SUMMARYEnsuring cancer patients and their families receive high-quality care at the very end of life is of paramount importance. The manner a family member dies has a profound impact on the bereaved. One way to assess this care is by using a post bereavement questionnaire.OBJECTIVE:The aim of the study was to translate into Brazilian Portuguese, conduct cross-cultural adaptation, validate and use a post-bereavement tool, “Care of the Dying Evaluation”.METHODS:An observational, international, cross-sectional multicenter study in seven countries, through 2018 to 2020. In Brazil, participants were recruited from two hospitals, Hospital Estadual Sumaré and Hospital das Clínicas, and had been admitted for a minimum of 3 days before death. Translation of CODETM in keeping with international principles, and pre-testing using patient and public involvement and cognitive interviews with bereaved relatives.RESULTS:The survey involved 235 bereaved family members, mostly female (70.6%), with 40% being sons and daughters of the deceased. Validity of the CODETM tool was assessed using confirmatory factor analysis, internal consistency through Cronbach’s α, and reliability via the Kappa coefficient and Spearman’s correlation. The study compared care quality perceptions between those who received palliative care and others. Findings revealed that 50.7% were informed about the dying process, and over 60% expressed that clarification of expected symptoms would have been beneficial.CONCLUSION:The study confirms that the CODETM questionnaire is a valid and reliable tool for evaluating the quality of end-of-life care within the Brazilian Portuguese context.

SUMMARYOBJECTIVE:Physical changes and scarring after cesarean section may negatively affect women’s body image. Combined with decision regret about the mode of delivery, this may cause psychological problems. The aim of this study was to examine the effects of cesarean scars on decision regret and body image in women with cesarean delivery.METHODS:This descriptive and cross-sectional study was conducted in Turkey between February and May 2025. A total of 219 women with a history of cesarean delivery voluntarily participated through an online survey. Data were collected using a personal information form, the Decision Regret Scale, and the Body Image Scale. Statistical analyses were performed using Statistical Package for the Social Sciences 22.0 software, including descriptive statistics, t-test, analysis of variance, correlation, and regression analyses.RESULTS:The mean age of participants was 34.90±7.96 years, and the mean time since the first cesarean was 9.38±8.31 years. The mean Decision Regret Scale score was 22.46±20.12, and the mean Body Image Scale total score was 50.22±16.71. Decision regret and body image significantly differed according to perceptions of scar appearance and its impact on body perception, social life, and psychological well-being (p<0.05). Regression analysis indicated that negative perceptions of scar appearance were the strongest predictor of decision regret (B=15.42, p<0.001).CONCLUSION:Cesarean section scars may negatively affect women’s body image and increase decision regret regarding the mode of delivery. Healthcare professionals should be aware of these psychosocial consequences and provide appropriate counseling and support services for women after cesarean section.

SUMMARYBACKGROUND:Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy are promising treatments for colorectal cancer-related peritoneal metastases. The learning curve may influence surgical outcomes.OBJECTIVE:The aim of the study was to compare outcomes of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy during the learning curve versus after surgical proficiency at a gastrointestinal cancer center.METHODS:A retrospective study of 83 patients treated between 2018 and 2023. Group 1 (n=42) included initial cases; Group 2 (n=41) represented the experienced phase. Operation time, organ resections, morbidity, transfusion needs, and survival were compared.RESULTS:Severe morbidity (Clavien-Dindo grade 3–4) was similar in both groups (G1: 21.4%, G2: 29.2%; p=0.947). No 30- or 90-day mortality occurred. Transfusions of ≥3 units were more frequent in G1 (p=0.003). Mean operative time was longer in G1 (8.5 vs. 7.2 h). More patients in G2 had multiple organ resections (p<0.001).CONCLUSION:The learning curve significantly influences perioperative outcomes in cytoreductive surgery and hyperthermic intraperitoneal chemotherapy procedures. As surgical experience increases, intraoperative transfusion requirements and operative time decrease, while the extent of resection improves. However, these improvements do not appear to translate into a survival benefit.

SUMMARYOBJECTIVE:Juvenile idiopathic arthritis is the most common chronic arthritis in children and adolescents. Nitric oxide mediates autoimmune responses and plays a role in the etiology of numerous rheumatic diseases. Endothelial nitric oxide synthase regulates nitric oxide levels through catalyzing its production. Here, we evaluated the effect of eNOS rs1799983 and variable number tandem repeat variants on disease occurrence and clinical findings in Turkish juvenile idiopathic arthritis patients.METHODS:One hundred and eight participants, including 58 juvenile idiopathic arthritis patients and 50 healthy controls, were included in the study. eNOS rs1799983 and variable number tandem repeat variants were genotyped using polymerase chain reaction and/or restriction fragment length polymorphism. The genotype distribution of the patients was investigated according to their clinical and laboratory results. The results of the analyses were evaluated for statistical significance.RESULTS:The eNOS genotype distributions did not differ between juvenile idiopathic arthritis patients and controls. Within the patient population, those carrying the rs1799983 GT/TT genotypes had higher body mass index, whereas those with the VNTR 4b/4b genotype had lower sedimentation rate.CONCLUSION:Our study results suggest that the eNOS rs1799983 and variable number tandem repeat variants may play a role in juvenile idiopathic arthritis patients’ clinical findings. These data need to be confirmed in different ethnic and larger sample groups.

SUMMARYOBJECTIVE:Natural medicines are considered an effective strategy for treating burns. A preclinical study of a new natural ointment, “Yubivaks,” was conducted to study acute dermal toxicity and irritant properties to ensure its safety.METHODS:The study investigated the acute dermal toxicity, local irritant effect on the skin and mucous membranes of eyes, and the sensitizing activity of the ointment. Adult nonlinear white rats and rabbits of both sexes were used in the experiment. The rats were randomly divided into three groups, each consisting of 10 animals: group I received recommended therapeutic dose (0.003 kg/day), group II received a “conditionally toxic” dose (0.020 kg /day), and group III served as the control group.RESULTS:There were no deaths or signs of intoxication in the acute dermal toxicity study. No local irritant, resorptive, or sensitizing effect and positive immunological tests were observed at the therapeutic dose. Treatment of experimental burns with “Yubivaks” reduced the wound surface by half on the 7th day (59.6%); on the 15th day, the restoration of the histostructure of the epidermal tissue was 99.8%; and by the 25th day, the burn area was completely restored (100%) compared to “Levomekol”: 43.6, 51.1, and 95.8%, respectively. Comparison with “Levomekol” was made based on its wide use as a recognized traditional medicine with complex action.CONCLUSION:At the recommended therapeutic dose, the ointment can be considered as an alternative medication due to accelerated regenerative processes, pronounced anti-inflammatory properties, and safety proven in experimental studies. A limitation of the study was that it was only conducted on rats and rabbits, without using guinea pigs or pig models for several reasons.

SUMMARYOBJECTIVE:The aim of this study was to analyze trends in avoidable mortality due to circulatory system diseases and ischemic heart diseases among individuals aged 30–69 years across the health macro-regions of Rio Grande do Sul, Brazil, from 2000 to 2023.METHODS:An ecological time-series study was conducted using data from the Mortality Information System and Department of Informatics of the Unified Health System, with calculation of age- and sex-adjusted mortality coefficients.RESULTS:A reduction in mortality from circulatory system diseases and ischemic heart diseases was observed among women in almost all macroregions, except for the Central-West. Among men, decreasing trends in mortality from circulatory system diseases were identified, except in the Vales macro-region and in the state overall. Mortality was higher among men and increased with age, with the highest coefficients observed in the South, Central-West, and Metropolitan macro-regions.CONCLUSION:A downward trend in mortality was observed despite population aging, which may be attributed to health policies that strengthened the Unified Health System, including the expansion of the Family Health Strategy, the Hypertension and Diabetes Mellitus Care Reorganization Plan, and the Popular Pharmacy Program, as well as measures for chronic disease control and health promotion.

SUMMARYOBJECTIVE:The aim of this study was to compare the return of spontaneous circulation and survival to discharge of patients who experienced in-hospital cardiac arrest assisted by a rapid response team during the day versus night and weekdays versus weekends.METHODS:This retrospective observational study was conducted at a tertiary teaching hospital. Patients aged 18 years or older who experienced a cardiac arrest in the wards between March 2018 and December 2021 were included. Patients with an express order of “natural death permission” were excluded. Data regarding the period of in-hospital cardiac arrest occurrence, return of spontaneous circulation, and survival to discharge were collected from medical records. In addition, data related to nursing staff leave were collected.RESULTS:A total of 387 patients were included in the analysis. The mean age was 65.4±14.8 years, and 53.7% were men. In the multivariate logistic regression, in-hospital cardiac arrest during the day versus night was not associated with return of spontaneous circulation. However, in-hospital cardiac arrest during weekdays versus weekends showed a significant association with return of spontaneous circulation (odds ratio=2.073; 95%CI 1.206–3.564; p=0.008). No differences were found in survival to discharge between daytime versus nighttime or weekdays versus weekends.CONCLUSION:There is no difference in return of spontaneous circulation rates between in-hospital cardiac arrest events occurring during the day versus night. However, a significant difference in return of spontaneous circulation rates was observed between weekdays and weekends, although this difference did not extend to in-hospital survival rates.

SUMMARYBACKGROUND:The prognostic value of TP53 mutations in metastatic colorectal cancer remains unclear owing to inconsistent findings in the literature. Given its central role in tumor biology, clarifying the impact of TP53 status on survival outcomes is clinically relevant.METHODS:This retrospective cohort study included 115 patients with metastatic colorectal cancer who underwent TP53 mutational analysis using next-generation sequencing (KAPA HyperPETE Pan Cancer Panel). Eligible patients were aged ≥18 years, had histologically confirmed metastatic colorectal cancer, and received first-line systemic therapy. Patients with incomplete clinical or molecular data were excluded. Based on mutation profiles, those with RAS or BRAF mutations received anti-VEGF therapy, whereas patients with wild-type tumors received anti-EGFR treatment. Patients were stratified according to TP53 mutation status to evaluate differences in clinical outcomes.RESULTS:Among the 115 patients included, 78 (67.8%) harbored TP53 mutations and 37 (32.2%) had wild-type TP53. The median progression-free survival was significantly longer in the TP53-mutant group (18.6 vs. 10.0 months; p=0.002). The median overall survival was also numerically longer in the TP53-mutant group (32.9 vs. 30.3 months), although this difference was not statistically significant (p=0.114). In the univariate analysis, TP53 mutation was associated with improved progression-free survival (HR 0.479; 95%CI 0.294–0.779; p=0.003). This association remained independently significant in the multivariate analysis (HR 0.477; 95%CI 0.289–0.787; p=0.004). None of the other variables consistently predicted survival.CONCLUSION:TP53 mutations appear to be an independent prognostic marker for prolonged progression-free survival in patients with metastatic colorectal cancer. Although the difference in overall survival was not statistically significant, these findings warrant further validation in prospective studies to confirm the prognostic utility of TP53 in therapeutic stratification.

SUMMARYOBJECTIVE:The aim of the study was to determine whether vaccinating older adults with PCV13 (pneumococcal conjugate vaccine) and/or PPSV23 (pneumococcal polysaccharide vaccine) and/or the influenza vaccine can reduce pneumonia-related hospitalizations and all-cause death.METHODS:Retrospective cohort of subjects ≥60 years who attended an outpatient clinic in Minas Gerais, Brazil (May 1, 2021 to April 26, 2024). Data regarding pneumonia hospitalizations, all-cause death, pneumococcal and influenza vaccination, demographic, and clinical characteristics were collected from an electronic health record (data in the cloud were available upon request). Only patients with valid data were included and were divided into groups based on their vaccination history, pneumococcal vaccinations (PVC13 and/or PPSV23), influenza vaccination, pneumococcal+influenza vaccinations, and unvaccinated, to calculate the association of vaccination with pneumonia hospitalizations and all-cause death by Cox proportional hazard models, adjusted for demographic and clinical factors.RESULTS:A total of 12,268 older adults were analyzed, with a median age of 79 (interquartile range 72–86), and 73% were female. Vaccination rates were 56% for influenza, 29% for pneumococcal vaccines, and 24% for both influenza and pneumococcal vaccines. Neither pneumococcal nor influenza vaccination alone showed a protective effect against pneumonia hospitalization. The combination of pneumococcal and influenza vaccines was associated with a 35% reduction in pneumonia hospitalization (HR 0.65; 95%CI 0.51–0.83). There was no association between vaccination and allcause death, although the influenza vaccine tended to reduce this risk (HR 0.68; 95%CI 0.46–1.00; p-value 0.053).CONCLUSION:Despite low vaccination rates, the combination of influenza and pneumococcal vaccines reduces pneumonia hospitalizations among older adults by 35%.

SUMMARYOBJECTIVE:Thiol–disulfide homeostasis is a marker of oxidative stress. The aim of the study was to compare the effects of low-flow desflurane and sevoflurane anesthesia on perioperative changes in thiol–disulfide balance in patients undergoing thyroidectomy.METHODS:In this randomized controlled trial, 50 ASA I–II patients were assigned to receive low-flow desflurane (n=25) or sevoflurane (n=25). Blood samples were collected before and after surgery. The primary outcomes were between-group comparisons of perioperative changes in total and native thiol levels. Secondary outcomes included changes in disulfide concentrations and thiol–disulfide ratios.RESULTS:For the primary outcomes, the magnitude of reduction in total thiol (86.4±159.7 vs. 151.5±104.9 μmol/L; p=0.095) and native thiol (79.3±130.1 vs. 115.1±86.3 μmol/L; p=0.257) did not differ significantly between the desflurane and sevoflurane groups. For the secondary outcomes, disulfide levels significantly decreased in the sevoflurane group (67.5±19.9 vs. 48.4±18.1 μmol/L; p=0.001), whereas no significant change was observed in the desflurane group (60.2±23.2 vs. 52.5±34.5 μmol/L; p=0.300). Between-group comparisons of disulfide/total thiol, native thiol/total thiol, and disulfide/native thiol ratios revealed no significant differences.CONCLUSION:Low-flow desflurane and sevoflurane anesthesia demonstrated similar effects on perioperative thiol–disulfide homeostasis in thyroidectomy patients.