Levantamento Estatistico Acerca Das Tipagens Sanguineas Do Grupo Abo/Rhd De Pacientes Atendidos Pela Santa Casa De Ourinhos Entre 2018 E 2022: Quantificacao E Prevalencia

Objetivo: Quantificar e determinar a prevalencia dos tipos sanguineos em nossa regiao. Materiais e metodos: Foi realizada coleta de dados dos arquivos de laudos imunohematologicos dos pacientes que receberam transfusao de hemocomponentesem nosso servico de imunohematologia da Santa Casa de Ourinhos entre os anos de 2018 ate julho de 2022, realizamos o levantamento das Fenotipagens ABO/RhD, realizados pela metodologia convencional em tubo empregando anti-soros. Para a analise dos resultados aplicamos estatistica simples. Resultados: Dentre os 3129 pacientes catalogados, 1641 eram do sexo feminino disposto em 41,44%(680) O positivo;6,09%(100) O negativo;35,22%(578) A positivo;3,96%(65) A negativo;8,84%(145) B positivo;1,34%(22) B negativo;2,86%(47) AB positivo;0,24%(4) AB negativo;1488 do sexo masculino disposto em 41,13% (612) O positivo;5,11% (76) O negativo;33,13%(493) A positivo;4,10%(61) A negativo;11,20%(167) B positivo;0,94%(14) B negativo;3,90%(58) AB positivo;0,47%(7) AB negativo. Discussao: A prevalencia da distribuicao fenotipica do sistema ABO foi de maioria O e A em ambos os sexos, em contrapartidaos tipos sanguineos B e AB aparecem em menor intensidade. Voltando a atencao para o RhD foi observado uma prevalencia de pacientes positivos para esse grupo, representando 88,85%. Atualmente no Brasil, estima-se que a producao de hemocomponentes supere 8 milhoes de unidades ao ano, o que possibilita cerca de 1,7 milhao de transfusoes. Quando o isolamento social foi decretado no estado de Sao Paulo, os bancos de sangue entraram em estado de alerta para com seus doadores pois os hemocomponentes mais utilizados em procedimentos de emergencia sao os concentrados de hemacias (CH), plasma fresco congelado (PFC) e concentrados plaquetas (CP). Nos anos de 2020 e 2021 os pacientes diagnosticados com COVID-19 necessitavam de grandes quantidades de CH, por conta de anemias causadas pela doenca. Conclusao: O estudo da prevalencia dos tipos sanguineos e de grande importancia para que haja por parte do banco de sangue uma captacao de doadores do mesmo perfil e com isso nao acarrete a falta de hemocomponentes no atendimento do paciente. Essas informacoes podem ser utilizadas em futuros estudos demograficos onde haja relacao entre tipagens sanguineas e certas patologias, como hemorragias ou neoplasias. Copyright © 2022

Remissao Espontanea De Leucemia Mieloide Aguda Apos Infeccao Grave Por Covid-19 E Choque Septico: Relato De Caso

Introducao: A remissao espontanea de leucemia mieloide aguda e um evento muito raro, e suas descricoes na literatura medica geralmente envolvem um evento infeccioso grave. Mais recentemente, a COVID-19 tambem foi descrita como um dos fatores associados a tal fenomeno, e a hipotese mais aceita para o mesmo e de que ha uma hiperativacao imune que tambem apresenta efeito antitumoral. Relato de caso: Paciente feminina, de 54 anos, foi admitida no Hospital Brigadeiro com historia de alteracao de nivel de consciencia e lesao em pododactilo direito que motivou a procura do pronto socorro. No hemograma da admissao, apresentava hemoglobina 8,2 g/dL VCM 87, plaquetometria 11.000/mm3, leucocitos 99560 com 88% de celulas de medio a grande tamanho, alta relacao nucleo citoplasma nucleolos evidentes e presenca frequente de bastonete de Auer. A imunofenotipagem de sangue periferico,22,4% destas celulas revelaram marcacao CD13, CD15++, CD33++/+++, CD34 par, CD38+++, CD64+, CD71+, CD117, CD123+, HLA-DR, MPO par, alem de 18,6% de monocitos maduros, com diagnostico de leucemia mieloide aguda. Foi colhido teste rapido para COVID-19 antes da internacao, com resultado positivo. Nos 3 dias que se seguiram, a paciente evoluiu com desconforto respiratorio, taquipneia, e a tomografia de torax revelou ainda broncopneumonia sobreposta a COVID-19, o que resultou em intubacao orotraqueal por insuficiencia respiratoria. Durante a intubacao, a paciente evoluiu com parada cardiorrespiratoria em atividade eletrica sem pulso, com retorno a circulacao espontanea apos 10 minutos. Dada a gravidade do quadro, foi optado por nao iniciar inducao quimioterapica. Ao longo da internacao em UTI, a paciente fez uso de piperacilina tazobactam com vancomicina nos primeiro 7 dias de internacao, teve Pseudomonas aeruginosa multissensivel isolada de aspirado traqueal, e recebeu meropenem e teicoplanina por novo evento de choque septico, por 7 dias. Sua internacao em UTI durou 41 dias, contudo, ao longo dos primeiros 30 dias de internacao houve clareamento de blastos em sangue periferico, e parametros como hemoglobina e plaquetometria tambem evoluiram com melhora. Ao final do 42degree dia, quando recebeu alta da UTI para a enfermaria, foi feita avaliacao medular, quel nao revelou blastos com as caracteristicas imunofenotipicas previamente descritas. A paciente se encontra atualmente internada e com remissao citomorfologica e sem doenca residual minima pela imunofenotipagem. Nao foi administrada qualquer terapia antineoplasica, somente hidroxiureia para fins de citorreducao, nos primeiros 7 dias do quadro. Discussao: O caso evidencia uma rara e ainda nao compreendida remissao de leucemia mieloide aguda apos infeccao por COVID-19 e complicacoes infecciosas bacterianas graves. Casos semelhantes ja foram descritos em sepse grave e COVID-19 isoladamente, mas a evolucao natural do quadro envolve a recaida da doenca apos alguns meses do quadro agudo. A terapia antineoplasica, por sua vez, e indispensavel para a remissao sustentada. A explicacao mais aceita para o fenomeno e de que um mecanismo imunologico ativado e producao excessiva de citocinas pro-inflamatorias, sobretudo na COVID-19, destruiria as celulas neoplasicas, que poderiam inclusive ser infectadas pelo virus. Conclusao: Apesar de o mecanismo exato da remissao ser desconhecido, o caso apresentado reforca o papel da imunidade do individuo no tratamento antineoplasico e justifica a imersao em mais estudos envolvendo imunoterapia para a leucemia mieloide aguda. Copyright © 2022

Prevalence of Burnout in Portuguese Public Health Medical Residents amid the Response to the COVID-19 Pandemic

Introduction: Burnout is a psychological syndrome characterized by a state of emotional exhaustion, depersonalization, and a lack of personal accomplishment at the workplace. We aimed to evaluate the prevalence of burnout among Portuguese Public Health Medical Residents during the SARS-CoV-2 virus pandemic. Methods: Burnout was assessed with the Maslach Burnout Inventory - Human Services Survey, using a zero (never) to six (always) ordinal scale. Sociodemographic and workplace setting data were also collected. Categorical variables were presented as frequencies and percentages, and continuous variables as means and standard deviations (SDs). Chi-squared and independent sample t tests were used to evaluate the distributions of these variables, with a p value of 0.05. Results: Eighty-three people participated. The average age was 30.46 (±3.91), and 57.8% were female. We found that 77.11% had high levels of emotional exhaustion, 61.4% had high levels of depersonalization, and 44.6% had low levels of personal accomplishment. 32.5% of the participants were experiencing burnout, 30.5% were at high risk, 25.3% were at moderate risk, and 12% were at low risk. Burned-out participants had higher levels of emotional exhaustion (40.63 ± 7.36;mean ± SD) and depersonalization (15.63 ± 5.94;mean ± SD), and lower levels of personal achievement (29.42 ± 7.30;mean ± SD) than their peers. Regarding sociodemographic and work setting-related data, no statistically significant differences were found between professionals with and with no burnout. Conclusion: The present study shows high scores on all components of burnout and its prevalence among the population studied. Further studies are needed to determine whether this phenomenon was specific to this period.

Exploring blended learning tools to transform a laboratory course unit in engineering: Challenges, setbacks and rewards

To boost students’ engagement on learning outcomes, promote active peer learning, and adopt more dynamic teaching practices, a module of a laboratory course unit (TPL) in engineering was reformulated exploring blended learning. This reformulation was even more challenging than initially anticipated as it was implemented during the Covid-19 pandemic. As TPL learning practises are based on the operation of laboratory modules mimicking heat and mass transfer phenomena, asynchronous and on-line synchronous learning classes and face-to-face laboratory classes were outlined. To promote the asynchronous learning, a full script of TPL and pitch and longer videos presenting, respectively, each work and its practical operation process were formerly prepared and available online. Students were required to work in group to define the variables and conditions to be evaluated in each laboratory module, organize and plan the experimental activities, create data recording documents, and later present and argue their options in virtual synchronous classes. In the face-to-face classes, different activities were performed in a rotating system, scheduled and tuned in the online classes. It was also aimed in-situ promoting peer discussion of the data and reports elaboration, goals not attained due to the pandemic restrictions, as only two students of each group were present in each hands-on class and in sequential times. TPL reformulation was a tough and time-consuming task since 73 students were enrolled, divided into 3 shifts, each one with 5 groups of five students. Students individual learning evolution was inferred through online quizzes that were periodically made available. A final inquiry, launched to obtain students` opinion about this transformation endeavour highlighted the script, videos, and the prompt teachers’ feedback on the reports as the most fruitful and important aspects for students’ engagement and guide their learning pathway. The rationale behind this paper was to disclose this transformation experience and share information and strategies that can be used in the teaching/learning of laboratory classes. © 2021 University of Minho. All rights reserved.

Effectiveness of contact tracing and quarantine on reducing COVID-19 transmission: a retrospective cohort study.

OBJECTIVES: Contact tracing and quarantine are common measures used in the management of infectious disease outbreaks. However, few studies have measured their impact on the control of the COVID-19 pandemic. This study aimed to assess the effectiveness of those measures on reducing transmission of severe acute respiratory syndrome coronavirus 2 in a community setting. STUDY DESIGN: The study design is a retrospective cohort study. METHODS: A retrospective cohort study of COVID-19 cases notified in Eastern Porto from March 1st to April 30th, 2020 was performed. Intervention and control cohorts were defined based on whether cases were subjected to contact tracing and quarantine measures before the laboratory confirmation of disease. The number of secondary cases per index case and the proportion of cases with subsequent secondary cases were the primary outcomes. Secondary outcomes included the time from symptom onset to specimen collection and the number of close contacts. The analysis was stratified according to whether national lockdown measures had already been implemented. RESULTS: The intervention and control cohorts comprised 98 and 453 cases, respectively. No differences were observed concerning primary outcomes. The intervention group had a shorter time between symptom onset and specimen collection (median: 3 days, interquartile range [IQR]: 1-6, vs. median: 5 days, IQR: 2-7, P-value = 0.004) and fewer close contacts (median: 0, IQR: 0-2, vs. median: 2, IQR: 1-4, P-value<0.001). The stratified analysis returned similar results. CONCLUSION: Local public health measures were effective in reducing the time between symptom onset and laboratory diagnosis and the number of close contacts per case. No effect was apparent on secondary case figures, suggesting that further measures may be required.