High Prevalence of Human Papillomavirus Infection among Brazilian Pregnant Women with and without Human Immunodeficiency Virus Type 1

Objective. To estimate HPV prevalence among pregnant women from Ribeirão Preto, Brazil, and the possible influence of HIV-1 infection on this prevalence. Methods. A cross-sectional study with 44 HIV-positive and 53 HIV-negative pregnant women was conducted. Cervicovaginal specimens were obtained from all women during gynecologic exam. HPV DNA, low and high risk HPV types, was detected using conventional PCR. Statistical analysis used Student's t-test, Mann-Whitney test, Fischer's Exact test, and prevalence ratios with 95% confidence interval. Results. HIV-positive pregnant women had higher proportion of HPV infection than HIV-negative pregnant women (79.5% versus 58.5%; P < .05). HPV positivity prevalence ratio for HIV-positive women was 1.36 (95% CI 1.04–1.8; P = .03). There was significant association between HIV viral load levels and HPV positivity (P < .05). Conclusions. Our results demonstrate higher HPV positivity in HIV-infected pregnant women. Higher values of HIV viral load were associated with HPV positivity

Revista Brasileira de Enfermagem

Profile of patients with brain tumors and the role of nursing care Revista Brasileira de Enfermagem, vol. 69, núm. 1, enero-febrero, 2016, pp. 150-155 Associação Brasileira de Enfermagem Brasília, Brasil ABSTRACT Objective: to describe the profi le of 200 patients with central nervous system tumors (CNST), and the role of the nursing care. Method: prospective, quantitative and descriptive analysis of medical records of 200 patients with TSNC. Results: a total of 61% of our patients had benign CNST and 39% had malignant tumors. The extent of patient dependence, according to the Karnofsky Performance Status scale, was signifi cantly greater for patients with malignant CNST (p &lt; .05), indicating that these patients needed more support with their activities of daily living. Conclusion: patients with CNST need specialized care, with specifi c guidance regarding their disease and aspects of daily living after treatment. Thus, the nurse can function as a key element for the effectiveness of care provided to patients and family members with the aim of enhancing the quality of life of all those affected, directly or indirectly, by the disease. Key words: Brain Neoplasms; Nurse&apos;s Role; Nursing Care; Karnofsky Performance Status; Oncology Nursing RESUMO Objetivo: descrever o perfi l de 200 pacientes com tumores no sistema nervoso central (TSNC) e o papel do cuidado em enfermagem. Método: análise prospectiva, quantitativa e descritiva de prontuários de 200 pacientes com TSNC. Resultados: 61% dos pacientes possuíam TSNC benignos e 39% tumores malignos. O grau de dependência do paciente de acordo com a Escala de Karnofsky foi signifi cativamente maior para pacientes com tumores malignos (P &lt;0,05), indicando que estes precisam de maior esforço e, consequentemente, apoio em suas atividades diárias. Conclusão: Pacientes com TSNC necessitam de cuidados especializados, com orientações específi cas a respeito de sua doença e aos aspectos da sua vida diária após o tratamento. Assim, o enfermeiro pode ser um elemento-chave para a efi cácia dos cuidados prestados aos pacientes e familiares com o objetivo de melhorar a qualidade de vida de todas as pessoas afetadas, direta ou indiretamente, pela doença. Descritores: Neoplasias Encefálicas; Papel do Profi ssional de Enfermagem; Cuidados de Enfermagem; Avaliação de Estado de Karnofsky; Enfermagem Oncológica. RESUMEN Objetivo: describir el perfi l de los 200 pacientes con tumores del sistema nervioso central (TSNC) y el papel de la enfermería. Método: análisis prospectivo, cuantitativo y descriptivo de los registros médicos de 200 pacientes con TSNC. Resultados: 61% de los pacientes tenían TSNC benignos y 39% tumores malignos. El grado de la dependencia de los pacientes según la Escala de Karnofsky fue signifi cativamente mayor en los pacientes con tumores malignos (P &lt;0,05), lo que indica que estos pacientes necesitan más apoyo en las actividades diarias. Conclusión: los pacientes con tumores cerebrales requieren atención especializada, con directrices específi cas sobre su enfermedad y aspectos de la vida diaria después del tratamiento. Por l

USING ENTRUSTABLE PROFESSIONAL ACTIVITIES IN THE DESIGN OF THREE NEW HEALTHCARE UNDERGRADUATE PROGRAMS: BIOMEDICINE, NURSING AND PSYCHOLOGY

Entrustable Professional Activities (EPAs) can be defined as a unit of professional practice that can be entrusted to a trainee after they have obtained adequate competency. EPAs integrate multiple competencies from several domains and are very useful in designing competency-based curricula. Using EPAs to design medical curricula has been widely described, but their application to curriculum design of other health-related undergraduate programs is scarce. This manuscript critically assesses an educational planning experience of using EPAs to simultaneously design three healthcare undergraduate programs (nursing, biomedicine and psychology) at Faculdade Santa Casa BH, Minas Gerais, Brazil. We present the EPAs for each program, curricula frameworks, educational strategies, and assessment methods. Expert groups of professors and educational specialists defined the core professional activities that would be directly assessed and entrusted to trainees from the three different programs. The expert group then defined the required knowledge, skills, and attitudes for each EPA and selected the appropriate assessment tools to be used in entrustment decisions. The expected entrustment level for each training phase guided the course’s distribution of core and elective courses. The experience of designing a curriculum using EPAs was successful and helped focus on the core activities of each profession. It also provided an opportunity to reflect upon formative and summative assessments throughout the course bringing the challenge of reorienting our teaching practices and assessment approaches. Designing undergraduate curricula of health-related professions using EPAs is feasible and might help operationalize competency-based curricula.  Article visualizations

Reduced expression of the murine HLA-G homolog Qa-2 is associated with malignancy, epithelialmesenchymal transition and stemness in breast cancer cells.

Qa-2 is believed to mediate a protective immune response against cancer; however, little is known about the role of Qa-2 in tumorigenesis. Here, we used 4T1 breast cancer cells to study the involvement of Qa-2 in tumor progression in a syngeneic host. Qa-2 expression was reduced during in vivo tumor growth and in cell lines derived from 4T1-induced tumors. Tumor-derived cells elicited an epithelialmesenchymal transition associated with upregulation of Zeb1 and Twist1/2 and enhanced tumor initiating and invasive capacities. Furthermore, these cells showed increased stem characteristics, as demonstrated by upregulation of Hes1, Sox2 and Oct3/4, and enrichment of CD44high/CD24median/low cells. Remarkably, Qa-2 cell-surface expression was excluded from the CD44high/CD24median/low subpopulation. Tumor-derived cells showed increased Src activity, and treatment of these cells with the Src kinase inhibitor PP2 enhanced Qa-2 but reduced Sox2 and CD44high/CD24median/low expression levels, suggesting that Src signaling, while positively associated with stemness, negatively regulates Qa-2 expression in breast cancer. Finally, overexpression of the Qa-2 family member Q7 on the cell surface slowed down in vivo tumor growth and reduced the metastatic potential of 4T1 cells. These results suggest an anti-malignant role for Qa-2 in breast cancer development, which appears to be absent from cancer stem cells.post-print2122 K

REBEN_69-1_MIOLO_POR.indd

ABSTRACT Objective: to describe the profi le of 200 patients with central nervous system tumors (CNST), and the role of the nursing care. Method: prospective, quantitative and descriptive analysis of medical records of 200 patients with TSNC. Results: a total of 61% of our patients had benign CNST and 39% had malignant tumors. The extent of patient dependence, according to the Karnofsky Performance Status scale, was signifi cantly greater for patients with malignant CNST (p &lt; .05), indicating that these patients needed more support with their activities of daily living. Conclusion: patients with CNST need specialized care, with specifi c guidance regarding their disease and aspects of daily living after treatment. Thus, the nurse can function as a key element for the effectiveness of care provided to patients and family members with the aim of enhancing the quality of life of all those affected, directly or indirectly, by the disease. Key words: Brain Neoplasms; Nurse&apos;s Role; Nursing Care; Karnofsky Performance Status; Oncology Nursing RESUMO Objetivo: descrever o perfi l de 200 pacientes com tumores no sistema nervoso central (TSNC) e o papel do cuidado em enfermagem. Método: análise prospectiva, quantitativa e descritiva de prontuários de 200 pacientes com TSNC. Resultados: 61% dos pacientes possuíam TSNC benignos e 39% tumores malignos. O grau de dependência do paciente de acordo com a Escala de Karnofsky foi signifi cativamente maior para pacientes com tumores malignos (P &lt;0,05), indicando que estes precisam de maior esforço e, consequentemente, apoio em suas atividades diárias. Conclusão: Pacientes com TSNC necessitam de cuidados especializados, com orientações específi cas a respeito de sua doença e aos aspectos da sua vida diária após o tratamento. Assim, o enfermeiro pode ser um elemento-chave para a efi cácia dos cuidados prestados aos pacientes e familiares com o objetivo de melhorar a qualidade de vida de todas as pessoas afetadas, direta ou indiretamente, pela doença. Descritores: Neoplasias Encefálicas; Papel do Profi ssional de Enfermagem; Cuidados de Enfermagem; Avaliação de Estado de Karnofsky; Enfermagem Oncológica. RESUMEN Objetivo: describir el perfi l de los 200 pacientes con tumores del sistema nervioso central (TSNC) y el papel de la enfermería. Método: análisis prospectivo, cuantitativo y descriptivo de los registros médicos de 200 pacientes con TSNC. Resultados: 61% de los pacientes tenían TSNC benignos y 39% tumores malignos. El grado de la dependencia de los pacientes según la Escala de Karnofsky fue signifi cativamente mayor en los pacientes con tumores malignos (P &lt;0,05), lo que indica que estos pacientes necesitan más apoyo en las actividades diarias. Conclusión: los pacientes con tumores cerebrales requieren atención especializada, con directrices específi cas sobre su enfermedad y aspectos de la vida diaria después del tratamiento. Por l

Qa-2 expression levels is related with tumor-infiltrating lymphocytes profile during solid Ehrlich tumor development

The Qa-2 has been described as Human Leucocyte Antigen G (HLA-G) murine homolog. This homology is well accepted to gene and protein structure, in different pathology process and embryos implantation. However, in some neoplasm, this homology is questioned, where Qa-2 has been proposed as an immunogenic molecule, associated to tumor rejection. In this way, the aim of this study was to describe the pattern of Qa-2 expression and its relationship with the profile of tumor-infiltrating lymphocytes in solid Ehrlich tumor. The Ehrlich tumor growth was evaluated in Balb/c female mice in different tumor stages. The inflammatory infiltration features were determined by histopathology and, both lymphocyte type and tissue Qa-2 expression by immunohistochemistry. ELISA kit was used to determine soluble Qa-2 in the serum from the animals. We observed that Qa-2 in neoplastic cells increases in intermediate tumor development stages, while, serum Qa-2 increases in the late stage. Qa-2 increasing is correlated with CD3+ increase. Our results suggest that Qa-2 has a role opposite to HLA-G in Ehrlich solid carcinoma, and may be modulating the immune response by attracting the inflammatory infiltrate, especially T CD8+ Lymphocytes.This paper was supported by a grant from CAPES Foundation (Higher Level Personnel Improvement Commission), with an International Scholarship Procs. Nr. 99999.009972/2014-05. Other grants were also provided by CNPq (Brazilian National Research and Development Council) and FAPEMIG (Foundation for Research Support of the State of Minas Gerais).Peer reviewe

Profile of patients with brain tumors and the role of nursing care

ABSTRACT Objective: to describe the profile of 200 patients with central nervous system tumors (CNST), and the role of the nursing care. Method: prospective, quantitative and descriptive analysis of medical records of 200 patients with TSNC. Results: a total of 61% of our patients had benign CNST and 39% had malignant tumors. The extent of patient dependence, according to the Karnofsky Performance Status scale, was significantly greater for patients with malignant CNST (p < .05), indicating that these patients needed more support with their activities of daily living. Conclusion: patients with CNST need specialized care, with specific guidance regarding their disease and aspects of daily living after treatment. Thus, the nurse can function as a key element for the effectiveness of care provided to patients and family members with the aim of enhancing the quality of life of all those affected, directly or indirectly, by the disease

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit