Hemofilia a Adquirida E a Precariedade Da Saude Bucal: A Dificuldade Do Manejo Hematologico E Odontologico

A hemofilia A adquirida (HAa) e uma coagulopatia autoimune rara, associada a deficiencia do fator de coagulacao VIII, diagnosticada em idosos, que apresenta altas taxas de morbidade e mortalidade. Os principais sintomas sao sangramentos recorrentes, espontaneos e prolongados em regioes subcutaneas e mucosas, alem de hematomas musculares. O prolongamento isolado do Tempo de Tromboplastina Parcial Ativada (TTPA) e o Tempo de Protrombina (TP) normal, acompanhados de sangramento anormal, sugerem aprofundar a investigacao diagnostica. Por ser um disturbio autoimune, o paciente desenvolve inibidores contra o fator de coagulacao VIII, tornando o tratamento ainda mais complexo, ja que a reposicao do fator de coagulacao deficiente pode sofrer ataque dos autoanticorpos envolvidos. Medicamentos antifibrinoliticos e imunossupressores sao opcoes terapeuticas complementares. Um homem de 71 anos, branco, com historico profissional na agricultura e construcao civil, foi encaminhado a equipe de Hematologia apresentando dor nas pernas, hemartrose no joelho e hematomas extensos nos membros superiores e inferiores, relatando inicio dos sintomas apos segunda dose vacinal para Sars-Cov-2. Com historico de hipertensao arterial, artrite reumatoide e hiperplasia prostatica benigna, encontrava-se em uso de sinvastatina, enalapril, prednisona, diclofenaco sodico, carisoprodol e doxazosina. Os exames laboratoriais demonstraram hemograma, RNI, TP e plaquetograma dentro dos limites de normalidade. Ja a dosagem de fator de coagulacao VIII foi de 3% e o TTPA de 69,5 segundos, levando ao diagnostico de HAa. Por queixa de dor dentaria, o paciente foi encaminhado a Odontologia. Ao exame fisico, observou-se edentulismo superior e uso de protese total, pseudomembrana removivel a raspagem no palato, compativel clinicamente com candidose pseudomembranosa, presenca de quatro dentes inferiores com mobilidade, acumulo de biofilme bacteriano e caries. Alem disso, apresentava pequena ulceracao em labio inferior, indolor, nao endurecida a palpacao, compativel clinicamente com queilite actinica. Para as manifestacoes estomatologicas, prescreveu-se dexpantenol labial, fator de protecao solar e nistatina suspensao oral (100.000UI) para bochecho durante 7 dias, ocasionando a melhora incompleta da lesao labial e resolucao completa da infeccao fungica. Apesar da conduta indicada ter sido a extracao de todos os dentes, o quadro hematologico instavel nao permitiu tais procedimentos, ja que agentes antifibrinoliticos foram considerados insuficientes para controlar a hemorragia e o uso de alfaeptacogue ativado nao foi liberado pelo Ministerio da Saude para realizacao das exodontias. Assim, optou-se pela prescricao de analgesicos e proservacao do caso, enquanto as condicoes hematologicas aguardavam estabilizacao. Esse fato limitou a acao da equipe multiprofissional, uma vez que os focos infecciosos dentarios podem ocasionar episodios de dor intensa e sangramentos espontaneos, agravando ainda mais a condicao geral. O caso demonstra a complexidade do manejo hematologico de um paciente com HAa, levando a dificuldade do tratamento odontologico, nao sendo possivel atender imediatamente as necessidades do paciente mesmo em condicoes onde a intervencao odontologica nao podia ser considerada eletiva. Copyright © 2022

O Novo Normal E O Comportamento Dos Doadores De Sangue No Periodo Pos-Pandemia - Gsh Banco De Sangue Serum Centro Rj

Objetivo: Tracar perfil epidemiologico dos candidatos a doacao de sangue do GSH Banco de Sangue de Serum RJ realizando um comparativo com o primeiro semestre de 2019 (pre pandemia) e o primeiro semestre de 2022 (pos pandemia COVID-19) com o retorno as atividades (o novo normal). Metodo: Realizada analise retrospectiva transversal para obtencao do perfil epidemiologico dos candidatos a doacao de sangue, com obtencao dos dados extraidos da base de dados do sistema informatizado utilizado na instituicao. Foram analisados os dados dos primeiros semestres de 2019 e de 2022. Resultados: Na analise do perfil dos candidatos a doacao de sangue no primeiro semestre de 2019 ficou evidenciado um total de 8.362 cadastros realizados. Quanto a inaptidao clinica e sorologica destes 21% ficaram impedidos de doarem. Referente ao perfil dos doadores 74,5% foram candidatos de 1vez;19,4% candidatos fidelizados, de repeticao e 6,1% candidatos esporadicos. Por fim, observando quanto ao genero, 63% candidatos do sexo masculino, e quanto a faixa etaria a predominancia dos candidatos se mostra 34% jovens entre 18 e 29 anos;seguidos por 28% de candidatos entre 30 e 39 anos;20% entre 40 e 49 anos;14% entre 50 e 59 anos e 4% com 60 anos ou mais. As principais causas de inaptidao clinica neste periodo foram de 1% casos com hipertensao, 0,50% dos casos com risco para DST, 0,20% com visitas para regioes malarigenas;0,18% dos casos com hipotensao.Ao avaliar o perfil dos candidatos no primeiro semestre de 2022, ficou evidenciado um total de 11.376 cadastros foram realizados, sendo considerados na Triagem 13 % inaptos. Quanto ao perfil, total de 50,7% doadores de 1vez;22,6% doadores de repeticao e 26,7% esporadicos. Ao analisar o perfil dos candidatos por genero, o resultado foi de 60% correspondente ao sexo masculino. Na analise da faixa etaria, a predominancia do perfil dos candidatos foi de jovens na faixa etaria entre 18 e 29 anos, totalizando 31%;27 % doadores entre 30 e 39 anos;23% entre 40 e 49 anos;14% entre 50 e 59 anos e 5% com 60 anos ou mais. As principais causas de inaptidao identificadas no periodo na triagem clinica foram de hipertensao com 0,83%;anemia com 0,82%;casos de visitas a regioes malarigenas com 0,78%;risco de DST com 0,50%;uso de drogas com 0,17%. Conclusao: O perfil epidemiologico dos candidatos a doacao de sangue que compareceram ao GSH Banco de Sangue SERUM no Centro do Rio de Janeiro no periodo pos pandemia ficou evidenciado um aumento no numero de candidatos para doacao de forma geral, com um crescimento na unidade de (3.100) 36%. Tambem foi possivel identificar nesta mudanca de cenario que o numero de doadores de 1vez sofreu uma reducao de 458 candidatos, os de repeticao apresentaram timido crescimento de 950 candidatos e o resultado de crescimento mais expressivo se mostrou nos candidatos esporadicos com aumento de 2520 candidatos.As variacoes quanto a genero nao foram expressivas, assim como quanto ao perfil de faixa etaria. A inaptidao por parametros relacionados a sindrome gripal (COVID-19) nao foi significativa, caracteristica que pode estar associada com a divulgacao de campanhas direcionadas para populacao, orientacoes e conscientizacao sobre a pandemia global. Conhecer e analisar o perfil epidemiologico dos candidatos a doacao de sangue e importante para o desenvolvimento de estrategias, eficientes e sustentaveis, direcionadas para acoes de conscientizacao e captacao de doadores. Copyright © 2022

Psychosocial risks among the healthcare workforce working in COVID services: findings from a crosssectional study on psychosocial risks

Introduction: Poor management in healthcare can have significant consequences in the workers' health, performance, and quality of care. Several risks worsened during the COVID-19 pandemic, namely among the workforce caring for patients with suspected/ confirmed COVID-19 infection. Objective(s): We aimed to assess psychosocial risks among a sample of 235 healthcare workers deployed in COVID-19-related services in Portugal's Lower Alentejo. Method(s): Participants filled out with ten sociodemographic questions and the Euro-Portuguese medium version of the COPSOQ II questionnaire. Data collection occurred February 2021. Tertiles were used to render a traffic light risk categorization. Results were processed with qualitative and quantitative descriptive statistical analysis. To compare groups relative to each outcome, t-tests were used for variables with two categories. Whenever data was not normally distributed, Mann-Whitney tests were used. For variables with more than two groups non-parametric Kruskal-Wallis was applied. Bonferroni correction was also applied, testing each individual hypothesis at the level of significance of alphai=0.05/29. A statistically significant difference between two groups did not necessarily yield a different risk colour. Result(s): Overall, cognitive demands, emotional demands and influence at work showed the highest risk, while 19 domains showed intermediate risk. The burnout domain showed to be highest among nurses and operational assistants working in the Intensive Care Unit. Several associations between COPSOQ domains and sociodemographic variables are also discussed. Conclusion(s): Assessment of psychosocial stressors in healthcare units is needed to promote risk reduction policies and workplace reforms. Accessible occupational services, therapeutic and rehabilitative strategies should play a role in improving health hazards in unhealthy workplaces.

P.0715 Sleep, stress, burnout, and depressive symptoms among healthcare workers from COVID-19 services: findings from a cross-sectional study on psychosocial risks

Background: Poor management in healthcare institutions can have significant consequences for the workplace and for the physical and mental health of its workers. The exposure to unsustainable pressure and demand can impair the worker's performance and the quality of care provided. Four common issues are sleeping troubles, stress, burnout, and depressive symptoms. Several of these risks were exacerbated during the COVID-19 pandemic, especially among healthcare workers working with patients either suspected of, or confirmed, COVID-19 infection. Methods: Using the Copenhagen Psychosocial Questionnaire (COPSOQ) II questionnaire, we aimed to assess the psychosocial risks among a sample of 235 healthcare workers deployed in COVID-19-related services in the Local Health Unit of Baixo Alentejo (Portugal). The participants filled out a questionnaire, which comprised ten sociodemographic questions and the Euro-Portuguese medium version of the COPSOQ II questionnaire. Data collection occurred February 15th-28th 2021. As recommended by the COPSOQ authors, tertiles cut-off points of 33.3 and 66.6 (percentage scale) were used, rendering a traffic light risk classification where green represents a favourable situation, red a health risk and yellow an intermediate risk. [1] The results were processed with qualitative and quantitative descriptive statistical analysis. To compare groups relative to each outcome, t-tests were used for variables with two categories. Whenever data was not normally distributed, Mann-Whitney tests were used. For variables with more than two groups non-parametric Kruskal-Wallis was applied. Bonferroni correction was also applied, testing each individual hypothesis at the level of significance of αi=0.05/29. Note that a statistically significant difference between two groups does not necessarily yield a different risk colour. The mean (and categorial) values of the COPSOQ's sleep, stress, burnout and depressive symptoms domains were also compared to a dataset from a previous assessment (same institution) performed in 2017 [2]. Results: Except for depressive symptoms in the paediatric and general emergency services, domains such as stress, burnout, sleep issues and depressive symptoms showed an intermediate health risk. The burnout domain showed the highest level of risk among nurses and operational assistants working in the Intensive Care Unit. Several associations, with sociodemographic variables, are also discussed, such as a statistically significant association between the burnout domain and the number of hours spent in COVID-19 services, as well as (in medical doctors) time of service with COVID-19 patients, or between stress and age group. Overall, comparing with a similar evaluation made in 2017 [1], depressive symptoms worsened in nurses, slightly ameliorated in medical doctors, while the rest of the four domains remained in the yellow risk category, even though most of them exhibited a numerical aggravation, though not sufficient to change risk category. Conclusions: Working in COVID-19 services can worsen sleep troubles, stress, burnout and depressive symptoms among health care workers. These results support the assessment of psychosocial stressors in healthcare units, to promote risk reduction policies in healthcare workers through workplace reforms. Accessible occupational services, therapeutic and rehabilitative strategies are also crucial. Neuropharmaceuticals may play a role in improving some health hazards in unhealthy workplaces. No conflict of interest

Study of the macrophage polarisation continuum with relevance to covid19

Background: Macrophages are immune cells known for the detection and destruction of bacteria and viruses. In addition, macrophages are vital for a more generalised inflammatory response, providing cell-cell contacts and producing a cocktail of cytokines that stimulate a variety of other immunopathology's;including wound healing. Importantly, macrophages exhibit plasticity in their specific phenotypes, able to transiently convert between pro or anti-inflammatory subsets of cells along a continuum. For example, the pro-inflammatory M1 subset are heavily involved in immune modulation and the anti-inflammatory M2c subset is central to the erythroblastic island in the bone marrow. Aims: The aim of our work was to further understand and characterise human macrophages and their polarity using a well characterised in vitro culture model. A multipronged approach of mass spectrometry, flow cytometry and a previously described2 imaging pipeline was utilised to interrogate the cell surface expression and behaviour of cultured cells. Methods: We compared three populations against our control unstimulated macrophage (M.) population, including the classically activated "inflammatory" M1 stimulated with interferon-g (IFNg) against the non-classically activated M2a macrophage subset stimulated with interleukin-4 (IL-4) and finally M2c macrophages stimulated with dexamethasone. The glucocorticoid dexamethasone was also applied as a treatment of the inflammatory M1 subset to better understand the specific effects of this steroid on macrophage polarisation to mimic anti-inflammatory steroid treatment for diseases such as COVID19. Results: In doing this we demonstrate an increase in CD163 and CD206, markers synonymous with anti-inflammatory M2 macrophages when compared with untreated M1 macrophages. We detected specific alterations in cell surface markers and behaviour between the subsets of in vitroproduced macrophages associated with the known phenotypes. Summary/Conclusion: This provides a detailed dissection of the macrophage polarity continuum that is relevant to the macrophage field as a whole and to the current situation with COVID-19. This ex vivo method of recapitulating an aspect of the inflammatory response to disease has the prospect to be a test bed for future drugs and therapeutics.

Gas Chromatography-Ion Mobility Spectrometry Instrument for Medical Applications: A Calibration Protocol for ppb and ppt Concentration Range

Medical diagnosis research is driven into the development of non-invasive diagnosis devices centered in fast and precise analytical tools and instrumentation. This led to Volatile Organic Compounds (VOCs) being identified as metabolomics biomarkers for several diseases, including respiratory infections, cancer and even COVID 19 non-invasive test. While VOCs give a direct access to physiological states, their applicability requires detections at low concentration ranges (ppbv-pptv). However, its clinical success is strongly dependent on precise and robust calibration methods. In this work we describe a calibration protocol of volatile organic compounds in low concentration range (ppbv-pptv) for analytical GC-IMS technology which offer a quick in-situ results in medical diagnosis. The calibration is based on permeation tubes which are monitored using thermogravimetric methods to estimate mass loss ratio over time establishing emitted concentrations. Notwithstanding future improvements, herein calibration methodology results are a promising step forward in medical diagnosis and applications. © 2021, IFIP International Federation for Information Processing.