Search

Cyntia Camilo Franco Borges Zago,1 Bruna de Freitas Oliveira,1 Giovanna Uehara,1 Ana Laura Carvalho da Silva,1 Laura Penna Rocha,1 Fabiano Bichuette Custódio,2 Liliane Silvano Araújo,1 Crislaine Aparecida da Silva,1 Marlene Antônia Reis,1 Juliana Reis Machado1 1Kidney Research Center-Department of Pathology, Genetics and Evolution, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil; 2Department of Clinical Medicine, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, BrazilCorrespondence: Juliana Reis Machado, Kidney Research Center – Department of Pathology, Genetics and Evolution, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil, Tel +55 (34) 3700-6450, Email juliana.patologiageral@gmail.comPurpose: In the kidneys, Systemic Lupus Erythematosus leads to Lupus Nephritis (LN), a form of glomerulonephritis. There is evidence that patients with LN may present activation of specific pathways for podocyte injury. This injury can occur through different mechanisms such as loss of podocyte adhesion to the glomerular basement membrane, cell death or dedifferentiation. Podocyturia with consequent podocytopenia has been described in some nephropathies such as LN, highlighting the importance of studying podocyte injuries in this condition. Evaluating in situ morphological characteristics of podocytes becomes relevant for a better understanding of the processes involved in their pathogenesis. This study investigated podocytes in different classes of LN in renal biopsies performed by the Kidney Research Center at the Federal University of Triângulo Mineiro.Patients and Methods: Twenty control cases and 29 biopsy cases diagnosed with LN were selected, divided according to the histopathological classes of the disease. Podocyte density was assessed through immunohistochemistry for Wilms tumor 1 protein and the evaluation of foot process effacement was performed by transmission electron microscopy.Results: Podocyte density was lower in the LN and this reduction was observed in all analyzed classes when compared to the control group. More foot process effacement was observed in the LN group, with more effacement in classes I/II and class IV compared to the control group. The class IV group showed more foot process effacement than the class III group and presented higher proteinuria levels compared to the classes I/II group. A strong, positive, and significant correlation was observed between the activity index and foot process effacement in the class IV group.Conclusion: Podocytes play an important role in the development of LN, and possibly, injuries to these cells are more closely related to the inflammatory/diffuse proliferative cellular process developed in class IV LN.Keywords: podocyte density, foot processes effacement, activity index, renal biopsy

Objectives: Excess weight, measured by a high body mass index (BMI), is associated with the onset of many diseases, which can, in turn, lead to disability and premature death, subsequently placing a significant burden on healthcare services. This study analysed the burden of disease and the direct costs to the Brazilian Unified Health System (Sistema Único de Saúde [SUS]) attributable to high BMI in the Brazilian population., Study Design: Ecological study., Methods: This ecological study had two components: (1) a time-series assessment to analyse the burden of diseases attributable to high BMI from 1990 to 2019 in Brazil; and (2) a cross-sectional design to estimate the direct costs of SUS hospitalisations and outpatient procedures attributable to high BMI in 2019. Estimates from the Global Burden of Disease study and the costs of hospital admissions and outpatient procedures from the Department of Informatics of the Brazilian Unified Health System were used. Deaths, years of life lost to premature death (YLLs), years lived with disability (YLDs), and years of life lost adjusted for disability (DALYs) were analysed. The direct health cost was obtained in Brazilian Real (R$) and converted in international Dollars (INT$)., Results: The current study found a reduction in the number of DALYs, YLLs, and deaths per 100,000 population of cardiovascular disease (CVD) attributable to high BMI and an increase in YLD due to diabetes and cardiovascular disease attributable to high BMI from 1990 to 2019. In 2019, high BMI resulted in 2404 DALYs, 658 YLDs, 1746 YLLs, and 76 deaths per 100,000 inhabitants. In the same year, INT$377.30 million was spent on hospitalisations and high- and medium-complexity procedures to control non-communicable diseases attributable to high BMI. The states in the South and Southeast regions of Brazil presented the highest total cost per 10,000 inhabitants. CVDs and chronic kidney disease showed the highest costs per hospital admission, whereas neoplasms and CVDs presented the highest costs for outpatient procedures., Conclusions: High BMI causes significant disease burden and financial costs. The highest expenses observed were not in locations with the highest burden of disease attributable to high BMI. These findings highlight the need to improve current public policies and apply cost-effective intervention packages, focussing on equity and the promotion of healthier lifestyles to reduce overweight/obesity, especially in localities with low socioeconomic status., (Copyright © 2024 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Purpose: Tumors affecting the female genital tract and their treatments have the potential to induce adverse modifications in vaginal health and impact personal aspects of patient's lives. Vulvovaginal atrophy is one of the morphological changes observed in individuals with a history of gynecological cancer, influenced both by the biological environment of tumors and the main therapeutic modalities employed. Therefore, the purpose of this study was to identify approaches to treat vulvovaginal atrophy while assessing the impact on the emotional and sexual health of women diagnosed with gynecological cancers., Methods: To achieve this goal, a systematic review was conducted following the methodological guidelines outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The databases used for literature research were PubMed and Web of Science., Results: Initially, 886 articles were obtained. After eliminating duplicates and applying inclusion/exclusion criteria, seven articles were selected for analysis. The period of highest publication activity spanned from 2017 to 2020, with the majority conducted in Italy. Five treatment modalities were identified and categorized as vaginal suppository, oral medication, surgical procedure, CO2 laser therapy, and vaginal dilator. Twenty-four outcomes related to vaginal health and 30 outcomes related to overall, sexual, and emotional quality of life were analyzed., Conclusion: In general, all interventions demonstrated the ability to improve vaginal health or, at the very least, the sexual health of patients. Thus, despite limitations, all treatments have the potential to address vulvovaginal atrophy in patients with a history of gynecological cancer., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Minimal Change Disease (MCD) and Focal Segmental Glomerulosclerosis (FSGS) are the main causes of nephrotic syndrome in the world. The complement system appears to play an important role in the pathogenesis of these diseases. To evaluate the deposition of immunoglobulins and particles of the complement system in renal biopsies of patients with FSGS and MCD and relate to laboratory data, we selected 59 renal biopsies from patients with podocytopathies, 31 from patients with FSGS and 28 with MCD. Epidemiological, clinical, laboratory information and the prognosis of these patients were evaluated. Analysis of the deposition of IgM, IgG, C3, C1q and C4d in renal biopsies was performed. We related IgM and C3 deposition with laboratory parameters. Statistical analysis was performed using GraphPad Prism version 7.0. Glomerular deposition of IgM was significantly higher in the FSGS group, as was codeposition of IgM and C3. The clinical course of patients and laboratory data were also worse in cases of FSGS, with a higher percentage progressing to chronic kidney disease and death. Patients with C3 deposition had significantly higher mean serum creatinine and significantly lower eGFR, regardless of disease. Patients with FSGS had more IgM and C3 deposition in renal biopsies, worse laboratory data and prognosis than patients with MCD. C3 deposition, both in FSGS and MCD, appears to be related to worsening renal function., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: to adapt and validate the Three-Dimensional Work Fatigue Inventory (3D-WFI) for Brazil's cultural reality and assess the psychometric properties., Methods: a methodological study developed in six stages: initial translation; synthesis of translations; back translation; review by expert committee; pretest; and review of the adaptation process by the researchers. For validity, the instrument was applied to a sample of 318 nursing professors from Brazilian federal and state public universities. Data were analyzed using exploratory and confirmatory factor analysis, composite reliability and instrument reliability (Cronbach's alpha and McDonald's omega)., Results: the 3D-WFI instrument showed excellent internal consistency (α=0.95 and ω=0.97), three dimensions and explained variance of 62.77%., Conclusions: the Brazilian version of the instrument showed excellent psychometric properties for assessing fatigue among Brazilian workers.

Background: This study aims to evaluate whether hypofractionated radiotherapy (HYPOFRT) is a cost-effective strategy than conventional fractionated radiotherapy (CFRT) for early-stage glottic cancer (ESGC) in the Brazilian public and private health systems., Methods: Adopting the perspective of the Brazilian public and private health system as the payer, a Markov model with a lifetime horizon was built to delineate the health states for a cohort of 65-year-old men after with ESGC treated with either HYPOFRT or CFRT. Probabilities of controlled disease, local failure, distant metastasis, and death and utilities scores were extracted from randomized clinical trials. Costs were based on the public and private health system reimbursement values., Results: In the base case scenario, for both the public and private health systems, HYPOFRT dominated CFRT, being more effective and less costly, with a negative ICER of R$264.32 per quality-adjusted life-year (QALY) (public health system) and a negative ICER of R$2870.69/ QALY (private health system). The ICER was most sensitive to the probability of local failure, controlled disease, and salvage treatment costs. For the probabilistic sensitivity analysis, the cost-effectiveness acceptability curve indicates that there is a probability of 99.99% of HYPOFRT being cost-effective considering a willingness-to-pay threshold of R$2,000 ($905.39) per QALY (public sector) and willingness-to-pay threshold of R$16,000 ($7243.10) per QALY (private sector). The results were robust in deterministic and probabilistic sensitivity analyses., Conclusions: Considering a threshold of R$ 40,000 per QALY, HYPOFRT was cost-effective compared to CFRT for ESGC in the Brazilian public health system. The Net Monetary Benefit (NMB) is approximately 2,4 times (public health system) and 5,2 (private health system) higher for HYPOFRT than CFRT, which could open the opportunity of incorporating new technologies., (© 2023. The Author(s).)

Objective: to analyze scientific evidence on moral courage and related factors among nursing undergraduate students., Method: the protocol of this scoping review was registered on Open Science Framework. A search was performed in five databases, according to the method provided by Joanna Briggs Institute Reviewers, the mnemonic strategy Population, Concept and Context, and a specific checklist., Results: a total of 2,812 results were identified, but only nine studies were eligible and presented three thematic approaches: Moral courage from the perspective of nursing students; Moral courage and related factors; and The teaching of moral courage in the training of nursing students. The factors related to moral courage include moral distress, moral sensitivity, age, and having a previous degree in the health field., Final Considerations: few studies were found with a low evidence level. Most were performed in developed countries, indicating some gaps that need to be addressed in the future.

Objective: To identify which functioning, personal and environmental factors are more relevant to adults in hemodialysis treatment., Materials and Methods: Data was collected by semi-structured interview, recorded, transcribed in full, verified and produced by Bardin Thematic content analysis. Two independent researchers identified the relevant themes and named the thematic categories found according to the coding of the International Classification of Functioning, Disability and Health (ICF)., Results: Six men and three women aged between 32-65 years were interviewed, with per capita family income between 1-2.9 minimum salaries and hemodialysis treatment time between 5 to 26 years. Fifty-seven ICF categories were listed: 17 Body Functions, 9 Body Structures, 21 Activities and Participation, and 10 Environmental Factors. Health, transportation and general social support services, systems and policies; doing housework; recreation and leisure; emotional functions, temperament and personality functions; energy and drive functions; sensation of pain; and structures of the cardiovascular system, lower extremity and musculoskeletal structures related to movement were the most reported aspects by the participants., Conclusion: Patients' need for physical/emotional support from their partners, friends and health professionals, including emotional and social support, with health policies, transportation and job maintenance, in order to increase their survival and quality of life.

Objectives: to analyze the profile of nursing students at a university in southern Brazil and verify the effectiveness of the use of social networks in students' location and adherence., Methods: a quantitative, descriptive and exploratory study, carried out with 314 students through a questionnaire prepared on Google Forms, made available through digital social networks and e-mails., Results: students were women, without training in a technical/assistance nursing course, participants in projects and research groups, with a graduate degree. Furthermore, more than 75% obtained their first job within six months after graduation, more than 80% worked in healthcare, with public employment, workload of up to 40 hours a week, income between four and ten minimum wages, and 92% indicated that they were satisfied and/or very satisfied with the course., Conclusions: the strategic use of social networks enabled greater adherence by the target audience and nursing students' profile design.

Objectives: to understand the conceptions of postgraduate Nursing students regarding integrity in scientific research., Methods: a qualitative, descriptive and exploratory study conducted in October 2020, with 40 students from a postgraduate program in Nursing from a public university in Southern Brazil. The interviews had an emphasis on scientific integrity and its importance for scientific research; they were conducted using synchronous communication tool and analyzed by textual discourse analysis., Results: two categories emerged: "Scientific integrity: the ethical dimension of research" and "Implications of academic productivism for scientific integrity". Such integrity is intrinsically related to the supporting ethical elements, as well as to the nuances of productivism and its impacts on integrity., Final Considerations: the cross-sectionalism of ethical practices is necessary in the production spheres of science, so that knowledge is perpetuated in harmony with integrity and its representations to the community.

Ezetimibe (EZM) is a selective inhibitor of the sterol transporter Niemann-Pick C1-Like 1 in the small intestine used as an adjunctive therapy to lower cholesterol levels in cases of hyperlipidemia. The goal of this work was to summarize the main physical-chemical, pharmacological and pharmacokinetic characteristics of EZM, as well as to describe the main analytical methodologies for the quantification of the drug. Methods described in the United States Pharmacopeia for EZM raw material and tablets were also presented. The drug has a large number of process-related impurities and degradation products and needs strict quality control of its impurities. Specific chiral methods for the evaluation of its chiral impurities are also a need for EZM. The main advantages and disadvantages of the compiled analytical methods were presented, as well as the limits of detection and quantitation. The fastest and most efficient methods were highlighted. Most methods for analyzing EZM used C 8 or C 18 stationary phases in gradient mode with binary mobile phases containing acetonitrile and an acidic buffer solution with ultraviolet detection. For analysis of EZM in biological matrices, liquid chromatography-tandem mass spectrometry is generally employed using electron spray ionization in negative ionization mode using multiple reaction monitoring. Different methods in the literature evaluate a large number of impurities for EZM, however new stability-indicating high-performance liquid chromatography methods for the drug are still needed.