Moderate and severe adverse events in pediatrics: characteristics of incidents reported during the COVID-19 pandemic / Eventos adversos moderados y graves en pediatría: características de los incidentes reportados durante la pandemia del COVID-19 / Eventos adversos moderados e graves em pediatria: características dos incidentes notificados durante a pandemia COVID-19

ABSTRACT Objective: To verify the characteristics of safety incident reports resulting in moderate and severe harm to pediatric patients in two hospitals during the COVID-19 pandemic. Method: Cross-sectional study conducted in two hospitals in southern Brazil. The sample consisted of 137 notifications from March 2020 to August 2021. The data were collected through the electronic records of the institutions' notification systems and analyzed using descriptive and inferential statistics. Results: The most prevalent incidents were related to clinical processes or procedures (41.6%), affecting slightly more females (49.6%) and infants (39.4%). The majority of incidents (48.2%) occurred in inpatient units. The event sector (p=0.001) and the shift (p=0.011) showed statistically significant associations in both hospitals. Conclusion: The characteristics of the notifications are similar between the institutions surveyed, with a low number of moderate and severe incidents.

RESUMEN Objetivo: Verificar las características de los informes de incidentes de seguridad que resultaron en daños moderados y graves a pacientes pediátricos en dos hospitales durante la pandemia de COVID-19. Método: Estudio transversal realizado en dos hospitales del sur de Brasil. La muestra consistió en 137 notificaciones entre marzo de 2020 y agosto de 2021. Los datos se recogieron a través de los registros electrónicos de los sistemas de notificación de las instituciones y se analizaron mediante estadística descriptiva e inferencial. Resultados: Los incidentes más prevalentes estuvieron relacionados con procesos o procedimientos clínicos (41,6%), afectando ligeramente más a mujeres (49,6%) y lactantes (39,4%). La mayoría de los incidentes (48,2%) se produjeron en unidades de hospitalización. El sector del suceso (p=0,001) y el turno (p=0,011) se asociaron de forma estadísticamente significativa en ambos hospitales. Conclusión: Las características de las notificaciones son similares entre las instituciones encuestadas, con un bajo número de incidentes moderados y graves.

RESUMO Objetivo: Verificar as características das notificações de incidentes de segurança resultantes em dano moderado e grave em pacientes pediátricos de dois hospitais durante a pandemia COVID-19. Método: Estudo transversal, realizado em dois hospitais no sul do Brasil. A amostra foi composta por 137 notificações correspondentes ao período de março de 2020 a agosto de 2021. Os dados foram coletados pelo registro eletrônico dos sistemas de notificação das instituições e analisados por estatística descritiva e inferencial. Resultados: Os incidentes mais prevalentes foram relacionados aos processos ou procedimentos clínicos (41,6%), acometeram discretamente mais o sexo feminino (49,6%) e lactentes (39,4%). A maioria dos incidentes (48,2%) ocorreram em unidades de internação. O setor do evento (p=0,001) e o turno (p=0,011) obtiveram associação estatística significativa nos dois hospitais. Conclusão: As características das notificações são semelhantes entre as instituições pesquisadas, sendo evidenciado baixo número de incidentes moderados e graves.

Promoção do cuidado seguro em áreas críticas pediátricas: participação e atribuição dos acompanhantes / Promotion of safe care in critical pediatric areas: participation and attribution of the companions / Promoción de la atención segura en áreas pediátricas críticas: participación y atribución de los acompañantes

Objetivo: analisar a participação e a atribuição dos acompanhantes de criança hospitalizada na promoção do cuidado seguro em áreas críticas. Método: estudo qualitativo exploratório-descritivo realizado em áreas críticas de três hospitais de Porto Alegre, RS, no período de novembro a dezembro de 2017. A seleção da amostra foi intencional e com participação de 34 acompanhantes de crianças hospitalizadas há pelo menos sete dias. Entrevistas semiestruturadas foram gravadas em áudio e transcritas para análise de conteúdo do tipo temática. Resultados: o processo de análise das entrevistas gerou duas grandes categorias: Participação do acompanhante para o cuidado seguro, auxiliando em situações de risco e Atribuição dos acompanhantes na promoção da segurança do paciente pediátrico, colaborando com um ambiente seguro. Conclusão: os acompanhantes percebem que sua presença e colaboração no cuidado de crianças hospitalizadas em áreas críticas, bem como a confiança e interação deles com a equipe de saúde são fatores coadjuvantes na promoção do cuidado seguro.

Objective: to analyze the participation and role of caregivers of hospitalized children in promoting safe care in critical areas. Method: qualitative exploratory-descriptive study conducted in critical areas of three hospitals in Porto Alegre, RS, from November to December of 2017. The sample selection was intentional and with the participation of 34 companions of children hospitalized for at least seven days. Semi-structured interviews were audio-recorded and transcribed for thematic content analysis. Results: the process of analyzing the interviews generated two major categories: Participation of the companion for safe care, assisting in risky situations, and Attribution of companions in promoting the safety of pediatric patients, collaborating with a safe environment. Conclusion: the caregivers perceive that their presence and collaboration in the care of children hospitalized in critical areas, as well as their trust and interaction with the health team, are supporting factors in promoting safe care.

Objetivo: analizar la participación y la atribución de los cuidadores de niños hospitalizados en promover un cuidado seguro en áreas críticas. Método: estudio cualitativo exploratorio-descriptivo, realizado en áreas críticas de tres hospitales de Porto Alegre, Rio Grande do Sul, de noviembre a diciembre de 2017. La selección de la muestra fue intencional, participaron 34 acompañantes de niños hospitalizados durante al menos siete días. Las entrevistas semiestructuradas se grabaron en audio y se transcribieron para el análisis de contenido temático. Resultados: el proceso de análisis de las entrevistas obtuvo dos grandes categorías: Participación del acompañante en el cuidado seguro, auxiliando en situaciones de riesgo, y Atribución de los acompañantes en la promoción de la seguridad de los pacientes pediátricos, colaborando con un ambiente seguro. Conclusión: los acompañantes advierten que su presencia y colaboración en el cuidado de los niños hospitalizados en áreas críticas, así como su confianza y seguridad respecto al equipo de salud, son factores coadyuvantes en la promoción de una atención segura.

Promoção do cuidado seguro em áreas críticas pediátricas: participação e atribuição dos acompanhantes / Promoción de la atención segura en áreas pediátricas críticas: participación y atribución de los acompañantes / Promotion of safe care in critical pediatric areas: participation and attribution of the companions

RESUMO Objetivo analisar a participação e a atribuição dos acompanhantes de criança hospitalizada na promoção do cuidado seguro em áreas críticas. Método estudo qualitativo exploratório-descritivo realizado em áreas críticas de três hospitais de Porto Alegre, RS, no período de novembro a dezembro de 2017. A seleção da amostra foi intencional e com participação de 34 acompanhantes de crianças hospitalizadas há pelo menos sete dias. Entrevistas semiestruturadas foram gravadas em áudio e transcritas para análise de conteúdo do tipo temática. Resultados o processo de análise das entrevistas gerou duas grandes categorias: Participação do acompanhante para o cuidado seguro, auxiliando em situações de risco e Atribuição dos acompanhantes na promoção da segurança do paciente pediátrico, colaborando com um ambiente seguro. Conclusão os acompanhantes percebem que sua presença e colaboração no cuidado de crianças hospitalizadas em áreas críticas, bem como a confiança e interação deles com a equipe de saúde são fatores coadjuvantes na promoção do cuidado seguro.

RESUMEN Objetivo analizar la participación y la atribución de los cuidadores de niños hospitalizados en promover un cuidado seguro en áreas críticas. Método estudio cualitativo exploratorio-descriptivo, realizado en áreas críticas de tres hospitales de Porto Alegre, Rio Grande do Sul, de noviembre a diciembre de 2017. La selección de la muestra fue intencional, participaron 34 acompañantes de niños hospitalizados durante al menos siete días. Las entrevistas semiestructuradas se grabaron en audio y se transcribieron para el análisis de contenido temático. Resultados el proceso de análisis de las entrevistas obtuvo dos grandes categorías: Participación del acompañante en el cuidado seguro, auxiliando en situaciones de riesgo, y Atribución de los acompañantes en la promoción de la seguridad de los pacientes pediátricos, colaborando con un ambiente seguro. Conclusión los acompañantes advierten que su presencia y colaboración en el cuidado de los niños hospitalizados en áreas críticas, así como su confianza y seguridad respecto al equipo de salud, son factores coadyuvantes en la promoción de una atención segura.

ABSTRACT Objective to analyze the participation and role of caregivers of hospitalized children in promoting safe care in critical areas. Method qualitative exploratory-descriptive study conducted in critical areas of three hospitals in Porto Alegre, RS, from November to December of 2017. The sample selection was intentional and with the participation of 34 companions of children hospitalized for at least seven days. Semi-structured interviews were audio-recorded and transcribed for thematic content analysis. Results the process of analyzing the interviews generated two major categories: Participation of the companion for safe care, assisting in risky situations, and Attribution of companions in promoting the safety of pediatric patients, collaborating with a safe environment. Conclusion the caregivers perceive that their presence and collaboration in the care of children hospitalized in critical areas, as well as their trust and interaction with the health team, are supporting factors in promoting safe care.

Percepção da equipe multiprofissional quanto à segurança do paciente pediátrico em áreas críticas / Percepción del equipo multiprofesional respecto de la seguridad del paciente pediátrico en áreas críticas / Perception of the multi-professional team regarding the safety of pediatric patients in critical areas

Objetivo: conhecer a percepção da equipe multiprofissional sobre as estratégias de segurança do paciente pediátrico em áreas críticas. Método: estudo qualitativo exploratório-descritivo realizado em unidades de terapia intensiva e emergências pediátricas de três hospitais da cidade de Porto Alegre, entre novembro/2018 a março/2019, vinculado ao projeto matriz "Segurança do paciente nos serviços de atenção hospitalar às crianças e adolescentes na cidade de Porto Alegre". Incluídos 20 profissionais que atuam nessas áreas e possuem experiência na pediatria de pelo menos um ano. Realizou-se cinco entrevistas coletivas, gravadas em áudio e após transcritas para análise de conteúdo. Resultados: surgiram três categorias, Manutenção da adesão aos protocolos/metas de segurança do paciente pediátrico, Ensino/educação em segurança do paciente e Envolvimento dos acompanhantes para promoção da segurança do paciente. Conclusão: os profissionais percebem que as estratégias descritas demonstram condições mínimas para alcançar a qualidade da assistência e prevenção de incidentes, essencial para segurança do paciente.

Objective: to know the perception of the multi-professional team regarding the strategies for the safety of pediatric patients in critical areas. Method: a qualitative and exploratory-descriptive study carried out in pediatric intensive care and emergency units of three hospitals in the city of Porto Alegre, between November 2018 and March 2019, linked to the matrix project entitled "Patient safety in hospital care services for children and adolescents in the city of Porto Alegre". A total of 20 practitioners who worked in these areas and who had experience in pediatrics for at least one year were included. Five collective interviews were conducted, which were audio-recorded and later transcribed for content analysis. Results: three categories arose: Maintenance of adherence to the protocols/goals of pediatric patient safety, Teaching/education in patient safety, and Involvement of companions for the promotion of patient safety. Conclusion: the practitioners acknowledge that the strategies described demonstrate minimal conditions to reach care quality and incident prevention, essential for patient safety.

Objetivo: conocer la percepción del equipo multidisciplinario sobre las estrategias de seguridad del paciente pediátrico en áreas críticas. Método: estudio cualitativo descriptivo y exploratorio realizado en unidades de cuidados intensivos y urgencias pediátricas de tres hospitales de la ciudad de Puerto Alegre, entre noviembre de 2018 y marzo de 2019, vinculado al proyecto matricial "Seguridad del paciente en servicios de atención hospitalaria para niños y adolescentes de la ciudad de Puerto Alegre". Se incluyó a 20 profesionales que trabajaban en estas áreas y tenían al menos un año de experiencia en pediatría. Se realizaron cinco entrevistas colectivas, grabadas en audio y luego transcriptas para análisis de contenido. Resultados: surgieron tres categorías: Mantenimiento de la adherencia a los protocolos/metas de seguridad del paciente pediátrico, Enseñanza/ educación en seguridad del paciente e Implicación de los acompañantes para promover la seguridad del paciente. Conclusión: los profesionales perciben que las estrategias descriptas demuestran condiciones mínimas para alcanzar la calidad de la atención y prevención de incidentes, imprescindibles para la seguridad del paciente.

Evaluation of the therapeutic effect of methylene blue on the liver of rats submitted to ischemia and reperfusion

Abstract Purpose: To analyze the effect of methylene blue (MB) therapy during the liver ischemia-reperfusion injury (I/R) process. Methods: Thirty-five male Wistar rats were used, (70%) submitted to partial ischemia (IR) or not (NIR) (30%) were obtained from the same animal. These animals were divided into six groups: 1) Sham (SH), 2) Sham with MB (SH-MB); 3) I/R, submitted to 60 minutes of partial ischemia and 15 minutes of reperfusion; 4) NI/R, without I/R obtained from the same animal of group I/R; 5) I/R-MB submitted to I/R and MB and 6) NI/R-MB, without I/R. Mitochondrial function was evaluated. Osmotic swelling of mitochondria as well as the determination of malondialdehyde (MDA) was evaluated. Serum (ALT/AST) dosages were also performed. MB was used at the concentration of 15mg/kg, 15 minutes before hepatic reperfusion. Statistical analysis was done by the Mann Whitney test at 5%. Results: State 3 shows inhibition in all ischemic groups. State 4 was increased in all groups, except the I/R-MB and NI/R-MB groups. RCR showed a decrease in all I/R and NI/R groups. Mitochondrial osmotic swelling showed an increase in all I/R NI/R groups in the presence or absence of MB. About MDA, there was a decrease in SH values in the presence of MB and this decrease was maintained in the I/R group. AST levels were increased in all ischemic with or without MB. Conclusions: The methylene blue was not able to restore the mitochondrial parameters studied. Also, it was able to decrease lipid peroxidation, preventing the formation of reactive oxygen species.

Prophylactic application of laser light restores L-FABP expression in the livers of rats submitted to partial ischemia

OBJECTIVES: The objective of the present study was to evaluate the protective effect of pre-conditioning treatment with laser light on hepatic injury in rats submitted to partial ischemia using mitochondrial function and liver fatty acid binding protein as markers. METHODS: Rats were divided into four groups (n=5): 1) Control, 2) Control + Laser, 3) Partial Ischemia and 4) Partial Ischemia + Laser. Ischemia was induced by clamping the hepatic pedicle of the left and middle lobes of the liver for 60 minutes. Laser light at 660 nm was applied to the liver immediately prior to the induction of ischemia at 22.5 J/cm2, with 30 seconds of illumination at five individual points. The animals were sacrificed after 30 minutes of reperfusion. Blood and liver tissues were collected for analysis of mitochondrial function, determination of malondialdehyde and analysis of fatty acid binding protein expression by Western blot. RESULTS: Mitochondrial function decreased in the Partial Ischemia group, especially during adenosine diphosphate-activated respiration (state 3), and the expression of fatty acid binding protein was also reduced. The application of laser light prevented bioenergetic changes and restored the expression of fatty acid binding protein. CONCLUSION: Prophylactic application of laser light to the livers of rats submitted to partial ischemia was found to have a protective effect in the liver, with normalization of both mitochondrial function and fatty acid binding protein tissue expression.

Políticas de Saúde e Jovens Infratores: uma análise de narrativas / Health policies and Youth in Conflict with the Law: a narrative analysis of

O Objetivo geral do estudo foi analisar as respostas apresentadas pelo Estado para a saúde de jovens que cumprem medida socioeducativa de internação a partir de documentos provenientes da esfera governamental, dos movimentos sociais e de produções acadêmicas. Especificamente, buscou-se identificar os atores que vocalizam as demandas de saúde de jovens em conflito com a lei, compreender a concepção de saúde expressa nas políticas e normas de saúde, discutir a perspectiva acerca da transgressão juvenil presente nas políticas e normas de saúde e problematizar as escolhas de prioridades apontadas pela política de saúde e os mecanismos que conduziram a sua adoção. Recorreu-se a estratégia metodológica de análise de narrativas políticas que possibilita a compreensão de mudanças no campo das políticas, tal análise reconhece a formulação de políticas públicas atrelada ao poder de certos discursos e personagens e aposta na ideia de que as narrativas contam uma história, com começo, meio e fim, onde atores chaves foram essenciais para o desenvolvimento do enredo. Através da análise documental identificamos os principais personagens e três narrativas que apresentam compreensões e proposições distintas entre si no que concerne a saúde dos jovens em conflito com a lei, foram elas: (1) O jovem potencialmente perigoso: perpassado pela violência, (2) O jovem em conflito com a lei: o cidadão de direitos e (3) O jovem delinquente: o adolescente portador de transtorno mental. Observou-se que a narrativa hegemônica estava associada ao referencial dos direitos humanos e aliada a marcos fundantes da democracia brasileira como a constituição de 1988, o ECA e o próprio SUS. Ademais, apontou-se para o caráter endógeno apresentado na a formulação da política de saúde para os jovens em conflito com a lei, sendo possível detectar poucas aberturas para diálogos com movimentos sociais e sociedade civil. Por fim, ponderou-se estigmas e preconceitos ainda vigentes que dificultam a legitimação de políticas de saúde que reconheçam os jovens em conflito com a lei cidadãos de direitos

The aim of the study was to analyze the responses submitted by the State for the health of youth in rehabilitation centers in the deprivation of liberty from documents originating from the governmental sphere, social movements and academic productions. Specifically, we were wanted to identify the actors that voice the demands of young in conflict with the law health, understand the concept of health expressed in health policies, discuss the perspective about the phenomenon of youth in conflict with the law health and finally, problematize the priorities chosen by health policy and the mechanisms that led to its adoption. We used the methodology of narrative policy analysis that makes possible the understanding changes, such method proposes that stories have beginnings, middles, and ends, as in scenarios; they are employed by actors in order to act under conditions of uncertainty, conflict and complexity. Through documentary analysis we have identified the main characters and three narratives, each of them with different perspectives and understandings. The narratives are the following: (1) The potentially dangerous youth: the referential of violence, (2) The youth in conflict with the law: Human rights referential, (3) The Delinquent Youth: Mental health referential. We observed that the hegemonic narrative was associated with the human rights referential talking with founding milestones of Brazilian democracy as the 1988 constitution, the Child and Adolescent Statute (ECA) and Health system (SUS) guidelines. In addition, it was pointed to the endogenous character in the formulation of the policy, without the strong presence of social movements and civil society. Finally, he wondered about stigmas and prejudices that hinder the recognition of young people as citizens of rights

Effect of irradiation with different laser wavelengths on oxidative stress of non-hepatectomized rats

PURPOSE: To assess the effect of two laser wavelengths, either separate or combined, on intact rat livers. METHOD: Nineteen male Wistar rats (200-300 g) were submitted to laser irradiation at 5 different sites on the liver surface.Wavelengths 660 and 780 nm were used, with a dose of irradiation of 60 J/cm2/site.The animals were divided into the groups:control (C) and animals irradiated with 660 nm laser (L1), with 780 nm laser (L2) or withboth wavelengths (L3).Mitochondrial function, mitochondrial swelling, and hepatocellular malondialdehyde (MDA) levels were determined.Data were analyzed by the Mann-Whitney test, with the level of significance set at 5%. RESULTS: There was a reduction of ADP-activated respiration (state 3) in group L1 compared to group C (p=0.0016), whereas the values of group L2 were similar to control.Group L3 also showed a reduction of state 3 (p=0.0159).There was a reduction of RCR in group L1 compared to control (p=0.0001) and to group L2 (p=0.0040).Mitochondrial swelling only differed between group L3 and control (p=0.0286).There was a increase in MDA levels in group L3 compared to control (p=0.0476) and to group L2 (p=0.0286) and in group L1 compared to group L2 (p=0.0132). CONCLUSION: Although laser irradiation reduced mitochondrial function,it did not interfere with the hepatocellular energy status.

Effects of hyperbaric oxygen therapy on the liver after injury caused by the hepatic ischemia-reperfusion process

PURPOSE: To evaluate the effects of hyperbaric oxygen on rats submitted to hepatic ischemia and reperfusion. METHODS: Twenty-three Wistar rats were divided at random into 3 groups: SHAM, rats submitted to surgical and anesthetic stress without induction of hepatic ischemia/reperfurion; I/R, rats submitted to total ischemia of the hepatic pedicle for 25 min followed by 5 min of reperfusion; HBOI/R, rats submitted to 60 min of hyperbaric oxygen therapy at a pressure of 2 absolute atmospheres immediately after the experimental protocol of ischemia/reperfusion. Hepatic function was evaluated by quantitation of serum alanine aminotranferase (ALT) and aspartate aminotransferase (AST), and by mitochondrial function through the determination of states 3 and 4 of mitochondrial respiration, respiratory control ratio (RCR) and mitochondrial swelling. Data were analyzed by the Mann-Whitney test, with the level of significance set at p <0.05. RESULTS: There was a significant difference in state 3 values for the SHAM group vs I/R and I/R vs IRHBO, in state 4 values for the SHAM group vs I/R; and in mitochondrial swelling for the SHAM groups vs I/RHBO, SHAM vs I/R, and IR vs I/RHBO. CONCLUSION: The use of hyperbaric oxygen after I/R improved in a relative manner both the production of energy and the effects on the mitochondrial wall. .

Effect of hyperbaric hepatic hyperoxia on the liver of rats submitted to intermittent ischemia/reperfusion injury

PURPOSE: To determine the effect of hyperbaric hyperoxia as hepatic preconditioning on hepatocellular integrity in rats submitted to intermittent hepatic ischemia/reperfusion injury. METHODS: Twenty male Wistar rats were divided into 4 groups (SHAM, I/R, HBO-I/R and CONTROL). The surgical technique consisted of total clamping of the hepatic pedicle for 15 min, followed by reperfusion for 5 min, performed twice. The application of hyperbaric oxygen (HBO) was carried out in a collective chamber (simultaneous exposure of 4 rats) pressurized directly with oxygen at 2 ATA for 60 min. Tissue malondialdehyde (MDA) levels were determined and blood samples were collected for the determination of serum AST and ALT levels. Data were analyzed statistically by the Mann-Whitney test, with the level of significance set at p < 0.05. RESULTS: A statistically significant difference in MDA (p< 0.05) was observed between control and HBO-I/R, but not between control and I/R. Regarding AST, there was a difference between control and I/R and HBO-I/R. Analysis of ALT revealed a significant difference between control and I/R (p<0.05) and between I/R and HBO-I/R, with no difference between control and HBO-IR. CONCLUSION: Hyperoxic preconditioning proved to be favorable regarding alanine transaminase, but not aspartate aminotranserase or malondialdehyde levels. .

Hyperoxic preconditioning in partial liver ischemia

PURPOSE: To evaluate the effect of the hyperbaric oxygen (HBO) treatment as a pre-conditioning for I/R effects in the liver ischemia. METHODS: Fifty-seven male Wistar rats (260-300g) were submitted to the following procedures: SHAM; I/R, rats submitted to I/R, consisting of partial ischemia of 70% of the liver for 90 minutes followed by 15 minutes of reperfusion; HBO I/R 1 ATA, 30 minutes of HBO treatment at the pressure of 1 absolute atmosphere (ATA) during the ischemia time. HBO I/R 2 ATA, 30 minutes of HBO (2 ATA) during the ischemia time. Pre HBO I/R 30', rats submitted to 30 minutes of HBO (2 ATA) immediately before the I/R time. Pre HBO I/R 90', rats submitted to 90 minutes of HBO (2 ATA) immediately before the I/R time. RESULTS: There was a significant worsening of all the parameters of mitochondrial energy production (state 3, 4, RCR and Swelling) in the I/R group, when compared to the Sham group (I/R <Sham, p<0.05). There was also a significant worsening in state 4, RCR and mitochondrial edema in the Pre HBO I/R 90' group compared to the I/R group. Hepatic enzyme concentrations were significantly higher in the I/R group. CONCLUSION: The use of hyperbaric oxygen before and during I/R did not improve the production of hepatocellular energy reduced by I/R, nor did it prevent the installation of mitochondrial edema induced by Iischemia/reperfusion. .

Eficácia da terapia Anti-IgE no controle da asma / Effectiveness of anti-IgE therapy for asthma control

Avaliar parâmetros de resposta à terapia anti-IgE com omalizumabe em pacientes com asma de difícil controle. Métodos: Foram avaliados 24 pacientes com asma de difícil controle, em uso de omalizumabe há pelo menos 32 semanas e considerados como respondedores à terapia. Avaliou-se a pontuação do teste de controle de asma (TCA), a presença de sintomas de asma, a frequência de uso de ß2-agonista de curta ação, as doses de corticoide inalatório e oral e o percentual previsto do volume expiratório forçado no 1° minuto (VEF1), antes e com 16 e 32 semanas de tratamento. Resultados: Na avaliação da pontuação do TCA foram obtidas as médias 12,4 para o momento inicial, 15,7 e 17,9 para a 16ª semana e 32ª semana respectivamente (p < 0,0001). A dose média de corticoide inalatório diminuiu ao longo das 32 semanas, de 1.416 mcg para 1.250 mcg na 32ª semana (p = 0,0797). O número de idas à emergência e de sintomas noturnos também diminuíram. Observou-se redução da dose de corticoide oral, sendo inicialmente a dose média de 17,4 mg e após 16 e 32 semanas 6,7 mg e 4,4 mg, respectivamente(p < 0,0001). Houve aumento na média do VEF1 (% do previsto), de 37,5% no início do tratamentopara 44,0% na 16ª semana (p = 0,007). Conclusões: O omalizumabe como terapia adjuvante no tratamento de pacientes com asma de difícil controle foi eficaz na melhora de parâmetros clínicose funcionais, contribuindo para o controle da asma e diminuição dos riscos futuros...

To assess parameters of response to anti-IgE therapy with omalizumab in patients with difficult-to-control asthma. Methods: Twenty four patients with difficult-to-control asthma using omalizumab for at least 32 weeks and considered as treatment responders were assessed. The Asthma Control Test (ACT) was used to assess the presence of asthma symptoms, frequency of use of short-acting beta2-agonists, inhaled and oral corticosteroid doses, and percentage of predicted forced expiratory volume in 1 second (FEV1) before treatment and after 16 and 32 weeks of treatment. Results: Mean ACT scores were 12.4 before treatment and 15.7 and 17.9 at 16 and 32 weeks post-treatment, respectively (p < 0.0001). Mean dose of inhaled corticosteroid decreased over the 32 weeks, from 1,416 mcg to 1,250 mcg (p = 0.0797). The number of visits to emergency services and nocturnal symptoms also decreased. There was a reduction in the mean dose of oral corticosteroids, from 17.4 mg at baseline to 6.7 mg and 4.4 mg after 16 and 32 weeks of treatment, respectively (p < 0.0001). Finally, an increase was found in the mean percentage values of predicted FEV1, from 37.5% at baseline to 44.0% at week 16 (p = 0.007). Conclusions: Omalizumab as adjunctive therapy in the treatment of patients with difficult-to-control asthma was effective in improving clinical and functional parameters, contributing to the control of asthma and to the reduction of future risks...

Association of giant congenital melanocytic nevus, halo nevus and vitiligo in a 75-year-old patient / Associação de nevo melanocítico congênito gigante, nevo halo e vitiligo. Relato de caso em paciente de 75 anos

A giant congenital melanocytic nevus represents a rare condition. The halo phenomenon may be seen in congenital or acquired melanocytic nevi. In the literature, association of halo nevus and giant congenital melanocytic nevus is rare and the association of both with vitiligo even more rare. A 75-yearold woman at first consultation complained of a hyperchromic bluish-brown hairy macula on the lower back, buttocks and thighs present since birth and an achromic halo of onset three years ago. The histological features were consistent with congenital melanocytic nevus and halo nevus, respectively. After two years the patient developed achromic areas in normal skin, histologically consistent with vitiligo. The authors emphasize the rarity of this triple combination, the patient's age and the absence of malignant degeneration to date.

Nevo melanocitico congênito gigante constitui uma condição rara. O fenômeno halo pode ser observado em nevos melanocíticos congênitos ou adquiridos. Na literatura a associação nevo halo e nevo melanocítico congênito gigante é rara e a associação de ambos com vitiligo ainda mais rara. Mulher de 75 anos que à primeira consulta apresentava mácula hipercrômica castanho-azulada pilosa na região lombar, nádegas e coxas desde o nascimento e halo acrômico de aparecimento há 3 anos. Os histológicos foram compatíveis com nevo melanocítico congênito e nevo halo respectivamente. Após dois anos evoluiu com áreas de acromia à distância, com histológico de vitiligo. Os autores ressaltam a raridade desta tripla associação; a idade da paciente e a ausência de degeneração maligna até o presente momento.

Synthesis, quality control and dosimetry of the radiopharmaceutical 18F-sodium fluoride produced at the Center for Development of Nuclear Technology - CDTN / Síntese, controle de qualidade e dosimetria do radiofármaco 18 -F de fluoreto de sódio produzido no Centro de Desenvolvimento da Tecnologia Nuclear - CDTN

18F-Sodium fluoride (Na18F) is a radiopharmaceutical used for diagnosis in nuclear medicine by positron emission tomography (PET) imaging. Bone scintigraphy is normally performed using 99mTc-MDP. However, 18F PET scans promise high quality imaging with increased resolution and improved sensitivity and specificity. In order to make available a tool for more specific studies of tumors and non-oncological diseases of bone tissue, the UPPR/CDTN team undertook the production and quality control of Na18F injectable solution with the physical-chemical, microbiological and biological characteristics recommended in the U.S. Pharmacopeia. Na18F radiochemical purity was 96.7 ± 1.3 percent, with Rf= 0.026 ± 0.006. The product presented a pH of 5.3 ± 0.6, half life of 109.0 ± 0.8 minutes, endotoxin limit < 5.0 EU.mL-1 and no microbial contaminants. The biodistribution of Na18F was similar to that described in the literature, with a clearance of 0.19 mL.min-1 and distribution volume of 18.76 mL. The highest bone concentration (5.0 ± 0.5 percentID.g-1) was observed 20 minutes after injection. Na18F produced at the UPPR presented all the quality assurance requirements of the U.S. Pharmacopeia and can be safely used for clinical bone imaging.

O Fluoreto de sódio 18F (Na18F) é um radiofármaco empregado para diagnóstico através da Tomografia por Emissão de Pósitrons (PET). Cintilografias ósseas são normalmente obtidas utilizando-se 99mTc-MDP. Entretanto, o interesse pelo Na18F é crescente, principalmente devido à obtanção de imagens de elevada resolução. Com o objetivo de tornar disponível uma ferramenta mais específica para estudos de tumores e doenças não-oncológicas do tecido ósseo, o grupo da UPPR/CDTN implementou a produção e o controle de qualidade da solução injetável de Na18F com as características físico-química, microbiológica e biológica preconizadas pela farmacopéia. Sua pureza radioquímica foi de 96,7 ± 1,3 por cento, com Rf= 0,026 ± 0,006. O produto apresentou pH igual a 5,3 ± 0,6, tempo de meia-vida de 109,0 ± 0,8 minutos, limite de endotoxinas < 5,0 EU.mL-1 e ausência de microrganismos. O perfil de biodistribuição em camundongos foi semelhante ao disponível na literatura, com depuração igual a 0,19 mL.min-1 e volume de distribuição igual a 18,76 mL. A concentração máxima (5,0 ± 0,5 por cento DI.g-1) foi observada no osso 20 minutos após a injeção. O Na18F produzido na UPPR do CDTN apresentou os parâmetros de qualidade definidos na farmacopéia americana e pode ser usado com segurança para uso clínico em cintilografia óssea.

Organized Filaments in the adhesive system of Macrostomum tuba Graff, 1882 ( Platyhelminthes, Macrostomida)

The adhesive organs or “duo-gland adhesive organs” of platyhelminths are formed by a specialized epithelialcell and extensions of two gland cells. These organs are used for temporary fixation of the organism tosurfaces in aquatic habitats. The mechanisms involved in adhesion to and release from a given surfacedepend on secretions produced by the glands; less is known about the involvement of cytoplasmic filamentsin the anchoring cell itself. In this study, we examined the structure of the adhesive organs present in thetail plate of Macrostomum tuba Graff, 1882 (Platyhelminthes, Macrostomida), a freshwater, free-livingflatworm. Scanning and transmission electron microscopy allowed elucidation of the three-dimensionalorganization of the adhesive system, especially of the microvilli that formed the outer collar (or papilla),which was endowed with a fibrous core. Electrical stimulation caused the flatworms to extend their papillaeabove the ciliated surface. The use of tannin- and diamine-containing fixatives showed that the filamentousarray contained tonofilaments and actin filaments. Tonofilaments concentrate in the axis of each microvillus;actin filaments, about 7-8 nm thick, spread out towards the periphery. Scanning images demonstrated thefinger-like shape of the papillae, about 7-8 ìm high, with a terminal opening. Microvilli followed a straightcourse along the surface.