Intravenous Immunoglobulin Prevents Murine Antibody-Mediated Acute Lung Injury at the Level of Neutrophil Reactive Oxygen Species (ROS) Production

Transfusion-related acute lung injury (TRALI) is a leading cause of transfusion-associated mortality that can occur with any type of transfusion and is thought to be primarily due to donor antibodies activating pulmonary neutrophils in recipients. Recently, a large prospective case controlled clinical study of cardiac surgery patients demonstrated that despite implementation of male donors, a high incidence of TRALI still occurred and suggested a need for additional interventions in susceptible patient populations. To examine if intravenous immunoglobulin (IVIg) may be effective, a murine model of antibody-mediated acute lung injury that approximates human TRALI was examined. When BALB/c mice were injected with the anti-major histocompatibility complex class I antibody 34-1-2s, mild shock (reduced rectal temperature) and respiratory distress (dyspnea) were observed and pre-treatment of the mice with 2 g/kg IVIg completely prevented these symptoms. To determine IVIg's usefulness to affect severe lung damage, SCID mice, previously shown to be hypersensitive to 34-1-2s were used. SCID mice treated with 34-1-2s underwent severe shock, lung damage (increased wet/dry ratios) and 40% mortality within 2 hours. Treatment with 2 g/kg IVIg 18 hours before 34-1-2s administration completely protected the mice from all adverse events. Treatment with IVIg after symptoms began also reduced lung damage and mortality. While the prophylactic IVIg administration did not affect 34-1-2s-induced pulmonary neutrophil accumulation, bone marrow-derived neutrophils from the IVIg-treated mice displayed no spontaneous ROS production nor could they be stimulated in vitro with fMLP or 34-1-2s. These results suggest that IVIg prevents murine antibody-mediated acute lung injury at the level of neutrophil ROS production and thus, alleviating tissue damage

Instrumentos de avaliação do aleitamento materno e seu uso na prática clínica

RESUMO Objetivos Identificar instrumentos de avaliação da amamentação e sua aplicação na prática clínica, validação e adaptação transcultural. Método Revisão integrativa, realizada em seis bases de dados e em uma biblioteca eletrônica, entre agosto/2014-dezembro/2015, sem limitação temporal. Resultados Foram identificados 19 instrumentos de avaliação do AM. Destes, 12 foram validados e cinco foram adaptados transculturalmente. Quanto à aplicação, destacam-se seu uso para a avaliação do risco de desmame (BAPT) e a percepção/comportamento da mulher em amamentar (BSES-SF e IIFAS). Conclusão A identificação dos instrumentos disponíveis e de suas indicações para a avaliação do AM pode auxiliar profissionais na escolha pelo instrumento a ser utilizado, qualificando a assistência materno-infantil

Douching Practice

Background: Vaginal douching (VD) is a very common practice in Turkish culture. This practice is affected by individual and cultural characteristics. Purpose: The aim of the research was to determine how the education based on Pender's Health Promotion Model (HPM) affects women's decision to quit vaginal douche and the factors that cause women to continue VD practices. Methods: The HPM guided the 2-hr education process. The sample has 58 women. Results: As a result, the model education-based HPM helped 69% of women to quit VD practice. It was also determined that education affected women who performed VD to feel clean and to comply with the religion but was less effective in women who had lower education or performed VD to comply with the husband's demand. Conclusions: Finally, the study showed that the education based on HPM affected the women to change their attitude toward VD and quit it

Birth With Different Types of Anesthesia

PurposeTo compare the breast-feeding outcomes and breast-feeding self-efficacy, in the first 24 postpartum hours, of mothers who underwent vaginal birth, cesarean birth with epidural anesthesia, and cesarean birth with general anesthesia.MethodsA comparative study was conducted in Turkey. A total of 334 mothers participated. Data were evaluated through descriptive data form, breast-feeding outcomes form, and the Breastfeeding Self-Efficacy Scale.FindingsIt was observed that the mothers who had cesarean birth with general anesthesia experienced more breast-feeding problems. With regard to breast-feeding self-efficacy, all the groups were similar.ConclusionFor reducing breast-feeding problems, nurses should provide more care and support to mothers undergoing cesarean birth. Therefore, the fact that the breast-feeding self-efficacy was similar among the groups might be related to culture.AmacVajinal, epduralli sezaryen ve genel anestizili sezaryen gecirmi annelerin postpartum ilk 24 satte emzirme sonuclarnn ve emzirme oz-yeterlilik alglarnn karlatrlmas.YontemTurkiye'de gercekletirilen karlatrmal bir calmadr. Toplam 334 anne katlmtr. Veriler tanmlayc veri formu, emzirme sonuclarn deerlendirme formu ve Emzirme oz-Yeterlilii olce ile toplanmtr.BulgularGenel anestezili sezaryen geciren annelerin daha cok emzirme problemi yaadklar belirlenmitir. Emzirme oz-yeterlilik algs acsndan ise gruplar arasnda fark saptanmamtr.SonucEmzirme sorunlarn en aza indirmek icin sezaryen geciren annelere hemireler daha iyi bir bakm ve destek salamaldr. Emzirme oz-yeterlilik algsnn benzer olmas kulturun etkisinden kaynaklanabilecei duunulmektedir kaynaklanabilmektedir

Recent outcome of liver transplantation for Budd Chiari syndrome - analysis of the european liver transplant registry (ELTR) and affiliated centres

peer reviewedBackground: Maintenance anticoagulation and Transjugular Intrahepatic Portosystemic Shunt (TIPS) have improved management of Budd-Chiari Syndrome (BCS) over the last decades. Most published studies on outcomes of liver transplantation (LT) for BCS in Europe date before these changes. Methods: Data were obtained from the European Liver Transplantation Registry (ELTR). Age <16, secondary BCS and hepatocellular carcinoma were excluded. Patient (PS) and graft survival (GS) before and after 2000 was compared. Multivariate Cox regression analysis (with re-transplantation as time- dependent covariate) identified predictors of PS and GS after 2000. Supplementary data was requested from all ELTR affiliated centres and received from 39. Results: 811 patients were transplanted for primary BCS between 2000 and 2020. Median age was 37.2y, 60% were female, median MELD was 17 and 29% had high urgency (HU) listing. One-, five- and ten-year PS rates between 2000-2020 were 83%, 76% and 69%, compared to 71%, 66% and 61% for the 293 patients transplanted before 2000 (p<0.001), while GS was 78%, 69%, 62% vs. 63%, 58% and 52%, respectively (p<0.001). Since 2000, BCS recurred in 3% and 12% received a re-transplant. Older recipient age (HR 1.02; 95%CI 1.01-1.04) and higher MELD (HR 1.03; 95%CI 1.01-1.06) were associated with worse PS while HU listing was associated with improved PS (HR 0.57; 95%CI 0.35-0.92). Older donor age was the only independent predictor of worse GS (HR 1.01; 95%CI 1.00-1.02). In n=236 (29%) with additional centre-data, 38% had myeloproliferative disease, 25% received TIPS pre-LT and 82% used anticoagulation post-LT. In these, anticoagulation was the only independent factor associated with PS (HR 0.38; 95%CI 0.15-0.98).Conclusions: LT for BCS results in excellent patient and graft survival. Outcomes have improved since 2000. Older recipient age and higher MELD result in poorer survival. HU listing appears to select patients with most favourable outcome. Long-term anticoagulation seems beneficial. Further validation is needed