promoter hypermethylation and Lynch Syndrome: When to test for constitutional epimutations of gene?

Lynch syndrome is a genetic condition predisposing to cancer, particularly colorectal cancer and endometrial cancer, due to germline mutations in MisMatch Repair genes. More rarely, Lynch syndrome is the result of a constitutional promoter methylation. This review summarizes the current knowledge about the role of this epigenetic mechanism in the Lynch syndrome.

Clinical outcomes of COVID-19 in patients with liver cirrhosis - a propensity-matched analysis from a multicentric Brazilian cohort.

Background: Cirrhosis has been pointed out as a clinical entity that leads to worse clinical prognosis in COVID-19 patients. However, this concept is controversial in the literature. We aimed to evaluate clinical outcomes by comparing patients with cirrhosis to those without cirrhosis in a Brazilian cohort.

From indoors to outdoors: Impact of waste anesthetic gases on occupationally exposed professionals and related environmental hazards - A narrative review and update.

Waste anesthetic gases (WAGs) are trace-concentration inhaled anesthetics that exist worldwide because they are released into the ambient air of operating rooms (ORs) and post-anesthesia care units. WAGs cause indoor contamination, especially in ORs lacking proper scavenging systems, and occupational exposure, while promoting climate change through greenhouse gas/ozone-depleting effects. Despite these controversial features, WAGs continue to pose occupational health hazards.

Enhancing recovery and reducing inflammation: the impact of enhanced recovery after surgery recommendations on inflammatory markers in laparoscopic surgery-a scoping review.

Introduction: The relationship between the Enhanced Recovery After Surgery (ERAS) guidelines and inflammatory markers in laparoscopic surgery has garnered increasing attention. These recommendations are designed to minimize surgical stress and potentially improve recovery outcomes by modifying perioperative care.

Objective: This scoping review aims to evaluate the impact of ERAS recommendations on inflammatory markers in patients undergoing laparoscopic surgeries, identifying current research gaps and consolidating findings from existing studies.

Respectful care for postpartum women with sickle cell disease: a netnographic study.

Objectives: to analyze principles of respectful maternity care in narratives of postpartum women with sickle cell disease, relating them to Sustainable Development Goals.

Methods: netnographic study, with two videos published in 2020. Deductive iconographic and thematic analysis by Respectful Maternity Care Charter, organized in MAXQDA.

High-Flow Nasal Oxygen vs Noninvasive Ventilation in Patients With Acute Respiratory Failure: The RENOVATE Randomized Clinical Trial.

Importance: High-flow nasal oxygen (HFNO) and noninvasive ventilation (NIV) are commonly used respiratory support therapies for patients with acute respiratory failure (ARF).

Objective: To assess whether HFNO is noninferior to NIV on the rates of endotracheal intubation or death at 7 days in 5 patient groups with ARF.

Design, Setting, And Participants: This noninferiority, randomized clinical trial enrolled hospitalized adults (aged ≥18 years; classified as 5 patient groups with ARF: nonimmunocompromised with hypoxemia, immunocompromised with hypoxemia, chronic obstructive pulmonary disease [COPD] exacerbation with respiratory acidosis, acute cardiogenic pulmonary edema [ACPE], or hypoxemic COVID-19, which was added as a separate group on June 26, 2023) at 33 hospitals in Brazil between November 2019 and November 2023 (final follow-up: April 26, 2024).

Validation of the Brazilian Portuguese Version of the Western Ontario Shoulder Instability Index (WOSI) Questionnaire.

 To evaluate the validity of the Brazilian Portuguese version of the Western Ontario Shoulder Instability Index (WOSI).  We assessed 51 patients aged 18 to 40 years who were divided into 3 groups: 17 patients with shoulder instability undergoing conservative treatment, 17 with shoulder instability treated surgically, and 17 without shoulder instability. The patients underwent functional and health assessments using the following scores: WOSI, Rowe, Visual Analog Scale (VAS), Subjective Shoulder Value (SSV), Disabilities of the Arm, Shoulder and Hand (DASH), and University of California-Los Angeles (UCLA) Shoulder Scale.

Comparison of External Circular Fixation and Plate and Screw Fixation Methods in Tibial Pilon Fractures.

 To compare the fixation methods for tibial pilon fractures among patients treated in a hospital.  We analyzed the medical records of 28 patients who underwent a surgical procedure for tibial pilon fracture, among whom 15 subjects received a circular external fixator, and 13 underwent internal fixation using a plate and screws. We assessed age, sex, aggravating factors, trauma energy (high or low), presence of soft tissue injuries, associated fractures, and clinical outcomes.

Effect of a driving pressure-limiting strategy for patients with acute respiratory distress syndrome secondary to community-acquired pneumonia: the STAMINA randomised clinical trial.

Background: This study aimed to assess whether a driving pressure-limiting strategy based on positive end-expiratory pressure (PEEP) titration according to best respiratory system compliance and tidal volume adjustment increases the number of ventilator-free days within 28 days in patients with moderate to severe acute respiratory distress syndrome (ARDS).

Methods: This is a multi-centre, randomised trial, enrolling adults with moderate to severe ARDS secondary to community-acquired pneumonia. Patients were randomised to a driving pressure-limiting strategy or low PEEP strategy based on a PEEP:FiO table.

The second Latin American catheter ablation registry ("II LAHRS EP registry").

Background: Patient's clinical characteristics, technical resources, center and operator volume, and operator experience and training are known variables impacting outcomes. Although international standards have been agreed to maximize the benefits of this therapy, regional and global differences still exist. Latin American information has not been updated in the last 10 years.

A New Natural Language Processing-Inspired Methodology (Detection, Initial Characterization, and Semantic Characterization) to Investigate Temporal Shifts (Drifts) in Health Care Data: Quantitative Study.

Background: Proper analysis and interpretation of health care data can significantly improve patient outcomes by enhancing services and revealing the impacts of new technologies and treatments. Understanding the substantial impact of temporal shifts in these data is crucial. For example, COVID-19 vaccination initially lowered the mean age of at-risk patients and later changed the characteristics of those who died.

Comprehensive statistical analysis reveals significant benefits of COVID-19 vaccination in hospitalized patients: propensity score, covariate adjustment, and feature importance by permutation.

Background: COVID-19 vaccines effectively prevent infection and hospitalization. However, few population-based studies have compared the clinical characteristics and outcomes of patients hospitalized for COVID-19 using advanced statistical methods. Our objective is to address this evidence gap by comparing vaccinated and unvaccinated patients hospitalized for COVID-19.

Development of a machine learning model to estimate length of stay in coronary artery bypass grafting.

Objective: To develop and validate a predictive model utilizing machine-learning techniques for estimating the length of hospital stay among patients who underwent coronary artery bypass grafting.

Methods: Three machine learning models (random forest, extreme gradient boosting and neural networks) and three traditional regression models (Poisson regression, linear regression, negative binomial regression) were trained in a dataset of 9,584 patients who underwent coronary artery bypass grafting between January 2017 and December 2021. The data were collected from hospital discharges from 133 centers in Brazil.

Advancing Cardiac Care: A Registry of Heart Transplantation in Latin America (1968-2022).

Introduction: Heart transplantation (HTx) has emerged as a pivotal intervention for end-stage heart failure, offering significant improvements in survival and quality of life. This manuscript elucidates the landscape of HTx across Latin America (LATAM) from its advent in 1968 through December 2022, shedding light on its evolution, current practices, and regional disparities.

Methods: We distributed a structured questionnaire to the national coordinators or representatives of the Interamerican Council of Heart Failure and Pulmonary Hypertension, collating responses from 20 LATAM nations.

Irreparable Cuff Injuries: Treatment Options and Clinical Outcomes.

Rotator cuff tear is a common source of pain and disfunction in shoulder, with prevalence increasing with age. Nonsurgical treatment is adequate for many patients; however, for those for whom surgical treatment is indicated, rotator cuff repair provides reliable pain relief and good functional results. However, massive and irreparable tears due to tear size, tendon retraction, muscle atrophy, fatty infiltration are a significant challenge for surgeons.

Comparative Analysis of ECG and Holter Monitoring in the Assessment of Heart Rate in Heart Failure with Reduced Ejection Fraction and Sinus Rhythm.

Background: Heart rate (HR) has shown prognostic value in patients with heart failure with reduced ejection fraction (HFrEF) and sinus rhythm. However, the method of measurement is debated in the literature.

Objectives: To compare HR on Holter with 3 resting electrocardiograms (ECG1, ECG2, and ECG3) in patients with HFrEF and sinus rhythm.

Palliative care and COVID-19: acknowledging past mistakes to forge a better future.

Context: COVID-19 induces complex distress across physical, psychological, and social realms and palliative care (PC) has the potential to mitigate this suffering significantly.

Objectives: To describe the clinical characteristics and outcomes of COVID-19 patients with an indication of PC, compared to patients who had no indication, in different pandemic waves.

Methods: This retrospective multicenter observational cohort included patients from 40 hospitals, admitted from March 2020 to August 2022.

Evaluation of Success and Complications Scores for Chronic Total Occlusion Percutaneous Coronary Interventions: Insights from the Latin American Registry.

Chronic total occlusion (CTO) percutaneous coronary intervention is a complex procedure and is associated with considerable risk of complications. Several success and complication scores have been developed; however, data regarding their external validation in other populations such as Latin America are scarce. This study aimed to evaluate the accuracy of the main predictors of success and complications in a broad cohort of procedures in the Latin American (LATAM) CTO registry.