DIAGNÓSTICOS DE ENFERMAGEM ENTRE USUÁRIOS DE ANTICOAGULANTE ORAL ACOMPANHADOS EM AMBULATÓRIO

Objetivo: identificar o perfil sociodemográfico e clínico, bem como principais diagnósticos de enfermagem entre usuários de anticoagulantes de uso oral acompanhados em ambulatório. Método: pesquisa descritiva, transversal de abordagem quantitativa. Realizada com 128 usuários elegíveis acompanhados em ambulatório de hospital universitário público do Paraná, Brasil. Foram coletadas, em consulta de enfermagem e fonte documental, variáveis sociodemográficas e clínicas, bem como identificados diagnósticos de enfermagem segundo taxonomia da NANDAInternational. Resultados: a amostra foi predominantemente idosa; casada; de baixa escolaridade; com indicação de anticoagulação oral por fibrilação atrial e trombose venosa profunda; com adequado tempo médio de coagulação, expresso pela Razão Normalizada Internacional. Os cinco diagnósticos de enfermagem elencados pertenciam às classes de respostas cardiovasculares/pulmonares; infecção; ingestão; e controle da saúde. Conclusão: os diagnósticos de enfermagem identificados coadunam-se ao perfil clínico dos usuários de anticoagulantes de uso oral acompanhados em ambulatório, o que reflete um cenário mais focado nas questões orgânico-funcionais, ainda que a necessidade de melhor controle da própria saúde e de domínio da promoção de saúde tenham emergido em menor proporção.Descritores: Diagnóstico de enfermagem. Anticoagulantes. Ambulatório hospitalar. Processos de enfermagem

Progesterone Levels and Reproductive Parameters in the Periovulatory Period of Nellore Cows under FTAI protocol

Background: Fixed Time Artificial Insemination (FTAI) has achieved a significant evolution in the last 18 years, however, despite the progress achieved by modern FTAI programs, the conception rates obtained are still low. Therefore, this study aimed to evaluate the interrelation between progesterone levels in the periovulatory period and reproductive parameters of Nellore cows submitted to an FTAI protocol. Materials, Methods & Results: On a random day, called day 0 (D0), 57 cows received a P4 device associated with the intramuscular (IM) application of 2.0 mg of estradiol benzoate. On D9, the P4 devices were removed and then were administered 500 μg of cloprostenol sodium IM; 0.6 mg of estradiol cypionate IM and 300 IUI of Equine Chorionic Gonadotrophin IM. Blood samples were collected for the determination of serum P4 concentrations on D9 and D11 of the protocol. The evaluations of follicular diameter (DFOL), follicular wall area (AFOL) and the vascularization area of the follicle wall (VFOL) were carried out on D11 using B-mode ultrasonography examination and colour Doppler, and then the artificial inseminations were performed. The evaluation of the corpus luteum diameter (CLD), of the total corpus luteum area (CLA), of the area of corpus luteum vascularization (CLV) and blood sampling for determination of post-ovulatory P4 levels (Post-P4) were performed on D24. For the analysis of the P4 concentration the chemiluminescence method was used, with a sensitivity of 0.1 ng/mL. According to the P4 concentrations on D11, cows were divided into 2 groups, LOW LEVELS OF P4 and HIGH LEVELS OF P4. The diagnosis of pregnancy was performed using transrectal ultrasonography on D45, at this point the cows were divided into 2 groups, PREGNANT and NON-PREGNANT. The correlation between DFOL and P4 dosage on D11 was moderate, negative and significant and between the AFOL and the serum P4 levels on D9, was moderate, negative and significant. As for the other correlations between follicular and luteal parameters and serum P4 levels, these were low to moderate, negative and not significant. Cows in the LOW LEVELS OF P4 group had significantly larger diameter and follicular areas than the cows in the HIGH LEVELS OF P4 group, the other follicular and luteal parameters showed no statistical difference. Of the total 57 cows that were inseminated, 30 cows became pregnant. Cows in the PREGNANT group had serum P4 levels on D9 equivalent to that obtained by the NON-PREGNANT group. However, at D11 the cows that became pregnant presented significantly lower serum P4 levels than cows that did not become pregnant. Discussion: The results of the interrelation between follicular parameters and P4 levels obtained in the present study, pointed out that the lower the levels of P4, the higher the follicular parameters, corroborating with other authors. Thus, larger preovulatory follicles provided high ovulation rates. Periovulatory serum P4 levels did not significantly affect the morphofunctional parameters of the CL. Such findings may be justified by high periovulatory P4 levels resulting from less efficient luteolysis, exert a negative effect on the results of FTAI protocols, because progesterone inhibits the release of LH pulses. It is concluded that lower periovulatory P4 levels established a favourable condition for follicular development and fertility, however, morphofunctional parameters of the corpus luteum were not affected. Keywords: follicular development, fertility, conception rate, ovarian hemodynamics, synchronization. Título: Níveis de progesterona e os parâmetros reprodutivos no período periovulatório de vacas Nelore submetidas ao protocolo de IATF. Descritores: crescimento folicular, fertilidade, índice de concepção, hemodinâmica ovariana, sincronização

Effect of the Estrus Expression on Follicular and Luteal Morphofunctional Characteristics and Fertility in Bos indicus females Synchronized for FTAI

Background: Recent studies have been conducted with the aim of improving the fertility rates in the FTAI programs in beef females. The observation of the estrus expression constitutes an important indicator of fertility in zebu females. Therefore, this work has as an objective to evaluate the impact of the estrus expression on the follicular, luteal and fertility morphofunctional characteristics of Nelore females synchronized for FTAI.Materials, Methods & Results: Sixty five lactating female Nelore (Bos taurus indicus) were used. On a random day, denominated day 0 (D0), the 65 Nelore females received a progesterone-releasing device associated to the application of 2.0 mg of estradiol benzoate intramuscularly (IM). On D9, the progesterone-releasing intravaginal devices were removed and was administered 500 μg of cloprostenol sodium IM; 0.6 mg of estradiol cypionate IM and 300 UI of Equine Chorionic Gonadotropin IM. At this point, the animals were marked with a marking stick for the determination of the estrus expression. On D11 of the synchronization protocol, the animals were characterized in two groups: without estrus expression (WO/ ESTRUS) and with estrus expression (W/ ESTRUS). The evaluation of the follicle diameter (FOLD), of the follicle wall area (FOLA), of the follicle wall vascularization (FOLV) and the percentage of vascularization in the area of the preovulatory follicle wall (%FOLV) were conducted on D11 using B-mode ultrasonography and color Doppler and then the artificial inseminations were performed. The evaluation of the corpus luteum diameter (CLD), the total area of the corpus luteum (CLA), of the area of vascularization of the corpus luteum (CLV), of the percentage of vascularization of the in the area of the corpus luteum (% CLV) and the collection of blood for the evaluation of the serum levels of progesterone were carried out on D24. The analysis of the serum progesterone concentration were performed by the chemiluminescence method using the Access immunoassay systems Progesterone, with a sensitivity of 0.1 ng/mL. The diagnosis of gestation was carried out by transrectal ultrasonography on D45.  The animals of the WITH ESTRUS group presented superior FOLD, FOLA, FOV (P < 0.05) averages to those presented by the cows of the WITHOUT ESTRUS group. In relation to the luteal characteristics, in the WITH ESTRUS group the cows exhibited averages for CLD, CLA, CLV and P4 significantly higher than those of the WITHOUT ESTRUS group. However, the bovines of the WITH ESTRUS group presented a % CLV similar to the presented by the females of the WITHOUT ESTRUS group. As for the fertility rates, there was difference between the experimental groups WITH ESTRUS and WITHOUT ESTRUS.Discussion: The present work demonstrated the impact of the estrus expression on the follicular morphological parameters, therefore in accordance with other studies. These authors show a relation between the estrus expression and levels of estradiol, which is directly related to the sperm transport in the female reproductive tract, oocyte maturation and fertilization directly affecting the fertility of females submitted to the FTAI program. Similarly, there was an interrelation between the estrus expression and the luteal morphological parameters, corroborating with the findings of some researches, where were verified higher luteal morphological parameters associated to higher conception rates in cows that demonstrated estrus behavior in the FTAI. Therefore, the estrus detection can be used as a tool to direct matings in synchronization protocols, promoting the identification of the animals with a higher probability of conception, owing to better follicular and luteal hemodynamic conditions

Anestesia em paciente portador de Volumoso Teratoma Mediastinal: relato de caso

O relato de caso apresenta uma paciente do sexo feminino, 22 anos, diagnosticada com um teratoma mediastinal de características significativas, evidenciado por imagens de tomografia computadorizada e ressonância magnética. A massa, localizada no hemitórax direito, causava compressão das câmaras cardíacas direitas, manifestando-se clinicamente com dispneia, discreto emagrecimento e dor na região posterior do hemitórax direito, especialmente em decúbito supino. Durante a anestesia para toracotomia antero-lateral direita, a paciente apresentou uma instabilidade hemodinâmica abrupta, refratária à fenilefrina, que foi revertida com a retomada do decúbito dorsal. Esse episódio destacou a fragilidade desse grupo de pacientes, ressaltando os impactos da perda de tônus muscular e vascular induzidos pela anestesia. A estratégia anestésica envolveu a indução e manutenção com remifentanil e propofol, bloqueadores neuromusculares, além da administração de dextrocetamina como adjuvante. Discussões sobre o diagnóstico de teratomas mediastinais destacam a necessidade de uma abordagem abrangente, incluindo história, exame físico e exames de imagem específicos. A correlação do caso com a literatura ressalta a importância da identificação precoce de pacientes com alto risco cardiorrespiratório, considerando sinais clínicos e achados imagiológicos. O manejo anestésico torna-se desafiador devido à possibilidade de colapso cardiorrespiratório causado pela compressão das vias aéreas e grandes vasos. A discussão multidisciplinar e a adaptação perioperatória são cruciais para otimizar os resultados, enfatizando a individualização do plano anestésico diante da complexidade dos teratomas mediastinais

Germline and Somatic mutations in postmenopausal breast cancer patients

OBJECTIVES: In breast cancer (BC) patients, the frequency of germline BRCA mutations (gBRCA) may vary according to the ethnic background, age, and family history of cancer. Phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) is the second most common somatic mutated gene in BC; however, the association of mutations in both genes with cancer has not been thoroughly investigated. Thus, our aims were to investigate gBRCA mutation frequency in a cohort of postmenopausal Brazilian BC patients and the association of gBRCA1/BRCA2 and PIK3CA somatic mutations. METHODS: Forty-nine postmenopausal (>55 years) and forty-one young (≤35 years) BC patients were included in this study. The postmenopausal group included patients who reported a positive family history of cancer. For these patients, gBRCA1/BRCA2 were sequenced using next-generation sequencing (NGS) or Sanger sequencing. Data for gBRCA in young patients were already available from a previous study. DNA from formalin-fixed, paraffin-embedded (FFPE) tumors was obtained from 27 postmenopausal and 41 young patients for analyzing exons 9 and 20 of PIK3CA. The association between gBRCA1/BRCA2 and somatic mutations in PIK3CA was investigated. RESULTS: The overall frequency of gBRCA1/BRCA2 among the 49 postmenopausal patients was 10.2%. The frequencies of somatic mutations in PIK3CA in the postmenopausal and young patients were 37% and 17%, respectively (ns). The most common PIK3CA mutation was found to be E454A. Nonsense and frameshift mutations, which may counteract the oncogenic potential of PIK3CA were also detected. Regardless of age, 25% of BRCA1/BRCA2 mutation carriers and non-carriers , each, had PIK3CA somatic mutations. CONCLUSIONS: Data obtained indicate that BRCA1/BRCA2 gene testing may be considered for postmenopausal patients with BC who have a family history of cancer. Although some of them are not considered pathogenic, somatic variants of PIK3CA are frequently observed in BC patients, especially in postmenopausal patients