ABSTRACT
Resumo O testamento vital é tema discutido no âmbito da saúde e do direito, e importante instrumento para direcionar a assistência prestada ao paciente terminal de acordo com suas aspirações. Esta pesquisa exploratória com abordagem qualitativa estuda a opinião de 36 médicos, residentes em hospital público, acerca da inserção das diretivas antecipadas da vontade do paciente ou testamento vital na prática médica. A coleta de dados ocorreu em agosto de 2013. Evidenciou-se a relevância do testamento vital no respeito à autonomia do paciente terminal, propiciando humanização do seu atendimento. Este artigo demonstra igualmente a necessidade de criação de dispositivo legal que regulamente sua utilização formal no Brasil, além de ampliar discussões acerca da temática, com ênfase na realidade brasileira, a fim de promover maior compreensão sobre o posicionamento de médicos quanto aos últimos momentos da vida dos pacientes.
Abstract The living will is a relevant theme to be discussed from the sanitary and legal points of view and is also an important instrument to drive the assistance to terminally ill patients according to their final wills. We performed this exploratory and qualitative research to study the opinion of 36 resident doctors in Brazil public hospitals, regarding to the inclusion of the living will in medical practice. Data were collected in August, 2013. Our results stressed the relevance of living will for the autonomy of the terminally ill patient, providing the humanization of his treatment. This article shows the need of a law to rule the formal use of this directory in Brazil. It is also important to point out the necessity to broaden the discussions about the theme in Brazilian reality, in order to promote a larger comprehension of those physicians' point of view when dealing with the last moments of their patients' lives.
Resumen El testamento vital es un tema debatido en el contexto de la salud y del derecho y es, también, un instrumento importante para guiar la asistencia prestada al paciente terminal de acuerdo con sus aspiraciones. Esta investigación exploratoria, con enfoque cualitativo, estudia la opinión de 36 médicos residentes en hospitales públicos sobre la inserción de las instrucciones anticipadas de la voluntad del paciente o testamento vital en la práctica médica. La recolección de los datos fue en agosto de 2013. Se puso en evidencia la importancia del testamento vital respecto a la autonomía del paciente terminal, favoreciendo la humanización de su atención. Este artículo también demuestra la necesidad de crear un dispositivo legal que regularice su uso formal en Brasil, además de ampliar el debate sobre el tema, con énfasis en la realidad brasileña, a fin de promover una mayor comprensión sobre la posición de los médicos ante los últimos momentos de vida de los pacientes.
Subject(s)
Humans , Male , Female , Health Personnel , Medical Care , Personal Autonomy , Professional Practice , Right to Die , Terminally Ill , Professional-Family Relations , Professional-Patient Relations , Qualitative ResearchABSTRACT
A esplenectomia diminui a atividade de células imunes e pode estar relacionada com translocação bacteriana (TB) e sepse. Investigou-se a presença de TB e sepse em camundongos esplenectomizados, por meio de análises de peso, de sexo, de alterações da microbiota digestória e mucosa duodenal. 20 fêmeas e 20 machos de camundongos Swiss webster com 125 dias foram divididos em dois grupos: esplenectomizados e controles. Os animais foram pesados diariamente. Após sete dias da esplenectomia total convencional, os animais foram eutanasiados para estudo da TB, microbiota e morfometria intestinais. Para microbiota, foram coletadas as fezes da região média do intestino delgado, que foi seccionado para análise morfométrica. Após o preparo dos tubos com amostras fecais nas diferentes diluições, foram inoculados 0,1 mL de cada na superfície de placas contendo meios cromogênicos. Fragmentos do fígado e linfonodos mesentéricos foram macerados e homogeneizados, separadamente, em placas de Petri estéreis, posteriormente, adicionadas a caldo cérebro coração (BHI) na proporção de 1:5 e incubados em estufa a 37 °C por 24 horas. Posteriormente, alçadas de caldo foram semeadas em placas de Petri com diferentes meios de culturas. Os camundongos esplenectomizados apresentaram redução da evolução ponderal e maior prevalência de coproculturas positivas. A análise morfométrica duodenal revelou redução na altura e da área das vilosidades dos grupos esplenectomizados comparados aos seus controles. Os machos esplenectomizados apresentaram maiores taxas de TB e sepse. A asplênia aumenta a suscetibilidade à TB e, consequentemente, as doenças de origem séptica em camundongos. Sexo e alterações da mucosa duodenal podem influenciar no aumento deste fenômeno(AU)
Ssplenectomy diminishes the immune cells activity and may be related to bacterial translocation (BT) and sepsis. The BT and sepsis presence in splenectomized mice was investigated through analyzes of weight, sex, changes in the digestive microbiota and duodenal mucosa. Swiss Webster mice (20 females/20 males) were divided into two equal groups: splenectomized and controls, aged 125 days of life. Total splenectomy was performed in splenectomized group. The animals were weighed every day. After seven days, the animals were euthanized for the study of TB, microbiota and intestinal morphology. For microbiota study, stools were collected from the middle region of the small intestine, which was sectioned for morphometric analysis. After the tubes preparation with fecal samples at different dilutions, 0.1 mL of each sample was inoculated on the surface of plates containing chromogenic media. Fragments of the liver and mesenteric lymph nodes were macerated and homogenized separately in sterile Petri dishes, subsequently added to a brain/heart broth (BHI) in concentration 1:5 and incubated in an oven at 37 °C for 24 hours. Subsequently, the broths were seeded in Petri dishes with different culture media. The splenectomized mice presented a reduction in the ponderal evolution and a higher prevalence of positive coprocultures. Duodenal morphometric analysis revealed a reduction in the height and villus area of the splenectomized groups compared to their controls. Splenectomized males had higher BT and sepsis rates. Asplenia increases susceptibility to BT, and consequently septic diseases in mice. Sex and duodenal mucosa alterations may influence the increase of this phenomenon.(AU)
ABSTRACT
INTRODUCTION : Bacterial translocation is the invasion of indigenous intestinal bacteria through the gut mucosa to normally sterile tissues and internal organs. Schistosomiasis may cause alterations in the immune system and damage to the intestines, portal system and mesenteric lymph nodes. This study investigated bacterial translocation and alterations in the intestinal microbiota and mucosa in schistosomiasis and splenectomized mice. METHODS : Forty female 35-day-old Swiss Webster mice were divided into the following four groups with 10 animals each: schistosomotic (ESF), splenectomized schistosomotic (ESEF), splenectomized (EF) and control (CF). Infection was achieved by introduction of 50 Schistosoma mansoni (SLM) cercariae through the skin. At 125 days after birth, half of the parasitized and unparasitized mice were subjected to splenectomy. Body weights were recorded for one week after splenectomy; then, the mice were euthanized to study bacterial translocation, microbiota composition and intestinal morphometry. RESULTS : We observed significant reductions in the weight increases in the EF, ESF and ESEF groups. There were increases of at least 1,000 CFU of intestinal microbiota bacteria in these groups compared with the CF. The EF, ESF and ESEF mice showed decreases in the heights and areas of villi and the total villus areas (perimeter). We observed frequent co-infections with various bacterial genera. CONCLUSIONS : The ESEF mice showed a higher degree of sepsis. This finding may be associated with a reduction in the immune response associated with the absence of the spleen and a reduction in nutritional absorption strengthened by both of these factors (Schistosoma infection and splenectomy). .