociation energy. We also investigated the involved multistage near-infrared-controlled cascade release of gas therapy, including the NO released from NRh-Ph-NO along with one NRh-Ph molecule generation, the superoxide anion O2⋅- produced by the photodynamic therapy (PDT) effect of NRh-Ph, and highly toxic peroxynitrite anion (ONOO‒) generated from the co-existence of NO and O2⋅-. After mild nano-modification, the nanogenerator (NRh-Ph-NO NPs) empowered with superior biocompatibility could target mitochondria. Under an 808 nm laser irradiation, NRh-Ph-NO NPs could induce NO/ROS to generate RNS, causing a decrease in the mitochondrial membrane potential and initiating apoptosis by caspase-3 activation, which further induced tumor immunogenic cell death (ICD). In vivo therapeutic results of NRh-Ph-NO NPs showed augmented RNS-potentiated gas therapy, demonstrating excellent biocompatibility and effective tumor inhibition guided by real-time FUCL imaging. Collectively, this versatile strategy defines the targeted RNS-mediated cancer therapy.

Application progress on in vivo drug analysis technique in clinical pharmacy / 药学实践杂志

Objective To explore the progress on the application of in vivo drug analysis techniques in clinical pharmacy work. Methods Relevant literature was reviewed to provide an overview of the characteristics of clinical samples, common in vivo drug analysis methods used in the clinic, the application and existing problems of in vivo drug analysis in clinical pharmacy. Results and Conclusion In recent years, with the increasing demand for individualized and precise treatment in clinical practice and the continuous development of analytical techniques, in vivo drug analysis techniques have been widely used in clinical pharmacy work, which have become one of the important auxiliary techniques to promote rational clinical drug use, improve individualized treatment and reduce the occurrence of adverse reactions. However, in the actual application, there were still problems such as the invasive blood sampling that hinders sampling, the weak ability to interpret drug monitoring results and clinical testing methods that still need to be improved. These problems should be taken seriously and continuously improved and solved in the subsequent research and application.

Preparation and in vivo Distribution of Essential Oil from Alpinia zerumbet Fructus Encapsulated Nanoemulsions / 中国实验方剂学杂志

ObjectiveTo prepare oral nanoemulsions encapsulating essential oil from Alpinia zerumbet fructus（EOFAZ） and to investigate its pro-absorption effect in vitro and distribution in vivo. MethodThe proteoglycan conjugate polysaccharides of vinegar-processed Bupleuri Radix-bovine serum albumin（VBCP-BSA） was prepared by Maillard reaction of VBCP and BSA. Taking VBCP-BSA as emulsifier， vitamin B12（VB12） as absorption enhancer， and medium chain triglycerides mixed with EOFAZ as oil phase， the nanoemulsions loaded with EOFAZ was prepared by high energy emulsification method. The particle size， particle size distribution， surface Zeta potential， EOFAZ content and appearance and morphology of the nanoemulsions were characterized， and fluorescein tracer method was used to investigate the absorption effect of fluorescein-labeled EOFAZ nanoemulsions in vitro and their distribution in vivo. ResultVBCP-BSA was formed by Maillard reaction for 48 h with high grafting rate. Using VBCP-BSA as emulsifier， the homogeneous pink nanoemulsions was prepared and denoted as EOFAZ@VBCP-BSA/VB12. The particle size of the nanoemulsions was less than 100 nm and the particle size distribution was uniform. The surface of the nanoemulsions was a weak negative charge， and the shape was spherical. The encapsulation rate of the nanoemulsions for EOFAZ was greater than 80%， which had a good absorption effect in vitro and could enhance liver accumulation after oral administration. ConclusionThe designed proteoglycan nanoemulsions can effectively load EOFAZ， promote oral absorption and enhance liver distribution， which can provide experimental basis for the development of oral EOFAZ liver protection preparations.

Analysis on Components Absorbed into Blood and Cerebrospinal Fluid of Schisandrae Chinensis Fructus Based on Sequential Metabolism / 中国实验方剂学杂志

ObjectiveTo identify the prototypical components and metabolites absorbed into blood and cerebrospinal fluid of Schisandrae Chinensis Fructus（SCF） based on sequential metabolism combined with liquid chromatography-mass spectrometry. MethodBlood and cerebrospinal fluid samples of integrated metabolism， intestinal metabolism and hepatic metabolism were collected from male SD rats after gavage and in situ intestinal perfusion administration， and ultra-performance liquid chromatography-quadrupole/electrostatic field orbitrap high-resolution mass spectrometry（UPLC Q-Exactive Orbitrap MS） was used to analyze and compare the differences in the spectra of SCF extract， blank plasma， administered plasma， blank cerebrospinal fluid and administered cerebrospinal fluid with ACQUITY UPLC BEH Shield RP18 column（2.1 mm×100 mm， 1.7 µm）， the mobile phase was acetonitrile（A）-0.1% formic acid aqueous solution（B） for gradient elution（0-7 min， 95%B； 7-12 min， 95%-35%B； 12-17 min， 35%-15%B； 17-20 min， 15%-12%B； 20-22 min， 12%-5%B； 22-23 min， 5%B； 23-25 min， 5%-95%B； 25-28 min， 95%B）. And heated electrospray ionization（HESI） was used with positive and negative ion modes， the scanning range was m/z 100-1 500. The prototypical constituents and their metabolites absorbed into blood and cerebrospinal fluid of SCF were identified according to the retention time， characteristic fragments， molecular formulae and the information of reference substances. ResultA total of 42 chemical components were identified in the extract of SCF， including lignans， flavonoids， amino acids， tannins， and others， of which lignans were the main ones. A total of 27 prototypical components and 14 metabolites were identified in plasma samples from different sites. A total of 15 prototypical components and 9 metabolites were identified in cerebrospinal fluid. The main metabolic reactions involved in the formation of metabolites were mainly demethylation， methylation， demethoxylation and hydroxylation. ConclusionThrough the systematic identification of the prototypical components and metabolites of SCF in rats， it provides data support for further better exploring the material basis of SCF in the treatment of central nervous system diseases.

Genotoxic and cytotoxic evaluation of venlafaxine in an acute and a subchronic assay in mouse

Abstract The present research was made to determine the micronuclei and cytotoxic capacity of the antidepressant venlafaxine in an in vivo acute and subchronic assays in mouse. In the first study, we administered once 5, 50, and 250 mg/kg of the drug, and included a negative and a daunorubicin treated group. Observations were daily made during four days. The subchronic assay lasted 5 weeks with daily administration of venlafaxine (1, 5, and 10 mg/kg) plus a negative and an imipramine administered groups. Observations were made each week. In the first assay results showed no micronucleated polychromatic erythrocytes (MNPE) increase, except with the high dose at 72 h. The strongest cytotoxic effect was found with 250 mg/kg at 72 h (a 51% cytotoxic effect in comparison with the mean control level). In the subchronic assay no MNPE increase was found; however, with the highest dose a significant increase of micronucleated normochromatic erythrocytes was observed in the last three weeks (a mean of 51% respect to the mean control value). A cytotoxic effect with the two high doses in the last two weeks was observed (a polychromatic erythrocyte mean decrease of 52% respect to the mean control value). Results suggest caution with venlafaxine.

Resumo A presente pesquisa foi feita para determinar a capacidade micronuclei e citotóxica do antidepressivo venlafaxina em ensaios agudos e subcrônicos in vivo em camundongos. No primeiro estudo, administramos uma vez 5, 50 e 250 mg/kg do medicamento e incluímos um grupo negativo e um grupo tratado com daunorubicina. As observações foram feitas diariamente durante quatro dias. O ensaio subcrônico durou cinco semanas com administração diária de venlafaxina (1, 5, e 10 mg/kg) mais um grupo negativo e um grupo administrado de imipramina. As observações foram feitas a cada semana. No primeiro ensaio, os resultados não mostraram aumento de eritrócitos policromáticos micronucleados (MNPE), exceto com a dose elevada a 72 h. O efeito citotóxico mais forte foi encontrado com 250 mg/kg a 72 h (um efeito citotóxico de 51% em comparação com o nível médio de controle). No ensaio subcrônico não foi encontrado aumento de MNPE; entretanto, com a dose mais alta, um aumento significativo de eritrócitos normocromáticos micronucleados foi observado nas últimas três semanas (média de 51% em relação ao valor médio de controle). Foi observado um efeito citotóxico com as duas altas doses nas últimas duas semanas (uma diminuição média de 52% em relação ao valor médio de controle dos eritrócitos policromáticos). Os resultados sugerem cautela com a venlafaxina.

Genotoxic and cytotoxic evaluation of venlafaxine in an acute and a subchronic assay in mouse / Avaliação genotóxica e citotóxica da venlafaxina em ensaio agudo e subcrônico em camundongos

Abstract The present research was made to determine the micronuclei and cytotoxic capacity of the antidepressant venlafaxine in an in vivo acute and subchronic assays in mouse. In the first study, we administered once 5, 50, and 250 mg/kg of the drug, and included a negative and a daunorubicin treated group. Observations were daily made during four days. The subchronic assay lasted 5 weeks with daily administration of venlafaxine (1, 5, and 10 mg/kg) plus a negative and an imipramine administered groups. Observations were made each week. In the first assay results showed no micronucleated polychromatic erythrocytes (MNPE) increase, except with the high dose at 72 h. The strongest cytotoxic effect was found with 250 mg/kg at 72 h (a 51% cytotoxic effect in comparison with the mean control level). In the subchronic assay no MNPE increase was found; however, with the highest dose a significant increase of micronucleated normochromatic erythrocytes was observed in the last three weeks (a mean of 51% respect to the mean control value). A cytotoxic effect with the two high doses in the last two weeks was observed (a polychromatic erythrocyte mean decrease of 52% respect to the mean control value). Results suggest caution with venlafaxine.

Resumo A presente pesquisa foi feita para determinar a capacidade micronuclei e citotóxica do antidepressivo venlafaxina em ensaios agudos e subcrônicos in vivo em camundongos. No primeiro estudo, administramos uma vez 5, 50 e 250 mg/kg do medicamento e incluímos um grupo negativo e um grupo tratado com daunorubicina. As observações foram feitas diariamente durante quatro dias. O ensaio subcrônico durou cinco semanas com administração diária de venlafaxina (1, 5, e 10 mg/kg) mais um grupo negativo e um grupo administrado de imipramina. As observações foram feitas a cada semana. No primeiro ensaio, os resultados não mostraram aumento de eritrócitos policromáticos micronucleados (MNPE), exceto com a dose elevada a 72 h. O efeito citotóxico mais forte foi encontrado com 250 mg/kg a 72 h (um efeito citotóxico de 51% em comparação com o nível médio de controle). No ensaio subcrônico não foi encontrado aumento de MNPE; entretanto, com a dose mais alta, um aumento significativo de eritrócitos normocromáticos micronucleados foi observado nas últimas três semanas (média de 51% em relação ao valor médio de controle). Foi observado um efeito citotóxico com as duas altas doses nas últimas duas semanas (uma diminuição média de 52% em relação ao valor médio de controle dos eritrócitos policromáticos). Os resultados sugerem cautela com a venlafaxina.

Small-fibre neuropathy in leprosy the role of in vivo confocal microscopy: A cross-sectional study

Background: Leprosy (or Hansen’s disease) continues to present considerable challenges regarding containment and early diagnosis. Leprosy is considered to be primarily a neural disease that first affects the sensory function of small fibres. Although the condition is well described in terms of clinical manifestations and histology, few studies have been undertaken to detect damage done to small-fibre sensory nerves. In vivo confocal microscopy is a useful tool for conducting a detailed evaluation of these structures, although its use in individuals affected by leprosy has still not been explored. Objective: To evaluate in vivo confocal microscopy findings in Hansen’s disease patients and their association with clinical variables relating to this disease. Method: A cross-sectional case-series type study was carried out between October 2019 and May 2021, in Recife, Pernambuco, Brazil. Socio-demographic and clinical data were gathered from 21 patients with leprosy. The douleur neuropathique 4 neuropathic pain questionnaire was used to evaluate pain. In vivo confocal microscopy of the cornea was employed to evaluate the small-calibre fibres. Findings were compared with those for a control group of 23 healthy individuals. Results: In relation to clinical parameters, 90.5% of the patients were classified as “multibacillary” according to the World Health Organization criteria, and 70% as dimorphic or borderline, in accordance with the Madrid classification. Around 52.4% had received a diagnosis after one year or less of living with the disease, while 95.2% presented alterations in small-fibre sensory function and 35% presented such alterations in the large fibre. Neuropathic pain was present in 81% of the patients. In vivo confocal microscopy found no statistically significant difference in mean age and distribution according to sex between the Hansen disease patients and the control group of healthy individuals. The median-of-means for dendritic cells and volume of sub-basal nerve fibres in the control group were used to test for normality. Both eyes of all leprosy patients examined contained higher number of dendritic cells than the median value and a volume of sub-basal nerve fibres lower than the mean. These differences were statistically significant (P < 0.001 and P < 0.001, respectively). Multibacillary individuals had a median number of dendritic cells two times that of paucibacillary individuals (P = 0.035). Limitations: No association was found between the variables examined using in vivo confocal microscopy and clinical variables relating to small-fibre damage, the neuropathic pain questionnaire or alterations detected by the neurological examination. We believe, however, that Cochet-Bonnet esthesiometry of the cornea may have revealed such an association. Conclusion: In vivo confocal microscopy is a useful diagnostic tool for detecting small fibre loss in individuals affected by leprosy and may constitute a useful addition to the range of tools available to help curb the effects of neuropathy in these patients.

Internal occupational dosimetry for the occupational worker exposed to [18F] FDG from the Cyclotron-PET/CT Laboratory of the Universidad de Costa Rica / Dosimetría ocupacional interna para el personal trabajador expuesto a [18F] FDG del ciclotrón-PET/CT en el Laboratorio de la Universidad de Costa Rica

ABSTRACT: The aim of this work is to provide a methodology for evaluating the committed effective dose E(50) due to the incorporation of [18F] FDG in the occupationally exposed worker (OEW) of the Cyclotron-PET/CT Laboratory of the Centro de Investigación en Ciencias Atómicas, Nucleares y Moleculares (CICANUM) at Universidad de Costa Rica using in vivo measurements. The measurement system was calibrated to perform in vivo measurements and defined as the corresponding bioassay function for the radiopharmaceutical used. The conversion factor was assessed with a known activity of 18F in the geometry and measurement time established. Among the most relevant results, the measurement parameters and the calibration procedure were defined. A value of 1.73 x 103 Bq/cps for in vivo brain measurements was obtained as a conversion factor. This study provides a methodology, to evaluate the committed effective dose due to the incorporation of 18F-FDG in a radionuclide production and diagnostic center

Tendência temporal de nascidos prematuros no estado de Santa Catarina entre 2011 e 2021 / Temporal trend of premature birth in the state of Santa Catarina between 2011 and 2021

Objetivo: Analisar a tendência temporal de nascimentos prematuros no estado de Santa Catarina entre 2011 e 2021. Métodos: Estudo observacional ecológico de tendência temporal realizado com informações do banco de dados do Sistema de Informação sobre Nascidos Vivos do estado de Santa Catarina (2011-2021), disponibilizado pela Diretoria de Vigilância Epidemiológica. Foram analisados todos os nascidos vivos prematuros segundo o ano de processamento e o local de residência em Santa Catarina (110.422). Foram incluídos os nascidos vivos de gestação com menos de 37 semanas completas. As taxas de nascimentos prematuros foram calculadas proporcionalmente à totalidade de nascimentos e calculadas segundo macrorregião, idade materna, número de consultas do pré-natal, instrução materna e cor de pele. Para o cálculo da tendência temporal, foi utilizada a regressão linear simples, com intervalo de confiança de 95% (p ≤ 0,05). Resultados: A taxa média de nascimentos prematuros no estado de Santa Catarina foi de 10,57%, com tendência estável (p < 0,001). Maiores taxas específicas foram encontradas nas macrorregiões Meio Oeste e Serra e Planalto Norte e Nordeste (11,46%), extremos de idade (10-14 anos e 45-64 anos) e menor escolaridade. Maior número de consultas de pré-natal apresentou taxa de prematuridade menor (7,69%). Tendências crescentes das taxas foram apenas encontradas na macrorregião Grande Oeste, faixa etária materna entre 40-44 anos e entre 4-6 consultas de pré-natal. Conclusão: A tendência da taxa de prematuridade manteve-se estável em Santa Catarina. Baixo número de consultas de pré-natal, extremos de idades e baixa escolaridade mostraram taxas maiores de prematuridade. (AU)

Objective: Analyzing the temporal trend of premature births in the state of Santa Catarina between 2011 and 2021. Methods: Observational ecological temporal trend study carried out with information from the database of the Information System on Live Births in the state of Santa Catarina (2011-2021), made available by the Epidemiological Surveillance Directorate. All premature live births were analyzed according to the year of processing and place of residence in Santa Catarina (110,422). Live births of less than 37 completed weeks were included. The rates of premature births were calculated in proportion to the total number of births and calculated according to macro-region, maternal age, number of prenatal consultations, maternal education and skin color. Simple linear regression was used to calculate the temporal trend, with a confidence interval of 95% (p ≤ 0.05). Results: The average rate of premature births in the state of Santa Catarina was 10.57%, with a stable trend (p < 0.001). Higher specific rates were found in the Midwest and Serra, North Plateau and Northeast macro-regions (11.46%), age extremes (10-14 years and 45-64 years) and lower schooling. A greater number of prenatal consultations had a lower prematurity rate (7.69%). Increasing trends in rates were only found in the Grande Oeste macro-region, maternal age group between 40-44 years and between 4-6 prenatal consultations. Conclusion: The prematurity rate trend remained stable in Santa Catarina. Low number of prenatal consultations, extremes of age and low education showed higher rates of prematurity. (AU)

Saúde em Dados / Health in data

O Boletim CEInfo "Saúde em Dados" é uma publicação em formato eletrônico com periodicidade anual e de livre acesso editado pela Coordenação de Epidemiologia e Informação (CEInfo) da Secretaria Municipal da Saúde de São Paulo (SMS-SP). O documento é apresentado em dois formatos: uma versão em PDF para consulta e download e outra em formato aberto com conteúdo das diferentes unidades territoriais/administrativas do Município de São Paulo ­ Coordenadoria Regional de Saúde/Supervisão Técnica de Saúde e Subprefeitura. O "Saúde em Dados" foi criado para promover a disseminação de dados sobre nascimentos, mortes e adoecimento da população paulistana, além da estrutura de estabelecimentos/serviços da rede SUS e sua produção assistencial com o objetivo de contribuir com a organização das ações de saúde no Município. Desde 2021, são apresentados os registros de síndrome gripal (SG), síndrome respiratória aguda grave (SRAG) e óbitos decorrentes da pandemia de Covid-19. Na sua 22ª edição, foram incluídos a proporção de nascidos vivos com anomalias congênitas prioritárias segundo definição do Ministério da Saúde, além de alguns agravos de notificação compulsória: doenças e agravos relacionados ao trabalho (DART), acidentes e violências. Os coeficientes foram calculados com a projeção da população residente em 2022 e padronizados por idade com base na população residente de 2020 do Município de São Paulo. Como destaque e a partir desta edição, são apresentados indicadores de mortalidade segundo sexo biológico para as doenças isquêmicas do coração, doenças cerebrovasculares, diabetes mellitus, câncer de pulmão e câncer colorretal. As informações podem ser utilizadas na produção de análises sobre a situação de saúde e de apoio aos gestores, trabalhadores e demais interessados em discutir as ações e políticas de saúde na cidade de São Paulo. Assim qualquer pessoa pode acessar estes conteúdos e utilizá-los com diferentes finalidades e formatos, sendo necessária apenas a preservação da sua origem e citação da fonte. Espera-se que esta publicação cumpra sua finalidade como mais um instrumento público de divulgação de informações de saúde, de apoio aos gestores e à participação social do SUS na cidade de São Paulo.

Argumentación ética en la donación de riñón de donante vivo y sano La autodeterminación, voluntad y generosidad superan los riesgos

el gesto altruista del donante vivo y sano de riñón, relacionado genética o sentimentalmente, se basa en autodeterminación, voluntad y generosidad. La argumentación ética alrededor de la donación de riñón de donante vivo y sano se orienta con las éticas principialista y personalista, la dignidad humana, la corporalidad, la divisibilidad del cuerpo, el mal menor y el mal mayor. Hace parte del derecho a la información amplia y suficiente que recibe el donante sobre los riesgos y posibles complicaciones físicas y morales del procedimiento, por medio del comité de bioética y el grupo de trasplantes. Con base en la argumentación ética planteada se procedió a contestar la pregunta de esta investigación: ¿se debe dejar que una persona viva y sana sea sometida a una cirugía que le dejará mononéfrico de por vida, solo por el deseo de ayudar a otro, a pesar de que existen programas activos con donante cadavérico? El objetivo de este artículo es plantear una argumentación ética sobre la donación de riñón de donante vivo y sano que contribuya a una adecuada orientación de su decisión.

the altruistic gesture of the healthy living kidney donor, genetically or sentimentally related, is based on self-determination, willingness, and generosity. The ethical argumentation around living and healthy kidney donation is guided by principled and personalistic ethics, human dignity, corporeality, divisibility of the body, the lesser evil, and the greater evil. It is part of the right to ample and sufficient information that the donor receives about the procedure's risks and possible physical and moral complications through the bioethics committee and the transplant group. Based on the ethical argumentation raised, we proceeded to answer the question of this research: should a living and healthy person be subjected to a surgery that will leave him/her mononephric for life, just because of the desire to help another, even though there are active programs with a cadaveric donor? This article aims to provide an ethical argumentation on living and healthy donor kidney donation that will contribute to an adequate orientation of their decision.

o gesto altruísta do doador de rim vivo e saudável, relacionado genética ou sentimentalmente, está baseado na autodeterminação, vontade e generosidade. A argumentação ética ao redor da doação de rim de doador vivo e saudável é orientada pelas éticas principialista e personalista, pela dignidade humana, pela corporalidade, pela divisibilidade do corpo, pelo mal menor e pelo mal maior. Faz parte do direito à informação ampla e suficiente que o doador recebe sobre os riscos e possíveis complicações físicas e morais do procedimento, por meio do comitê de bioética e do grupo de transplantes. Com base na argumentação ética proposta, procedeu-se a contestar a seguinte pergunta de pesquisa: deve-se deixar que uma pessoa viva e saudável seja submetida a uma cirurgia que a deixará mononéfrico para sempre, somente pelo desejo de ajudar o outro, apesar de existirem programas ativos com doador cadavérico? Nesse contexto, o objetivo deste artigo é apresentar uma argumentação ética sobre a doação de rim de doador vivo e saudável que contribua para uma adequada orientação de sua decisão.

Nefrolitotomía Endoscópica ex vivo del injerto renal de donante vivo con instrumento flexible

Introduction: The finding of an asymptomatic stone in the study of a living kidney donor does not necessarily contraindicate donation, however, there is no consensus on the management of these cases. The use of a graft with lithiasis may represent a risk of recurrence in the remaining kidney in the donor and eventual obstructive complications in the transplanted kidney. The objective of this work is to present the usefulness of ureteroscopy (URS) to resolve lithiasis ex vivo before transplantation. Material and Methods: Donors with a small, asymptomatic kidney stone and with an analysis of lithogenic factors without relevant findings were considered to continue in the donation process. The kidney unit with stone was selected for nephrectomy. Results: Four donor kidneys underwent flexible URS after nephrectomy under hypothermic preservation conditions during bench preparation. The average time of the procedure was 35 minutes and the stone was extracted in all cases without incident. The transplant was carried out in the usual way and the evolution of the recipients was without complications and with excellent renal function. During follow-up, no recurrence of lithiasis was observed in donors or recipients. Conclusions: In this experience, the URS of the donor kidney was a feasible procedure and was not associated with adverse consequences for the graft. The main advantage of this procedure is to avoid the potential risk to the recipient of an obstructive graft complication.

Results of Use of Ringer Solution and Preservation Solution as Kidney Washing Solution in Living Donor Renal Transplantation / Resultados del uso de la solución Ringer y la solución de conservación como solución de lavado de riñón en el trasplante renal de donante vivo

ABSTRACT Background and Aims: Preservation solutions used as kidney washing solutions in transplantation are necessary for the longer preservation of the kidney. The study aims to compare different kidney-washing solutions used in living renal transplantation. Methods and Results: Forty-nine patients who underwent renal transplantation from live donors were included in the retrospective study. The Ringer's solution flushed the renal graft in 37 patients (Group 1), and the preservation solution was in 12 patients (Group 2). Group 1, and Group 2 patients were included in the study. There were 22 (59.5%) males in Group 1 and 9 (75%) males in Group 2. Twenty-seven (73%) patients using Ringer's and 7 (58.3%) patients on preservation solution had comorbidities. There was no significant difference between Group 1 and Group 2 in warm ischemia time, cold ischemia time, and HLA mismatch levels (p> 0.05). The preoperative creatinine value was significantly higher in the preservation solution group (p = 0.003). There was no significant difference between the two groups in values of creatinine levels on the postoperative (p> 0.05). Conclusion: In living renal transplantation, an inexpensive Ringer's solution, may be used instead of the expensive preservation solution to wash the graft.

RESUMEN Antecedentes y Objetivos: Las soluciones de conservación utilizadas como soluciones de lavado de riñón en trasplantes son necesarias para una conservación más prolongada del riñón. El estudio tiene como objetivo comparar diferentes soluciones de lavado de riñón utilizadas en el trasplante renal vivo. Métodos y Resultados: Cuarenta y nueve pacientes sometidos a trasplante renal de donante vivo incluidos en el estudio retrospectivo. La solución de Ringer se utilizó para lavar el injerto renal en 37 pacientes (Grupo1) y la solución de conservación se utilizó en 12 pacientes (Grupo2). Se incluyeron en el estudio pacientes del Grupo 1 y del Grupo 2. Había 22 (59,5%) hombres en el Grupo 1 y 9 (75%) hombres en el Grupo 2. Veintisiete (73%) pacientes que usaban Ringer y 7 (58,3%) pacientes que usaban solución de conservación tenían comorbilidades. No hubo diferencias significativas entre el Grupo 1 y el Grupo 2 con respecto a la isquemia caliente, los tiempos de isquemia fría y los niveles de desajuste (p> 0,05). El valor de creatinina preoperatorio fue significativamente mayor en la solución de conservación (p = 0,003). No hubo diferencia significativa entre los dos grupos en términos de niveles de creatinina en el postoperatorio (p> 0.05). Conclusión: En el trasplante renal vivo, se puede utilizar una solución económica de Ringer en lugar de la costosa solución de conservación para lavar el injerto.

Doppler de la arteria oftálmica: un modelo para predicción de preeclampsia / Ophthalmic artery Doppler: a model for the prediction of preeclampsia

Resumen ANTECEDENTES: En México, la preeclampsia sigue siendo un problema de salud pública; en la actualidad es la principal causa de muerte materna. Su incidencia es de 47.3 casos por cada 1000 nacimientos. La preeclampsia trae consigo repercusiones en la madre y el feto; de ahí la necesidad de la validación de modelos de tamizaje efectivos que permitan su diagnóstico oportuno. La evaluación Doppler de la arteria oftálmica sigue siendo motivo de diversas investigaciones porque aporta información valiosa de los cambios hemodinámicos intracraneales que suceden, incluso, antes del curso sintomático de la enfermedad. OBJETIVO: Analizar las recomendaciones emitidas por diferentes autores que han evaluado la utilización del Doppler de la arteria oftálmica como modelo de tamizaje para la predicción y diagnóstico tempranos de preeclampsia. METODOLOGÍA: Estudio retrospectivo basado en la búsqueda exhaustiva en diferentes bases de datos de metanálisis y estudios clínicos aleatorizados que describieran, detalladamente, la población estudiada y los parámetros de la arteria oftálmica evaluados. RESULTADOS: Se identificaron 22 publicaciones y en el cribado se excluyeron 8 artículos que estaban duplicados, 2 por no cumplir con los criterios de inclusión y 1 por encontrarse en otro idioma diferente al inglés; al final se revisaron 11 títulos y para complementar el tema de estudio se revisaron otros 60 artículos. CONCLUSIONES: La evaluación mediante Doppler de la arteria oftálmica es un examen simple, rápido, reproducible, seguro y no invasivo que puede incorporarse a la predicción y diagnóstico temprano de pacientes con alto riesgo de preeclampsia.

Abstract BACKGROUND: Preeclampsia remains a public health problem in Mexico and is currently the leading cause of maternal death. Its incidence is 47.3 cases per 1000 live births. Pre-eclampsia has consequences for the mother and the fetus, so there is a need to validate effective screening models for early diagnosis. Doppler assessment of the ophthalmic artery continues to be studied because it provides valuable information on intracranial hemodynamic changes that occur before the symptomatic course of the disease. OBJECTIVE: To analyze the recommendations of different authors who have evaluated the use of ophthalmic artery Doppler as a screening model in the prediction and early diagnosis of pre-eclampsia. METHODOLOGY: Retrospective study based on the search exhaustive search of different databases of meta-analyses and randomized clinical trials describing in detail the population studied and the ophthalmic artery parameters evaluated. RESULTS: Twenty-two publications were identified and after screening, 8 articles were excluded as duplicates, 2 for not meeting the inclusion criteria and 1 for being in a language other than English; finally, 11 titles were reviewed, and another 60 articles were reviewed to complement the study topic. CONCLUSIONS: Doppler evaluation of the ophthalmic artery is a simple, rapid, reproducible, safe, and noninvasive test that can be used to evaluate the ophthalmic artery.

Development, physicochemical evaluation, and in vivo permeation studies of topical formulations containing 0.1% tacrolimus

Abstract The objective of this paper was to develop and evaluate two semi-solid pharmaceutical forms containing 0.1% tacrolimus: cream (CRT01) and gel (GLT01). For the evaluation of physicochemical stability, at times 0, 30, 60 and 90 days, at 23°C and at 40°C, High Performance Liquid Chromatography coupled with a Diode Array Detector (HPLC-DAD) was employed. This method was developed and validated for tacrolimus quantification. The occlusivity test and skin permeation assay were also performed, using an animal model (Wistar rats), and the CRT01 and GLT01 were compared to the 0.1% tacrolimus ointment (PFU01) obtained from the University Pharmacy, Federal University of Rio de Janeiro, Brazil. CRT01 and GLT01 presented a homogeneous aspect and consistency adequate for topical products, along with sensory characteristics above PFU01. They also presented adequate physicochemical stability for 90 days and a lower occlusive effect than PFU01 (p<0.05). CRT01 showed greater affinity for the skin when compared to PFU01 and GLT01, with low systemic absorption. The CRT01 semi-solid formulation was considered the most adequate one to treat patients with atopic dermatitis or other dermatologic inflammatory diseases, promoting rational use of tacrolimus

Gestational age: comparing estimation methods and live births' profile / Gestational age: comparing estimation methods and live births' profile

ABSTRACT Objective: To identify factors associated with the definition of the gestational age (GA) estimation method recorded in the live birth certificate (LBC), and to compare the results obtained according to the method in the city of São Paulo (CSP), between 2012 and 2019. Methods: Cross-sectional population-based study using the Live Birth Information System. Descriptive and comparative analysis was performed according to the GA estimation method, followed by a univariate and multivariate logistic regression model to identify the predictor variables of the method used. Results: The estimation of GA by the date of the last menstrual period (LMP) (39.9%) was lower than that obtained by other methods (OM) (60.1%) — physical examination and ultrasound, between 2012-2019. LMP registration in the LBC increased with the mother's age, it was higher among women who were white, more educated and with partners, in cesarean sections and with private funding. In the logistic regression, public funding was 2.33 times more likely than private funding to use OM. The proportion of preterm infants (<37 weeks) with GA by LMP was 26.5% higher than that obtained by OM. Median birth weight was higher among preterm infants with GA estimated by LMP. Conclusion: Prematurity was higher with the GA estimated by LMP in the CSP, which may indicate overestimation by this method. The source of funding was the most explanatory variable for defining the GA estimator method at the LBC. The results point to the need for caution when comparing the GA obtained by different methods.

RESUMO Objetivo: Identificar fatores associados à definição do método estimador da idade gestacional (IG) registrado na declaração de nascido vivo (DNV) e comparar os resultados obtidos segundo método no município de São Paulo, entre 2012 e 2019. Métodos: Estudo transversal de base populacional utilizando o Sistema de Informações sobre Nascidos Vivos. Realizou-se análise descritiva e comparativa segundo método de estimativa da IG, seguida de modelo de regressão logística uni e multivariada para identificar as variáveis preditoras do método utilizado. Resultados: A estimativa da IG pela data da última menstruação (DUM) (39,9%) foi inferior à obtida por outros métodos (OM) (60,1%) — exame físico e ultrassonografia, entre 2012-2019. O registro da DUM na DNV aumentou com a idade da mãe, foi maior entre as brancas, mais escolarizadas e com companheiro, nas cesarianas e nos partos realizados com financiamento privado. Na regressão logística, o financiamento público apresentou chance 2,33 vezes maior que o privado para uso de OM. A proporção de prematuros (<37 semanas) com IG pela DUM foi 26,5% maior do que a obtida por OM. A mediana de peso ao nascer foi maior entre prematuros com IG estimada pela DUM. Conclusão: A prematuridade foi mais elevada com a IG estimada pela DUM no MSP, o que pode indicar superestimação por este método. A fonte de financiamento foi a variável mais explicativa para definição do método estimador da IG na DNV. Os resultados apontam a necessidade de cautela ao comparar a IG obtida por métodos diferentes.

Tendência da incompletude das variáveis escolaridade e raça/cor da pele da mãe no Sistema de Informações sobre Nascidos Vivos do Brasil, 2012-2020 / Tendencia de incompletitud de las variables escolaridad y raza/color de piel materno en el sistema de información sobre nacidos vivos en Brasil, 2012-2020 / Trend of incompleteness of maternal schooling and race/skin color variables held on the Brazilian Live Birth Information System, 2012-2020

Objective: to analyze the trend of incompleteness of the maternal schooling and race/skin color variables held on the Brazilian Live Birth Information System (SINASC) between 2012 and 2020. Methods: this was an ecological time series study of the incompleteness of maternal schooling and race/skin color data for Brazil, its regions and Federative Units, by means of joinpoint regression and calculation of annual percentage change (APC) and average annual percentage change. Results: a total of 26,112,301 births were registered in Brazil in the period; incompleteness of maternal schooling data decreased for Brazil (APC = -8.1%) and the Southeast (APC = -19.5%) and Midwest (APC = -17.6%) regions; as for race/skin color, there was a downward trend for Brazil (APC = -8.2%) and all regions, except the Northeast region, while nine Federative Units and the Federal District showed a stationary trend. Conclusion: there was an improvement in filling out these variables on the SINASC, but with regional disparities, mainly for race/skin color.

Objetivo: analizar la tendencia de incompletitud de educación y raza/color de piel materna en el Sistema de Información de Nacidos Vivo (Sinasc), Brasil, entre 2012-2020. Métodos: estudio ecológico de serie temporal sobre la incompletitud de la educación y raza/color de piel materna para Brasil, regiones y Unidades de la Federación (UF), a través de regresión de joinpoint y cálculo de cambio porcentual anual (APC) y cambio porcentual anual promedio Resultados: se registraron 26.112.301 nacimientos en Brasil en el período. Brasil (APC = -8,1%) y regiones Sudeste (APC = -19,5%) y Centro-Oeste (APC = -17,6%) disminuirán la incompletud de la educación materna. En cuanto a raza/color de piel, hubo un descenso para Brasil (APC = -8,2%) y todas las regiones, excepto Nordeste, y nueve UF y Distrito Federal presentaron tendencia estacionaria. Conclusión: e llenado das variables en el Sinasc ha mejorado, pero con disparidades regionales, principalmente por raza/color de piel.

Objetivo: analisar a tendência da incompletude das variáveis escolaridade e raça/cor da pele da mãe no Sistema de Informações sobre Nascidos Vivos (Sinasc), Brasil, entre 2012 e 2020. Métodos: estudo ecológico de série temporal sobre a incompletude da escolaridade e da raça/cor da pele da mãe para o Brasil, suas macrorregiões e Unidades da Federação, pela regressão por joinpoint, e cálculo da variação percentual anual (VPA) e da variação percentual anual média. Resultados: foram registrados 26.112.301 nascimentos no Brasil, no período; no país (VPA = -8,1%) e em suas regiões Sudeste (VPA = -19,5%) e Centro-Oeste (VPA = -17,6%), houve redução da incompletude da escolaridade materna; quanto à raça/cor da pele da mãe, observou-se queda para o Brasil (VPA = -8,2%) e todas as suas regiões, exceto o Nordeste, e nove UFs e o Distrito Federal com tendência estável. Conclusão: o preenchimento das variáveis no Sinasc melhorou, porém com disparidades regionais, principalmente quanto à raça/cor da pele.

Procedimiento clínico-quirúrgico en una paciente embarazada con una derivación urológica compleja. Reporte de un caso / Clinical-surgical approach in a pregnant patient with complex urological diversion. A case report

Resumen ANTECEDENTES: El mielomeningocele es el defecto del tubo neural más frecuente; se registra un caso por cada 1000 nacidos vivos. Es más frecuente en mujeres, que resultan con secuelas discapacitantes, entre ellas las urológicas. Pueden subsanarse con diferentes técnicas quirúrgicas y derivaciones urológicas complejas que las predispone a infecciones de vías urinarias de repetición y, cuando hay embarazo, complicaciones materno-fetales y dificultad para el acceso quirúrgico, en caso de cesárea. CASO CLÍNICO: Paciente con 14 semanas de embarazo, 27 años de edad, con diagnóstico de mielomeningocele y vesicoplastia, con múltiples infecciones urinarias y ruptura de membranas pretérmino. Finalización del embarazo por cesárea a las 33 semanas, por indicación de las condiciones fetales. La técnica de la cesárea se modificó para no dañar la cistoplastia y evitar complicaciones con las adherencias en la pelvis. CONCLUSIONES: El mejor pronóstico materno-fetal en pacientes con derivación urológica compleja se consigue con la búsqueda intencionada de infecciones urinarias y tratamiento oportuno y adecuado, además de una planificación multidisciplinaria al momento de la finalización del embarazo.

Abstract BACKGROUND: Myelomeningocele is the most common neural tube defect; one case per 1000 live births is reported. It is more frequent in females, resulting in disabling sequelae, including urological sequelae. They can be corrected with different surgical techniques and complex urological derivations that predispose them to repeated urinary tract infections and, when there is pregnancy, maternal-fetal complications and difficulty for surgical access, in case of cesarean section. CLINICAL CASE: Patient 14 weeks pregnant, 27 years old, diagnosed with myelomeningocele and vesicoplasty, with multiple urinary tract infections and preterm rupture of membranes. Termination of pregnancy by cesarean section at 33 weeks, due to fetal conditions. The cesarean section technique was modified so as not to damage the cystoplasty and to avoid complications with adhesions in the pelvis. CONCLUSIONS: The best maternal-fetal prognosis in patients with complex urologic diversion is achieved with the intentional search for urinary tract infections and timely and adequate treatment, in addition to multidisciplinary planning at the time of termination of pregnancy.