Hemovigilância em reações tranfusionais tardias de doenças transmissíveis / Hemovigilance in late transfusion reactions of communicable diseases

Esta pesquisa teve como objetivos analisar as Reações Transfusionais Tardias por Doenças Transmissíveis (RTT/DT) no Brasil, e comparar com as notificações de outros países, identificar as ações de melhoria ao longo dos anos na segurança do sangue. Realizar um estudo na autoavaliação dos Serviços Hemoterápicos no Brasil e realizar levantamento de artigos que sugerem não notificação em Reação Transfusional no Brasil. A abordagem utilizada no estudo foi epidemiológico transversal quantitativo e descritivo, através da coleta dos relatórios anuais em oito países: África do Sul, Austrália, Estados Unidos da América, França, Holanda, Portugal, Reino Unido e Brasil. Ademais, conta com o levantamento bibliográfico em bases de dados da Biblioteca Virtual em Saúde e PubMed. As notificações em reações transfusionais tardias de doenças transmissíveis de hemocomponentes foram em sua maioria doenças virais no Brasil e em outros países. Entre as quais destacaram-se hepatites virais com 130 (56,3%) notificações nos países estudados, sendo em ordem decrescente HEV, HBV, HCV e HAV. No Brasil e na África do Sul houve importante notificação de casos de HIV, sendo o último caso reportado no Brasil, em 2015. Entre as notificações que podemos considerar endêmicas, como WNO e Babesia microti ocorreram apenas nos EUA, enquanto Zika, Malária e HLTV notificadas apenas no Brasil. Entre as Reações Transfusionais Tardias segundo a gravidade de ocorrência, a transmissão de doenças infecciosas correspondeu a 45,05% das notificações no grau 3 (grave). A autoavaliação do sangue nos Serviços Hemoterápicos no Brasil foi realizada em pelo menos 21% dos estabelecimentos em nível nacional, com cinco requisitos conformes acima de 80% no módulo 1B, que contempla (hemovigilância, retrovigilância e registros) são eles: Notificação de eventos adversos, comunicação da investigação e bloqueio do doador,documento formal que define a responsabilidade no processo de investigação, convocação do doador sob investigação para repetir exames e realizar treinamento em sistema informatizado. Foram encontrados cinco trabalhos relatando possíveis reações transfusionais não notificadas até o momento, especialmente de hepatites virais HBV e HCV. As ações para melhoria do sangue foram: investimento em melhor seleção de doadores, triagem clínica e laboratorial (redução da janela imunológica com a implementação do NAT); aumento de medidas de segurança, atendendo às boas práticas no ciclo do sangue; Instituição de notificação de doença transfusional em receptores. Para melhorar a segurança do sangue é necessário o incentivo e obtenção de dados corretos na ficha de investigação com o preenchimento completo das doenças e reações...(AU)

This research aimed to analyze Transfusion-transmitted infections (TTIs) in Brazil, and compare with reports from other countries, identifying actions to improve blood safety over the years. Carry out a study on the self-assessment of Hemotherapy Services in Brazil and carry out a survey of articles that suggest non-reporting of Transfusion-transmitted infections (TTIs) in Brazil. The approach used in the study was quantitative and descriptive cross-sectional epidemiological, through the collection of annual reports in eight countries: South Africa, Australia, United States of America, France, Netherlands, Portugal, United Kingdom and Brazil. Furthermore, it relies on bibliographical research in databases from the Virtual Health Library and PubMed. Reports of late transfusion reactions of transmissible diseases from blood components were mostly viral diseases in Brazil and other countries. Among which viral hepatitis stood out with 130 (56.3%) notifications in the countries studied, in descending order HEV, HBV, HCV and HAV. In Brazil and South Africa there were important notifications of HIV cases, with the last case reported in Brazil in 2015. Among the notifications that we can consider endemic, such as WNO and Babesia microti occurred only in the USA, while Zika, Malaria and HLTV reported only in Brazil. Among Transfusion-transmitted infections (TTIs) according to the severity of occurrence, the transmission of infectious diseases corresponded to 45.05% of notifications in grade 3 (severe). Blood self-assessment in Hemotherapy Services in Brazil was carried out in at least 21% of establishments nationally, with five requirements complying with above 80% in module 1B, which includes (hemovigilance, retro-surveillance and records) they are: Notification of adverse events, communication of the investigation and blocking of the donor, formal document that defines responsibility in the investigation process, summoning the donor under investigation to repeat exams and carry out training in a computerized system. Five studies were found reporting possible transfusion reactions not reported to date, especially HBV and HCV viral hepatitis. The actions to improve blood were: investment in better donor selection, clinical and laboratory screening (reduction of the immunological window with the implementation of NAT); increased safety measures, taking into account good practices in the blood cycle; Institution for reporting transfusion disease in recipients. To improve blood safety, it is necessary to encourage and obtain correct data in the investigation form by completely filling out the diseases and reactions. As a whole, all the measures mentioned value Hemovigilance actions. However, there is difficulty in obtaining information in a transparent manner, which is why it is necessary to define measures that encourage the exchange of organized information between services.

Diagnostic Dilemma and Management Difficulties in a Young Patient With Psychosis and Benign Chorea: A Case Report and Review of the Literature.

Psychosis presents with hallucinations, delusions, disorganized speech, abnormal psychomotor behavior, and negative symptoms. It most commonly appears in the setting of schizophrenia, although it could also appear in bipolar disorder, major depression, post-traumatic stress disorder (PTSD) and even in medical conditions and substance use. In young people, the diagnosis of psychosis can present as a challenge due to the overlap of psychotic conditions and other emotional, behavioral, and developmental disorders. In this case report, we present the case of a 19-year-old female with a history of bipolar disorder, oppositional defiant disorder (ODD), depression, anxiety, PTSD, and schizophrenia-spectrum disorder who was admitted to an inpatient psychiatric facility after presenting with acute onset of confusion.

Melia azedarach L. extract induced the production of phytocystatin in passion fruit leaves / Extrato de Melia azedarach L. induz a produção de uma fitocistatina em folhas de maracujá

Phytocystatins belong to the family of cysteine proteinases inhibitors. These proteinase inhibitors have crucial functions in plant defense against insects and pathogens attack. In the present study Melia azedarach L. extract acts as an elicitor of plant defense responses in passion fruit seedlings inducing the increase of a phytocystatin levels in of these plants. The leaf protein content of the seedlings was extracted 24 hours after treatment with plant extract and analyzed for the induction of proteinase inhibitor activity. The results demonstrated the induction of a ~ 60 kD phytocystatin (Pfcyst) that has in vitro inhibitory effects against papain.  These findings suggest that M. azedarach plant extracts may act as a potential activator of induced resistance against insects and pathogens by upregulating cystatin proteins synthesis in passion fruits plants. Thus, the use of plant extracts as biodefensives could reduce the use of pesticides in economically important agricultural crops.

As fitocistatinas pertencem à familia de inibidores de proteinase cisteínica. Esses inibidores de proteinase têm função crucial na defesa de plantas contra o ataque de insetos e patógenos. No presente estudo, extrato de Melia azedarach L. atuam como um eliciador da resposta de defesa em plântulas de maracujá induzindo o aumento dos níveis de fitocistatinas nessas plantas. O conteúdo proteico foliar dessas plântulas foi extraído 24 horas após o tratamento com o extrato vegetal e analisado quanto a indução da atividade do inibidor de proteinase. Os resultados demonstraram a indução de uma fitocistatina (Pfcyst) de ~60 kDa que possui efeito inibitório in vitro contra a papaína. Essas descobertas sugerem que o extrato da planta M. azedarach pode atuar como um potencial ativador da resistência induzida contra insetos e patógenos por regular positivamente a síntese de proteínas cistatinas em plantas de maracuja. Dessa forma, o uso de extratos vegetais como biodefensivos poderia reduzir o uso de agrotóxicos em culturas agrícolas economicamente importantes.

Social Rejection and Alcohol Use in Daily Life.

BACKGROUND: Prior studies have found that social rejection is associated with increases in negative affect, distress, and hostility. Fewer studies, however, have examined the impact of social rejection on alcohol use, and no known studies have tested whether the impact of social rejection by close others differs from social rejection by acquaintances in its association with subsequent drinking. METHODS: Participants completed event-contingent reports of their social interactions and alcohol use for 14 consecutive days on smartphones. Multilevel negative binomial regression models tested whether experiencing more social rejection than usual was associated with increased drinking, and whether this association was stronger when participants were rejected by close others (e.g., friends, spouses, family members) versus strangers or acquaintances. RESULTS: Results showed a significant interaction between social rejection and relationship closeness. On days characterized by rejection by close others, the likelihood of drinking significantly increased. On days characterized by rejection by acquaintances, by contrast, there was no increase in the likelihood of drinking. There was no main effect of rejection on likelihood of drinking. CONCLUSIONS: These results suggest that relationship type is a key factor in whether social rejection translates to potentially harmful behaviors, such as increased alcohol use. This finding is in contrast to many laboratory paradigms of rejection, which emphasize rejection and ostracism by strangers rather than known others. In the more naturalistic setting of measuring social interactions on smartphone in daily life, our findings suggest that only social rejection delivered by close others, and not strangers, led to subsequent drinking.