Francisco Sandro Menezes-Rodrigues

Background/Objectives: Plinia peruviana (Myrtaceae), commonly known as jabuticabeira, is a fruit-bearing species native to Brazil and traditionally used for gastrointestinal disorders. The present study evaluated the gastroprotective potential of P. peruviana juice (SPP) and elucidated its underlying mechanisms. Methods: SPP was obtained by manual pressing of peeled fruits, followed by lyophilization. Following chemical characterization, gastroprotective activity was assessed in Swiss mice (Mus musculus) using ethanol, acidified ethanol, and indomethacin-induced gastric injury models. SPP was administered orally at doses of 100, 250, and 500 mg/kg. The roles of gastric mucus, sulfhydryl (SH) groups, nitric oxide (NO), α2-adrenergic receptors, prostaglandin E₂ (PGE₂), and myeloperoxidase (MPO) activity were investigated. Results: Chemical analysis identified caffeoylquinic acid, p-coumaric acid, ellagic acid, citric acid, (−)-epicatechin, myricetin, and trans-β-cryptoxanthin. SPP significantly reduced gastric lesion indices by 78.44%, 62.12%, and 52.88% in the ethanol model; 79.10%, 74.12%, and 37.72% in the acidified ethanol model; and 53.19%, 35.55%, and 22.84% in the indomethacin model at 100, 250, and 500 mg/kg, respectively. Mechanistic studies demonstrated increased mucus and PGE₂ production, SH group levels, NO signaling, and α2-adrenergic receptor involvement, as well as reduced MPO activity. Conclusions: SPP exhibits gastroprotective effects by enhancing mucosal defense mechanisms and modulating inflammatory and oxidative processes. These results support the biological potential of P. peruviana juice and its bioactive constituents as promising gastroprotective agents.

Proton pump inhibitors (PPIs) are widely prescribed for acid-related disorders and are generally considered safe for short-term use. However, increasing experimental and clinical evidence suggests potential cardiovascular effects associated with chronic exposure, possibly related to endothelial dysfunction and impaired nitric oxide bioavailability. Therefore, we decided to investigate whether the cardiovascular effects of omeprazole are dependent on the timing of administration in a model of cardiac ischemia–reperfusion (CIR) in normotensive Wistar rats (NWR) and spontaneously hypertensive rats (SHR). Twelve- to sixteen-week-old male NWR and SHR were allocated into four groups: (1) SHAM: NWR and SHR were submitted to surgery with no ischemia; (2) (SS + CIR): NWR and SHR were treated with a 0.9% saline solution and submitted to CIR; and (3) (OME + ISQ): NWR and SHR were treated with 10 mg/kg i.v. omeprazole (OME) before cardiac ischemia and submitted to CIR or (4) after cardiac ischemia but before cardiac reperfusion (ISQ + OME). Electrocardiograms were monitored to assess ventricular arrhythmias (VA), atrioventricular block (AVB), and lethality (LET). Serum creatine kinase-MB (CK-MB) levels were quantified, and histopathological analyses were performed to evaluate the degree of myocardial injury in the different study groups. Administration of OME prior to cardiac ischemia increased the incidence of VA, AVB, LET, and serum CK-MB levels in both NWR and SHR. In contrast, administration before cardiac reperfusion did not exacerbate cardiac injury and was associated with the attenuation of electrophysiological instability. Histopathological findings corroborated the biochemical and functional outcomes. OME, when administered prior to cardiac ischemia, worsens both cardiac arrhythmias and myocardial injury; however, administration immediately prior to cardiac reperfusion does not increase cardiac arrhythmias and decreases myocardial injury in both NWR and SHR.

SUMMARY OBJECTIVE: To develop a national consensus catalog of essential psychomotor competencies and establish the minimum expected competence levels for graduating medical students across anesthesiology and surgical specialties in Brazil using a modified Delphi process. METHODS: This national consensus-development study used a two-round modified Delphi process coordinated by the Brazilian Medical Association. Scientific Committees representing anesthesiology and 14 surgical specialty societies developed preliminary specialty-specific catalogs and proposed the expected competence level for each competency. Board-certified specialists evaluated the competency–competence-level combinations using a five-point Likert scale. Consensus was predefined as ≥75% combined agreement. RESULTS: A total of 802 specialists participated in the first Delphi round, and 622 completed the second round. The preliminary catalogs comprised 343 competency statements. Of these, 273 (79.6%) achieved consensus, whereas 70 (20.4%) were excluded. During the first Delphi round, participants proposed 103 additional competency statements, of which 90 (87.4%) achieved consensus after evaluation during the second Delphi round. The final consensus catalog comprised 363 specialty-specific psychomotor competencies, corresponding to 244 unique psychomotor competencies after harmonization. Most competencies were classified as Perform independently (n=274), followed by Perform under supervision (n=55) and Master the technique (n=34). CONCLUSION: This modified Delphi study established a national consensus catalog of psychomotor competencies and expected competence levels for graduating medical students across anesthesiology and 14 surgical specialties. The catalogue provides a national consensus-based reference for competency-based undergraduate medical education. Future studies should evaluate its implementation and educational impact.

SUMMARY OBJECTIVE: To develop Part II of the National Consensus Catalogue of essential psychomotor competencies and establish the minimum expected competence levels for graduating medical students across 11 clinical and diagnostic support specialties in Brazil using a modified Delphi process. METHODS: This national consensus-development study used a two-phase, two-round modified Delphi process coordinated by the Brazilian Medical Association. Preliminary specialty-specific catalogues were developed between February and June 2025 by Scientific Committees from 11 specialty societies, which also proposed the minimum expected competence level for each psychomotor competency statement. Round 1 of the modified Delphi process was conducted from August to December 2025, and Round 2 was conducted from February to June 2026. Board-certified physicians evaluated each competency-competence level combination using a five-point Likert scale. Consensus was predefined as ≥75% agreement. Statements achieving <60% agreement were excluded after Round 1, whereas those achieving 60.0–74.9% agreement were revised and reassessed in Round 2. Additional competency statements proposed during Round 1 were evaluated in Round 2. RESULTS: A total of 667 physicians participated in Round 1, and 499 completed Round 2. The preliminary catalogues comprised 346 psychomotor competency statements; 240 (69.4%) achieved consensus and 106 (30.6%) were excluded. Participants proposed 38 additional statements, of which 36 (94.7%) achieved consensus in Round 2. The Part II catalogue comprised 276 specialty-specific psychomotor competency statements, corresponding to 229 unique psychomotor competencies after harmonization. Most competency statements were classified as perform independently (n=195), followed by perform under supervision (n=62) and master the technique (n=19). CONCLUSION: This modified Delphi study established Part II of the National Consensus Catalogue of essential psychomotor competencies and minimum expected competence levels for graduating medical students, encompassing 11 clinical and diagnostic support specialties in Brazil.

Purpose: Although methylene blue (MB) has long been used to treat vasoplegic syndrome, its pharmacodynamics and cardiovascular effects remain unclear. Therefore, we decided to evaluate the potential molecular targets of MB through molecular docking and its cardioprotective and antioxidant actions. Methods: Adult male spontaneously hypertensive rats (SHR) were allocated into four groups: sham-operated; treated with vehicle and subjected to cardiac ischemia and reperfusion (CIR) (SS+CIR); treated with 2 mg/kg of MB before cardiac ischemia and reperfusion (MB+ISQ); and treated with 2 mg/kg of MB before cardiac reperfusion (ISQ+MB). The animals were monitored with electrocardiogram to assess the incidence of ventricular arrhythmias (VA), atrioventricular blocks (AVB), and lethality (LET). Blood samples and hearts were collected for histopathological analysis, serum creatine kinase MB dosage, and measurement of lipid hydroperoxide (LH) in myocardium serum creatine kinase MB. Results: The incidences of AVB and LET, serum CK-MB concentration, and myocardial injury increased in the MB+ISQ group, but not in the ISQ+MB group when compared with the SS+CIR group. LH concentration decreased in both MB-treated groups when compared with the SS+CIR group. Conclusion: These results indicate that MB produces a cardiotoxic effect only when administered before CIR, but not when administered before cardiac reperfusion.

Purpose: Hypothesis centered on the idea that ranolazine could induce responses similar to ischemic preconditioning, involving nitric oxide, adenosine, bradykinin, and adenosine triphosphate (ATP)-dependent potassium channels. Methods: Ischemia-reperfusion injury was established using Langendroff technique. Thirty-minute ischemia and 120-minute reperfusion to coronary artery to isolated heart were model of myocardial infarction. There were studied the following groups: control (ischemia-reperfusion), ischemic preconditioning, ranolazine (10 µmol/L), ranolazine + L-NAME (30 µmol/L) and ranolazine + aminoguanidine (30 µmol/L), ranolazine + theophylline (50 µmol/L), ranolazine + aminophylline (50 µmol/L), ranolazine + icatibantl (100 µmol/L), ranolazine + bromelain (250 µmol/L), ranolazine + 5-hydroxydecanoate (30 µmol/L), and ranolazine + glimepiride (50 µmol/L) in perfusate. Results: Ranolazine and ischemic preconditioning groups demonstrated cardioprotective effects by reducing infarct size, as well as levels of lactate dehydrogenase (LDH), creatine phosphokinase myoglobin (CK-MB), and troponin I and cardiac parameters like left ventricular developed pressure (LVDP) and left ventricular maximum rate of contraction (dP/dTmax). Maximum rate of relaxation (dP/dTmin) was improved. Conversely, treatments with L-NAME, aminoguanidine, theophylline, aminophylline, icatibant, bromelain, 5-hydroxydecanoate, and glimepiride increased infarct size, LDH, CK-MB, and troponin I levels, and cardiac parameters like LVDP, dP/dTmax, and dP/dTmin were depressed. This data provides evidence that ranolazine employs nitric oxide, adenosine, bradykinin, and ATP-dependent potassium channels as secondary messengers in cardioprotection. Conclusion: ranolazine can be a pharmacological alternative to surgical ischemic preconditioning utilized prior to interventional procedures like coronary artery bypass graft surgery and heart transplantation, offering improved patient compliance.

The most common cause of morbidity and death worldwide is acute myocardial infarction (AMI), which is typified by severe and deadly arrhythmias resulting from cardiac ischemia and reperfusion (CIR). We chose to investigate the possible cardioprotective activity of epiisopiloturine (EPI), an imidazole alkaloid presents in the leaves of Pilocarpus microphyllus, in an animal model of CIR in rats. Control rats were treated with 0.9% saline solution and then subjected to CIR (SS + CIR); they were compared to rats pretreated with either 10 mg/kg (EPI10 + CIR group) or 15 mg/kg EPI (EPI15 + CIR) before CIR. ECG analysis was used to assess the incidence of ventricular arrhythmias (VAs), atrioventricular block (AVB), and lethality (LET) brought on by CIR in these rats. Serum creatine kinase-MB (CK-MB) was assessed using a colorimetric assay. In comparison to the SS + CIR group, animals treated with EPI15 + CIR had lower AVB incidence, which decreased from 85.7% to 21.4%, while LET incidence decreased from 71.4% to 21.4%. In both EPI10 + CIR and EPI15 + CIR groups, serum CK-MB was lower than in SS + CIR positive controls. These findings suggest that administration of EPI (15 mg/kg) before CIR could reduce the incidences of AVB and LET, as well as cardiac injury markers, which suggests that, likely due to its antioxidant effects, EPI may be a promising drug to reduce LET in patients with severe and fatal arrhythmia due to AMI.

Background: The mechanisms underlying fibrinolysis failure in patients with STEMI who are undergoing a pharmacoinvasive strategy appear to be multifactorial and may be associated with the thrombus’s architecture and composition. Objective: We aimed to compare the thrombus composition in patients with STEMI who were undergoing rescue percutaneous coronary intervention (rPCI) versus primary PCI (pPCI) using optical microscopy (OM) and scanning electron microscopy (SEM). Methods: Fifty-three patients were prospectively enrolled, with twenty-five undergoing rPCI and twenty-eight undergoing pPCI. After thrombus aspiration, each harvested fragment was divided into two pieces: one was analyzed using OM with a 60× magnifying lens on hematoxylin–eosin-stained samples, and the other with SEM at 5000× magnification. Results: Patients who underwent rPCI had significantly higher C-reactive protein levels and a longer ischemic interval at admission compared to those treated with pPCI (9.92 h [range: 1.58–106.17] vs. 2.14 h [range: 0–48]; p < 0.001). Optical microscopy analysis revealed that thrombi from rPCI patients exhibited a significantly higher erythrocyte area percentage (18.36% [range: 0.3–50.08] vs. 0.91% [range: 0–70.1]; p = 0.001), a lower fibrin content as assessed by optical microscopy (79.49% [range: 49.2–98.25] vs. 94.43% [range: 29.19–99.92]; p = 0.006), and a greater amount of cholesterol crystals as measured by SEM (1.73 μm² [range: 0–18.51] vs. 0.08 μm² [range: 0–0.71]; p < 0.001). Conclusions: The thrombus composition of patients with STEMI who are undergoing rPCI had higher amounts of erythrocytes and cholesterol crystals and a lesser area occupied by fibrin compared to those undergoing pPCI. The composition of thrombi in rPCI could potentially contribute to the failure of fibrinolytic therapy within a pharmacoinvasive strategy.