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Abstract Introduction: Sensitization to human leukocyte antigen is a barrier to. Few data have been published on desensitization using polyvalent human intravenous immunoglobulin (IVIG) alone. Methods: We retrospectively reviewed the of 45 patients with a positive complement-dependent cytotoxicity crossmatch (CDCXM) or flow cytometry crossmatch (FCXM) against living donors from January 2003 to December 2014. Of these, 12 were excluded. Patients received monthly IVIG infusions (2 g/kg) only until they had a negative T-cell and B-cell FCXM. Results: During the 33 patients, 22 (66.7%) underwent living donor kidney transplantation, 7 (21.2%) received a deceased donor graft, and 4 (12.1%) did not undergo transplantation. The median class I and II panel reactive antibodies for these patients were 80.5% (range 61%-95%) and 83.0% (range 42%-94%), respectively. Patients (81.8%) had a positive T-cell and/or B-cell CDCXM and 4 (18.2%) had a positive T-cell and/or B-cell FCXM. Patients underwent transplantation after a median of 6 (range 3-16). The median donor-specific antibody mean fluorescence intensity sum was 5057 (range 2246-11,691) before and 1389 (range 934-2492) after desensitization (p = 0.0001). Mean patient follow-up time after transplantation was 60.5 (SD, 36.8) months. Nine patients (45.0%). Death-censored graft survival at 1, 3, and 5 years after transplant was 86.4, 86.4, and 79.2%, respectively and patient survival was 95.5, 95.5, and 83.7%, respectively. Conclusions: Desensitization using IVIG alone is an effective strategy, allowing successful transplantation in 87.9% of these highly sensitized patients.
Resumo Introdução: Sensibilização HLA é uma barreira ao transplante em pacientes sensibilizados. Há poucos dados publicados sobre dessensibilização utilizando somente imunoglobulina intravenosa humana polivalente (IgIV). Métodos: Revisamos retrospectivamente prontuários de 45 pacientes com prova cruzada positiva por citotoxicidade dependente do complemento (CDCXM) ou citometria de fluxo (FCXM) contra doadores vivos, de Janeiro/2003-Dezembro/2014. Destes, excluímos 12. 33 pacientes receberam infusões mensais de IgIV (2 g/kg) apenas até apresentarem FCXM células T e B negativa. Resultados: Durante dessensibilização, 22 pacientes (66,7%) realizaram transplante renal com doador vivo, 7 (21,2%) receberam enxerto de doador falecido, 4 (12,1%) não realizaram transplante. A mediana do painel de reatividade de anticorpos classes I e II para estes pacientes foi 80,5% (intervalo 61%-95%) e 83,0% (intervalo 42%-94%), respectivamente. 18 pacientes (81,8%) apresentaram CDCXM célula T e/ou B positiva; 4 (18,2%) apresentaram FCXM célula T e/ou B positiva. Pacientes realizaram transplante após mediana de 6 (intervalo 3-16) infusões. A mediana da somatória da intensidade média de fluorescência do anticorpo específico contra o doador foi 5057 (intervalo 2246-11.691) antes e 1389 (intervalo 934-2492) após dessensibilização (p = 0,0001). O tempo médio de acompanhamento do paciente pós transplante foi 60,5 (DP, 36,8) meses. Nove pacientes (45,0%) não apresentaram rejeição e 6 (27,3%) apresentaram rejeição mediada por anticorpos. Sobrevida do enxerto censurada para óbito em 1, 3, 5 anos após transplante foi 86,4; 86,4; 79,2%, respectivamente, e sobrevida do paciente foi 95,5; 95,5; 83,7%, respectivamente. Conclusões: Dessensibilização utilizando apenas IgIV é uma estratégia eficaz, permitindo transplante bem-sucedido em 87,9% destes pacientes altamente sensibilizados.
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Background: Atypical hemolytic uremic syndrome (aHUS) is an ultra-rare disease. Therefore, studies involving large samples are scarce, making registries powerful tools to evaluate cases. We present herein the first analysis of the Brazilian aHUS Registry (BRaHUS). Methods: Analysis of clinical, laboratory, genetic and treatment data from patients inserted in the BRaHUS, from 2017 to 2020, as an initiative of the Rare Diseases Committee of the Brazilian Society of Nephrology. Results: The cohort consisted of 75 patients (40 adults and 35 pediatric). There was a predominance of women (56%), median age at diagnosis of 20.7 years and a positive family history in 8% of cases. Renal involvement was observed in all cases and 37% had low C3 levels. In the <2 years of age group, males were predominant. Children presented lower levels of hemoglobin (P = .01) and platelets (P = .003), and higher levels of lactate dehydrogenase (LDH) (P = .004) than adults. Genetic analysis performed in 44% of patients revealed pathogenic variants in 66.6% of them, mainly in CFH and the CFHR1-3 deletion. Plasmapheresis was performed more often in adults (P = .005) and 97.3% of patients were treated with eculizumab and its earlier administration was associated with dialysis-free after 3 months (P = .08). Conclusions: The cohort of BRaHUS was predominantly composed of female young adults, with renal involvement in all cases. Pediatric patients had lower hemoglobin and platelet levels and higher LDH levels than adults, and the most common genetic variants were identified in CFH and the CFHR1-3 deletion with no preference of age, a peculiar pattern of Brazilian patients.
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O Brasil convive com grande número de pessoas em situação de rua, e esses indivíduos têm, na prática, direitos básicos limitados, a despeito da existência da Política Nacional para População em Situação de Rua desde 2014. A condição de vulnerabilidade em que vivem aumenta os riscos sanitários a que estão expostos. Muitas vezes, esses indivíduos, acompanhando uma tendência da sociedade contemporânea, têm em sua companhia animais domésticos, como os cães. Desse modo, o objetivo do presente trabalho foi buscar entender essa relação entre os indivíduos em situação de rua e seus cães. Trata-se de um trabalho desenvolvido com metodologia qualitativa, exploratória e descritiva, em que foram utilizadas entrevistas semiestruturadas. Os resultados encontrados denotam a importância que os cães têm para os indivíduos em situação de rua, que envolve a melhoria da segurança, da autoestima, da estabilidade emocional e da responsabilização, além da afetividade. Desse modo, pode-se concluir que essa relação pode ser o primeiro passo para a reinserção desses indivíduos na sociedade, que até então não os vê, ou os vê de maneira estigmatizada e pejorativa.
Brazil coexists with a great number of homeless people and these individuals have, effectively, limitedbasic rights, despite de existence of the National Policy for the Homeless People since 2014.Thevulnerable condition they live in increases the sanitary risks to which they are exposed. Many times theseindividuals have in their company domestic pets like dogs. In this way, the objective of this project was toestablish an understanding of the relationship between these individuals and their dogs. This project wasdeveloped with a qualitative, exploratory and descriptive methodology in which were used semi-structured interviews. The results found indicate the importance the dogs have for these individuals, whichinvolves improvement in security, self-esteem, emotional stability, as well as affection. Therefore, it canbe concluded thatthis relationship can be the first step to the reinsertion of these individuals in society,that until now does not see them, or sees them in a stigmatized and pejorative manner.
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Pessoas Mal Alojadas , Animais de EstimaçãoRESUMO
INTRODUCTION: Sensitization to human leukocyte antigen is a barrier to. Few data have been published on desensitization using polyvalent human intravenous immunoglobulin (IVIG) alone. METHODS: We retrospectively reviewed the of 45 patients with a positive complement-dependent cytotoxicity crossmatch (CDCXM) or flow cytometry crossmatch (FCXM) against living donors from January 2003 to December 2014. Of these, 12 were excluded. Patients received monthly IVIG infusions (2 g/kg) only until they had a negative T-cell and B-cell FCXM. RESULTS: During the 33 patients, 22 (66.7%) underwent living donor kidney transplantation, 7 (21.2%) received a deceased donor graft, and 4 (12.1%) did not undergo transplantation. The median class I and II panel reactive antibodies for these patients were 80.5% (range 61%-95%) and 83.0% (range 42%-94%), respectively. Patients (81.8%) had a positive T-cell and/or B-cell CDCXM and 4 (18.2%) had a positive T-cell and/or B-cell FCXM. Patients underwent transplantation after a median of 6 (range 3-16). The median donor-specific antibody mean fluorescence intensity sum was 5057 (range 2246-11,691) before and 1389 (range 934-2492) after desensitization (p = 0.0001). Mean patient follow-up time after transplantation was 60.5 (SD, 36.8) months. Nine patients (45.0%). Death-censored graft survival at 1, 3, and 5 years after transplant was 86.4, 86.4, and 79.2%, respectively and patient survival was 95.5, 95.5, and 83.7%, respectively. CONCLUSIONS: Desensitization using IVIG alone is an effective strategy, allowing successful transplantation in 87.9% of these highly sensitized patients.
Assuntos
Imunoglobulinas Intravenosas , Transplante de Rim , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Doadores Vivos , Estudos Retrospectivos , Rejeição de Enxerto/prevenção & controle , Anticorpos , Sobrevivência de EnxertoRESUMO
As feridas neoplásicas são formadas a partir de uma proliferação descontrolada das células tumorais e sua infiltração nas estruturas da pele, sendo a meta principal do cuidado o conforto do paciente a partir do manejo dos sintomas físicos e psicossociais. Este estudo inovador teve como objetivo analisar a implementação da Teoria do Conforto a partir da intervenção clínica de desbridamento no cuidado de enfermagem ao paciente com ferida neoplásica. Trata-se de uma pesquisa de método misto onde as abordagens quantitativa e qualitativa foram contempladas nas diferentes fases da pesquisa passando pela coleta, análise de dados e interpretação dos resultados. No primeiro momento foi desenvolvido um estudo piloto de um ensaio clínico randomizado e no segundo momento foram analisados os dados coletados durante o cuidado e registrados em um diário de campo. Após a aprovação pelo Comitê de Ética em Pesquisa sob o número de parecer 4.292.777, iniciou-se a coleta de dados em novembro de 2020 até novembro de 2021. Os participantes foram distribuídos de forma aleatória em dois grupos, Intervenção (Papaína 6%) e Controle (Gel de Carboximetilcelulose a 2%) por um tempo de seguimento de 12 semanas. Foi realizada uma análise descritiva dos dados baseada em distribuições de frequências e gráficos sendo a mediana a medida síntese principal utilizada. Os resultados apontam que nenhuma participante apresentou evolução positiva de melhora na quantidade de exsudato. No que se refere a variável dor, em termos medianos, houve melhora da dor ao longo das 12 avaliações. Quanto ao odor, pode-se afirmar que no global, houve evolução positiva de melhora do grau de odor das feridas das participantes. Os dados referentes à análise do desconforto mostram um aumento tanto da mediana, de 9,0 na primeira avaliação para 10,0 na segunda avaliação, quanto na média, que passou de 8,0 na primeira avaliação para 8,5 na segunda avaliação. Conclui-se que quanto ao desconforto, houve melhora do escore em apenas 20% das participantes. Com relação aos eventos adversos, o mais incidente e recorrente foi a hiperemia perilesional, que ocorreu para 60,0% das participantes em 64,3% das avaliações. O prurido tem um índice de recorrência igual a 54,2% e a maceração de 20,8%, estando presentes para 40,0% das participantes. O sangramento apresentou um índice de recorrência de 16,7%, estando presente em 20,0% das participantes, sendo induzido pelas remoções das gazes. A identificação das variáveis intervenientes, a partir dos dados coletados durante o cuidado, subsidiou a construção da Estrutura Taxonômica da Teoria de Conforto para pacientes com feridas neoplásicas. Esse produto técnico pode contribuir para a prática profissional, na orientação do enfermeiro para a elaboração do plano de cuidados baseado nas necessidades relatadas pelo paciente. A partir da construção da Estrutura Taxonômica foi possível elaborar um diagrama da Teoria do Conforto de Kolcaba aplicada ao paciente com ferida neoplásica. Na primeira etapa do estudo, apesar dos resultados da análise descritiva terem apontado indícios de benefícios no quesito dor e odor para as participantes no geral, os dados obtidos não mostraram significância suficiente para refutar ou aceitar as hipóteses formuladas. Cabe ressaltar que o número reduzido de participantes, imposto pela pandemia COVID-19, período em que ocorreu a coleta de dados, foi um fator de limitação para o desenvolvimento do estudo. Já na segunda etapa, a partir da análise das diferentes formas de conforto em seus diversos contextos, há indícios favoráveis de que a intervenção clínica de desbridamento é efetiva para o alivio, relaxamento ou transcendência do paciente com ferida neoplásica, à luz da Teoria do Conforto. Este estudo mostra-se relevante ao contribuir com evidencias científicas que podem apoiar um cuidado de enfermagem de qualidade ao paciente com ferida neoplásica tendo em vista a expectativa de aumento no número destas lesões concomitante a um aumento na estimativa do número de casos de câncer. Ao contribuir na formação de profissionais qualificados, integra-se às ações de controle do câncer que propõe um cuidado integral a este paciente, impactando ainda nos custos da assistência de enfermagem. A complexidade desta situação associado ao sofrimento imposto a esta parcela da população demanda uma urgência na implementação de intervenções efetivas e seguras e neste sentido este estudo mostra-se relevante em seu aspecto inovador ao buscar associar uma tecnologia técnica de enfermagem ao conforto do paciente com ferida neoplásica.
Neoplastic wounds develop from an uncontrolled proliferation of tumor cells with infiltration into the skin structures. The main goal of wound care is patient comfort by managing physical and psychosocial symptoms. The objective of this innovative study was to analyze the implementation of the Comfort Theory, drawing on clinical intervention of debridement in nursing care to neoplastic wound patient. This was a mixed method research with quantitative and qualitative approaches contemplated in the various phases of collection, data analysis and interpretation of outcomes. In the first stage, a pilot study of a randomized clinical trial was developed; in the second stage, there was the analysis of data collected during care, which were registered in a field diary. The research was approved by the Research Ethics Committee, under the Opinion Nº 4.292.777. Data collection was conducted from November 2020 to November 2021. The participants were randomly distributed in two groups, Intervention (papain 6%) and Control (Carboxymethyl Cellulose gel 2%), for care continuity of 12 weeks. The descriptive analysis of data was performed based on distribution of frequencies and graphics, with the median used as main synthesis measure. The outcomes point that no participant presented a positive improvement evolution of exudate amount. Regarding the variable pain, in median terms, there was pain improvement during the 12 assessments. Regarding odor, it can be stated that globally there was a positive improvement evolution of the degree of odor of the participants' wounds. Data referring to the analysis of discomfort show an increase of the median, of 9.0 in the first assessment to 10.0 in the second assessment, and of the average, of 8.0 in the first assessment to 8.5 in the second assessment. The conclusion was that in terms of discomfort, there was score improvement in only 20% of participants. In relation to adverse events, the most incident and recurrent was perilesional hyperemia, which occurred for 60.0% of participants in 64.3% of assessments. Itching had a recurrence rate of 54.2% and necrosis of 20.8%, being present in 40.0% of participants. Bleeding presented a recurrence rate of 16.7%, being present in 20.0% of participants, induced by gauze removal. The identification of intervening variables drawing on data collected during care subsidized the construction of the Taxonomic Structure of the Comfort Theory for patients with neoplastic wounds. This technical product can contribute to the professional practice, in guiding the nurse on the elaboration of a plan of care based on the needs reported by the patient. From the construction of the Taxonomic Structure, it was possible to develop a diagram of the Kolcaba's Comfort Theory applied to the patient with neoplastic wound. In the first stage of the study, although the results of the descriptive analysis had pointed indication of benefits in the aspects of pain and odor for participants in general, the data obtained did not show sufficient significance to refute or accept the formulated hypotheses. A limiting factor for the development of the study was the reduced amount of participants due to the Covid-19 pandemic, period when data collection took place. In the second stage, drawing on the analysis of different forms of discomfort in several contexts, there are favorable indications that clinical debridement intervention is effective for relief, ease or transcendence of the patient with neoplastic wound, in the light of the Comfort Theory. This study is relevant by contributing with scientific evidence that can give support to quality nursing care to patients with neoplastic wound, considering the probability of the increase in the number of lesions, concomitant with an estimated increase in the number of cancer cases. By contributing to the training of qualified professionals, this study is integrated to the actions of cancer control that propose patient integral care, with an impact on nursing care costs. The complexity of this situation, associated to the suffering imposed to this segment of the population, requires urgency in the implementation of effective and safe interventions. In this sense, this study is relevant in its innovative aspect by seeking to associate nursing technical technology to the comfort of the patient with neoplastic wound.
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Cuidados Paliativos , Ferimentos e Lesões , Papaína , Desbridamento , Conforto do Paciente , Cuidados de EnfermagemRESUMO
In this report, physical and chemical properties, and total arsenic (As) concentrations were analyzed in agricultural (MASE) and mining soils (SMI) in the State of Guanajuato, México. Additionally, a metagenomic analysis of both types of soils was the bases for the identification and selection of bacteria and fungi resistant to As. The SMI soil showed higher concentration of As (39 mg kg-1) as compared to MASE soil (15 mg kg-1). The metagenome showed a total of 175,240 reads from both soils. MASE soil showed higher diversity of bacteria, while the SMI soil showed higher diversity of fungi. 16S rRNA analysis showed that the phylum Proteobacteria showed the highest proportion (39.6% in MASE and 36.4% in SMI) and Acidobacteria was the second most representative (24.2% in SMI and 11.6% in MASE). 18S rRNA analysis, showed that the phylum Glomeromycota was found only in the SMI soils (11.6%), while Ascomycota was the most abundant, followed by Basidiomycota, and Zygomycota, in both soils. Genera Bacillus and Penicillium were able to grow in As concentrations as high as 5 and 10 mM, reduced As (V) to As (III), and removed As at 9.8% and 12.1% rates, respectively. When aoxB, arsB, ACR3(1), ACR3(2,) and arrA genes were explored, only the arsB gene was identified in Bacillus sp., B. simplex, and B. megaterium. In general, SMI soils showed more microorganisms resistant to As than MASE soils. Bacteria and fungi selected in this work may show potential to be used as bioremediation agents in As contaminated soils.
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Arsênio/toxicidade , Bactérias/genética , Biodiversidade , Fungos/genética , Microbiologia do Solo , Solo/química , Agricultura , Bactérias/classificação , Bactérias/efeitos dos fármacos , Fungos/classificação , Fungos/efeitos dos fármacos , Metagenoma , México , Microbiota/efeitos dos fármacos , Microbiota/genética , Mineração , RNA Ribossômico 16S/genética , Poluentes do Solo/análise , Poluentes do Solo/toxicidadeRESUMO
ABSTRACT Objective: To reflect on the possible connections between Katharine Kolcaba's Theory of Comfort and Cicely Saunders's concept of Total Pain and the implications to the care of the oncology palliative care patient. Method: Theoretical reflection based on a literature review carried out in May 2020, in the PubMed and LILACS databases, which sought to answer the question: "Are there any theoretical-conceptual connections between Kolcaba's Theory of Comfort and the concept of Total Pain by Saunders?" Results: The knowledge of the concepts presented allows redirecting the focus of care towards individualized actions to strengthen the patient and his participation in the choices of comfort interventions. Conclusion: Understanding the connections between the concept and theory presented provides the patient in oncology palliative care with individualized and qualified care, focused on the person and not on the disease and can contribute to a greater effectiveness of nursing interventions aimed at the relief of suffering.
RESUMEN Objetivo: Reflexionar acerca de las posibles conexiones entre la Teoría del Confort de Katharine Kolcaba, el concepto de Dolor Total de Cicely Saunders y sus implicaciones para la atención al paciente en cuidados paliativos oncológicos. Método: Estudio teórico-reflexivo basado en una revisión de la literatura realizada en mayo de 2020, en las bases de datos PubMed y LILACS, que buscaba dar respuesta a la pregunta: "Existen conexiones teórico-conceptuales entre la Teoría del Confort de Kolcaba y el concepto de Dolor Total de Saunders?" Resultados: El conocimiento de los conceptos presentados permite reorientar el foco de atención hacia acciones individualizadas para fortalecer al paciente y su participación en las elecciones de intervenciones de confort. Conclusiones: La comprensión de las conexiones entre el concepto y la teoría presentada proporciona al paciente en cuidados oncológicos paliativos un cuidado individualizado y calificado, enfocado en la persona y no en la enfermedad y puede contribuir a una mayor resolución de las intervenciones de enfermería orientadas al alivio del sufrimiento.
RESUMO Objetivo: Refletir sobre possíveis conexões entre a Teoria do Conforto de Katharine Kolcaba e o conceito de Dor Total de Cicely Saunders e suas implicações no cuidado ao paciente em cuidados paliativos oncológicos. Método: Estudo teórico-reflexivo baseado em revisão de literatura realizada em maio de 2020, nas bases de dados PubMed e LILACS que buscou responder à questão: "Existem conexões teórico-conceituais entre a Teoria do Conforto de Kolcaba e o conceito de Dor Total de Saunders?" Resultados: O conhecimento dos conceitos apresentados permite redirecionar o foco do cuidado para ações individualizadas com fortalecimento do paciente e sua participação nas escolhas das intervenções de conforto. Conclusões: Compreender as conexões entre o conceito e teoria apresentados proporciona ao paciente em cuidados paliativos oncológicos um cuidado individualizado e qualificado, focado na pessoa e não na doença podendo contribuir para uma maior resolutividade das intervenções de enfermagem direcionadas para o alívio do sofrimento.
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During the Covid-19 pandemic, the issue is how to maintain adequate care for people with other diseases. In this document, the SBN Rare Diseases Committee (COMDORA) gives some guidelines on the care of patients with rare kidney diseases. These patients should follow the recommendations for the general population, bearing in mind that, as they have chronic kidney disease, they are included in the risk group for more serious outcomes if they develop Covid-19. Non-essential decision-making procedures should be postponed. In stable cases under appropriate treatment, we must choose to contact our patients remotely, using teleconsultations and home exam collections (if possible). In the presence of a symptom or sign of decompensation of the underlying disease, or infection with Sars-cov-2, advise the patient to seek medical assistance. The patient should not be waiting to get worse. Changes to the prescription should only be made on a scientific basis. Dosage suspension or change is not recommended, even in cases in which the patient needs to go to a center to receive his medication; in this case, the infusion center must follow the recommendations of the Ministry of Health. If the patient develops Covid-19 and uses any drugs, check the need for dose adjustment of the routine medications. Avoid the use of antimetabolics and anti-CD20 in patients with Covid-19, as they reduce viral clearance and predispose to bacterial infections. Contact between the patient and the medical team is essential; changes are recommended only with specialized medical guidance.
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Betacoronavirus , Infecções por Coronavirus/epidemiologia , Nefropatias/terapia , Pneumonia Viral/epidemiologia , Doenças Raras/terapia , Brasil , COVID-19 , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Interações Medicamentosas , Humanos , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde , Pneumonia Viral/diagnóstico , Pneumonia Viral/tratamento farmacológico , SARS-CoV-2 , Avaliação de SintomasRESUMO
A rash is a disseminated eruption of cutaneous lesions with great variation in appearance, cause, and severity. When the physician is facing a rash, the history and physical examination of the patient are extremely important for the identification of the disease and its causal agent. There are various causes for a rash, which may be infectious, allergic, or rheumatologic, besides many others. Rashes associated with mucosal ulcers may have causes related to viral and bacterial infections or drug reactions. They may be associated with measles; erythema infectiosum; roseola infantum; rubella; hand, foot, and mouth disease; pityriasis rosea; dengue fever; chikungunya; zika; scarlet fever; meningococcal diseases; syphilis; and exanthematous drug eruptions.
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Infecções Bacterianas/complicações , Exantema/etiologia , Exantema/microbiologia , Mucosa/patologia , Úlcera/etiologia , Úlcera/microbiologia , Viroses/complicações , Infecções Bacterianas/patologia , Exantema/patologia , Humanos , Úlcera/patologia , Viroses/patologiaRESUMO
ABSTRACT During the Covid-19 pandemic, the issue is how to maintain adequate care for people with other diseases. In this document, the SBN Rare Diseases Committee (COMDORA) gives some guidelines on the care of patients with rare kidney diseases. These patients should follow the recommendations for the general population, bearing in mind that, as they have chronic kidney disease, they are included in the risk group for more serious outcomes if they develop Covid-19. Non-essential decision-making procedures should be postponed. In stable cases under appropriate treatment, we must choose to contact our patients remotely, using teleconsultations and home exam collections (if possible). In the presence of a symptom or sign of decompensation of the underlying disease, or infection with Sars-cov-2, advise the patient to seek medical assistance. The patient should not be waiting to get worse. Changes to the prescription should only be made on a scientific basis. Dosage suspension or change is not recommended, even in cases in which the patient needs to go to a center to receive his medication; in this case, the infusion center must follow the recommendations of the Ministry of Health. If the patient develops Covid-19 and uses any drugs, check the need for dose adjustment of the routine medications. Avoid the use of antimetabolics and anti-CD20 in patients with Covid-19, as they reduce viral clearance and predispose to bacterial infections. Contact between the patient and the medical team is essential; changes are recommended only with specialized medical guidance.
RESUMO Durante a pandemia da Covid-19, fica a questão de como manter o atendimento adequado aos portadores de outras doenças. O Comitê de Doenças Raras (COMDORA) da SBN neste documento dá algumas orientações ao atendimento de pacientes com doenças renais raras. Estes pacientes devem seguir as recomendações destinadas à população geral tendo em mente que, por serem portadores de doença renal crônica, estão incluídos no grupo de risco para desfechos mais graves, caso venham a desenvolver a Covid-19. Procedimentos não essenciais para tomada de decisão devem ser adiados. Deve-se optar por contatos a distância, como teleconsultas, e coletas de exames domiciliares (se possível) nos casos estáveis sob tratamento adequado. Na presença de sintoma ou sinal de descompensação da doença de base ou infecção pelo Sars-cov-2, orientar o paciente a procurar a equipe médica. O paciente não deve ficar esperando o quadro agravar-se. Alterações na prescrição só devem ser feitas com embasamento científico. Não se recomenda a suspensão ou alteração posológica, mesmo nos casos em que o paciente necessita ir a um centro para receber sua medicação; neste caso o centro de infusão deve seguir as recomendações do Ministério da Saúde. Caso o paciente desenvolva a Covid-19 e faça uso de alguma droga, verificar a necessidade de ajuste nas doses dos medicamentos rotineiros. Evitar o uso de antimetabólicos e antiCD20 nos pacientes com a Covid-9, por reduzirem o clareamento viral e predisporem a infecções bacterianas. O contato entre paciente e equipe médica é essencial; alterações são recomendadas apenas com orientação médica especializada.
Assuntos
Humanos , Pneumonia Viral/epidemiologia , Doenças Raras/terapia , Betacoronavirus , Nefropatias/terapia , Pneumonia Viral/diagnóstico , Pneumonia Viral/tratamento farmacológico , Brasil , Aceitação pelo Paciente de Cuidados de Saúde , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Interações Medicamentosas , Pandemias , Avaliação de Sintomas , SARS-CoV-2 , COVID-19RESUMO
BACKGROUND: BK polyomavirus (BKPyV)-associated nephropathy (BKPyVAN) is a consequence of BKPyV replication in the urinary tract in kidney transplant recipients (KTR). OBJECTIVES: The objectives were to determine the prevalence of BKPyV replication and BKPyVAN, risk factors associated to sustained viremia and BKPyVAN, and viremia cut-off that best predict the occurrence of sustained viremia and nephropathy in KTR of a single University Hospital Kidney Transplant Center. PATIENTS AND METHODS: All KTR undergoing transplantation from August 2010 to December 2011 were enrolled and monitored up to 2 years posttransplantation for BKPyV viruria by decoy cells shedding or polymerase chain reaction (PCR) and viremia by PCR. Kidney biopsy was indicated if sustained viremia (two or more viremia above 10 000 copies/mL) to confirm BKPyVAN diagnosis. RESULTS: In this study, 326 transplants were performed and 246 patients were included. Prevalence of viruria was 36.9%, viremia 22.3% and nephropathy 3.2%. Male gender was the only risk factor associated to sustained viremia or nephropathy. Cut-off value of viremia that best discriminates the progression to sustained viremia and to BKPyVAN was 37 488 and 44 956 copies/mL, respectively. CONCLUSIONS: Prevalence of viruria, viremia, and nephropathy were similar to those reported in literature but the cut-off value of viremia that best discriminates the risk of progression to nephropathy was greater than the value usually reported, which is 10 000 copies/mL.
Assuntos
Vírus BK/isolamento & purificação , Nefropatias/epidemiologia , Infecções por Polyomavirus/epidemiologia , Infecções Tumorais por Vírus/epidemiologia , Viremia/diagnóstico , Adolescente , Adulto , Idoso , Vírus BK/fisiologia , Biópsia , DNA Viral/isolamento & purificação , Progressão da Doença , Feminino , Rejeição de Enxerto/sangue , Rejeição de Enxerto/epidemiologia , Rejeição de Enxerto/patologia , Rejeição de Enxerto/virologia , Humanos , Terapia de Imunossupressão/efeitos adversos , Terapia de Imunossupressão/métodos , Rim/patologia , Rim/virologia , Nefropatias/diagnóstico , Nefropatias/patologia , Nefropatias/virologia , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Infecções por Polyomavirus/diagnóstico , Infecções por Polyomavirus/patologia , Infecções por Polyomavirus/virologia , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Fatores de Risco , Infecções Tumorais por Vírus/diagnóstico , Infecções Tumorais por Vírus/patologia , Infecções Tumorais por Vírus/virologia , Viremia/epidemiologia , Viremia/virologia , Adulto JovemRESUMO
The impact of the kinetics of the anti-HLA antibodies after KTx on the occurrence of acute rejection as well as the better time-point to monitor anti-HLA Abs after transplantation is not completely defined. This prospective study followed 150 patients over 12 months after transplantation. Serum IgG anti-HLA Abs were detected by single antigen beads after typing donors and recipients for loci A, B, C, DR, and DQ. Before KTx, 89 patients did not present anti-HLA Abs and 2% developed "de novo" Abs during the 1st year, 39 patients were sensitized without DSAs, and 13% developed DSA after surgery; all of them presented ABMR. Sensitized patients presented higher acute rejection rates (36.4% versus 13.5%, p < 0.001), although 60% of the patients did not present ABMR. Patients, in whom DSA-MFI decreased during the first two weeks after surgery, did not develop ABMR. Those who sustained their levels presented a rate of 22% of ABMR. 85% of patients developed ABMR when MFIs increased early after transplantation (which occurred in 30% of the DSA positive patients). In the ABMR group, we observed an iDSA-MFI sharp drop on the fourth day and then an increase between the 7th and 14th POD, which suggests DSA should be monitored at this moment in sensitized patients for better ABMR prediction.
RESUMO
Dermatologists must be familiar with the peculiarities of the micro-organisms that may affect the elderly, in order to optimize the diagnosis and treatment of infections, which may affect their skin, especially because the world population is rapidly aging. It is estimated that there will be 434 million individuals over 80 years of age in 2050. Since the elderly population is rapidly increasing and their infections are usually more severe and different from those observed in younger adults, it leads to a statistical increase of the rates regarding hospitalization and mortality caused by infectious diseases among people over 85 years. Other health issues may be involved in the older population. These include nutritional alterations, as malnutrition or obesity, which can aggravate the infections. Also the usual signs and symptoms of infection are subtle or uncharacteristic in elderly patients, and frequently, they are unable to report their symptoms, which can delay the diagnosis. Among the many infections that may affect the elderly we reviewed the most frequent and those that are different in this age group, as herpes zoster, cytomegalovirus, herpes simplex, bacterial skin infections, erysipelas, celullitis, impetigo, folliculitis, furunculosis and carbunculosis, secondary infections, intertrigo (body folds), fungal infection, and scabies.
Assuntos
Herpes Zoster/prevenção & controle , Dermatopatias Infecciosas/tratamento farmacológico , Dermatopatias Infecciosas/microbiologia , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Antifúngicos/uso terapêutico , Antivirais/uso terapêutico , Celulite (Flegmão)/diagnóstico , Celulite (Flegmão)/tratamento farmacológico , Dermatomicoses/diagnóstico , Dermatomicoses/microbiologia , Erisipela/diagnóstico , Foliculite/tratamento farmacológico , Foliculite/microbiologia , Herpes Zoster/tratamento farmacológico , Humanos , Intertrigo/microbiologia , Pessoa de Meia-Idade , Escabiose/diagnóstico , Escabiose/tratamento farmacológico , Dermatopatias Infecciosas/diagnóstico , Dermatopatias Infecciosas/virologiaRESUMO
The complete genome of a Trichoplusia ni granulovirus (TnGV) is described and analyzed. The genome contains 175,360 bp (KU752557), becoming the third largest genome within the genus Betabaculovirus, smaller only than the Xestia c-nigrum GV (XecnGV) (178,733 pb) and the Pseudaletia unipuncta GV (PsunGV) (176,677 pb) genomes. The TnGV genome has a 39.81% C+G content and a total of 180 ORFs were identified, 96 of them in the granulin gene direction and 84 in the opposite direction. A total of 94.38% of the ORFs showed high identity with those of ClanGV, HaGV, and SlGV. Eight homologous regions (hrs) were identified as well as one apoptosis inhibitor (IAP-3). Interestingly, three viral enhancing factors (VEFs) were located in TnGV genome: VEF-1 (orf153), VEF-3 (orf155), and VEF-4 (orf164), additional to another metalloprotease (orf37). Two ORFs were unique to TnGV (orf100 and orf101) and another one was shared by only TnGV and AgseGV (orf2). Eleven of the deduced proteins showed high identity with proteins from nucleopolyhedroviruses, three with proteins from ascoviruses, and one with an entomopoxvirus protein. The largest deduced protein contains 1,213 amino acids (orf43) and the smallest deduced protein contains only 50 amino acids (orf143). Sequence identity and phylogenetic analyses showed that the closest related genomes to TnGV are, to date, those of PsunGV and XecnGV. This genome analysis may contribute to functional research on TnGV, and may form the bases for the utilization of this betabaculovirus as a pest control agent.
Assuntos
Baculoviridae/classificação , Baculoviridae/genética , Genoma Viral , Genômica , Lepidópteros/virologia , Animais , Baculoviridae/isolamento & purificação , Composição de Bases , Fases de Leitura Aberta , Filogenia , Análise de Sequência de DNA , Homologia de Sequência , Sintenia , Proteínas Virais/genética , Fatores de Virulência/genéticaRESUMO
RESUMO Objetivo: identificar intervenções de enfermagem para o diagnóstico de odor fétido em ferida tumoral. Métodos: revisão integrativa da literatura realizada por meio das bases de dados MEDLINE, CINAHL, LILACS e Cochrane, que culminou com a seleção de 48 artigos científicos sobre a temática pesquisada. Resultados: com base nas evidências empíricas identificadas nos artigos incluídos no estudo, foram elaboradas 24 intervenções de enfermagem para o controle e a redução do odor fétido em feridas tumorais. Conclusão: as intervenções de enfermagem apresentadas neste estudo possibilitam a promoção da qualidade de vida ao paciente com ferida tumoral em cuidado paliativo. Como sugestão posterior ao Conselho Internacional de Enfermeiros, devem ser validadas clinicamente para que sua inserção seja feita no subconjunto terminológico cuidados paliativos para uma morte digna, da Classificação Internacional para a Prática de Enfermagem (CIPE®).
RESUMEN Objetivo: identificar intervenciones de enfermería para el diagnóstico de olor fétido en herida tumoral. Métodos: revisión integradora de la literatura a partir de las bases de datos MEDLINE, CINAHL, LILACS e Cochrane, que resultó en la selección de 48 artículos científicos acerca de la temática investigada. Resultados: con base en las evidencias empíricas identificadas en los artículos incluidos en el estudio, se elaboraron 24 intervenciones de enfermería para el control y la reducción del olor fétido en heridas tumorales. Conclusiones: las intervenciones de enfermería presentadas en el estudio posibilitan la promoción de la calidad de vida al paciente con herida tumoral en cuidado paliativo. Como sugerencia posterior al Consejo Internacional de Enfermeros, se deben validar clínicamente para que su inserción se realice en el subconjunto terminológico cuidados paliativos para una muerte digna, de la Clasificación Internacional para la Práctica de Enfermería (CIPE®).
ABSTRACT Objective: The objective of the study was to identify nursing interventions to diagnose foul odor from malignant wounds. Methods: An integrative review of the literature in the MEDLINE, CINAHL, LILACS and Cochrane databases resulted in the selection of 48 scientific articles on the subject. Results: Based on the empirical evidence found in the articles included in the study, 24 nursing interventions were developed to control and reduce foul odor from malignant wounds. Conclusions: The nursing interventions outlined in the study make it possible to improve the quality of life for patients in palliative care who have malignant wounds. A subsequent suggestion to the International Council of Nurses is that these interventions be clinically validated so they can be inserted into the subset of the International Classification of Nursing Practice (ICNP) concerning palliative care for a dignified death.
Assuntos
Humanos , Enfermagem Oncológica , Ferimentos e Lesões , Cuidados de Enfermagem , Cuidados PaliativosRESUMO
Resumo Objetivo Desenvolver e validar um subconjunto terminológico, utilizando a Classificação Internacional para Prática de Enfermagem para pacientes em cuidados paliativos com feridas tumorais malignas. Métodos Estudo metodológico com revisão integrativa da literatura, que busca evidências empíricas relacionadas às feridas tumorais malignas e intervenções de enfermagem para manejo dos sintomas, nas bases de dados MEDLINE, CINAHL, LILACS e COCHRANE, recorte temporal de 2002 a 2015. Após cruzamento das evidências com termos da CIPE® 2013, baseado no Modelo 7 Eixos, foram elaboradas declarações de diagnósticos e intervenções de enfermagem, distribuídas de acordo com necessidades humanas básicas do referencial conceitual de Wanda Horta e avaliadas por peritos. Resultados Das 51 afirmativas de diagnósticos e 134 intervenções de enfermagem, 84,31% e 91,04% foram validadas respectivamente, sendo elaborado o subconjunto. Conclusão O instrumento poderá constituir-se numa referência de fácil acesso para enfermeiros, propiciando um cuidado da ferida baseado em evidências e linguagem de enfermagem unificada.
Abstract Objective To develop and validate a terminological subgroup using the International Classification for Nursing Practice for palliative care patients with malignant tumor wounds. Methods A methodological study with an integrative literature review that searched empirical evidence related to malignant tumor wounds and nursing interventions for the management of symptoms in MEDLINE, CINAHL, LILACS and COCHRANE, time frame from 2002 to 2015. After crossing the evidence with 2013 ICNP® terms based on the Model 7 Axis, statements were prepared as diagnoses and nursing interventions, distributed according to basic human needs of the conceptual framework of Wanda Horta, and evaluated by experts. Results From 51 affirmative diagnoses and 134 nursing interventions, 84.31%, and 91.04% were validated, respectively, establishing the subgroup. Conclusion The instrument may constitute an easy access reference for nurses, providing wound care based on evidence and a unified nursing language.
RESUMO
The combination of immunosuppressive drugs is part of the treatment regimen of patients undergoing kidney transplantation (RT). Thymoglobulin®, a rabbit immunoglobulin directed against human thymocytes, is the most commonly agent used for induction therapy in RT in the US. In Brazil, Thymoglobulin® is approved by ANVISA for the use in patients who underwent kidney transplantation and despite being widely used, there are controversies regarding the drug administration. We prepared a systematic review of the literature, evaluating studies that used Thymoglobulin® for induction and for acute rejection treatment in patients undergoing RT. The review used the computadorized databases of EMBASE, LILACS and MedLine. Data were extracted from the studies concerning general features, methodological characteristics and variables analyzed in each study. From the results, a practical guide was prepared analyzing various aspects on the use of Thymoglobulin® in patients submitted to RT.
Assuntos
Soro Antilinfocitário/uso terapêutico , Rejeição de Enxerto/tratamento farmacológico , Rejeição de Enxerto/prevenção & controle , Imunossupressores/uso terapêutico , Transplante de Rim , Humanos , Guias de Prática Clínica como AssuntoRESUMO
Este estudo transversal, exploratório-descritivo, verificou a prevalência de Transtorno Mental e Comportamental (TMC) e percepção do suporte familiar em Policiais Civis de Santa Catarina, afastados do trabalho pela Perícia Médica do Estado, no período entre 2009 e 2010. Utilizaram-se na coleta de dados: a) planilha de dados de prevalência de TMC da Secretaria de Estado da Administração/SC; b) inventário de percepção de suporte familiar; c) investigação das dimensões desse suporte e do processo de adoecimento relacionado ao trabalho, na perspectiva do policial e do familiar. Os dados de prevalência referem-se aos afastamentos por TMC (n = 148) no período mencionado e os de suporte familiar, aos policiais (n = 19) e familiares (n = 13) participantes da entrevista. Detectou-se que, para cada 100 policiais, 4,6 foram afastados por TMC. A percepção do suporte familiar por parte dos policiais indicou ser ele um recurso importante durante o período de afastamento do trabalho, na recuperação e no retorno à atividade, corroborando a existência de uma associação inversa entre nível de apoio social e sofrimento psíquico. Conclui-se que o incentivo à valorização do suporte familiar e o estímulo às relações interpessoais na família, no trabalho e nas relações sociais ampliadas, tornam-se ferramentas importantes para a percepção de bem-estar e se relacionam com o aumento da satisfação de vida, da autoestima e, por consequência, contribuem para o controle dos sintomas...
This cross-sectional, exploratory, and descriptive study examined the prevalence of mental and behavioral disorder (MBD) and perception of family support in the civil police of Santa Catarina, signed off work by State medical experts during 20092010. The following were used in data collection: a) a datasheet of MBD prevalence from the State Department of Administration/SC; b) an inventory of perceived family support; c) inquiry about the dimensions of this support and the process of work-related illness from the perspective of police officers and their families. The prevalence data provide absence because of MBD (n = 148) in the specified period and the family support provided to police officers (n = 19) and their families (n = 13) who participated in the interview. We found that, in every 100 police officers, 4.6 were absent because of MBD. The police officers' perception of family support indicated this to be an important resource during the period of absence from work, in recovery, and in returning to full activity, revealing an inverse association between the level of social support and psychological distress. It was concluded that the incentive value of family support and the encouragement of interpersonal relationships in the family, at work, and in extended social relations are important tools for the perception of well-being and are associated with an improved life satisfaction and self-esteem, contributing to symptom control...
Este estudio transversal, exploratorio-descriptivo, verificó la prevalencia de Trastorno Mental y del Comportamiento (TMC) y la percepción de soporte familiar en Policías Civiles de Santa Catarina, incapacitados por la Pericia Médica del Estado entre 2009 y 2010. Para la toma de datos fueron utilizados a) Banco de datos de prevalencia de TMC de la Secretaría de Estado de la Administración/SC; b) inventario de percepción de soporte familiar; c) investigación de las dimensiones de ese soporte y del proceso de enfermedad relacionado al trabajo, en la perspectiva del policía y del familiar. Los datos de prevalencia se refieren a las incapacidades por TMC (n=148) en el periodo mencionado y, los de soporte familiar a los policías (n=19) y familiares (n=13) que participaron en la entrevista. Se encontró que 4,6 de cada 100 policías fueron incapacitados por TMC. La percepción del soporte familiar por parte de los policías indicó que éste es un recurso importante durante el periodo de incapacidad laboral, en la recuperación y en el retorno al trabajo, corroborando la existencia de una asociación inversa entre el nivel de apoyo social y el sufrimiento psíquico. Se concluye que el incentivo a la valorización del soporte familiar y el estímulo a las relaciones interpersonales en la familia, en el trabajo y en las relaciones sociales ampliadas, se convierten en herramientas importantes para la percepción de bienestar y se relacionan con una mayor satisfacción de la vida, de la autoestima y, por consecuencia, contribuyen para el control de los síntomas...