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Introducción: El tacrolimo es uno de los inmunosupresores más utilizados en pacientes postrasplante hepático y suele existir una amplia variación en su nivel sérico. Es fundamental evaluar el tiempo medio para alcanzar el nivel sérico (NS) objetivo de tacrolimo después del trasplante de hígado, ya que los niveles muy bajos aumentan las posibilidades de rechazo del injerto y los niveles muy altos se asocian con toxicidad. Metodología: Estudio observacional de cohorte retrospectivo realizado en el Hospital de Clínicas de Porto Alegre. Se incluyeron pacientes trasplantados de hígado entre diciembre de 2012 y diciembre de 2017 en uso de tacrolimo oral. Los pacientes que alcanzaron un nivel sérico entre 6 y 8 ng/mL durante el mes 1 posterior al trasplante se consideraron un nivel sérico objetivo. Resultados: el 78% (67/87) de los pacientes alcanzaron el NS objetivo dentro de los 10 días posteriores al trasplante hepático. Los pacientes que experimentaron rechazo más de 1 año después del trasplante tardaron alrededor de 9 días en alcanzar el SL objetivo durante la hospitalización-índice frente a los 7 días de los pacientes que no experimentaron rechazo. Conclusión:Nuestro estudio, al considerar valores objetivo terapéuticos entre 6-8 ng/mL en pacientes postrasplante hepático inmediato, mostró que esta población realizó un tiempo promedio que parece determinar un buen pronóstico ya que en menos de 2 semanas el 78% de los pacientes alcanzaron el objetivo de NS cercano al recomendado.

Introduction: Tacrolimus is one of the most used immunosuppressants in patients after liver transplantation and there is often a wide variation in its serum level. Assessing the mean time to reach the target serum level of tacrolimus after liver transplantation is critical, as very low levels increase with chances of graft rejection and very high levels are associated with toxicity. Methodology:Observational, retrospective cohort study conducted at Hospital de Clínicas de Porto Alegre. Liver transplant patients between December 2012 and December 2017 using oral tacrolimus were included. Patients who reached a serum level between 6–8 ng/mL during month 1 post-transplant were considered as target serum levels. Results: 78% (67/87) of patients reached the target serum level within 10 days after liver transplantation. Patients who experienced rejection over 1 year after transplantation took around 9 days to reach the target serum level during the index hospital stay. Patients who did not present rejection reached target serum level within 7 days after starting the immunosuppressant. Conclusion: Our work, considering therapeutic target values between 6–8 ng/mL in patients after immediate liver transplantation, demonstrated that this population performed a mean time that seems to determine a good prognosis, since in less than 2 weeks 78% of patients reached target serum level close to what was recommended.

Introduction. Pharmaceutical service optimization requires a comprehensive understanding of resource usage. The aim of the study is to analyze how Lean Healthcare principles can contribute toward turning a pharmacy service patient-centered and value oriented. Methods. Understand how clinical pharmacists’ resources are effectively used by patients in an academic hospital using lean tools, such as value stream mapping and activity designation matrix, determine the amount of time each professional is involved in specific activities, and identify activities that add value. The data were mainly obtained through interviews with professionals, time-motion observational studies, chronoanalysis and meetings with the head of the unit. Results. A process flow map is designed for clinical pharmacy services, and it considers the relationship between the activities and their added value base. An exploration of the map shows that the activity “clinical rounds” is the most time consuming (27%) and not necessarily considered value-added by both parties (pharmacists staff and head of service). It is notable the opportunity the service has to prioritize the high-risk patients and to make a good time management; furthermore, activities that are of high value to patients are being performed and monitored by interns. Conclusions. The role of pharmacists should evolve from now on to be congruent with the new realities of healthcare. When value is questioned, we are encouraged to reflect on the activities engaged in by professional pharmacists in a clinical/surgical unit of a hospital. Through these tools, we could infer how the system is engaged and how it can be transformed toward added value.

The new psychoactive substances (NPS) market is in a constant state of flux, with new substances being synthesized regularly and marketed in many ways and forms. These substances often emerge quickly, just as they disappear, evidencing a clear attempt to circumvent the control trafficking enforcement agencies and the international community. Among the wide variety of NPS, the NBOMe series attracted attention from medical and legal authorities due to the high number of cases of intoxication, followed or not by death in several countries around the world, including Brazil. So, this brief communication aimed to evaluate the number of NBOMe Brazilian Federal Police (BFP) over the past eight years, and highlight the NPS constant state of flux, evidencing by the Brazilian NBOMe case. This is a retrospective study based on information from forensic analysis reports from seizures of BFP. The NBOMe seizures generated 4 forensic analysis requests in 2012, 21 in 2013, 45 in 2014, 61 in 2015, 80 in 2016, 22 in 2017, 19 in 2018 and 2 in 2019, totaling 254 forensic analysis reports analyzed. This NPS emerged quickly in Brazil from the year 2012, and tented to disappear in recent years, from the perspective of the BPF forensic analysis reports, evidencing the NPS constant state of flux, represented here by the Brazilian NBOMe case.

OBJETIVO relatar a experiência da sistematização de round interdisciplinar no cuidado a pacientes com fratura da extremidade proximal de fêmur internados em unidade cirúrgica. MÉTODO Relato da experiência de discussão clínica compartilhada pela equipe multiprofissional em unidade de internação cirúrgica do Hospital de Clínicas de Porto Alegre, referência em ortopedia, no período de outubro de 2017 até junho de 2018. RESULTADOS Sistematizou-se seis etapas a serem seguidas sequencialmente durante encontro multiprofissional semanal, com otimização do tempo e foco no paciente. Novas condutas foram acordadas com base em evidências científicas e visão multiprofissional, com repercussões sobre a prevenção de lesão por pressão, realização de curativo, retirada de sonda vesical, suporte nutricional e organização precoce da alta hospitalar. CONCLUSÃO A implementação do round interdisciplinar estruturado trouxe implicações positivas para a comunicação efetiva, reduzindo riscos e falhas nos processos de cuidado, podendo ser considerada boa prática no que tange à segurança do paciente. OBJECTIVE To report the experience of interdisciplinary round in care of patients with proximal femoral fractures hospitalized in a surgical unit. METHOD Report on the experience of clinical discussion shared by the multiprofessional team in a surgical hospitalization unit of the Hospital de Clínicas de Porto Alegre referred to in orthopedics, from October 2017 to June 2018. RESULTS Six steps were systematized sequenced to be followed during a weekly with time optimization and patient focus. New approaches were agreed upon based on scientific evidence and multiprofessional vision, with repercussions on prevention of pressure injury, dressing, removal of urethral catheter, nutritional support and early organization of hospital discharge. CONCLUSION The implementation of the structured interdisciplinary round has had positive implications for effective communication, reducing risks and failures in the care process, and can be considered good practice regarding patient safety. OBJETIVO Relatar la experiencia de la sistematización de round interdisciplinario en el cuidado a pacientes con fractura proximal de fémur internados en unidad quirúrgica. MÉTODO Relato de la experiencia de discusión clínica compartida por el equipo multiprofesional en una unidad de internación quirúrgica del Hospital de Clínicas de Porto Alegre, referencia en ortopedia, en el período de octubre de 2017 a junio de 2018. RESULTADOS Se sistematizaron seis etapas a ser seguidas secuencialmente durante un encuentro semanal con la optimización del tiempo y el foco en el paciente. Los nuevos conductos se acordaron a partir de evidencias científicas y una visión multiprofesional, con repercusiones sobre la prevención de lesión por presión, realización de curativos, retirada de sonda vesical, soporte nutricional y organización precoz del alta hospitalaria. CONCLUSIÓN La implementación del round interdisciplinario estructurado trajo implicaciones positivas para la comunicación efectiva, reduciendo riesgos y fallas en los procesos de cuidado, pudiendo ser considerada buena práctica en lo que se refiere a la seguridad del paciente.

To report the experience of interdisciplinary round in care of patients with proximal femoral fractures hospitalized in a surgical unit.Report on the experience of clinical discussion shared by the multiprofessional team in a surgical hospitalization unit of the Hospital de Clínicas de Porto Alegre referred to in orthopedics, from October 2017 to June 2018.Six steps were systematized sequenced to be followed during a weekly with time optimization and patient focus. New approaches were agreed upon based on scientific evidence and multiprofessional vision, with repercussions on prevention of pressure injury, dressing, removal of urethral catheter, nutritional support and early organization of hospital discharge.The implementation of the structured interdisciplinary round has had positive implications for effective communication, reducing risks and failures in the care process, and can be considered good practice regarding patient safety.relatar a experiência da sistematização de round interdisciplinar no cuidado a pacientes com fratura da extremidade proximal de fêmur internados em unidade cirúrgica.Relato da experiência de discussão clínica compartilhada pela equipe multiprofissional em unidade de internação cirúrgica do Hospital de Clínicas de Porto Alegre, referência em ortopedia, no período de outubro de 2017 até junho de 2018.Sistematizou-se seis etapas a serem seguidas sequencialmente durante encontro multiprofissional semanal, com otimização do tempo e foco no paciente. Novas condutas foram acordadas com base em evidências científicas e visão multiprofissional, com repercussões sobre a prevenção de lesão por pressão, realização de curativo, retirada de sonda vesical, suporte nutricional e organização precoce da alta hospitalar.A implementação do round interdisciplinar estruturado trouxe implicações positivas para a comunicação efetiva, reduzindo riscos e falhas nos processos de cuidado, podendo ser considerada boa prática no que tange à segurança do paciente.Relatar la experiencia de la sistematización de round interdisciplinario en el cuidado a pacientes con fractura proximal de fémur internados en unidad quirúrgica.Relato de la experiencia de discusión clínica compartida por el equipo multiprofesional en una unidad de internación quirúrgica del Hospital de Clínicas de Porto Alegre, referencia en ortopedia, en el período de octubre de 2017 a junio de 2018.Se sistematizaron seis etapas a ser seguidas secuencialmente durante un encuentro semanal con la optimización del tiempo y el foco en el paciente. Los nuevos conductos se acordaron a partir de evidencias científicas y una visión multiprofesional, con repercusiones sobre la prevención de lesión por presión, realización de curativos, retirada de sonda vesical, soporte nutricional y organización precoz del alta hospitalaria.La implementación del round interdisciplinario estructurado trajo implicaciones positivas para la comunicación efectiva, reduciendo riesgos y fallas en los procesos de cuidado, pudiendo ser considerada buena práctica en lo que se refiere a la seguridad del paciente.

It is known that oxidative stress occurs in peripheral blood in an experimental animal model of diabetes and depression, and acute treatment with insulin and clonazepam (CNZ) has a protective effect on oxidative stress in this model.This study evaluated the effect of insulin plus CNZ on oxidative stress parameters in the liver of diabetic male rats induced with streptozotocin (STZ) and subjected to forced swimming test (FST).Diabetes was induced by a single intraperitoneal (i.p.) dose of STZ 60 mg/kg in male Wistar rats. Insulin (4 IU/kg) plus CNZ acute i.p. treatment (0.25 mg/kg) was administered 24, 5 and 1 h before the FST. Nondiabetic control rats received i.p. injections of saline (1 mL/kg). Protein oxidative damage was evaluated by carbonyl formation and the antioxidant redox parameters were analyzed by the measurements of enzymatic activities of the superoxide dismutase (SOD), catalase and glyoxalase I (GLO). Glycemia levels also were determined.Our present study has shown an increase in carbonyl content from diabetic rats subjected to FST (2.04 ± 0.55), while the activity of catalase (51.83 ± 19.02) and SOD (2.30 ± 1.23) were significantly decreased in liver from these animals, which were reverted by the treatment. Also, the activity of GLO (0.15 ± 0.02) in the liver of the animals was decreased.Our findings showed that insulin plus CNZ acute treatment ameliorate the antioxidant redox parameters and protect against protein oxidative damage in the liver of diabetic rats subjected to FST.

Resumo: O livro didático público de língua estrangeira do Estado do Paraná procura abordar de maneira diferenciada o ensino de língua inglesa através do uso de textos, tentando seguir uma proposta de trabalho baseada na perspectiva bakhtiniana de linguagem. Por meio deste trabalho, tenta-se demonstrar a relação entre a teoria da linguagem defendida pelo Círculo de Bakhtin e os textos presentes no livro, relacionando os aspectos interculturais e o ensino de inglês. A partir da escolha de uma unidade temática, a pesquisa analisa os textos e as atividades propostas a fim de verificar se a intenção dos autores de ensinar a língua inglesa através da perspectiva sociológica de linguagem é efetivada, demonstrando os pressupostos da teoria do Círculo e as relações presentes nas Diretrizes Curriculares de Língua Estrangeira do Estado do Paraná (2009). As Diretrizes explicitam que a língua estrangeira proporciona um espaço de construção de conhecimento e interpretações da realidade através do discurso e do contexto, e não através da decodificação de um sistema linguístico. Pensando nisso, o livro didático analisado atenderia em boa parte a proposta na qual foi concebido. Palavras-chave: interculturalidade; leitura em língua inglesa; Círculo de Bakhtin.