Brain Death: Knowledge of Future Brazilian Physicians.

BACKGROUND: Thousands of people die on the waiting list for transplants. The shortage of organs and tissues for transplantation is considered a serious global problem. Brain death (BD) is the main source of organs for transplantations. OBJECTIVE: Given that BD is assessed by medical staff and that this diagnosis is ethically relevant, the goal of this work was to analyze the knowledge of 5th- and 6th-year medical students of Southern Brazil regarding the process of determining BD. METHOD: This observational, cross-sectional study was conducted between September 2013 and March 2014. RESULTS: A total of 635 students participated in the study, with 337 (53.1%) from public and 298 (46.9%) from private schools. Approximately 333 (52.4%) attended the 6th year of the medical program. The mean age of the students was 25.4 ± 3.56 years, with a prevalence of females of 54.6% (347) and a prevalence of Catholic religion of 61.7% (392); 84.2% of the students reported not feeling confident performing the BD protocol. A low percentage (15.7%) correctly answered 75% or more of the questions about BD, a criterion used to determine sufficient knowledge of BD. Approximately 45% (282) of respondents were not able to identify the patients who were candidates for the BD protocol. Analyzing the medical students' knowledge at the end of the program can provide information about the quality of undergraduate education on the topic of determining BD. CONCLUSION: It was concluded that 5th- and 6th-year medical students of Paraná State have little knowledge about the BD protocol.

Early Vascular Thrombosis After Kidney Transplantation: Can We Predict Patients at Risk?

BACKGROUND: Renal transplant is the therapy of choice for patients with chronic renal disease. In recent years, improvement in immunosuppressive drugs reduced early graft loss associated with acute rejection. However, vascular thrombosis, accounting for 5% of early graft loss, can sensitize the recipient for human leukocyte antibodies, reducing the chance for a second transplant. The aim of this study was to identify risk factors for vascular thrombosis in a single transplant center, to design specific prevention protocol. METHODS: This was a retrospective, case-control study. From the Renal Transplant Unit database, we identified 21 cases of vascular thrombosis in recipients of kidneys from deceased donors. Recipients from the contralateral kidney from the same donor, without vascular complications, were assigned to the control group. Data analyzed included donor, recipient, transplant surgery, and post-operative follow-up. The local ethics committee approved the protocol. RESULTS: Thrombosis and control groups were comparable for recipient characteristics, cold ischemia time, organ side (right or left), and site of arterial anastomosis. We observed an increased risk for vascular thrombosis in kidneys with multiple veins (odds ratio, 11.32; P = .03). Organ retrieval surgery complications, such as vascular lesions or heterogeneous perfusion, despite normal pre-implantation biopsy, were considered risk factors for vascular thrombosis within the first post-operative day (odds ratio, 7.1; P = .03). CONCLUSIONS: In this series, multiple renal vein and organ retrieval surgery complications were risk factors for early vascular thrombosis.

Organ and tissue donation for transplantation from fatal trauma victims.

INTRODUCTION: The aim of this study was to analyze multiple aspects of organ donation after mortality owing to trauma-related causes. METHODS: We completed a cross-sectional, retrospective, descriptive study that used data were extracted from monthly death reports and clinical records of fatal external injury victims 2-70 years of age who were assisted at 1 of 4 hospitals in the municipality of Maringá and the surrounding metropolitan area in Paraná state, Brazil, in 2012. RESULTS: A total of 871 individuals within the age range for donation died, 15.4% owing to external causes of injury. Of these 134 cases, 80.6% were male and 52.23% were 18-40 years old. A total of 57% of deaths were owing to traffic accidents, 58% of which involved motorcycles. Aggression was a factor in 25% of deaths, with 55% owing to firearm wounds. Approximately 52% of families consented to organ donation when asked. A total of 58% of families who refused consent did not indicate a specific reason. At 62%, the majority of refusals involved brain-dead patients. Approximately 58% of the families did not receive a request for consent. Out of these 78 cases, 83% showed contraindications, 44% had sepsis, 40% hemodilution, and 10% logistical/infrastructural problems. CONCLUSIONS: The highest proportion of non donor cases was owing to the lack of a formal request for consent from the family. Thus, continued training for health care professionals on the donation-transplantation process and early identification of potential donors and appropriate organ maintenance is necessary.

Causes of organ donation failure in Brazil.

INTRODUCTION: There has been a great improvement in transplantation medicine in Brazil in the last 2 decades. However, there remain several barriers regarding notification of brain and cardiac death as well as completion of the donation process. METHODS: This retrospective study was performed between January 2008 and December 2010. We reviewed all deaths in a University Hospital, observing the causes of non-notification to the State Transplantation Authority and non-donations. RESULTS: There were 41 notifications of brain death resulting in donation in only 19.5% of those cases. Cardiac death was diagnosed in 21 patients, resulting in 52.4% donations. The main cause for non-donation were family refusal (37.2%), infectious diseases (30.2%), and clinical contraindications (32.6%). Most of the missed possible donors occurred during the night (54.8%) and in the emergency room (80.9%). CONCLUSION: There is an urgent need for better education of the Brazilian population about organ donation and brain death definitions. Other identified problems include lack of uniformity in brain death determinations among hospitals, rigid contraindications to donation in the State of Parana, physician unawareness or disbelief about brain death diagnostic criteria, and lack of structure of our Hospital.

Flagellate infections of Brazilian sand flies (Diptera: Psychodidae): isolation in vitro and biochemical identification of Endotrypanum and Leishmania.

Flagellate infections were found in 1,063 of 18,895 sand flies collected in the states of Amazonas, Pará, Rondonia and Acre, Brazil. Infection rates were 13.4% (species group Shannoni); 7.5% (subgenus Nyssomyia); 6.7% (subgenus Lutzomyia series Cruciata); 0.5% (genus Psychodopygus) and 3.1% for other sand flies (various subgenera). Leishmania braziliensis guyanensis and L. mexicana amazonensis were isolated, respectively, from the known vectors, Lutzomyia umbratilis and L. flaviscutellata. Single stocks of L. braziliensis-like and L. mexicana-like organisms were isolated, respectively, from L. whitmani and L. yuilli. Thirty-eight flagellate stocks, isolated by direct culture from sand flies were characterized in detail by morphology in culture, behavior in hamsters and mice and by enzyme profiles. Sixteen stocks from Lutzomyia sp. (Shannoni group) were identified as Endotrypanum schaudinni; 8 stocks from Lutzomyia sp. (Shannoni group) were identified as Endotrypanum sp.; 7 stocks from Psychodopygus ayrozai and P. paraensis were identified as Leishmania sp. previously isolated from the armadillo, Dasypus novemcinctus; 2 stocks of Trypanosoma rangeli were isolated from recently fed Lutzomyia sp. (Shannoni group) sand flies; the remaining 5 stocks from L. umbratilis and L. yuilli could not be identified. Observations suggested that Shannoni group sand flies were the natural vectors of Endotrypanum. Leishmania sp. infections in the man-biting flies P. ayrozai and P. paraensis were restricted to the midgut and associated with recent bloodmeals. Unidentified flagellates in L. umbratilis and L. yuilli were distributed throughout the digestive tract with no trace of bloodmeals.

Hosts of sandfly vectors of Leishmania braziliensis guyanensis in the central Amazon of Brazil.

The blood meals of 2,569 phlebotomine sandflies from areas endemic for cutaneous leishmaniasis in the central Amazon of Brazil were tested by the microcapillary precipitin method to determine their vertebrate hosts. The two-toed sloth, Choloepus didactylus, was the predominant host of two incriminated vectors of Leishmania braziliensis guyanensis in the region, Lutzomyia umbratilis and Lu. anduzei (64.0% and 63.6%, respectively). The Lu. "shannoni" group, a complex of several species in which females are indistinguishable, also fed predominantly on sloths (73.0%). Species comprising the Lu. "shannoni" group have not been implicated as vectors of leishmaniasis; however, their feeding patterns in the study area illustrate their potential involvement in the transmission of the parasites to two-toed sloths, which are the principal reservoir hosts of L. braziliensis in Panama. Rodents, and particularly porcupines, were the second most frequently fed-on mammal by Lu. umbratilis (11.6%) and the Lu. "shannoni" group (8.5%).