O transplante autologo de medula ossea como terapeutica para pacientes com leucemia mieloide cronica

Orientadores: Carmen Silvia Passos Lima, Carmino Antonio de SouzaDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: INTRODUÇÃO: O papel do transplante autólogo de medula óssea (TMO-auto) para o tratamento da leucemia mielóide crônica (LMC) permanece incerto. PACIENTES E MÉTODOS: Onze pacientes com LMC foram indicados para receber o TMO-auto com célula precursora periférica (CPP) mobilizada até seis meses após o diagnóstico, com o mini-ICE (três pacientes) ou a hidroxiuréia (oito pacientes), e obtida por leucaférese. Os pacientes receberam o interferon alfa (IFN) após o TMO-auto. Amostras de medula óssea (MO) obtidas ao diagnóstico e durante o seguimento foram avaliadas por meio da análise citogenética convencional, do método de hibridização ¿in situ¿ com fluorescência (FISH) e por transcrição reversa e reação em cadeia da polimerase (RT-PCR), para a identificação e a quantificação do cromossomo Philadephia (Ph) e do gene BCR-ABL. RESULTADOS: A mediana de seguimento dos pacientes após o TMO-auto foi de 22,7 meses (variação, 0,7-49,1). Um paciente evoluiu para o óbito durante o período de aplasia da MO após a mobilização da CPP. Dez pacientes foram transplantados com CPP com o Ph+ (mediana: 100,0%; variação: 25,0-100,0) e com o gene BCR-ABL (mediana: 68,2%; variação: 27,3-83,5). Um paciente evoluiu para óbito durante a aplasia da MO determinada pelo condicionamento para o TMO-auto. Oito pacientes (88,9%) obtiveram resposta hematológica, sete (77,8%) resposta citogenética, todos (100,0%) obtiveram resposta citogenética molecular por FISH e um paciente (10,0%) obteve resposta molecular por RT-PCR. A mediana das porcentagens de cromossomo Ph, em amostras de MO obtidas seis meses após o TMO-auto (78,0%), foi menor do que a observada ao diagnóstico (100,0%; P=0,035). Foram também menores as medianas das porcentagens de núcleos interfásicos com o gene BCR-ABL em amostras de MO obtidas três, seis e nove meses após o TMO-auto (4,0%, 7,3% e 15,7%, respectivamente), em comparação a observada ao diagnóstico (82,5%; P<0,050). Ao final do estudo, nove pacientes estavam vivos, em fase crônica da doença, sendo que quatro deles apresentavem respostas hematológica, citogenética e citogenética molecular. CONCLUSÃO: O TMO-auto em associação com o IFN possibilita a obtenção de respostas hematológica, citogenética, citogenética molecular e molecular para pacientes com fases iniciais da LMCAbstract: INTRODUCTION: The role of the autologous stem cell transplantation (ASCT) as a treatment procedure for chronic myeloid leukaemia (CML) patients remains uncertain. PATIENTS AND METHODS: Eleven CML patients were indicated to receive ASCT with peripheral blood progenitor cells (PBPCs) mobilised within six months from diagnosis with mini-ICE (three patients) or hydroxyurea (eight patients) and obtained by leukapheresis. The interferon alpha (IFN) was administered to patients after ASCT. Bone marrow (BM) samples obtained at diagnosis and during evaluations after ASCT were analysed by cytogenetics, fluorescence ¿in situ¿ hybridisation (FISH) and reverse transcription-polimerase chain reaction (RT-PCR), with the purpose of identifying and quantifying the Philadelphia chromosome (Ph+) and the BCR-ABL gene. RESULTS: The median follow-up of patients after ASCT was 22.7 months (range: 0.7-49.1). One patient died during the aplastic period determined by the mobilisation regimen of PBPCs. Ten patients received ASCT with PBPCs with Ph+ (median: 100.0%; range: 25.0-100.0) and FISH+ cells (median: 68.2%; range: 27.3-83.5). One patient died during the aplastic phase due to BM conditioning regimen. Eight patients (88,9%) achieved haematological response, seven (77.8%), all of them (100.0%) molecular cytogenetics response by FISH, and one unique patient (10,0%) achieved molecular response by RT-PCR. The median percentage of Ph metaphases in BM samples obtained after three months of ASCT (78.0%) was lower than the percentage obtained at diagnosis (100,0%; P=0.035). The median percentages of FISH+ interphase nuclei obtained after three, six, and nine months after ASCT (4.0%, 7.3% and 15.7%, respectively) were also lower than that obtained at diagnosis (82,5%; P<0.050). At the end of the study, nine patients were alive, in chronic phase of CML. Four of them presented haematological, cytogenetics, and cytogenetics responses. CONCLUSION: The ASCT associated with IFN therapy results in haematological, cytogenetics, molecular cytogenetics and molecular responses in early chronic phase of CML¿s patientsMestradoMestre em Clinica Medic

Cirurgias potencialmente contaminadas: fatores de risco para infecção do sítio cirúgico: Potentially contaminated surgery: risk factors for infection at the surgical site

A Infecção Relacionada à Assistência à Saúde trata-se de um meio de estudo de grande preocupação dos serviços de saúde. Verifica-se que entre as topografias das IRAS, a Infecção de Sítio Cirúrgico está intimamente concernente aos procedimentos cirúrgicos, sendo, atualmente, uma das mais importantes entre as IRAS. A infeção relacionada à assistência à saúde é capaz de gerar graves consequências, abrangendo o aumento nos gastos devido ao seu tratamento e a um aumento do tempo de internação. O risco de morte dos pacientes com ISC vem se mostrando aumentado quando comparado aos que não desenvolveram a infecção. Diante da literatura encontrada contatou-se a existência de diferentes fatores de risco para ocorrência das infecções do sítio cirúrgico e dentre elas pode-se destacar o índice de massa corporal, tabagismo, hemotransfusão, doença crônica preexistente e também o potencial de contaminação da ferida operatória. Sabe-se que na literatura brasileira ainda existe uma exiguidade de estudo capazes de abordar procedimentos cirúrgicos o que, portanto, dificulta a utilização de estimativas de diferentes taxas de infecções do sítio cirúrgico e o consequente reconhecimento dos fatores de riscos associados. A maior parte dos ISC podem ser controladas, se obtiverem as intervenções adequadas, sendo estes integrantes críticos do programa para a segurança do paciente

MANEJO DE CRANIECTOMIA DESCOMPRESSIVA EM NEUROCIRURGIA PEDIÁTRICA

The aim of this article is to provide a comprehensive overview of pediatric decompressive craniectomy, covering from surgical decision-making to post-operative care and reintegration. The multidisciplinary analysis emphasizes the importance of monitoring, pain management, psychosocial support, and continuous education, aiming not only for surgical effectiveness but also the overall well-being of the child for a successful recovery. Methodology: This involves an integrative review with literature search in specialized databases such as PubMed and Scopus, using relevant terms related to decompressive craniectomy and pediatric neurosurgery, descriptors: "Craniectomy," "Decompressive Craniectomy," "Child Health," "Pediatric Care." Results: In the development, the article explores the phases of pediatric decompressive craniectomy, encompassing surgical decision-making, post-operative care, and reintegration. It emphasizes the importance of aspects such as monitoring, pain management, psychosocial support, and continuous education to promote a complete recovery. The integrative approach seeks a holistic understanding, considering both medical and emotional-social aspects. Conclusion: Pediatric decompressive craniectomy requires comprehensive care, including monitoring and emotional support. Successful reintegration is promoted through continuous guidance, covering home care and school adaptations. This approach aims for surgical effectiveness and overall well-being in recovery.O objetivo deste artigo é oferecer uma visão abrangente sobre a craniectomia descompressiva em crianças, abordando desde a decisão cirúrgica até os cuidados pós-operatórios e reintegração. A análise multidisciplinar destaca a importância da monitorização, manejo da dor, apoio psicossocial e educação contínua, visando não apenas a eficácia cirúrgica, mas também o bem-estar global da criança para uma recuperação bem-sucedida. Metodologia: Trata-se de uma revisão integrativa com a busca de literatura em bases de dados especializadas, como PubMed e Scopus, utilizando termos relevantes relacionados à craniectomia descompressiva e neurocirurgia pediátrica, os descritores: “Craniectomia”, “Craniectomia Descompressiva”, “Saúde da Criança”, “Cuidado Infantil”. Resultados: No desenvolvimento, o artigo explora as fases da craniectomia descompressiva pediátrica, abrangendo a decisão cirúrgica, cuidados pós-operatórios e reintegração. Destaca a importância de aspectos como monitorização, manejo da dor, apoio psicossocial e educação contínua para promover uma recuperação completa. A abordagem integrativa busca uma compreensão holística, considerando tanto os aspectos médicos quanto os emocionais e sociais. Conclusão: A craniectomia descompressiva em crianças demanda cuidados abrangentes, incluindo monitorização e suporte emocional. A reintegração bem-sucedida é promovida por meio de orientações contínuas, abrangendo cuidados em casa e adaptações escolares. Essa abordagem visa eficácia cirúrgica e bem-estar total na recuperação

Impact of hospitalization on the functional capacity of the elderly: A cohort study

<div><p>Abstract Objective: To verify the trajectory of the functional capacity of elderly persons hospitalized due to clinical conditions in a university hospital. Method: A descriptive, prospective cohort study was conducted between 2015 and 2016. Elderly patients admitted to the Hospital das Clínicas of Botucatu Medical School (Unesp), Brazil, were evaluated for the functional assessment of basic activities of daily living (BADL) using the Katz scale, nutritional status (body mass index (BMI)) and presence of the Frailty Syndrome (FS) (Fried criteria). A description of the trajectory of functional capacity was carried out at four times: 15 days before admission (T0), at admission (T1), at hospital discharge (T2) and 30 days after discharge (T3). Results: 99 elderly people with a mean age of 74 (+7.35) years, 59.6% of whom were male, were evaluated. Of these, 81.8% presented functional independence at T0, 45.5% at T1, 57.6% at T2 and 72.8% at T3. According to their functional trajectories, 28.2% of the elderly lost functional capacity between T0 and T3. There was an association between worsening of functional capacity between T0 and T3 and the FS (RR 4.56; 95% CI 1.70-12.26, p=0.003). Conclusion: Elderly patients have worse functional capacity at hospital discharge than before hospitalization. About 28.0% of the elderly had worse functional capacity 30 days after discharge than 15 days before admission. The elderly with Frailty Syndrome have a greater risk for worse functional capacity results 30 days after discharge.</p></div

Brazilian National Front for Strengthening Long-Term Care Facilities for Older People: history and activities

In April 2020, the COVID-19 pandemic became a severe threat to long-term care facility patients worldwide. A national front was urgently organized to integrate regional oversight and workgroups, coordinate activities, and develop educational materials, meetings, and communication strategies with these institutions in Brazil. As of August 2021, the front’s initiatives have demonstrated its relevance for helping long-term care facilities cope with the COVID-19 pandemic, as well as for the ongoing struggle to include this issue in the public agenda, given that these facilities are an indispensable link in the development of a national policy for continuing care. This paper describes the history and initiatives of the National Front for Strengthening Long-Term Care Facilities regarding the COVID-19 pandemic, as well as its successful volunteer initiatives regarding the care of institutionalized older adults.</p

Hip fracture in a developing country: a picture in need of change

Objectives: To describe the clinical profile, patterns of care and mortality rates of aged patients who have undergone hip fracture surgical repair. Design: Retrospective patient record study. Setting: A public university hospital in Rio de Janeiro, Brazil. Participants: 352 patients aged 60 and older who underwent surgery for hip fracture between 1995-2000. Measurements: Sociodemographic data, type of fracture, cause of fracture, time from fracture to surgery, physical status, Charlson comorbidity index, type of surgery and anesthesia, access to in-hospital physiotherapy, use of antibiotic and thromboembolism prophylaxis, and mortality within one year after hospital admission. Results: Among 352 subjects, 74.4% were women. The mean age overall was 77.3 years. Very long delays from the time of fracture to hospital admission (mean 3 days) and from hospital admission to surgery (mean 13 days) were observed. Most femoral neck fractures (82.7%) were managed by hip arthroplasties, while 92.8% of the intertrochanteric fractures underwent internal fixation procedures. Less than 10% of patients received in-hospital physiotherapy. Mortality rates 30 days, 90 days and one year after hospital admission were 3.4%, 8.0% and 13.4%, respectively. Conclusion: Our study provides evidence within the context of a developing country of major gaps in the quality of care of vulnerable older adults who suffered a hip fracture. Our findings suggest that hip fracture has not been treated as an urgent condition or a priority within the Brazilian public healthcare system. Further research should address current patterns of care for hip fracture in Brazil and in other developing countries.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Frailty and mortality in long-term care facilities for older people in Brazil: a survival analysis

OBJECTIVES: To investigate the effect of frailty on 1-year mortality in long term-care facility (LTCF) residents. METHODS: This was a prospective cohort study with survival analysis of 209 participants living in 15 Brazilian LTCFs. Data on chronic diseases, age, sex, medication use, dependence in activities of daily living (ADLs; Katz index), and frailty (FRAIL scale) were collected at baseline, and death after 1 year was the outcome measure. Kaplan-Meier estimate and log-rank test were used to analyze the survival of residents. RESULTS: In the initial assessment, 65.07 of the residents were women, and the median age was 82 (interquartile range, 71–88) years, with 55% being over 80 years old. Overall, 88% had 2 or more diseases, 59.81% were using 5 or more medications, 42.11% were considered frail, 34.92% pre-frail, and 22.97% robust, and 69.94% were dependent in 3 or more ADLs. During the 12-month follow-up, 19.61% of the residents (n = 41) died. In the survival analysis for death, there was a statistically significant association with frailty (p = 0.03) and dependence in ADLs (p = 0.04). CONCLUSIONS: In this population of LTCF residents, frailty and functional dependence were associated with death.</p