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INTRODUCTION: In the current scenario, in which evidence-based medicine is almost obligatory, therapeutic approaches are increasingly being restricted to measures that are proven to bring benefits to the patient. Transfusion therapy follows the same concept. Even though it can be an essential support procedure in some situations, it must be carefully used, exclusively in situations in which the literature assures scientific support for its usage. Transfusion exposes patients to risks and complications, so it is necessary that we, as doctors, continue working to reduce possible mistakes involving the practice of this type of therapy. OBJECTIVE: To analyze if the red blood cell requests are properly made, analyzing the indication written on them (by the doctor, comparing them to the references in the actual literature. METHOD: In this research, we have analyzed and reviewed the requests for red blood cell concentrates between August and September of 2018 received at the Hematology and Hemotherapy Center studied to find the most common mistakes made by requesters/doctors. RESULTS: A total of 397 of the 754 analyzed requests were evaluated as inadequate. Therefore, 1 out of every 2 transfusions performed did not have their requests properly completed in the city of Cascavel, Paraná. CONCLUSIONS: The number of inappropriate requests was high during the studied period, especially when compared to studies available in the literature. The number of inadequacies suggests that the blood component requests and the subsequent evaluation by the transfusion agency needs to be better addressed in clinical practice.
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Abstract Introduction In the current scenario, in which evidence-based medicine is almost obligatory, therapeutic approaches are increasingly being restricted to measures that are proven to bring benefits to the patient. Transfusion therapy follows the same concept. Even though it can be an essential support procedure in some situations, it must be carefully used, exclusively in situations in which the literature assures scientific support for its usage. Transfusion exposes patients to risks and complications, so it is necessary that we, as doctors, continue working to reduce possible mistakes involving the practice of this type of therapy. Objective To analyze if the red blood cell requests are properly made, analyzing the indication written on them (by the doctor, comparing them to the references in the actual literature. Method In this research, we have analyzed and reviewed the requests for red blood cell concentrates between August and September of 2018 received at the Hematology and Hemotherapy Center studied to find the most common mistakes made by requesters/doctors. Results A total of 397 of the 754 analyzed requests were evaluated as inadequate. Therefore, 1 out of every 2 transfusions performed did not have their requests properly completed in the city of Cascavel, Paraná. Conclusions The number of inappropriate requests was high during the studied period, especially when compared to studies available in the literature. The number of inadequacies suggests that the blood component requests and the subsequent evaluation by the transfusion agency needs to be better addressed in clinical practice.
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Transfusão de Sangue , Erros Médicos , Serviço de Hemoterapia , Reação Transfusional , HematócritoRESUMO
Single nucleotide polymorphisms (SNPs) of BCL11A gene and HBS1L-MYB intergenic region (named HMIP-2) affect both fetal hemoglobin (HbF) concentration and clinical outcomes in patients with sickle cell anemia (SCA). However, no previous study has examined the interaction among these SNPs in the regulation of HbF. We examined whether HbF-boosting haplotypes combining alleles of functional SNPs of BCL11A and HMIP-2 were associated with clinical outcomes and hematological parameters, and whether they interact to regulate HbF in a cohort of Brazilian children with SCA. The minor haplotype of BCL11A ("TCA", an allele combination of rs1427407, rs766432, and rs4671393) was associated with higher HbF, hemoglobin and lower reticulocytes count compared to reference haplotype "GAG". The minor haplotype of HMIP-2 ("CGC", an allele combination of rs9399137, rs4895441, and rs9494145) was associated with higher HbF and hemoglobin compared to reference haplotype "TAT". Subjects carrying minor haplotypes showed reduced rate of clinical complications compared to reference haplotypes. Non-carriers of both minor haplotypes for BCL11A and HMIP-2 showed the lowest HbF concentration. Subjects carrying only the minor haplotype of BCL11A showed significantly higher HbF concentration than non-carriers of any minor haplotype, which showed no significant difference compared to subjects carrying only the minor haplotype of HMIP-2. Interestingly, subjects carrying both minor haplotypes of BCL11A ("TCA") and HMIP-2 ("CGC") showed significantly higher HbF levels than subjects carrying only the minor haplotype of BCL11A. Our novel findings suggest that HbF-boosting haplotypes of BCL11A and HMIP-2 can predict clinical outcomes and may interact to regulate HbF in patients with SCA.
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Anemia Falciforme , Hemoglobina Fetal , Criança , Humanos , Hemoglobina Fetal/genética , Haplótipos , DNA Intergênico , Anemia Falciforme/genética , Estudos de Coortes , Fatores de Transcrição , Polimorfismo de Nucleotídeo Único , Proteínas Repressoras/genéticaRESUMO
Since the discovery of ischemic pre- and post-conditioning, more than 30 years ago, the knowledge about the mechanisms and signaling pathways involved in these processes has significantly increased. In clinical practice, on the other hand, such advancement has yet to be seen. This article provides an overview of ischemic pre-, post-, remote, and pharmacological conditioning related to the heart. In addition, we reviewed the cardioprotective signaling pathways and therapeutic agents involved in the above-mentioned processes, aiming to provide a comprehensive evaluation of the advancements in the field. The advancements made over the last decades cannot be ignored and with the exponential growth in techniques and applications. The future of pre- and post-conditioning is promising.
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Pós-Condicionamento Isquêmico , Precondicionamento Isquêmico Miocárdico , Transdução de Sinais , Coração , HumanosRESUMO
O presente trabalho apresenta uma revisão integrativa da produção científica nacional e internacional, dos últimos cinco anos, sobre estudos existentes na literatura que abordem a correlação entre a maternidade na adolescência ao nascimento de um bebê prematuro e de baixo peso. Foram acessadas publicações indexadas nas bases de dados Lilacs, Pubmed Central, SciELO (Web of Science), e Scopus (Elsevier), através dos descritores: adolescent, mother, baby ou infant newborn,preterm e low birth weight em artigos de língua inglesa e portuguesa. Entre 206 publicações encontradas, 11 trabalhos foram selecionados de acordo com os critérios de inclusão e por avaliação entre juízes, os quais permitiram compreender temáticas especificas da maternidade adolescente frente ao parto prematuro e de baixo peso ao nascimento. Algumas temáticas foram destacadas como: aspectos emocionais das mães, questões psicossociais, associação entre IMC (índice de massa corporal - peso) materno (pré e peri gestacional) as taxas relativas do nascimento prematuro e ou baixo peso do bebê e o risco da maternidade adolescente e suas comorbidades. Conclui-se que programas de acompanhamento para prevenção da gravidez adolescente, educação em saúde são essenciais para minimizar as taxas de nascimentos prematuros e com baixo peso, assim como a assistência pré-natal direcionada a problemática relativa a condição de saúde do adolescente.
The present work presents an integrative review of the national and international scientific production, of the last five years, on existing studies in the literature that address the correlation between motherhood in adolescence and the birth of a premature and low weight baby. Publications indexed in the Lilacs, Pubmed Central, SciELO (Web of Science), and Scopus (Elsevier) databases were accessed through the descriptors: adolescent, mother, baby or infant newborn, preterm and low birth weight, in English and Portuguese languages. Among 206 publications found, 11 papers were selected according to the inclusion criteria and by evaluation among judges, which allowed to understand specific themes of adolescent motherhood in the face of premature birth and low birth weight. Some themes were highlighted as: emotional aspects of mothers, psychosocial issues, association between maternal BMI (body mass index - weight) (pre and peri gestational), relative rates of premature birth and or low weight of the baby and the risk of motherhood adolescent and his comorbidities. It is concluded that follow-up programs for the prevention of adolescent pregnancy, health education are essential to minimize the rates of premature births and low birth weight, as well as prenatal care directed to problems related to the adolescent's health condition.
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Fetal hemoglobin (HbF) ameliorates clinical severity of sickle cell anemia (SCA). The major loci regulating HbF levels are HBB cluster, BCL11A, and HMIP-2 (HBS1L-MYB). However, the impact of noncoding single-nucleotide polymorphisms (SNPs) in these loci on clinical outcomes and their functional role on regulating HbF levels should be better elucidated. Therefore, we performed comprehensive association analyses of 14 noncoding SNPs in five loci with HbF levels and with clinical outcomes in a cohort of 250 children with SCA from Southeastern Brazil, and further performed functional annotation of these SNPs. We found SNPs independently associated with HbF levels: rs4671393 in BCL11A (ß-coefficient = 0.28), rs9399137 in HMIP-2A (ß-coefficient = 0.16), and rs4895441 in HMIP-2B (ß-coefficient = 0.15). Patients carrying minor (HbF-boosting) alleles for rs1427407, rs93979137, rs4895441, rs9402686, and rs9494145 showed reduced count of reticulocytes (p < 0.01), while those carrying the T allele of rs9494145 showed lower white blood cell count (p = 0.002). Carriers of the minor allele for rs9402686 showed higher peripheral saturation of oxygen (p = 0.002). Patients carrying minor alleles in BCL11A showed lower risk of transfusion incidence rate ratio (IRR ≥ 1.3; p < 0.0001). This effect was independent of HbF effect (p = 0.005). Carriers of minor alleles for rs9399137 and rs9402686 showed lower risk of acute chest syndrome (IRR > 1.3; p ≤ 0.01). Carriers of the reference allele for rs4671393 showed lower risk of infections (IRR = 1.16; p = 0.01). In conclusion, patients carrying HbF-boosting alleles of BCL11A and HMIP-2 were associated with milder clinical phenotypes. Higher HbF concentration may underlie this effect.
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Anemia Falciforme/diagnóstico , Anemia Falciforme/genética , Hemoglobina Fetal/metabolismo , Proteínas de Ligação ao GTP/genética , Genes myb , Polimorfismo de Nucleotídeo Único , Proteínas Repressoras/genética , Alelos , Anemia Falciforme/sangue , Anemia Falciforme/epidemiologia , Brasil/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Hemoglobina Fetal/genética , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Humanos , Lactente , Recém-Nascido , Masculino , Prognóstico , Estudos RetrospectivosRESUMO
Objetivou-se identificar o conhecimento das parturientes sobre violência obstétrica, levantar se conseguem identificar as principais ações presentes na violência obstétrica, detectar os impactos físicos e psicológicos da violência obstétrica. Os sujeitos desse estudo foram 14 puérperas residentes do estado do Rio de Janeiro. Foi realizado um estudo do tipo descritivo, exploratório com abordagem quali-quantitativa. A coleta de dados foi realizada por meio de um formulário eletrônico online, na qual foi viabilizado um formulário individual composto de perguntas relacionadas ao objetivo da pesquisa sendo de fácil e rápido acesso ao sujeito participante. Concluiu-se através dos resultados desta pesquisa que as mulheres possuem um conhecimento limitado acerca da violência obstétrica, podendo estar relacionado à falta de informação durante o pré-natal.(AU)
The aim was to identify the parturients' knowledge about obstetric violence, to get up if they can identify the main actions present in obstetric violence, to detect the physical and psychological impacts of obstetric violence. The subjects of this study were 14 puerperal women living in the state of Rio de Janeiro. A descriptive, exploratory study with a qualitative and quantitative approach was carried out. Data collection was performed using an online electronic form, in which an individual form was made available, consisting of questions related to the research objective, being easily and quickly accessed by the participating subject. It was concluded through the results of this research that women have limited knowledge about obstetric violence, which may be related to the lack of information during prenatal care.(AU)
El objetivo era identificar el conocimiento de las parturientas sobre la violencia obstétrica, levantarse si pueden identificar las principales acciones presentes en la violencia obstétrica, detectar los impactos físicos y psicológicos de la violencia obstétrica. Los sujetos de este estudio fueron 14 mujeres puerperales que viven en el estado de Rio de Janeiro. Se realizó un estudio exploratorio descriptivo con enfoque cualitativo y cuantitativo. La recopilación de datos se realizó mediante un formulario electrónico en línea, en el que se puso a disposición un formulario individual, que consta de preguntas relacionadas con el objetivo de la investigación, de fácil y rápido acceso por parte del sujeto participante. A través de los resultados de esta investigación, se concluyó que las mujeres tienen un conocimiento limitado sobre la violencia obstétrica, que puede estar relacionada con la falta de información durante la atención prenatal.(AU)
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Humanos , Feminino , Gravidez , Parto Obstétrico/instrumentação , Dor do Parto , Saúde Materna , Complicações do Trabalho de Parto , Enfermagem ObstétricaRESUMO
RESUMO Este estudo analisa as fontes de autoeficácia docente de universitários em Educação Física. Foram empregados procedimentos de pesquisa qualitativa de caráter descritivo-diagnóstico. Os dados foram obtidos através de entrevista semiestruturada, baseada nos instrumentos: escala de autoeficácia docente e escala de fontes de autoeficácia docente, com 7 universitários da última fase do curso de licenciatura em Educação Física de uma universidade pública no Estado de Santa Catarina. Para a análise dos casos múltiplos, utilizou-se a técnica de análise de conteúdo, que consiste, primeiramente, na transcrição e descrição de cada caso individualmente, seguida do cruzamento e confronto das informações dos casos. Os resultados mostraram que as fontes de autoeficácia, referentes ao manejo de classe, foram: experiência de domínio (6), persuasão social (5) e vicária (4). Sobre a intencionalidade docente, as fontes mais citadas foram: experiências vicárias (7), persuasão social (7) e domínio (6). Especificamente sobre a intencionalidade docente, os universitários mencionaram uma maior diversidade de situações de autoeficácia frente ao manejo de classe. Conclui-se que a observação e a persuasão social foram as fontes de autoeficácia consensualmente valorizadas pelos universitários. Essas situações foram proporcionadas pela universidade nos estágios obrigatórios, observando e recebendo orientações dos professores da universidade e dos professores da escola.
ABSTRACT The aim of this study was to analyze the sources of self-efficacy of pre-service teachers in physical education. Were employed qualitative research procedures and the data were collected through semistructured interview with 7 pre-service teachers in Physical Education from a public university. For the analysis of multiple cases was used the content analysis technique, which consists, first, in transcription and description of each case individually, then crossing and confrontation of information for all cases. The results showed that the sources of self-efficacy for the class management were the mastery experiences (6), social persuasion (5) and vicarious (4). About the teaching intentionality, the most cited sources were the vicarious experiences (7), social persuasion (7) and the mastery experiences (6). Specifically on teaching intentionality, the pre-service teachers mentioned more variety of situations of self-efficacy when compared to the management class. The observation and social persuasion were the sources of self-efficacy commonly valued by students. These situations were provided in the required stages, watching and getting supervision from teachers at the University and teachers from school.
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Educação Física e Treinamento , Autoeficácia , DocentesRESUMO
This experiment studied congenital transmission in sheep experimentally infected with oocysts of Toxoplasma gondii and reinfected at one of three stages of pregnancy. Twenty ewes were experimentally infected with T. gondii strain ME49 (day 0). After the T. gondii infection became chronic (IFAT≤512), the ewes were allocated with rams for coverage. After the diagnosis of pregnancy, these ewes were allocated into four experimental groups (n = 5): I-reinfected with T. gondii on the 40th day of gestation (DG); II-reinfected on DG 80; III-reinfected on DG 120; and IV-saline solution on DG 120 (not reinfected). Five ewes (IFAT<64) were kept as negative controls (uninfected, group V), therefore in groups I-III were infected prior to pregnancy and re-infected during pregnancy, group IV was only infected prior to pregnancy, and group V was not infected. Parasitism by T. gondii was investigated (histopathology, immunohistochemistry, mouse bioassay and PCR) in mothers and lambs tissue. All ewes produced lambs serologically positive for T. gondii. The results of the mouse bioassay, immunohistochemistry and PCR assays revealed the presence of T. gondii in all 20 sheep and their lambs. The congenital transmission of T. gondii was associated with fetal loss and abnormalities in persistently infected sheep and in ewes infected and subsequently reinfected by this protozoan. Therefore, congenital T. gondii infection was common when ewes were chronically infected prior to pregnancy, with or without reinfection during at various stages of gestation.
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Toxoplasmose Congênita , Animais , Doença Crônica , DNA de Protozoário/genética , Feminino , Imunidade Humoral , Camundongos , Oocistos/parasitologia , Especificidade de Órgãos , Gravidez , Ovinos , Toxoplasma/genética , Toxoplasma/fisiologia , Toxoplasmose Congênita/imunologia , Toxoplasmose Congênita/patologiaRESUMO
The PR-11 peptide corresponds to the N-terminal and active region of the endogenously synthesized PR-39 molecule, of porcine origin. It is known to possess various biological effects including antimicrobial properties, angiogenic and anti-inflammatory activities. Apart from its reported activity as a proteasome inhibitor, a more comprehensive understanding of its function, at the molecular level, is still lacking. In this study, we used a label-free shotgun strategy to evaluate the proteomic alterations caused by exposure of cultured fibroblasts to the peptide PR-11. This approach revealed that more than half of the identified molecules were related to signalling, transcription and translation. Proteins directly associated to regulation of angiogenesis and interaction with the hypoxia-inducible factor 1-α (HIF-1α) were significantly altered. In addition, at least three differentially expressed molecules of the NF-κB pathway were detected, suggesting an anti-inflammatory property of PR-11. At last, we demonstrated novel potential ligands of PR-11, through its immobilization for affinity chromatography. Among the eluted molecules, gC1qR, a known complement receptor, appeared markedly enriched. This provided preliminary evidence of a PR-11 ligand possibly involved in the internalization of this peptide. Altogether, our findings contributed to a better understanding of the cellular pathways affected by PR-39 derived molecules.
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Peptídeos Catiônicos Antimicrobianos/farmacologia , Animais , Peptídeos Catiônicos Antimicrobianos/metabolismo , Proteínas de Transporte/metabolismo , Células Cultivadas , Fibroblastos/efeitos dos fármacos , Fibroblastos/metabolismo , Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Proteínas Imobilizadas/metabolismo , Proteínas Imobilizadas/farmacologia , Ligantes , Espectrometria de Massas , Proteínas Mitocondriais/metabolismo , NF-kappa B/metabolismo , Fragmentos de Peptídeos/metabolismo , Fragmentos de Peptídeos/farmacologia , Inibidores de Proteassoma/metabolismo , Inibidores de Proteassoma/farmacologia , Proteoma/efeitos dos fármacos , Proteoma/metabolismo , Proteômica , Ratos , Ratos Wistar , SuínosRESUMO
Mineralocorticoid receptor (MR) antagonists of aldosterone (spironolactone and eplerenone) display beneficial effects in the treatment of cardiopathies; however, many of these responses are independent of this antagonism. The mechanisms of action of these drugs are not well known; few studies have comparatively evaluated whether eplerenone as well as spironolactone display cardioprotective effects independent of the blockade of aldosterone. To study these mechanisms, which lead to cardioprotective responses, and to evaluate comparatively their effects in vitro, we have evaluated the proliferative effect of spironolactone and eplerenone in primary culture of cardiomyocytes and fibroblasts of neonatal Wistar rats in the presence and absence of aldosterone. Spironolactone and eplerenone promoted proliferation of cardiomyocyte even in the absence of aldosterone, suggesting a signaling pathway independent of the antagonism over aldosterone. Spironolactone was able to reduce the proliferation of fibroblasts and to reverse the proliferation promoted by aldosterone, which was also displayed by eplerenone. To elucidate the biochemical pathways evoked by these drugs, we sought to analyze Ca(2+), cAMP, and cGMP, and the activity of PKC and ERK1/2. Spironolactone and eplerenone increased the levels of Ca(2+), cGMP and activity of ERK 1/2, and reversed the action of aldosterone on the activity of PKC and ERK1/2. Interestingly, only spironolactone increased the levels of cAMP. Our data support the fact that in addition to aldosterone, both spironolactone and eplerenone display rapid responses (non-genomic) such as an increase on cAMP, Ca(2+), and cGMP by spironolactone, and Ca(2+) and cGMP by eplerenone. We have observed a more consistent cardioprotection promoted by spironolactone; however, these effects have yet to be tested clinically. Therefore, our data show that these drugs do not only act as an antagonist of MR, but could lead to a new pharmacological classification of these drugs.