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BACKGROUND: The 3rd Global Consultation on Organ Donation and Transplantation stated that every nation should achieve self-sufficiency in organ donation. In the Middle East the deceased organ donation (DD) average rate is 2.29 donors/pmp. The United Arab Emirates (UAE) started their DD program in 2017 approving brain death declaration. UAE National Transplant Committee started an international collaboration with Donation and Transplantation Institute (DTI Foundation) in 2017 for the development of the DD program. In 2019, 4 hospital-based organ donation unit (H-ODU) were established in Abu Dhabi. The aim of this study was to combine the ISO 9001:2015 quality management system (QMS) and the Organ Donation European Quality System (ODEQUS) to improve DD. METHOD: SEUSA is based on the Spanish, European and USA models tailored to the local needs. The QMS used was a combination of the ISO with ODEQUS methodology. The Abu Dhabi hospitals were selected according to their DD potentiality. Monthly follow-up between H-ODU's staff and DTI team were performed to monitor SOPs development and ODEQUS KIPs measurement. After a 6 months implementation period, an internal audit was performed by a DTI experts in DD/ISO QMS. Finally, an external audit was performed and ISO 9001:2015 quality certification was granted. RESULTS: 10 SOPs regarding DD were developed per unit and 4 ODEQUS key indicators (KPI) were selected (Table 1). After completed the internal audits, 1 H-ODU applied for the external audit and quality certification. As a result of the measures implemented, UAE moved from 0 donors to 1.1 donors/pmp in 2019. Lastly, in 2020 the Abu Dhabi Department of Health released the KPIs as a mandate for all hospitals to improve DD performance. CONCLUSION: The collaboration between local and international organization supports the successful implementation of DD best practices in new regions.

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Oocyte quality is the resultant of multifactor interactions that should be carefully taken into account either for in vitro embryo production technologies or for studying follicle dynamics. Different approaches may be used to perform an analysis of variables related to oocyte quality which may focus on the ovary, the follicle, the cumulus-oocyte complex and, finally, the oocyte. The information obtained may answer key questions, such as what does the oocyte need to acquire meiotic competence and whether follicle activity can be manipulated to improve the in vitro embryo production efficiency. Although morphological evaluation represents the most common procedure used to discriminate the developmental potential of the oocyte and in spite of a good relationship that has been found between the quality of the oocyte and the atresia grade of the follicle that comprises it, there is not yet a clear correspondence between th e visual criteria and the developmental competence of oocytes submitted to in vitro embryo production. New technologies have b ecome available, including emerging ‘omics’ sciences that, through analysis of the cumulus cells, offer the opportunity, by a non-invasive method, to indirectly predict the developmental potential of the oocyte.

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Repeated oocyte collection by transvaginal ultrasound-guided follicular puncture (Ovum Pick-Up: OPU), implicitly associated to in vitro embryo production (IVEP), has become altern ative and competitive to superovulation for embryo production in cattle. It is alternative because it can be applied successfully irrespective of the reproductive status of the donor, i.e. in pregnant and acyclic animals, in those having patent tube or genital tract infections and in animals insensitive to superovulatory treatment. It is competitive because it can yield more transferable embryos per donor on a monthly basis. Through the years, the number of transferable embryos provided by OPU has significantly increased mainly due to the technological improvement of IVEP. However, limits to OPU application remain due to lower pregnancy rate of in vitro vs. in vivo produced embryos or non optimal cooperation between OPU practitioners and IVF laboratories. This review will focus on the technical modifications proposed for improving OPU efficiency, the analysis of the physiological parameters that affect OPU and IVEP efficiency and, finally, the use of OPU as a tool to study and manipulate reproductive activity in cattle.

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Repeated oocyte collection by transvaginal ultrasound-guided follicular puncture (Ovum Pick-Up: OPU), implicitly associated to in vitro embryo production (IVEP), has become altern ative and competitive to superovulation for embryo production in cattle. It is alternative because it can be applied successfully irrespective of the reproductive status of the donor, i.e. in pregnant and acyclic animals, in those having patent tube or genital tract infections and in animals insensitive to superovulatory treatment. It is competitive because it can yield more transferable embryos per donor on a monthly basis. Through the years, the number of transferable embryos provided by OPU has significantly increased mainly due to the technological improvement of IVEP. However, limits to OPU application remain due to lower pregnancy rate of in vitro vs. in vivo produced embryos or non optimal cooperation between OPU practitioners and IVF laboratories. This review will focus on the technical modifications proposed for improving OPU efficiency, the analysis of the physiological parameters that affect OPU and IVEP efficiency and, finally, the use of OPU as a tool to study and manipulate reproductive activity in cattle.(AU)

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Oocyte quality is the resultant of multifactor interactions that should be carefully taken into account either for in vitro embryo production technologies or for studying follicle dynamics. Different approaches may be used to perform an analysis of variables related to oocyte quality which may focus on the ovary, the follicle, the cumulus-oocyte complex and, finally, the oocyte. The information obtained may answer key questions, such as what does the oocyte need to acquire meiotic competence and whether follicle activity can be manipulated to improve the in vitro embryo production efficiency. Although morphological evaluation represents the most common procedure used to discriminate the developmental potential of the oocyte and in spite of a good relationship that has been found between the quality of the oocyte and the atresia grade of the follicle that comprises it, there is not yet a clear correspondence between th e visual criteria and the developmental competence of oocytes submitted to in vitro embryo production. New technologies have b ecome available, including emerging ‘omics sciences that, through analysis of the cumulus cells, offer the opportunity, by a non-invasive method, to indirectly predict the developmental potential of the oocyte.(AU)

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INTRODUCTION: Nephroureterectomy for transplantation has increased owing to the greater number of deceased donors. Anatomic variations may complicate the procedure or, if unrecognized, compromise the viability of kidneys for transplantation. METHODS: We reviewed 254 surgical descriptions of nephroureterectomy specimens from January 2008 to December 2009. All organs collected according by standard techniques were evaluated for age, cause of death, renal function, frequency of injury during the procedure, as well as variations in the vascular and collecting systems. RESULTS: The mean donor age was 42 years (range, 2-74). The mean serum creatinine was 1.2 mg/dL (range, 1.0-7.0). The causes of death were cerebrovascular cause (stroke; n = 130), traumatic brain injury (n = 81) or other cause (n = 43). Among the anatomic variations: 8.6% (n = 22) were right arterial anatomical variations: 19 cases with 2 arteries and 3 cases with 3 arteries. In 25 cases (9.8%) the identified variation was the left artery: 2 arteries (n = 23), 3 arteries (n = 1) and 4 arteries (n = 1). We observed 9.8% on right side and 1.5% on left side venous anatomic variations, including 24 cases with 2 veins on the right side and 4 cases with 2 veins on the left side. Three cases of a retroaortic left renal vein and 1 case of a retro necklace vein (anterior and posterior to the aorta). Two cases of ureteral duplication were noted on the left and 1 on the right kidney. There were 3 horseshoe and 1 pelvic kidney. In 7.5% of cases, an injury to the graft included ureteral (n = 3), arterial (n = 10), or venous (n = 6). CONCLUSION: The most common anatomic variation was arterial (17.8%). Duplication of the renal vein was more frequent on the right. The high incidences of anatomic variations require more attention in the dissection of the renal hilum to avoid an injury that may compromise the graft.

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In Brazil, organ transplantation has been regulated by a federal law since 1997. This law was created to guarantee equal access to treatment on a national scale. Deceased donor organ procurement and sharing are centralized and controlled by the Health Department of each state of the nation, following a regional allocation policy. In São Paulo, time on the waiting list was the main criterion adopted to allocate deceased donor kidneys up to January 1, 2002. After that, HLA mismatches (MM) were the main criterion. The aim of this study was to investigate the impact of HLA compatibility on graft survival among 3312 consecutive kidney recipients. The 2-year kidney graft survival rates were compared among recipients transplanted based on the waiting time policy and based on HLA MM. Better results were observed in the HLA MM group (78.1% vs 64.9%; P < .0001). Regarding kidney allocation based on HLA MM, recipients transplanted with 0 HLA-A, -B, or -DR MM showed significantly better 5-year survival rates than those with 1-2 or 3-4 or 5-6 HLA-A, -B, or -DR MM (70.36% vs 64.71% vs 58.07% vs 55.64%; P < .050). We concluded that HLA compatibility is a feasible criterion to allocate deceased donor kidneys in Brazil.

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Since 1997, organ transplantation in Brazil has been regulated by a federal law, which was created to guarantee equal access to treatment on a national scale. Centralized deceased donor organ procurement and sharing are controlled by the Health Department of each state of the nation, following a regional allocation policy. In São Paulo, time on the waiting list was the main criterion adopted to allocate deceased donor livers up to July 15, 2006. After that, model for end-stage liver disease/pediatric end-stage liver disease (MELD/PELD) scores were the main criteria. The aim of this study was to investigate the impact of the new criteria on patient survival rates using 895 consecutive liver recipients. The 1-year patient survival rates were compared between recipients transplanted based on the waiting time policy and based on MELD/PELD scores showing similar results (69.79% vs 66.69%; P = NS). Regarding liver allocation based on MELD/PELD scores, worse survival outcomes were observed among recipients transplanted with higher MELD scores. Also, under the new criteria, a high frequency of hepatocellular carcinoma and pediatric recipients underwent transplantation.

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The objective of this investigation was to carry out a literature review on the choroid plexus cysts and theirimportance in fetal prognosis with search on PubMed, Web of Science, LILACS and MEDLINE databases usingkeywords in English without time restrictions. Choroid plexus cysts, which are also termed intraventricularneuroepithelial cysts, choroid epithelial cysts or ependimary cysts, are structures localized within the interiorof the lateral ventricles, comprising secretory epithelium, the principal function of which is the production ofcerebrospinal fluid. Ultrasound images of the choroid plexuses within the lateral ventricles consist of hyperechogenicstructures at the level of the body, trigon and inferior horn of the ventricles. Between the 16th andthe 20th week of gestation, cystic structures in the interior of the ventricular plexuses may be observed at arate of 0.3-1.0% in an ultrasound examination of the fetal head, as is shown. Most choroid plexus cysts regressspontaneously without after effects, although there is a possible association with chromosomal abnormalities,notably trisomy 18 (Edwards’ syndrome) and less frequently cited, trisomy 21 (Down syndrome). The presenceof this kind of cyst is considered to be a lesser marker for them, except when combined with other morefrequently used and accepted ecographic markers, such as nuchal translucency, intracardiac echogenic focusand others. Its isolated presence as the sole characteristic of this aneuploidy is rare. The majority of choroidcysts are transitory and of little clinical significance, and may be identified through a computerized tomographyexamination. As such, the existence of isolated choroid cysts does not indicate the confirmation of chromosomalaneuploidies so much as an alarm that should trigger an investigation in greater depth in search ofother more important markers, emphasizing the importance of pre-natal monitoring.

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OBJECTIVES: Few studies of comorbidity among cocaine users have been undertaken in Brazil, despite the fact that cocaine is one of the most commonly used illegal drugs in the country. The aim of this paper is to review existing data on psychiatric evaluations of cocaine users, and present data from two studies that have addressed this issue as it pertains to the Brazilian public health system. STUDY DESIGN: Review and results from two studies (cross-sectional and matched control). METHODS: The Brazilian literature on PubMed, Lilacs, Psychinfo and DATASUS was searched using the key words: 'psychiatric symptoms', 'diagnosis', 'evaluation', 'assessment', 'cocaine disorders' and others related to this issue. Intake data from two studies of male and female cocaine users were also analysed with regard to psychiatric symptoms as measured by the Symptom Check List - 90 Revised (SCL-90). RESULTS: The literature review found no specific studies regarding psychiatric evaluation of cocaine users in Brazil. Analyses from the two studies presented showed high levels of psychiatric symptoms in this population. In the first study, psychiatric symptoms were measured at treatment entry and their prevalence was high, ranging from 27.4% to 53.4%. In the second study, SCL-90R scores at programme admission were higher in cocaine users than normal controls, with effect sizes ranging from moderate to high. CONCLUSIONS: To the authors' knowledge, this is the first article to discuss psychiatric evaluations of comorbidity among cocaine users in Brazil. The results indicate a need to: pay more attention to the evaluation of psychiatric symptoms in cocaine users; emphasize the importance of standardized data collection in this area; and evaluate the course of these symptoms, their impact on outcome, and how they are best addressed in treatment.

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Anatomical brain asymmetries are subtle and still little studied in humans. Among all the animals, humans have the most asymmetric brains Crow (2004). The language faculty and handedness are localized on the left side. The objective this paper is to verify whether the temporal lobes are anatomically different. Our sample was composed of 40 post mortem adult brains of both sexes, which were investigated at the Human Anatomy Laboratory of the Nove de Julho University Center in Sao Paulo, Brazil. The brains were fixed in a solution of 5% paraformaldehyde. Three different measurements were taken using a pachimeter (Mitutoyo) and a goniometer (Card) on both hemispheres: Ml - the length of the lateral sulcus; M2 - the distance from the lateral sulcus to the inferior margin of the inferior temporal gyrus, and M3 - the angle formed between the lines of the collateral sulcus and the inferior margin of the inferior temporal gyrus. Results were submitted to a statistical analysis (ANOVA) and demonstrated that Ml was larger in the left hemisphere, by contrast with the data obtained for M2 and M3, which were larger in the right hemisphere. The measurements taken showed differences between the right and left temporal lobes.

Las asimetrías anatómicas del cerebro humano son sutiles y aún poco estudiadas. Entre todos los animales, el Hombre es el que presenta el cerebro más asimétrico (Crow, 2004). En el lado izquierdo del cerebro se localiza la facultad del lenguaje, como también de la lateralidad manual. El objetivo del trabajo fue verificar si los lóbulos temporales son anatómicamente diferentes. La muestra estuvo compuesta de 40 encéfalos adultos, post mortem, de ambos sexos, del Laboratorio de Anatomía del Centro Universitario Nove de Julho, en Sao Paulo, SP, Brasil. Los encéfalos fueron fijados en solución de formalina al 5%. Fueron realizadas 3 medidas diferentes utilizando un pié de metro Mitutoyo y goniómetro (Carci), en ambos hemisferios: medida MI, largo del surco lateral; medida M2 distancia del surco lateral hasta el margen inferior del giro temporal inferior y la medida M3 el ángulo formado entre las líneas del surco colateral y margen inferior del giro temporal inferior. Los resultados se sometieron a análisis estadístico y mostraron que MI era mayor en el hemisferio izquierdo, en contraposición a los datos obtenidos en M2 y M3, que fueron mayores en el hemisferio derecho. Las medidas realizadas presentaron diferencias entre los lóbulos temporales derecho e izquierdo.

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OBJECTIVE: To evaluate criterion convergent and discriminant validity of the World Health Organization Instrument (WHOQoL-BREF) in evaluating quality of life and to verify its convergent validity with the Medical Outcomes study Short-forms (SF-36) and the Symptom Check List (SCL-90) instruments in male alcohol dependent patients who seek treatment at two Brazilian treatment centers. METHODS: A cross-sectional study was performed, in which cases were divided in to two groups according to the severity of alcohol dependence, ascertained by the Short Form Alcohol Dependence Data scale (SADD). RESULTS: The sample was comprised of 36 males, and 63.9% had severe dependence. Subjects with low/moderate dependence showed higher scores in all domains of the WHOQoL-BREF and in nearly all domains of the SF-36. Criterion validity and internal consistency in the WHOQoL-BREF were satisfactory. With regard to convergent validity between the WHOQoL-BREF and SF-36, most correlation coefficients were significant. CONCLUSIONS: The WHOQoL instrument proved to be satisfactory for evaluating quality of life in this sample.

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Dissemination of Acinetobacter baumannii strains in different units of a hospital in Sorocaba, São Paulo, Brazil was evaluated over a period of two years. By using biotyping, serotyping and ribotyping, 27 distinct clones were differentiated among 76 strains isolated between 1993-94, from clinical specimens of hospitalized patients. Two clones, 2:O4:A (biotype:serotype:ribotype) and 2:O29:A accounted for the majority of strains widely disseminated in the units during 1993. The introduction in the hospital setting, of a new clone, 6:O13:B, at the end of 1993 and its predominance through 1994 is discussed. Among 15 strains isolated from neonates, 6 (40%) belonged to the same clone, 2:O4:A. Interestingly, this clone was almost all recovered in neonatal intensive care unit, nursery and in pediatric unit. All strains were susceptible to imipenem and polymyxcin B. Multiresistant strains (up to 12 antimicrobial agents) accounted for 66.7% and 84.8% of the strains isolated in 1993 and in 1994, respectively.

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