Microsatellite instability (MSI) is a novel predictive biomarker for chemotherapy and immunotherapy response, as well as prognostic indicator in colorectal cancer (CRC). The current standard for MSI identification is polymerase chain reaction (PCR) testing or the immunohistochemical analysis of tumor biopsy samples. However, tumor heterogeneity and procedure complications pose challenges to these techniques. CT and MRI-based radiomics models offer a promising non-invasive approach for this purpose. A systematic search of PubMed, Embase, Cochrane Library and Scopus was conducted to identify studies evaluating the diagnostic performance of CT and MRI-based radiomics models for detecting MSI status in CRC. Pooled area under the curve (AUC), sensitivity, and specificity were calculated in RStudio using a random-effects model. Forest plots and a summary ROC curve were generated. Heterogeneity was assessed using I² statistics and explored through sensitivity analyses, threshold effect assessment, subgroup analyses and meta-regression. 17 studies with a total of 6,045 subjects were included in the analysis. All studies extracted radiomic features from CT or MRI images of CRC patients with confirmed MSI status to train machine learning models. The pooled AUC was 0.815 (95% CI: 0.784-0.840) for CT-based studies and 0.900 (95% CI: 0.819-0.943) for MRI-based studies. Significant heterogeneity was identified and addressed through extensive analysis. Radiomics models represent a novel and promising tool for predicting MSI status in CRC patients. These findings may serve as a foundation for future studies aimed at developing and validating improved models, ultimately enhancing the diagnosis, treatment, and prognosis of colorectal cancer.

ObjectiveTo describe the process of conception and articulation of the Care Pathways in Palliative Care in Primary Health Care in the locations served by BP's TeleNordeste project in the interior of the Brazilian Northeast.MethodsExperience report on the process of designing and articulating Care Pathways in Palliative Care for regions far from urban centers in 3 states in Brazil: Alagoas, Maranhão and Piauí, through the TeleNordeste Project of Hospital Beneficência Portuguesa in São Paulo through the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (SUS) in the 2021-2023 period. After pre-operational alignments with health representatives, processes were defined and training was carried out for local teams on the flows and modalities of care available through telehealth, connecting the patient, doctor from the Basic Health Unit and palliative doctor to establish a care plan timely to the needs of patients.ResultsA total 178 teleconsultations were carried out in the specialty of Palliative Care, 124 (69.7%) were teleinterconsultations and 54 (30.3%) were teleconsulting. The median age was 75 years with an interquartile range of 16. Approximately 74,699 miles and 1845 hours of patient time in palliative care were saved. Approximately 29,880kg of CO2 emissions were avoided.DiscussionThe development of Care Pathways presented an innovative proposal for access to specialized Palliative Care in the SUS, considering the sustainability of the health system and promoting better equity in access to palliative care for regions far from reference centers.

BackgroundThe Dietary Guidelines for the Brazilian Population provide recommendations for healthy diets to prevent noncommunicable chronic diseases, emphasizing the golden rule: always prefer natural or minimally processed foods and freshly prepared dishes and meals to ultra-processed foods. While widely recognized, the integration of dietary advice based on the Dietary Guidelines recommendations has not yet been sufficiently incorporated into Primary Health Care. Protocols based on the Brazilian Dietary Guidelines for Individual Dietary Advice were developed to support healthcare professionals in providing individualized dietary advice based on the Brazilian Dietary Guidelines tailored to different stages of lifetime. Training healthcare professionals to use the Protocols might increase their confidence and is a strategic step toward implementing the Guidelines in routine care. This study aimed to develop and validate a Massive Open Online Course (MOOC) on the Protocols based on the Brazilian Dietary Guidelines for individual dietary advice.MethodsThis methodological study investigated the development and content validity of a Massive Open Online Course designed to qualify Primary Health Care professionals in dietary advice based on the Protocols. Development and validation involved defining objectives, theoretical frameworks and learning skills; creating content and structure; conducting content validity assessments through a panel of experts; analyzing the results via content validity index scores and thematic content analysis with a comprehensive approach; and refining pedagogical tools in the virtual learning environment.ResultsA Massive Open Online Couse, titled QualiGuia, was developed. All the content sessions achieved content validity index scores above the cutoff grade (0.8). Experts’ perceptions were categorized to assess content adequacy, clarity, relevance, and alignment with the theoretical framework. Suggestions for improvement and potential implementation challenges were also addressed. The course included case studies reflecting typical Primary Health Care situations with appropriate complexity and depth, effectively meeting learning objectives.ConclusionsThe Massive Open Online Course QualiGuia was validated as an effective tool for training Primary Health Care professionals to use the Protocols based on the Brazilian Dietary Guidelines. Its content and structure align with the goals of the Guidelines, supporting healthcare providers in integrating dietary advice into Primary Health Care practices.

Radical treatment of rectal cancer has evolved quite significantly over the last few decades with the development of optimal local disease staging with magnetic resonance (MR), refined surgical techniques including total mesorectal excision (TME) with or without sphincter-preservation, and multimodality treatment with the use of chemotherapy and radiation. While oncological outcomes have shown some significant improvements in terms of local disease control and distant metastases rates, complication rates and functional sequelae remain quite significant for patients undergoing TME surgery. In this setting, organ-preserving alternatives, including transanal local excision (TAE) and Watch and Wait (WW), have become increasingly attractive to patients in an attempt to avoid major surgery (TME) as an alternative treatment strategy with no oncological compromise. In the present narrative review, the fundamentals of selection and outcomes of patients undergoing WW will be covered to provide updated information for colorectal surgeons and surgical oncologists interested in this treatment alternative in clinical practice.

Similar to the cerebrum, the cerebellum exhibits a central neuronal core region enveloped by a network of white fibers, identified as the central nucleus. The dentate nucleus and the extension of its fibers into the superior cerebellar peduncle play a key role. Understanding this anatomical and functional concept would improve the accuracy of surgical interventions for cerebellar infiltrative lesions. Twenty-two formalin-fixed and frozen human cerebellar and brainstems were stored at -16º C for two weeks, according to the Klingler protocol. Dissection was performed to identify the cerebellar central nucleus and its structures. Images were captured, analyzed, and processed for the distribution of landmarks in each dissection phase. We defined the cerebellar landmarks proximal to the central nucleus. The anatomical division into planes: Superoinferior; we found the superior border of the amygdala and the MCP. Superior: the anterior portion of the horizontal fissure, the MCP, and the origin of the V cranial nerve. Anteroposterior plane: the cerebello-mesencephalic fissure and the postclival fissure. In the medio-lateral plane, we identify the cerebellar vermis's PCS and lateral border. Laterally, the fibers of the MCP and the lateral aspect of the tonsil. The biventral lobule may obscure this landmark, and we consider it an alternative landmark. This study provides reliable anatomical landmarks of the cerebellum, which describe the central cerebellar nucleus. Establishing these landmarks favors three-dimensional knowledge and helps avoid associated neurological damage in this crucial structure.

Telemedicine represents an essential tool with the potential to reduce health costs, thus avoiding patient displacement and improving patient care outcomes, positioning it as a significant social technology. This study aims to analyze the implementation of a telehealth cabin at BP Hospital (A Beneficência Portuguesa de São Paulo), focusing on the evaluation of the experiences of both patients and health care professionals, as well as the acceptability of this tool. A mixed methods study was conducted with 229 participants, divided into 2 phases. The first phase involved 40 apparently healthy individuals to assess the usability, experience, and satisfaction of this group for the later safe application in the group with clinical complaints. The second phase included 189 participants, with complaints to assess the usability, experience, and satisfaction of patients and doctors. In both phases, participants completed screening questionnaires (to assess the eligibility criteria), a socioeconomic demographic questionnaire before using the cabin, and a questionnaire including the System Usability Scale and the Net Promoter Score (NPS) after using the cabin. The data analysis of the first phase showed high acceptance of the telehealth cabin, which supported the progression to the second phase. In the second phase, a high usability score was observed among participants with clinical complaints (mean System Usability Scale score of 85.97, SD 15.50) and a high favorability rating (NPS score of 9.4). Health care professionals also reported favorable results, with a usability score of 67.8 and an NPS of 8.0. The results of this study reinforce the potential for scaling up this practice based on usability outcomes, and highlight its relevance for the development of public policies aimed at expanding access to quality health care in Brazil. This approach improves the interaction of patients with the health care system, while providing professionals with an extended view of clinical conditions through integrated devices, particularly in areas with limited access to medical care.

Over the last decades, the donor network for hematopoietic cell transplantation (HCT) has grown exponentially, including unrelated and haploidentical (Haplo) donors. This study aimed to describe HCT outcomes with MSD, Haplo, and matched unrelated donors (MUD) in an early period of Haplo with posttransplant cyclophosphamide in a developing country with a large unrelated donor registry. This study was conducted in collaboration with the CIBMTR. We included patients with acute leukemias undergoing HCT between 2014-2018. With 595 patients, 2-year overall survival (OS) was 69% for the MSD, 65% for the Haplo, and 71% for MUD (p=0.24) in CR1, confirmed in multivariable analysis. Relapse rate was lower for MUD (HR=0.35, p=0.0005) than MSD in patients with CR2+, leading to higher OS. Relapse was also higher with Haplo compared with MUD (HR=2.06, p=0.03). Only survival bias can explain these findings in CR2+, suggesting some high-risk MUD patients, in which HCT timing is crucial, may not achieve HCT. Alternative donors were associated with higher non-relapse mortality, while PTCy-based Haplo offered the best protection against chronic graft-versus-host disease. Our study suggests Haplo and MUD are acceptable options for patients lacking MSD in developing countries like ours.