Lactation induction for transgender women and transfeminine people in health care: a scoping review.

There are countless proven benefits of breastfeeding, and the demand for such a right in health for transfeminine people is rarely addressed in the literature, reinforcing inequities in health. The article aims to conduct a scoping review of lactation induction for transfeminine people in the health care context. Systematic literature review in six selected databases, looking for articles with terms related to lactation and transfeminine people. Data were extracted and analyzed, summarizing the main results in tables. Three hundred ninety articles were found. After the exclusion of the duplicates there was a selection by title/abstract and a following selection by the full reading of the remaining articles, considering the pre-determined exclusion and inclusion criteria. Twenty-one articles were included, published between 2018 and 2023. Among them, six are case reports with unprecedented information on the topic, and the others are publications in various formats. Lactation induction was achieved in all the case reports. There is a fragile and recent body of evidence affirming the success of lactation induction in transgender women. There is a necessity to support this demand by health professionals and robust studies to optimize necessary interventions.

Lactation induction for transgender women and transfeminine people in health care: a scoping review / Indução da lactação para mulheres transgênero e pessoas transfemininas no cuidado à saúde: uma revisão de escopo

Abstract There are countless proven benefits of breastfeeding, and the demand for such a right in health for transfeminine people is rarely addressed in the literature, reinforcing inequities in health. The article aims to conduct a scoping review of lactation induction for transfeminine people in the health care context. Systematic literature review in six selected databases, looking for articles with terms related to lactation and transfeminine people. Data were extracted and analyzed, summarizing the main results in tables. Three hundred ninety articles were found. After the exclusion of the duplicates there was a selection by title/abstract and a following selection by the full reading of the remaining articles, considering the pre-determined exclusion and inclusion criteria. Twenty-one articles were included, published between 2018 and 2023. Among them, six are case reports with unprecedented information on the topic, and the others are publications in various formats. Lactation induction was achieved in all the case reports. There is a fragile and recent body of evidence affirming the success of lactation induction in transgender women. There is a necessity to support this demand by health professionals and robust studies to optimize necessary interventions.

Resumo São inúmeros os benefícios comprovados do aleitamento materno, e a demanda por tal direito em saúde para as pessoas transfemininas é pouco abordada na literatura, reforçando as iniquidades em saúde. O artigo objetiva realizar uma revisão de escopo sobre a indução da lactação para pessoas transfemininas no contexto de assistência à saúde. Revisão sistemática da literatura em seis bases de dados selecionadas, buscando artigos com termos relacionados à lactação e pessoas transfemininas. Os dados foram extraídos e analisados, resumindo os principais resultados em tabelas. Foram encontrados 390 artigos. Após a exclusão dos duplicados, procedeu-se à seleção por título/resumo e posterior seleção pela leitura na íntegra, considerando os critérios de exclusão e inclusão. Foram incluídos 21 artigos, publicados entre 2018 e 2023. Entre eles, seis são relatos de casos com informações inéditas sobre o tema, e os demais são publicações em diversos formatos. A indução da lactação foi alcançada em todos os relatos de casos. Existe um corpo de evidências frágil e recente que afirma o sucesso da indução da lactação em mulheres trans. Há necessidade de respaldar essa demanda por parte dos profissionais e estudos robustos para otimizar as intervenções necessárias.

Enfermagem em Prática Avançada no pronto atendimento: uma reflexão promissora / Nursing in Advanced Practice in emergency care unit: a promising reflection

OBJETIVO: Refletir acerca das Unidades de Pronto Atendimento 24h como cenário de atuação para a Prática Avançada de Enfermeiros nos serviços de urgência e emergência. MÉTODO: Este estudo utilizou a metodologia de reflexão. RESULTADOS: A Enfermagem de Prática Avançada é uma especialidade em que atuam enfermeiros com conhecimento e habilidades ampliado, capazes de tomar decisões complexas, além de possuírem nível avançado de práticas específicas. Os serviços de urgência e emergência são cenários promissores ao desenvolvimento da Enfermagem de Prática Avançada, incluindo as Unidade de Pronto Atendimento 24h, pela capacidade de atendimentos de alta complexidade e atuação de profissionais altamente capacitados. Portanto, há necessidade de reflexão sobre avanços e entraves na atuação, regulamentação, sobretudo no que se refere a este cenário, pouco discutido no contexto da Enfermagem de Prática Avançada no Brasil. CONCLUSÃO: Existe grande necessidade de ampliação da discussão da Enfermagem de Prática Avançada para os demais níveis de atenção no Brasil. Há serviços com amplo potencial a serem desenvolvidos, sendo um deles as Unidades de Pronto Atendimento 24h. Observa-se que o enfermeiro de práticas avançadas nestes serviços poderá trazer grandes benefícios para a população, além de melhorar a qualidade da assistência, trazendo maior autonomia aos profissionais destes serviços.

OBJECTIVE: To reflect about the Emergency Care Unit an action scenario for the Advanced practice of nurses in emergency and urgency services. METHOD: This study utilized the methodology of reflection. RESULTS: Advanced Practice Nursing is a specialty in which nurses with expanded knowledge and additional skills can make complex decisions in addition to having an advanced level of specific practices. Emergency and urgency services are promising scenarios for the development of Advanced Practice Nursing, including the 24-hour Care Unit, especially due to the capacity of high complexity care and the performance of highly qualified professionals. Therefore, there is a need for reflection on the advances, obstacles in the performance and regulation, especially in relation to this scenario, which is little discussed in the context of Advanced Practice Nursing in Brazil. CONCLUSION: There is a great need to expand the discussion of Advanced Practice Nursing to the other levels of care in Brazil. There are services with vast potential to be developed, one of them being the 24-hour Care units. It is observed that nurses from advanced practices in these services can bring great benefits to the population, in addition to improving the quality of care, bringing greater autonomy for nurses in these services.

Impact of baseline abnormal liver enzymes in the outcome of COVID-19 infection.

Background: Little is known about the significance of liver function tests (LFT) abnormalities in COVID-19 and their impact on disease outcomes. The aims of the study were to evaluate abnormalities of LFT in patients with COVID-19 and their impact on disease severity, mortality, and correlation with leukocyte markers of inflammation. Methods: All patients with COVID-19 admitted to the emergency department (ED) of a single reference center were retrospectively evaluated. Data were collected using an electronic medical database covering the following variables: demographics, baseline complete blood count (CBC) and ratios, neutrophil-lymphocyte (NLR) and monocyte-lymphocyte ratios (MLR), systemic immune-inflammation index (SII), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels. Disease severity was defined by the presence of organ failure (OF) or requirement for intensive care unit (ICU) support. Mortality was considered as patient death during hospitalization. Results: A total of 1,539 subjects (799 women, mean age 57±18 years) with COVID-19 were evaluated. Abnormal AST and/or ALT were seen in 50% of them, with a frequency and magnitude that significantly correlated with leukocyte count and ratios. Both LFT were significantly associated with requirement for hospital and ICU admission and mortality. High AST levels were significantly associated with the presence, number, and types of OFs and in-hospital length of stay (LOS). Elevated ALT was also significantly associated with the aforementioned variables, with the exception of OFs presence, circulatory failure and LOS. Conclusions: LFT abnormalities are frequently seen in COVID-19 patients, reflect SARS-CoV-2 associated inflammation and may predict adverse outcomes. LFT may be useful to aid decision-making in the ED for hospital admission or scheduled outpatient reevaluation.

Leukocyte ratios are useful early predictors for adverse outcomes of COVID-19 infection.

Leukocyte biomarkers, including the neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte-(MLR), platelet-to-lymphocyte (PLR) ratios and systemic immune-inflammation index (SII) have been associated with severity and mortality of patients with COVID-19. The purpose of this study was to evaluate the association of baseline leukocyte biomarkers calculated in the emergency department (ED) with the disease severity and mortality. This was a retrospective cohort study that evaluated 1,535 (mean age 57+18 years) patients with SARS-CoV-2 infection in the ED of a single reference center. Outcomes were severity, defined as intensive care unit (ICU) admission requirement, and in-hospital mortality. All leukocyte biomarkers were calculated in the ED before the hospital admission. Their ability to predict the severity and mortality was measured using receiver operating characteristic (ROC) curves. Severity and mortality were observed in 30.9% and 12.6% of the patients, respectively, and were significantly correlated with NLR, MLR, PLR and SII, but only NLR was independently associated with both outcomes on multivariate analysis. Analysis of ROC curves revealed that NLR (0.78 for severity and 0.80 for mortality) and SII (0.77 for severity and 0.75 for mortality) had the best ability to predict mortality, when compared to other ratios. The highest AUC was observed for NLR, employing cut-off points of 5.4 for severity and 5.5 for mortality. Leukocyte biomarkers, particularly NLR, are capable of predicting the severity and mortality of patients with SARS-CoV-2 infection and could be important adjunct tools to identify patients in the ED that are more prone to develop adverse outcomes.

Leukocyte ratios are useful early predictors for adverse outcomes of COVID-19 infection

ABSTRACT Leukocyte biomarkers, including the neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte-(MLR), platelet-to-lymphocyte (PLR) ratios and systemic immune-inflammation index (SII) have been associated with severity and mortality of patients with COVID-19. The purpose of this study was to evaluate the association of baseline leukocyte biomarkers calculated in the emergency department (ED) with the disease severity and mortality. This was a retrospective cohort study that evaluated 1,535 (mean age 57+18 years) patients with SARS-CoV-2 infection in the ED of a single reference center. Outcomes were severity, defined as intensive care unit (ICU) admission requirement, and in-hospital mortality. All leukocyte biomarkers were calculated in the ED before the hospital admission. Their ability to predict the severity and mortality was measured using receiver operating characteristic (ROC) curves. Severity and mortality were observed in 30.9% and 12.6% of the patients, respectively, and were significantly correlated with NLR, MLR, PLR and SII, but only NLR was independently associated with both outcomes on multivariate analysis. Analysis of ROC curves revealed that NLR (0.78 for severity and 0.80 for mortality) and SII (0.77 for severity and 0.75 for mortality) had the best ability to predict mortality, when compared to other ratios. The highest AUC was observed for NLR, employing cut-off points of 5.4 for severity and 5.5 for mortality. Leukocyte biomarkers, particularly NLR, are capable of predicting the severity and mortality of patients with SARS-CoV-2 infection and could be important adjunct tools to identify patients in the ED that are more prone to develop adverse outcomes.

Fluorescence and Docking Studies of the Interaction between Human Serum Albumin and Pheophytin.

In the North of Brazil (Pará and Amazonas states) the leaves of the plant Talinum triangulare (popular: cariru) replace spinach as food. From a phytochemical point of view, they are rich in compounds of the group of pheophytins. These substances, related to chlorophyll, have photophysical properties that give them potential application in photodynamic therapy. Human serum albumin (HSA) is one of the main endogenous vehicles for biodistribution of molecules by blood plasma. Association constants and thermodynamic parameters for the interaction of HSA with pheophytin from Talinum triangulare were studied by UV-Vis absorption, fluorescence techniques, and molecular modeling (docking). Fluorescence quenching of the HSA's internal fluorophore (tryptophan) at temperatures 296 K, 303 K, and 310 K, resulted in values for the association constants of the order of 104 L∙mol(-1), indicating a moderate interaction between the compound and the albumin. The negative values of ΔG° indicate a spontaneous process; ΔH° = 15.5 kJ∙mol(-1) indicates an endothermic process of association and ΔS° = 0.145 kJ∙mol(-1)∙K(-1) shows that the interaction between HSA and pheophytin occurs mainly by hydrophobic factors. The observed Trp fluorescence quenching is static: there is initial non-fluorescent association, in the ground state, HSA:Pheophytin. Possible solution obtained by a molecular docking study suggests that pheophytin is able to interact with HSA by means of hydrogen bonds with three lysine and one arginine residues, whereas the phytyl group is inserted in a hydrophobic pocket, close to Trp-214.

Chemical compounds isolated from Talinum triangulare (Portulacaceae).

This first phytochemical study of Talinum triangulare Leach (Portulacaceae), also known as 'cariru', which is a commonly consumed food in Northern Brazil, allowed the isolation and structural determination of four new compounds: one acrylamide, 3-N-(acryloyl, N-pentadecanoyl) propanoic acid (5), and three new phaeophytins named (15(1)S, 17R, 18R)-Ficuschlorin D acid (3(1),3(2)-didehydro-7-oxo-17(3)-O-phytyl-rhodochlorin-15-acetic acid), (13), Talichorin A (17R, 18R)-phaeophytin b-15(1)-hidroxy, 15(2),15(3)-acetyl-13(1)-carboxilic acid (14), and (15(1)S, 17R, 18R)-phaeophytin b peroxylactone or (15(1)S, 17R, 18R)-hydroperoxy-ficuschlorin D (16), together with twelve known compounds, including four phaeophytins (11,12, 15 and 17). The structures of the compounds were established on the basis of 1D and 2D NMR, IR, HRESI-MS spectra, including GC-MS, and HPLC-UV analysis, as well as comparisons with the literature data. The CD spectra data analysis were used to define the absolute configuration of phaeophytins 12 (13(2)R, 17R, 18R)-13(2)-hydroxyphaeophytin a, 13 and 16, 15 (15(1)S, 17R, 18R)-3(1),3(2)-didehydro-15(1)-hydroxyrhodochlorin-15-acetic acid δ-lactone-15(2)-methyl-17(3)-phytyl ester and 17 (17R, 18R)-purpurin 18-phytyl ester.

Antioxidant, Iron Chelating and Tyrosinase Inhibitory Activities of Extracts from Talinum triangulare Leach Stem.

The aim of this work is to evaluate the antioxidant activity against the radical species DPPH, the reducing capacity against Fe II ions, and the inhibitory activity on the tyrosinase enzyme of the T. triangulare. Hydromethanolic crude extract provided two fractions after the liquid/liquid partition with chloroform. The Folin-Ciocalteu method determined the total phenolic content of the crude extract (CE) and the hydromethanolic fraction (Fraction 1), resulting in a concentration of 0.5853 g/100 g for Fraction 1, and 0.1400 g/100 g for the CE. Taking into account the results of the DPPH, the free radical scavenging capacity was confirmed. The formation of complexes with Fe II ions was evaluated by UV/visible spectrometry; results showed that CE has complexing power similar to the positive control (Gingko biloba extract).The inhibitory capacity of samples against the tyrosinase enzyme was determined by the oxidation of L-DOPA, providing IC50 values of 13.3 µg·mL(-1) (CE) and 6.6 µg·mL(-1) (Fraction 1). The values indicate that Fraction 1 was more active and showed a higher inhibitory power on the tyrosinase enzyme than the ascorbic acid, used as positive control. The hydromethanolic extract of T. triangulare proved to have powerful antioxidant activity and to inhibit the tyrosinase enzyme; its potential is increased after the partition with chloroform.

A semiparametric estimator of the bivariate distribution function for censored gap times.

Let (T(1), T(2)) be gap times corresponding to two consecutive events, which are observed subject to random right-censoring. In this paper, a semiparametric estimator of the bivariate distribution function of (T(1), T(2)) and, more generally, of a functional E [φ(T(1),T(2))] is proposed. We assume that the probability of censoring for T(2) given the (possibly censored) gap times belongs to a parametric family of binary regression curves. We investigate the conditions under which the introduced estimator is consistent. We explore the finite sample behavior of the estimator and of its bootstrap standard error through simulations. The main conclusion of this paper is that the semiparametric estimator may be much more efficient than purely nonparametric methods. Real data illustration is included.

Policitemia vera: relato de caso / Polycythemia vera: case report

A policitemia vera (PV) é um transtorno mieloproliferativo das células hematopoiéticas, caracterizada poruma produção anormal e acentuada de eritrócitos, leucócitos e plaquetas. É uma doença rara, com uma incidênciade 2,3/100.000 pessoas por ano. Apresentamos um relato de caso de uma paciente de 45 anos com sintomas,sinais e achados sugestivos de policitemia vera.

The polycythemia vera is a myeloproliferative disturb from haematopoietic cells characterized by abnormal and overstated production of erythrocytes, leukocytes and platelets. It is a rare disease with an incidenceof 2.3/100.000 people per year. We present a case report of a 45 years old patient with symptoms, signs andsuggestive results of polycythemia vera.