RESUMO
BACKGROUND Electrical storm is a rare but potentially life-threatening syndrome characterized by recurrent ventricular arrhythmias. Liver transplant recipients are at increased risk of developing electrical storms due to conditions that prolong QT intervals, such as cirrhotic cardiomyopathy. However, limited information exists on electrical storms in this specific population. This case report presents a patient who experienced 13 cardiac arrests during ventricular fibrillation following liver transplantation. CASE REPORT A 61-year-old woman with a medical history of diabetes, obesity, and cirrhosis due to non-alcoholic fatty liver disease underwent liver transplantation using a deceased donor's liver. Following the procedure, she developed a deterioration in her respiratory function, necessitating orotracheal intubation. Approximately 21 hours post-surgery, she experienced cardiac arrest during ventricular fibrillation, which was rapidly reversed with electrical defibrillation. However, the patient entered a state of electrical storm. Management involved antiarrhythmic medications and temporary transvenous cardiac pacing. She remained stable for 40 hours, but a dislodgment of the device triggered another episode of ventricular fibrillation, leading to her death. CONCLUSIONS This case report highlights the clinical presentation and challenges in managing electrical storms in liver transplant recipients. We hypothesize that cirrhotic cardiomyopathy could be the cause of her recurrent ventricular arrhythmias. Further studies are needed to better understand the underlying mechanisms and risk factors of this life-threatening syndrome in this population, which may enhance risk stratification and enable earlier intervention.
Assuntos
Cardiomiopatias , Parada Cardíaca , Transplante de Fígado , Feminino , Humanos , Pessoa de Meia-Idade , Fibrilação Ventricular/terapia , Fibrilação Ventricular/complicações , Transplante de Fígado/efeitos adversos , Arritmias Cardíacas/etiologia , Parada Cardíaca/terapia , Parada Cardíaca/complicações , Cirrose Hepática/complicações , Cardiomiopatias/complicaçõesRESUMO
BACKGROUND Liver transplantation is a life-saving intervention for patients with a diagnosis of acute liver failure or end-stage liver disease. Despite advances in surgical techniques and immunosuppressive therapies, primary nonfunction remains a concern, often necessitating retransplantation. In these scenarios, the anhepatic state, achieved through total hepatectomy with a temporary portacaval shunt, serves as a bridge to retransplantation. However, the challenge lies in the uncertain survival period and several potential complications associated with this procedure. CASE REPORT We present a case of a 35-year-old male patient with autoimmune hepatitis who underwent liver transplantation from a deceased donor. Seven days later, he experienced acute liver failure, leading to an urgent listing for retransplantation. To prevent the intense systemic inflammatory response, the patient underwent a total hepatectomy with a temporary portacaval shunt while awaiting another graft and endured a 57-h anhepatic state. On day 17 following retransplantation, he had cerebral death due to a hemorrhagic stroke. CONCLUSIONS This case underscores one of the most prolonged periods of anhepatic state as a bridge to retransplantation, highlighting the complexities associated with this technique. The challenges include sepsis, hypotension, coagulopathy, metabolic acidosis, renal failure, electrolyte disturbances, hypoglycemia, and hypothermia. Vigilant monitoring and careful management are crucial to improve patient outcomes. Further research is needed to optimize the duration of the anhepatic state and minimize complications for liver transplantation recipients.
Assuntos
Falência Hepática Aguda , Transplante de Fígado , Masculino , Humanos , Adulto , Transplante de Fígado/métodos , Reoperação , Derivação Portocava Cirúrgica/métodos , Falência Hepática Aguda/etiologia , Falência Hepática Aguda/cirurgiaRESUMO
Introduction: Nutritional deficiencies, hormonal changes and severe weight loss after Roux-en-Y Gastric Bypass (RYGB) can promote changes in bone metabolism which may lead to a reduction in bone mineral density (BMD). Objective: to investigate the prevalence of osteopenia/osteoporosis and factors associated with BMD in pre-menopausal women who underwent RYGB. Methodology: a cross-sectional study conducted with secondary data of patients followed-up in a specialized center for obesity treatment. Variables studied: biochemical and anthropometric data, body composition by multifrequency bioimpedance and BMD of the lumbar spine (LS), total femur (TF) and femur neck (FN) by dual-energy X-ray absorptiometry. For statistical analysis, the SPSS® software and a 5% significance level were utilized. Results: seventy-two (72) pre-menopausal women were evaluated. Mean age, BMI and mean post-surgery time was 38.7±6.5 years, 25.8±2.5 kg/m² and 13.1±1.7 months, respectively. The prevalence of osteopenia in at least one of the densitometry sites was 13.9%, with LS being the most frequent site. A lower LS BMD was associated with greater weight loss, higher percentage of body fat before surgery and lower post-surgery serum vitamin D levels. There was a positive correlation between skeletal muscle mass index adjusted for height in the pre-surgery period and LS BMD (r=0.361; p=0.010) and TF (r=0.404; p=0.004). Conclusion: a relevant prevalence of osteopenia was detected in pre-menopausal women after RYGB, mainly in the LS.
Introdução: o Bypass Gástrico em Y de Roux (BPGYR) pode promover mudanças no metabolismo ósseo decorrentes de deficiências nutricionais, alterações hormonais e perda severa de peso, podendo acarretar redução da Densidade Mineral Óssea (DMO). Objetivo: investigar a prevalência de osteopenia/osteoporose e fatores associados à DMO em mulheres pré-menopausadas submetidas à BPGYR. Metodologia: estudo transversal com dados secundários de pacientes acompanhadas em um serviço especializado no tratamento da obesidade. Variáveis estudadas: dados bioquímicos e antropométricos, composição corporal por bioimpedância multifrequencial e DMO de coluna lombar (CL), fêmur total (FT) e colo do fêmur (CF) por Absorciometria por Dupla Emissão de Raios X. Para análise estatística foi utilizado o programa SPSS®, com o nível de significância de 5%. Resultados: foram avaliadas 72 mulheres pré-menopausadas, com média de idade e de IMC de 38,7±6,5 anos e 25,8±2,5 kg/m², respectivamente, e tempo médio de pós-operatório de 13,1±1,7 meses. A prevalência de osteopenia em pelo menos um dos sítios densitométricos foi de 13,9%, sendo a CL o sítio mais frequente. Uma menor DMO na CL se associou a maior perda de peso, maior percentual de massa gorda antes da cirurgia e níveis séricos menores de vitamina D pós-operatória. Observou-se correlação positiva entre o índice de massa muscular esquelética ajustada pela altura no pré-operatório e a DMO da CL (r=0,361; p=0,010) e do FT (r=0,404; p= 0,004). Conclusão: detectou-se prevalência relevante de osteopenia em mulheres pré-menopausadas após BPGYR, principalmente na CL.
Assuntos
Feminino , Adulto , Pessoa de Meia-Idade , Vitamina D , Composição Corporal , Doenças Ósseas Metabólicas , Densidade Óssea , Pré-Menopausa , Cirurgia Bariátrica , Estudos TransversaisRESUMO
O câncer de mama (CM) é o tumor maligno que mais mata mulheres no mundo, sendo considerado um grave problema de saúde pública. Este artigo investiga as ações de enfermeiros atuantes na Atenção Primária à Saúde na prevenção do CM em Campina Grande-PB. Trata-se de um estudo descritivo-exploratório, de abordagem qualitativa, realizado com 10 enfermeiros que atuam em unidades básicas de saúde do referido município, por meio de entrevista semiestruturada. Os dados coletados foram analisados por meio da análise de conteúdo, com o auxílio do software Atlas.ti. Em seus resultados emergiram cinco categorias: Conhecimentos gerais sobre CM; Capacitação profissional e educação em saúde da população; Abordagem clínica do enfermeiro na prevenção do CM; Dificuldades na prevenção; Autoanálise da prática profissional. Entre estas, destacou-se a influência negativa da falta de capacitações para ajustamento das ações dos enfermeiros às diretrizes nacionais de prevenção do CM na Atenção Primária à Saúde.
Breast cancer is the malignant tumor that kills the most women worldwide, being considered a serious public health problem. This article investigates the actions of nurses working in Primary Health Care in the prevention of breast cancer in Campina Grande-PB. This is a descriptive-exploratory study, with a qualitative approach, carried out with 10 nurses who work in basic health units in that city, through semi-structured interviews. The collected data were analyzed through content analysis, with the help of the Atlas.ti software. Five categories emerged from their results: General knowledge about breast cancer; Professional training and health education for the population; Nurses' clinical approach to breast cancer prevention; Difficulties in prevention; Self-analysis of professional practice. Among these, the negative influence of the lack of training to adjust the nurses' actions to the national guidelines for the prevention of breast cancer in Primary Health Care was highlighted.
RESUMO
The association of a bariatric operation during liver transplantation may benefit patients with liver failure and obesity and sleeve gastrectomy emerges as the procedure of choice. The aim of this study is to present our experience with combined liver transplantation and sleeve gastrectomy. During an 18-month period, seven patients were submitted to simultaneous liver transplant and sleeve gastrectomy (LTSG). There were four male and three female, and the mean recipient age was 60.5 years, mean BMI was 38.2 kg/m2, and mean MELD score was 25 points. The indication for liver transplantation was nonalcoholic steatohepatitis (NASH) with hepatocellular carcinoma (HCC) in four cases, hepatitis C with HCC in one case, pure NASH in one case and alcoholic cirrhosis with HCC in one case. Six patients are alive with normal allograft function. There were no biliary complications.
Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Transplante de Fígado , Brasil , Carcinoma Hepatocelular/cirurgia , Feminino , Gastrectomia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Neuroendocrine tumors are part of a heterogeneous group of tumors located in organs such as the gastrointestinal tract (GIT), lungs, thymus, thyroid, and adrenal glands. The most prevalent sites are the small intestine, cecal appendix, and pancreas. More than 50% of these tumors are associated with metastases at the time of diagnosis. Neuroendocrine tumors are classified according to the degree of cell differentiation and the histopathological proliferation index of the lesion. Neuroendocrine tumors can be well differentiated or poorly differentiated. G3 tumors are characterized by Ki-67 expression greater than 20% and can be either well differentiated (G3 NET) or poorly differentiated (G3 NEC). Neuroendocrine carcinoma (NEC G3) is subdivided into small-cell and large-cell types. When neuroendocrine tumors present clinical and compressive symptoms, carcinoid syndrome is evident. Carcinoid syndrome occurs when the tumor produces neuroendocrine mediators that cannot be metabolized by the liver due to either the size of the tumor or their secretion by the liver itself. Several therapeutic strategies have been described for the treatment of metastatic neuroendocrine tumors, including curative or palliative surgical approaches, peptide receptor radionuclide therapy, percutaneous therapy, systemic chemotherapy, and radiotherapy. Liver surgery is the only approach that can offer a cure for metastatic patients. Liver metastases must be completely resected, and in this context, orthotopic liver transplantation has gained prominence for yielding very promising outcomes in selected cases. The aim of this study is to review the literature on OLT as a form of treatment with curative intent for patients with gastroenteropancreatic neuroendocrine tumors with liver metastasis.
RESUMO
INTRODUCTION: coronavirus 2019 Disease (COVID-19) was quickly declared a pandemic, and Brazil is facing the most significant health and hospital crisis in its history. From March to June 2021 represented 50.8% of all deaths in the State of Espirito Santo OBJECTIVE: to analyze the lethality and mortality by COVID-19 in the State of Espirito Santo from March 2020 to June 2021. METHODS: an ecological study was carried out, using a time series of public and official data available on the Health Department of the State of Espirito Santo, Brazil. Were considered information about cases and deaths (from March 2020 to June 2021) of COVID-19. Percentage case-fatality and mortality and incidence rates per 100,000 population were calculated. Time-series analyses were performed using the Prais-Winsten regression model, estimating the Daily Percent Change (DPC), and the trends were classified as flat, increasing, or decreasing. Significant differences were considered when p<0.05. RESULTS: 524,496 confirmed cases of COVID-19 as of June 30, 2021, and 11,516 progressed to death. The presence of cardiovascular diseases represents more than half of confirmed comorbidities (54.37%) in patients with COVID-19, followed by diabetes (19.95%) and obesity (9.34%). Men had higher mortality and lethality, especially in older age groups, but the incidence was higher among women. A characteristic profile of two waves was observed; the first wave was extended from March to October 2020 and the second complete wave from November 2020 to June 2021. During the second wave, high peaks of incidence, lethality, and mortality were recorded. At the end of the second wave, the incidence rate remained with increasing trends (p < 0.05), with a DPC of 2.06%. CONCLUSION: the peak concentration of cases, deaths, and indicators of lethality, mortality evidenced even after one year of pandemic, characterizes the severity of the COVID-19 pandemic, still in entire evolution in the State Espirito Santo and Brazil.
INTRODUÇÃO: a doença do Coronavírus 2019 (COVID-19) foi rapidamente declarada pandemia, e o Brasil está enfrentando a crise hospitalar e de saúde mais significativa de sua história. De março a junho de 2021 representou 50,8% de todas as mortes no Estado do Espírito Santo. OBJETIVO: analisar a letalidade e mortalidade por COVID-19 no Estado do Espírito Santo no período de março de 2020 a junho de 2021. MÉTODO: foi realizado um estudo ecológico, utilizando uma série histórica de dados públicos e oficiais disponíveis na Secretaria de Saúde do Estado do Espírito Santo, Brasil. Foram consideradas informações sobre casos e óbitos (de março de 2020 a junho de 2021) da COVID-19. Foram calculadas as percentagens de letalidade e mortalidade e taxas de incidência por 100.000 habitantes. As análises de séries temporais foram realizadas usando o modelo de regressão de Prais-Winsten, estimando a variação percentual diária (DPC), e as tendências foram classificadas como estacionaria, crescentes ou decrescentes. Diferenças significativas foram consideradas quando p <0,05. RESULTADOS: 524.496 casos confirmados de COVID-19 até 30 de junho de 2021 e 11.516 evoluíram para óbito. A presença de doenças cardiovasculares representa mais da metade das comorbidades confirmadas (54,37%) em pacientes com COVID-19, seguida de diabetes (19,95%) e obesidade (9,34%). Os homens apresentaram maior mortalidade e letalidade, principalmente nas faixas etárias mais velhas, mas a incidência foi maior entre as mulheres. Observou-se um perfil característico de duas ondas; a primeira onda foi estendida de março a outubro de 2020 e a segunda onda completa de novembro de 2020 a junho de 2021. Durante a segunda onda, altos picos de incidência, letalidade e mortalidade foram registrados. Ao final da segunda onda, a taxa de incidência manteve-se com tendência crescente (p <0,05), com DPC de 2,06%. CONCLUSÃO: o pico de concentração de casos, óbitos e indicadores de letalidade, mortalidade evidenciados mesmo após um ano de pandemia, caracteriza a gravidade da pandemia COVID-19, ainda em evolução total no Estado do Espírito Santo e Brasil.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Perfil de Saúde , COVID-19/mortalidade , Brasil/epidemiologia , Incidência , Prevalência , Estudos Ecológicos , Análise Espaço-TemporalRESUMO
Since introduction into Brazil in 2014, chikungunya virus (CHIKV) has presented sustained transmission, although much is unknown about its circulation in the midwestern states. Here, we analyze 24 novel partial and near complete CHIKV genomes from Cuiaba, an urban metropolis located in the Brazilian midwestern state of Mato Grosso (MT). Nanopore technology was used for sequencing CHIKV complete genomes. Phylogenetic and epidemiological approaches were used to explore the recent spatio-temporal evolution and spread of the CHIKV-ECSA genotype in Midwest Brazil as well as in the Americas. Epidemiological data revealed a reduction in the number of reported cases over 2018-2020, likely as a consequence of a gradual accumulation of herd-immunity. Phylogeographic reconstructions revealed that at least two independent introductions of the ECSA lineage occurred in MT from a dispersion event originating in the northeastern region and suggest that the midwestern Brazilian region appears to have acted as a source of virus transmission towards Paraguay, a bordering South American country. Our results show a complex dynamic of transmission between epidemic seasons and suggest a possible role of Brazil as a source for international dispersion of the CHIKV-ECSA genotype to other countries in the Americas.
Assuntos
Febre de Chikungunya/epidemiologia , Febre de Chikungunya/transmissão , Vírus Chikungunya/genética , Genoma Viral/genética , Adolescente , Adulto , Teorema de Bayes , Brasil/epidemiologia , Febre de Chikungunya/diagnóstico , Vírus Chikungunya/isolamento & purificação , Monitoramento Epidemiológico , Feminino , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Filogenia , Análise Espaço-Temporal , Sequenciamento Completo do Genoma , Adulto JovemRESUMO
Objetivo analisar o uso do protocolo de saúde da mulher na prevenção do câncer de colo do útero por enfermeiros na Atenção Básica. Método estudo de caso, exploratório, de abordagem qualitativa. Os participantes foram enfermeiros da Estratégia Saúde da Família. Utilizou-se como técnica de coleta de dados a entrevista semiestruturada, analisada pela Análise de Conteúdo do tipo categorial temática. Resultados o enfermeiro realiza o acolhimento limitado à queixa da mulher motivada por demanda espontânea e apresenta autonomia para a realização do citopatológico, embora nem todos realizem avaliação do resultado desse exame. Conclusão a análise do uso do protocolo de saúde da mulher permitiu constatar-se uma discrepância entre as ações realizadas por enfermeiros na Atenção Básica, que ora estavam de acordo com o Protocolo de Atenção Básica, ora divergiam de suas normativas.
Objetivo analizar el uso del protocolo de salud de la mujer en la prevención del cáncer cervical por parte de las enfermeras de Atención Primaria. Método se trata de un estudio de caso exploratorio con enfoque cualitativo. Los participantes fueron enfermeras de la Estrategia de Salud de la Familia. La técnica de recogida de datos utilizada fue la entrevista semiestructurada, analizada mediante Análisis de Contenido de tipo categórico temático. Resultados el enfermero realiza el acolchado limitado a la piel de la mujer motivado por la demanda espontánea y se muestra autónomo para la realización del citopatológico, aunque no todos realizan la evaluación del resultado de este examen. Conclusión el análisis del uso del protocolo de salud de la mujer permitió constatar una discrepancia entre las acciones realizadas por los enfermeros en la Atención Básica, que a veces estaban de acuerdo con el Protocolo de Atención Básica, y a veces divergían de sus normativas.
Objetivo analisar o uso do protocolo de saúde da mulher na prevenção do câncer de colo do útero por enfermeiros na Atenção Básica. Método estudo de caso, exploratório, de abordagem qualitativa. Os participantes foram enfermeiros da Estratégia Saúde da Família. Utilizou-se como técnica de coleta de dados a entrevista semiestruturada, analisada pela Análise de Conteúdo do tipo categorial temática. Resultados o enfermeiro realiza o acolhimento limitado à queixa da mulher motivada por demanda espontânea e apresenta autonomia para a realização do citopatológico, embora nem todos realizem avaliação do resultado desse exame. Conclusão a análise do uso do protocolo de saúde da mulher permitiu constatar-se uma discrepância entre as ações realizadas por enfermeiros na Atenção Básica, que ora estavam de acordo com o Protocolo de Atenção Básica, ora divergiam de suas normativas.
Assuntos
Humanos , Feminino , Atenção Primária à Saúde , Prevenção Primária , Neoplasias do Colo do Útero , Protocolos Clínicos , Saúde da MulherRESUMO
Background: Obesity is associated with lower levels of 25-hydroxyvitamin D [25(OH)D] and higher cardiovascular risk related to metabolic syndrome (MetS). Our purpose was to investigate if there is an association between levels of 25(OH)D and the components of MetS in an obese sample. Methods: This cross-sectional study enrolled obese patients referred for bariatric surgery in a specialized clinic. Secondary data were gathered as follows: glycemic and lipid profiles, 25(OH)D, anthropometric parameters, and clinical and sociodemographic information. The results were presented as means (standard deviations) or medians and interquartile intervals or absolute and relative frequencies. The patients were divided into three groups based on 25(OH)D terciles for analysis and were compared using ANOVA, Kruskal-Wallis or chi-squared tests. The correlations were calculated by Spearman's or Pearson's correlation tests. Results: We studied 299 patients, with the majority being women (74.9%). The patients' average (SD) age and 25(OH)D level were 36 (9) years and 25.8 (7.5) ng/mL, respectively. There was no association between vitamin D and MetS or its components. A progressive decrease in total cholesterol, low-density lipoprotein cholesterol (LDL-c), and nonhigh-density lipoprotein cholesterol (HDL-c) was observed as the serum vitamin D level increased, although only the latter reached statistical significance (P = 0.033). The correlation analysis showed a negative linear association between 25(OH)D and total cholesterol (r = -0.157; P = 0.047), 25(OH)D and LDL-c (r = -0.164; P = 0.038), and 25(OH)D and non-HDL-c (r = -0.176; P = 0.026). Conclusions: There was a negative correlation between 25(OH)D levels and the atherogenic profile but none with the MetS.
Assuntos
Doenças Cardiovasculares/etiologia , Síndrome Metabólica/complicações , Obesidade/complicações , Deficiência de Vitamina D/sangue , Vitamina D/análogos & derivados , Adulto , Biomarcadores/sangue , Fatores de Risco Cardiometabólico , Doenças Cardiovasculares/diagnóstico , Estudos Transversais , Feminino , Humanos , Lipídeos/sangue , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/diagnóstico , Pessoa de Meia-Idade , Obesidade/sangue , Obesidade/diagnóstico , Prognóstico , Medição de Risco , Vitamina D/sangue , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/diagnósticoRESUMO
Introdução: obesidade é um problema de saúde pública e está relacionada com fatores genéticos, ambientais e comportamento alimentar. É uma doença de difícil controle e a cirurgia bariátrica tem surgido com uma terapêutica de sucesso para obesos graves. Objetivo: descrever o comportamento e preferências alimentares de pacientes obesos encaminhados à cirurgia bariátrica. Metodologia: estudo descritivo baseado em dados secundários de uma clínica especializada no tratamento da obesidade. Foram estudadas variáveis antropométricas, sociodemográficas e outras referentes ao comportamento e preferências alimentares. Para análise dos dados foram utilizados: estatística descritiva e qui-quadrado de Pearson, sendo considerados significantes valores de p<0,05. Resultados: foram avaliados 542 pacientes com média (desvio padrão) de idade e índice de massa corporal de 35,9 (9,8) anos e 41,5 (4,9) kg/m2 respectivamente, sendo 73,6% do sexo feminino. Observou-se que os pacientes tinham preferência por cereais e massas (62,4%), seguido de carne e ovos (58,1%). Destacou-se que adultos jovens realizavam menos o desjejum (65,1% x 75,4%; p= 0,011) e ingeriam maior volume de alimentos nas refeições (90,7% x 81,1%; p=0,007) quando comparados aos mais velhos e que o comportamento de acordar para comer à noite foi mais frequente nos homens do que nas mulheres (31,2% x 21,6%; p=0,029). Conclusão: o estudo mostrou que os grupos alimentares preferidos foram os cereais e massas seguidos de carne e ovos. Quanto ao comportamento alimentar foi observado influência do sexo e da idade dos indivíduos, o mesmo não acontecendo em relação ao grau de obesidade.
Introduction: obesity is a public health problem related to genetic, environmental and eating behaviour factors. It is difficult to control, and bariatric surgery has emerged as a successful treatment for the severely obese. Objective: to describe the behaviour and food preferences of obese patients referred to bariatric surgery. Methodology: descriptive study based on secondary data from a clinic specialized in the treatment of obesity. Anthropometric, sociodemographic and other variables related to behavioural and food preferences were studied. For data analysis, descriptive statistics and Pearson's chi-square were used, with p <0.05 being considered significant. Results: 542 patients with mean age (standard deviation) and body mass index of 35.9 (9.8) years and 41.5 (4.9) kg / m2 respectively were evaluated, 73.6% of which were female. It was observed that the patients preferred to eat cereals and pasta (62.4%), followed by meat and eggs (58.1%). It was highlighted that young adults had less breakfast (65.1% x 75.4%; p = 0.011) and ingested a greater volume of food at meals (90.7% x 81.1%; p = 0.007) when compared to older people and that the behaviour of waking up to eat at night was more frequent in men than in women (31.2% x 21.6%; p = 0.029). Conclusion: the study showed that the preferred food groups were cereals and pasta followed by meat and eggs. As for eating behaviour, the influence of the individuals' sex and age was observed, the same not happening in relation to the degree of obesity.
Assuntos
Humanos , Masculino , Feminino , Adulto , Cirurgia Bariátrica , Comportamento Alimentar , Preferências Alimentares , Obesidade , Epidemiologia DescritivaRESUMO
Objetivo: compreender a percepção da equipe de enfermagem em relação ao cuidado humanizado prestado ao adulto na Unidade de Terapia Intensiva de um Hospital Público no município de Imperatriz-MA. Metodologia: trata-se de uma pesquisa descritiva caracterizada por abordagem qualitativa, ancorada na Análise Temática proposta por Minayo. A coleta de dados foi realizada mediante entrevista semiestruturada realizada com 30 profissionais de enfermagem, nos meses de abril e maio de 2019. Resultados: os resultados mostraram que os profissionais de enfermagem associaram o significado do cuidado humanizado ao cuidado que envolve: a totalidade do paciente, empatia, comunicação, tratamento com respeito, carinho e conforto. Emergiram três categorias: Cuidado Holístico de Enfermagem, Cuidado Humanizado de Enfermagem e Desafios no processo do Cuidado Humanizado. Conclusão: concluiu-se que o cuidado humanizado para ser considerado precisa estar alicerçado nos princípios e diretrizes da Política Nacional de Humanização e deve envolver pacientes, trabalhadores e gestores, sendo necessário que os gestores forneçam condições favoráveis para que a equipe de enfermagem possa prestar o cuidado humanizado de forma integral, atendendo os pacientes em todas as dimensões, dessa forma favorecendo a qualidade do atendimento na Unidade de Terapia Intensiva.
Objective: the objective of this study is to understand the nursing team's perception regarding the humanized care provided to the adult in Intensive Care Unit of a Public Hospital in the municipality of Imperatriz. Methodology: it is a descriptive and exploratory research, characterized by a qualitative approach, anchored in the Thematic Analysis proposed by Minayo. Data collection was performed through the semi-structured interview applied to 30 nursing professionals in the months of April and May 2019. Results: the results showed that nursing professionals associated the meaning of humanized care with a care that involves the whole patient, empathy, communication, treatment with respect, affection and comfort. From the analysis of these associations emerged three categories: Holistic Nursing Care, Nursing Humanized Care and Challenges in the process of Humanized Care. Conclusion: it was concluded that a humanized care to be considered complete must be based on the principles and guidelines of the National Humanization Policy and should involve patients, workers and managers, and it is necessary that managers provide favorable conditions so that the nursing team can provide humanized care in a holistic way, attending patients in all dimensions, this way favoring the quality of care in Intensive Care Unit.
Assuntos
Cuidados Críticos , Humanização da Assistência , Unidades de Terapia Intensiva , Equipe de EnfermagemRESUMO
Environmental pollution in the form of particulate matter <2.5 µm (PM2.5 ) is a major risk factor for diseases such as lung cancer, chronic respiratory infections, and major cardiovascular diseases. Our goal was to show that PM2.5 eliciting a proinflammatory response activates the immune-pineal axis, reducing the pineal synthesis and increasing the extrapineal synthesis of melatonin. Herein, we report that the exposure of rats to polluted air for 6 hours reduced nocturnal plasma melatonin levels and increased lung melatonin levels. Melatonin synthesis in the lung reduced lipid peroxidation and increased PM2.5 engulfment and cell viability by activating high-affinity melatonin receptors. Diesel exhaust particles (DEPs) promoted the synthesis of melatonin in a cultured cell line (RAW 264.7 cells) and rat alveolar macrophages via the expression of the gene encoding for AANAT through a mechanism dependent on activation of the NFκB pathway. Expression of the genes encoding AANAT, MT1, and MT2 was negatively correlated with cellular necroptosis, as disclosed by analysis of Gene Expression Omnibus (GEO) microarray data from the human alveolar macrophages of nonsmoking subjects. The enrichment score for antioxidant genes obtained from lung gene expression data (GTEx) was significantly correlated with the levels of AANAT and MT1 but not the MT2 melatonin receptor. Collectively, these data provide a systemic and mechanistic rationale for coordination of the pineal and extrapineal synthesis of melatonin by a standard damage-associated stimulus, which activates the immune-pineal axis and provides a new framework for understanding the effects of air pollution on lung diseases.
Assuntos
Pulmão/metabolismo , Macrófagos Alveolares/metabolismo , Melatonina/metabolismo , Material Particulado/efeitos adversos , Glândula Pineal/metabolismo , Receptores de Melatonina/metabolismo , Poluição do Ar/efeitos adversos , Animais , Arilalquilamina N-Acetiltransferase/metabolismo , Humanos , RatosRESUMO
O debate sobre a necessidade de melhoria da utilização de recursos em saúde fez aumentar o interesse em evidências do mundo real (EMR) nos últimos anos. No sétimo congresso Latino-Americano da Sociedade Internacional de Farmacoeconomia e Pesquisa de Desfechos, diferentes palestrantes exploraram como o manejo desses dados pode auxiliar no processo de tomada de decisão. Quatro membros representando diferentes segmentos do Sistema de Saúde Suplementar (SSS) brasileiro foram convidados a participar de um painel de especialistas, a fim de entender suas percepções sobre o assunto. O nível de confiança na informação atualmente disponível variou entre 70% e 90% e os dados são utilizados na rotina de tomada de decisão. Considerando a utilização de evidências para prever decisões, os especialistas relatam não existir uma matriz institucional, mas que as informações existentes são utilizadas na construção de modelos preditivos por meio da criação de pacotes de serviços. A priorização da tomada de decisão é hoje essencialmente baseada em estimativas de custos. Apesar disso, são observadas diferentes situações em que dados de mundo real podem balizar esse processo. Existiu consenso de que uma mudança de paradigmas está ocorrendo e que esses processos representam um futuro plausível. O uso de EMR é de grande importância no processo de tomada de decisão na perspectiva do SSS e, acima de tudo, no suporte de modelos de saúde baseados em valor, sendo recomendado pela Agência Nacional de Saúde Suplementar como um pilar estratégico para a sustentabilidade do sistema.
The debate about the needs for healthcare resource utilization improvement has been soaring during the last years. As a result, discussions on enhancements of the decision-making process through the leverage of real-world evidence (RWE) has also been fostered. In the 7th Latin American congress of the International Society for Pharmacoeconomics and Outcomes Research, different speakers explored how the management of these data support real-life healthcare decisions. Four members representing different segments from the Brazilian Supplementary Healthcare System (SHS) were invited to participate on an expert panel in order to understand their perceptions on this subject. The confidence level on available data ranges from 70% to 90% and information is used on decision-making routine. When the use of real-world evidence to predict decision was considered, panelists reported the absence of an institutional decision matrix, but that existing information is used to build predictive models through the creation of service packages. The prioritization of decision-making today is essentially based on the estimation of costs. However, different situations in which real-world data can guide this process are observed. There was a consensus on a paradigm shift ongoing and that these processes represent a plausible future. The use of RWE is of great importance on decision-making process from the SHS perspective and, above all, in a support of value-based healthcare model which is recommended by Brazilian private agency (ANS) as the strategic pillar to system sustainability
Assuntos
Tomada de Decisões , Saúde Suplementar , Recursos em SaúdeRESUMO
Objetivos Avaliar a prevalência das dermatites de contato (DC) ocupacionais, destacando os principais tipos de cosméticos indutores, o conhecimento dos participantes sobre a doença, o seu diagnóstico e tratamento em uma amostra de 378 profissionais da beleza atuantes em Goiânia, Goiás. Métodos Estudo transversal descritivo, prospectivo, com abordagem quantitativa. Resultados Um total de 43,9% dos participantes deste estudo declararam apresentar DC após exposição a produtos cosméticos no trabalho. Cerca de 64,0% dos participantes desta pesquisa não demonstraram conhecimento satisfatório relacionado aos principais agentes causadores diretos das DC ocupacionais. As tinturas e descolorantes capilares, produtos para alisamentos capilares e produtos para maquilagem foram os cosméticos mais relacionados com o desenvolvimento das DC ocupacionais nestes profissionais. As regiões corporais dos profissionais mais afetadas pelas lesões das DC ocupacionais foram as mãos, o couro cabeludo e a face. A partir do diagnóstico da DC 25,8% dos profissionais tiveram que mudar de atividade laboral dentro do seu segmento de trabalho. Cerca de 28,8% dos profissionais apresentaram conhecimento insatisfatório sobre as principais medidas de prevenção das DC ocupacionais. Conclusão A implementação ou aprimoramento de programas preventivos primários eficazes, pelos estabelecimentos e instituições formadoras destes profissionais é primordial para a redução da prevalência das dermatites ocupacionais. O conhecimento e a conscientização sobre fatores de risco individuais pela categoria é extremamente importante, especialmente nos aprendizes, que constituem um grupo-alvo para a execução de medidas de prevenção primária
Objectives To evaluate the prevalence of occupational contact dermatites (CD), highlighting the main types of inductive cosmetics, the participants' knowledge about the disease, its diagnosis and treatment in a sample of 378 beauty professionals working in Goiania, Goias. Methods Descriptive, prospective cross-sectional study with a quantitative approach. Results A total of 43.9% of the participants in this study reported having CD after exposure to cosmetic products at work. About 64.0% of the participants of this research did not demonstrate satisfactory knowledge related to the main direct causative agents of occupational CD. Hairdye and bleaching agents for hair, hair straighteners and make-up products were the cosmetics most associated with occupational CD in these professionals. The body regions of the professionals most affected by occupational DC injuries were the hands, scalp and face. From the diagnosis of CD 25.8% of the professionals had to change their work activity within their work segment. About 28.8% of the professionals presented unsatisfactory knowledge about the main measures of prevention of occupational DC. Conclusion The implementation or improvement of effective primary prevention programs by the institutions and training institutions of these professionals is necessary to reduce the prevalence of occupational dermatitis. Knowledge and awareness of individual risk factors by category is extremely important, especially for apprentices, who are a target group for the implementation of primary prevention measures
RESUMO
Melatonin production by pineal glands is modulated by several immune signals. The nuclear translocation of nuclear factor kappa-B (NFκB) homodimers, lacking transactivation domains, once induced by lipopolysaccharide (LPS) or tumor necrosis factor (TNF), inhibits the expression of Aanat gene and the synthesis of noradrenaline (NA)-induced melatonin. Interferon gamma (IFN-γ), on the other hand, increases melatonin synthesis. Furthermore, this cytokine activates the signal transducer as well as the activator of transcription 1 (STAT1) pathway, which was never evaluated as a melatonin synthesis modulator before. Reports demonstrated that IFN-γ might also activate NFκB. The present study evaluated the role of STAT1-NFκB crosstalk triggered by IFN-γ regarding the regulation of NA-induced pineal glands' hormonal production. Moreover, IFN-γ treatment increased NA-induced Aanat transcription, in addition to the synthesis of N-acetylserotonin (NAS) and melatonin. These effects were associated with STAT1 nuclear translocation, confirmed by the co-immunoprecipitation of STAT1 and Aanat promoter. Pharmacological STAT1 enhancement augmented NA-induced Aanat transcription as well as NAS and melatonin production. Additionally, IFN-γ induced the nuclear translocation of RelA-NFκB subunits. The blockade of this pathway prevented IFN-γ effects on the pineal function. The present data show that STAT1 and NFκB crosstalk controls melatonin production through a synergistic mechanism, disclosing a new integrative mechanism regarding pineal hormonal activity control.
Assuntos
Interferon gama/farmacologia , NF-kappa B/metabolismo , Norepinefrina/farmacologia , Glândula Pineal/metabolismo , Fator de Transcrição STAT1/metabolismo , Animais , Imunoprecipitação da Cromatina , Cromatografia Líquida de Alta Pressão , Biologia Computacional , Ensaio de Desvio de Mobilidade Eletroforética , Masculino , Técnicas de Cultura de Órgãos , Glândula Pineal/efeitos dos fármacos , Regiões Promotoras Genéticas/genética , Ratos , Ratos WistarRESUMO
BACKGROUND The associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is an important tool to induce fast liver hypertrophy. The degree of hepatic fibrosis/cirrhosis in patients with HCC negatively impacts their health, and the risk of liver failure is always present. In these cases, liver transplantation may be necessary as a rescue procedure. We present the case of a patient with HCC who underwent ALPPS and developed liver failure. A living donor liver transplant was performed as a rescue procedure. CASE REPORT A 49-year-old man with chronic hepatitis B without cirrhosis underwent computed tomography, which revealed an expansive lesion in the right lobe of his liver that was diagnosed as hepatocellular carcinoma. Liver resection was indicated and liver cirrhosis was observed with high portal pressure after transection. The treatment strategy was switched from right hepatectomy to ALPPS. The patient developed severe liver dysfunction and liver transplantation was indicated. His postoperative course was uneventful and 3 months after the procedure the patient was without complications. CONCLUSIONS Living donor liver transplantation may be necessary as a rescue procedure for patients who underwent ALPPS and develop liver dysfunction.
Assuntos
Carcinoma Hepatocelular/cirurgia , Cirrose Hepática/cirurgia , Falência Hepática/etiologia , Neoplasias Hepáticas/cirurgia , Transplante de Fígado/métodos , Veia Porta/cirurgia , Carcinoma Hepatocelular/patologia , Hepatectomia/métodos , Hepatite B Crônica/complicações , Hepatite B Crônica/diagnóstico , Hepatite B Crônica/cirurgia , Humanos , Ligadura/métodos , Cirrose Hepática/patologia , Cirrose Hepática/virologia , Falência Hepática/fisiopatologia , Falência Hepática/cirurgia , Neoplasias Hepáticas/patologia , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Prognóstico , Medição de Risco , Terapia de Salvação , Resultado do TratamentoRESUMO
Melatonin (5-methoxy-N-acetylserotonin), the pineal hormone, is also synthesized by immune-competent cells. The pineal hormone signals darkness, while melatonin synthesized on demand by activated macrophages at any hour of the day acts locally, favoring regulatory/tolerant phenotypes. Activation of ß-adrenoceptors in pinealocytes is the main route for triggering melatonin synthesis. However, despite the well-known role of ß-adrenoceptors in the resolution macrophage phenotype (M2), and the relevance of macrophage synthesized melatonin in facilitating phagocytic activity, there is no information regarding whether activation of ß-adrenoceptors would induce melatonin synthesis by monocytes. Here we show that catecholamines stimulate melatonin synthesis in bone marrow-derived dendritic cells and RAW 264.7 macrophages. Activation of ß-adrenoceptors promotes the synthesis of melatonin by stimulating cyclic AMP/protein kinase A (PKA) pathway and by activating the nuclear translocation of NF-κB. Considering the great number of macrophages around sympathetic nerve terminals, and the relevance of this system for maintaining macrophages in stages compatible to low-grade inflammation, our data open the possibility that extra-pineal melatonin acts as an autocrine/paracrine signal in macrophages under resolution or tolerant phenotypes.
Assuntos
Macrófagos/metabolismo , Melatonina/metabolismo , Fagócitos/metabolismo , Receptores Adrenérgicos beta/metabolismo , Animais , Vias Biossintéticas , Células Cultivadas , Proteínas Quinases Dependentes de AMP Cíclico/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Células RAW 264.7 , Transdução de SinaisRESUMO
Melatonin and glucocorticoids are key hormones in determining daily rhythmicity and modulating defense responses. In nocturnal animals, corticosterone peaks at light/dark transition,while melatonin peaks at the middle of the night in both nocturnal and diurnal animals. The crosstalk between adrenal and pineal glands under inflammatory conditions indicates that corticosterone potentiates nocturnal melatonin synthesis by reducing the activity of NFκB. This transcription factor, which modulates the expression of a key enzyme in melatonin synthesis, is sharply reduced at the entrance of darkness in the rat pineal gland. In this study, we established the basis for understanding the crosstalk between adrenal and pineal glands in physiological conditions. Here we show that the expression of 70 out of 84 genes implied in defense responses exhibit a sharp reduction exactly at the entrance of darkness. Mifepristone impair the changes of 13 out of 84 genes, suggesting that the rhythm of corticosterone modulates pineal phenotype, as mifepristone also reduces the expression of Aanat and the nocturnal synthesis of melatonin. Therefore, darkness-induced synthesis of the pineal hormone, besides being controlled by the central clock located in the hypothalamus, is also influencedby glucocorticoids through the regulation of NFκB transcriptional program.
Assuntos
Ritmo Circadiano , Corticosterona/metabolismo , NF-kappa B/metabolismo , Glândula Pineal/metabolismo , Ativação Transcricional , Animais , Arilalquilamina N-Acetiltransferase/genética , Arilalquilamina N-Acetiltransferase/metabolismo , Células Cultivadas , Masculino , Melatonina/genética , Melatonina/metabolismo , Ratos , Ratos WistarRESUMO
BACKGROUND/AIM: The nocturnal production of melatonin by the pineal gland is triggered by sympathetic activation of adrenoceptors and may be modulated by immunological signals. The effect of glucocorticoids on nocturnal melatonin synthesis is controversial; both stimulatory and inhibitory effects have been reported. During pathophysiological processes, an increased sympathetic tonus could result in different patterns of adrenoceptor activation in the pineal gland. Therefore, in this investigation, we evaluated whether the pattern of adrenergic stimulation of the pineal gland drives the direction of the glucocorticoid effect on melatonin production. METHODS: The corticosterone effect on the pineal hormonal production induced by ß-adrenoceptor or ß+α1-adrenoceptor activation was evaluated in cultured glands. We also investigated whether the in vivo lipopolysaccharide (LPS)-induced inhibition of melatonin is dependent on the interaction of glucocorticoids and the α1-adrenoceptor in adrenalectomized animals and on the in vivo blockade of glucocorticoid receptors (GRs) or the α1-adrenoceptor. RESULTS: Corticosterone potentiated ß-adrenoceptor-induced pineal melatonin synthesis, whilst corticosterone-dependent inhibition was observed when melatonin production was induced by ß+α1-adrenoceptors agonists. The inhibitory effect of corticosterone is mediated by GR, as it was abolished in the presence of a GR antagonist. Moreover, LPS-induced reduction in melatonin nocturnal plasma content was reversed by adrenalectomy and by antagonizing GR or α1-adrenoceptors. CONCLUSIONS: The dual effect of corticosterone on pineal melatonin synthesis is determined by the activation pattern of adrenoceptors (ß or ß+α1) in the gland during GR activation, suggesting that increased activation of the sympathetic system and the hypothalamic-pituitary-adrenal axis are necessary for the control of melatonin production during defense responses.