Profile of organ donors in Ceará, northeastern Brazil, from 1998 to 2012.

The use of cadaver donors for transplantation is often the only alternative in the treatment of patients with organ failure. The purpose of this study was to draw a comprehensive profile of solid organ donors in Ceará, northeastern Brazil, from 1998 to 2012. The study was retrospective and based on secondary data regarding sex, age, blood typing, and cause of brain death obtained from the solid organ donor database of the Ceará Transplantation Center covering the period November 1998 to December 2012. During the study period, 976 donors (69% male) were used. Donors were distributed in 4 age groups as follows: 12.9% <18 years, 50.9% 18-40 years, 28.5% 41-60 years, and 7.7% >60 years. The average age was 35 ± 16 years. On the average, female donors were older than male donors (38.4 ± 17 y vs 33.5 ± 16 y; P < .0001). Men were predominant in the age groups 18-40 y (75.3%; P < .0001) and 41-60 y (59.4%; P < .0001). The main causes of brain death were traumatic brain injury (TBI) (56.7%) and stroke (33.1%). The former was more common in men (P < .0001), the latter in women (P < .0001). TBI was caused by traffic accidents (51.4%), of which 50.7% were motorcycle accidents, and urban violence (22.6%), of which 71.2% were associated with firearms. The number of donations increased in the study period (11.2 donors per million population in 1998-2002 to 68.1 in 2008-2012). In Ceará, solid organ donation is on the rise. The predominant donor profile was young men aged 18-40 years with brain death due to TBI caused by traffic accidents and urban violence.

An educational international partnership responding to local needs: process evaluation of the Brazil FAIMER Regional Institute.

INTRODUCTION: The Brazilian public health system requires competent professionals sensitive to the needs of the population. The Foundation for Advancement of International Medical Education and Research (FAIMER) provides a two-year faculty development programme for health professions educators, aiming to build leadership in education to improve health. A partnership with governmental initiatives and FAIMER was established for meeting these needs. This paper describes the initial process evaluation results of the Brazilian FAIMER Institute Fellowship (FAIMER BR). METHODS: Data were analysed for the classes 2007-2010 regarding: application processes; innovation project themes; retrospective post-pre self-ratings of knowledge acquisition; and professional development portfolios. RESULTS: Seventeen of 26 Brazilian states were represented among 98 Fellows, predominantly from public medical schools (75.5%) and schools awarded Ministry of Health grants to align education with public health services (89.8%). One-third (n = 32) of Fellows' innovation projects were related to these grants. Significant increases occurred in all topic subscales on self-report of knowledge acquisition (effect sizes, 1.21-2.77). In the follow up questionnaire, 63% of Fellows reported that their projects were incorporated into the curriculum or institutional policies. The majority reported that the programme deepened their knowledge (98%), provided new ideas about medical education (90%) and provided skills for conflict management (63%). One-half of the Fellows reported sustained benefits from the programme listserv and other communications, including breadth of expertise, establishment of research collaboration and receiving emotional support. CONCLUSION: Contributors to initial programme success included alignment of curriculum with governmental initiatives, curriculum design merging educational technology, leadership and management skills and central role of an innovation educational project responding to local needs.

Corticosteroid reduction with tacrolimus (CORRETA) TRIAL: a prospective Brazilian multicenter, randomized trial of early corticosteroid reduction versus regular corticosteroid dosage maintenance on a tacrolimus (Prograf) and mycophenolate mofetil (Cellcept) immunosuppression regimen in kidney transplant recipients: interim analysis.

Corticosteroids are a cornerstone of immunosuppressive therapy in renal transplantation despite their side effects and morbidity. Newer immunosuppressive agents may be more effective to allow corticosteroid sparing. An interim analysis of 60 completed out of 100 planned primary kidney transplant recipients is presented. All patients on tacrolimus (Prograf) and MMF (Cellcept) were randomized into two groups following a 1:1 distribution for early steroid reduction at posttransplant day 7 (G1; n = 31) versus to long-term maintenance steroids (G2; n = 29). Primary efficacy endpoints were composite endpoint of death, graft loss, or severe acute rejection at 6 and 12 months follow-up. Safety evaluation included severity and frequency of diabetes mellitus, hypertension, hyperlipidemia, leukopenia, infection, malignancy, and severe adverse events. Mean age was 39.1 years, with 45.0% males and 66.7% Caucasians. African-Americans were 25.8% in G1 and 27.6% in G2. One death occurred in each group, as well as one case of severe (Banff III) rejection in G1 (P = 1.00). The incidence of rejection episodes between groups was not significant, namely, 41.9% in G1 and 20.7% in G2 (P = .077). There were no differences between groups concerning mean, systolic and diastolic blood pressure, HbA1c, or creatinine at 12 months. This interim analysis showed no evidence of an increased risk of poorer performance among the early steroid reduction or safety differences in kidney transplant recipients versus a regular dosage steroid group of patients. Further analysis of the complete study data is underway.

Visceral leishmaniasis in renal transplant recipients: clinical aspects, diagnostic problems, and response to treatment.

Visceral leishmaniasis (VL) is a parasitic infection that uncommonly affects renal transplantation recipients, even in endemic areas. It may be associated with other infections, or masked by these, and may present subclinically and/or atypically for extended periods. The evolution may be particularly severe and diagnosis is often delayed. If not adequately diagnosed and treated, VL can be fatal and so should be suspected in renal transplantation recipients presenting unexplained fever, splenomegaly, and pancytopenia. The authors report 8 cases of VL out of a total of 800 renal transplant recipients from two transplant hospitals centers in Brazil. The clinical, diagnostic, and therapeutic features are reviewed.

Do we need living unrelated organ donation in Brazil?

The remarkable success achieved by organ transplantation has also engendered the major problem of organ shortage. As a consequence, the use of living unrelated donors (LURD) has been proposed as an ethically justifiable alternative for developed nations to minimize their waiting lists for organ transplantation (OTx). This change in attitude has caused an ethical dilemma for developing countries like Brazil, which is struggling to increase the cadaver donor pool. Due to a huge socioeconomic gap of values and needs among nations, the incentive to use LURD in developed countries may not only produce a disincentive to cadaver organ donation but also stimulate organ trade in developing countries. In this paper we aimed to show that in Brazil, we do not need to use LURD because we have not optimized our cadaver donor pool. The exploitation of LURD might be a good option for developed countries, but it is not useful for developing countries. The Transplantation Society urgently needs to solve and clarify this problem by establishing basic ethical and justice principles that can serve as a guide for every country, throughout the entire process required, to achieve an adequate pool of cadaver donors.

Expanding criteria for the use of living donors: what are the limits?

The cadaver organ shortage has pushed the transplant community to extend the boundaries beyond the traditional criteria used for living donor transplantation. This new liberal policy involves: (1) the type of donor, such as emotionally related individuals, the direct or indirect interchange of donors, anonymous as well as rewarded donation; (2) challenging immunological criteria, using incompatible ABO blood types and or transplantation across a positive cross-match; (3) relaxing clinical criteria related to elderly, hypertensive, or obese donors, or patients with nephrolithiasis, fibromuscular renal artery disease, hematuria, or renal cell carcinomas. However, these practices may be dangerous. They must be clearly validated to promote a liberal policy of donor acceptance since it may carry a risk for both the donor and the recipient as well as for society. It is crucial to ensure the physical integrity of the donor as well as to provide guarantees, for instance a 1-year policy of life insurance, an indefinite long-term medical follow-up and the assurance of going to the top of the waiting list if the donor becomes uremic in the future.

Mycophenolate mofetil attenuates Walker's tumor growth when used alone, but the effect is lost when associated with cyclosporine.

PURPOSE: To investigate the effect of mycophenolate mofetil on Walker's carcinosarcoma, without versus with the growth and regression of cyclosporine. METHODS AND RESULTS: Wistar rats received water (control), MMF, and/or CsA-N 1 day before tumor inoculation. On day 10, tumor volume (TV) was lower among MMF (10.3 +/- 2.8 cm(3)) than control rats (14.9 +/- 4.2 cm(3), P <.05), and similar to that in CsA-N (13.9 +/- 3.0 cm(3)). However, tumor weight (TW) was significantly lower in MMF (5.2 +/- 2.0 g) than CsA-N (8.8 +/- 2.1g) or control hosts (7.3 +/- 2.0 g, P < or =.01). Growth was inhibited by MMF (-28.2%). In experiment II, CsA-N, MMF + CsA-N, or water were introduced 1 day before tumor inoculation. On day 10, TV and TW were similar for MMF + CsA-N as compared to CsA-N and control animals. In experiment III, water or MMF was introduced on the day 4 after tumor inoculation. On day 10, tumor growth are TW in the MMF group was similar to, that in the controls. CONCLUSIONS: MMF produces an anti-tumoral effect against Walker's carcinosarcoma. However, this inhibitory effect was lost when MMF was used in combination with CsA-N or administered in the presence of a well- established tumor.

Effect of one booster dose in antirabies vaccination.

The antibody response obtained after one booster dose of rabies vaccine prepared in suckling mice brains at Serviço de Saúde Pública da Cidade do Rio de Janeiro is described. Four prime vaccinal groups were used: group I, persons who had received 16 doses 10 years before this investigation; group II, persons who had received 5 doses of the vaccine 10 years before; group III, persons who had received 9 doses 5 years before; and group IV, persons who had received 16 doses 5 years before. One booster dose of the vaccine was administered to all persons involved in the study. Blood samples were collected before vaccination (day 0), then 7 and 30 days after vaccination. Antibody titres were determined by seroneutralization test in mice (SWM). The results demonstrated that all persons who had been treated with 5, 9 or 16 doses of the vaccine 5 to 10 years before had their antibody titres increased on the 7th and 30th days after one booster dose.

Avaliacao do cateter de subclavia como acesso vascular para hemodialise. / Evaluation of the subclavian catheter as a vascular access for hemodialysis

Os autores relatam a experiencia de 7 meses com o uso do cateter de subclavia como acesso vascular para hemodialise. Foram realizadas 81 sessoes em 11 pacientes, utilizando-se 15 cateteres colocados segundo tecnica de Seldinger pela via subclavicular. O tempo de permanencia variou de 3 a 44 dias (media 15,4). A recirculacao media, calculada em 3 pacientes, foi 11,2% e nao houve divergencia entre as diferencas pre e pos-dialise de ureia, creatinina e acido urico, quando comparados aos valores obtidos em 3 pacientes em dialise com dupla puncao de fistula de Cimino. Nao foram observadas complicacoes na puncao, sendo a dobra do cateter responsavel pelo baixo fluxo e coagulacao em 2 casos. Registrou-se apenas 1 episodio de infeccao com hemocultura e cultura da ponta do cateter positivas