EVOLUÇÃO DOS CANDIDATOS À DOAÇÃO DE SANGUE DO GÊNERO FEMININO NO BANCO DE SANGUE DO HOSPITAL SANTA MARCELINA EM 10 ANOS

Objetivos

Elucidar através de gráficos e porcentagens, a ocupação de mulheres em espaços majoritariamente masculinos, sendo um deles a doação de sangue. Analisamos a evolução do gênero do doador do Banco de Sangue do Hospital Santa Marcelina ao longo de 10 anos (2011 a 05/2021) para determinar a linha de tendência das doações do sexo feminino e a importância de fortalecer o papel igualitário dos gêneros na sociedade.

Material e métodos

Através da coleta do dado “Quanto ao gênero do doador” informado no SISHEMO, coletamos as informações de 01/2011 a 05/2021 e avaliamos a evolução ao longo do tempo.

Resultados

Em 2011, o Banco de Sangue do Hospital Santa Marcelina apresentava média anual de 39,1% de doadores do sexo feminino, ao longo dos anos seguintes até 2019, essa taxa aumentou gradativamente e em 2019 atingiu 46,2%. Em 2020, pela pandemia por SARS-CoV-2, houve queda nessa tendência de alta, ficando em 44,6% a média anual. Em 2021, estratificando por mês, em janeiro houve 45,2% de doadoras e em maio atingiu 47,4%, índice superior à média mensal de 2019, mostrando que após a queda de 2020 a taxa voltou a crescer.

Discussão

A doação voluntária de sangue é um ato de causa humanitária, este comportamento é regido e administrado pelas diretrizes da lei vigente e padrões internacionais de qualidade para segurança dos receptores e dos doadores, diante disto, existem algumas restrições quanto a aptidão por gênero. Enquanto o candidato do sexo masculino pode doar 4 vezes em 12 meses, a candidata do sexo feminino tem algumas restrições a mais, podem doar sangue total até 3 vezes ao ano; as multíparas são excluídas da doação de plaquetas por aférese como forma de prevenir a lesão pulmonar aguda associada à transfusão (transfusion-related acute lung injury, TRALI), temos restrições relacionadas a gestação, amamentação, entre outras diferenças por gênero. Porém, essas peculiaridades podem ser compensadas com mais doadoras aptas. Dados de 2019 da OMS (Organização Mundial da Saúde) mostram que mundialmente 33% das doações são feitas por mulheres, mas esse número pode ser muito baixo em alguns países. Em 14, dos 111 países que notificaram à pesquisa da OMS, menos de 10% das doações são feitas por doadoras. No Brasil, a participação feminina é mais expressiva, a média nacional da ANVISA em 2019, mostra que 42,63% das doações são do sexo feminino, a região Sul atinge o maior percentual, com 43,89%. No Banco de Sangue do Hospital Santa Marcelina os índices estão acima da média nacional, em 2019 alcançamos 46,20%, e em especial no mês de setembro/2019 esse índice atingiu 49,2%, maior índice da série histórica de 10 anos. Houve uma queda em 2020, mas apesar do momento sanitário em que o país se encontra, ainda ficamos acima da média nacional, com 44,65%. Em 2021 os índices mensais estão aumentando progressivamente, mostrando que com o avanço do controle da pandemia as mulheres estão retornando as doações. Tais números evidenciam a transformação e a evolução da expressão da mulher na sociedade a um caminho de empoderamento e emancipação do sistema patriarcal.

Conclusão

Manter os estoques de hemocomponentes suficientes para atender toda demanda transfusional de um hospital de grande porte que atende também a outros serviços é um desafio para o setor de captação e triagem. O equilíbrio entre quantidade diária constante e qualidade, tem que nortear as ações de recrutamento. O estímulo a esse grupo de doadoras é fundamental como ferramenta para o suporte aos estoques e está associado a evolução histórica do papel da mulher perante a sociedade que cada vez mais ocupa posições importantes enquanto membro ativo, mostrando a necessidade de dinamismo e coparticipação entre ambos. Todos juntos, pelo ato de doar-se.

First report on ototoxicity of meglumine antimoniate

Introduction: Pentavalent antimonials are the first drug of choice in the treatment of tegumentary leishmaniasis. Data on ototoxicity related with such drugs is scarcely available in literature, leading us to develop a study on cochleovestibular functions.

Case Report: A case of a tegumentary leishmaniasis patient, a 78-year-old man who presented a substantial increase in auditory threshold with tinnitus and severe rotatory dizziness during the treatment with meglumine antimoniate, is reported. These symptoms worsened in two weeks after treatment was interrupted.

Conclusion: Dizziness and tinnitus had already been related to meglumine antimoniate. However, this is the first well documented case of cochlear-vestibular toxicity related to meglumine antimoniate.

Oral manifestations in the American tegumentary leishmaniasis

Introduction

American tegumentary leishmaniasis (ATL) can affect the skin or mucosa (mucocutaneous leishmaniasis – MCL) including the oral cavity. MCL oral lesions are often confused with other oral diseases, delaying diagnosis and specific treatment, and increasing the likelihood of sequelae. Thus, increasing the knowledge of the evolution of ATL oral lesions can facilitate its early diagnosis improving the prognosis of healing.

Objectives

Evaluate the frequency of ATL oral lesion and describe its clinical, laboratory and therapeutic peculiarities.

Methods

A descriptive transversal study was carried out, using data from medical records of 206 patients with MCL examined at the outpatient clinics-IPEC-Fiocruz between 1989 and 2013. Proportions were calculated for the categorical variables and the association among them was assessed by the Pearson's chi-square test. Measures of central tendency and dispersion were used for the continuous variables and their differences were assessed by both parametric (t test) and non parametric (Mann-Whitney) tests. P-values <0.05 were considered as significant.

Results

The most affected site was the nose, followed by the mouth, pharynx and larynx. Seventy eight (37.9%) have oral lesions and the disease presented a lower median of the evolution time than in other mucous sites as well as an increased time to heal. The presence of oral lesion was associated with: the presence of lesions in the other three mucosal sites; a smaller median of the leishmanin skin test values; a longer healing time of the mucosal lesions; a higher recurrence frequency; and a smaller frequency of treatment finishing and healing. When the oral lesion was isolated, it was associated with an age 20 years lower than when the oral lesion was associated with other mucosal sites.

Conclusion

Considering the worst therapy results associated with the presence of oral lesions, we suggest that lesions in this location represent a factor of worse prognosis for MCL.

Intralesional meglumine antimoniate for treatment of cutaneous leishmaniasis patients with contraindication to systemic therapy from Rio de Janeiro (2000 to 2006)

We evaluated the effectiveness and safety of intralesional meglumine antimoniate (MA) in 24 not submitted to previous treatment patients with cutaneous leishmaniasis (CL) and with contraindication to systemic therapy. Each treatment consisted of one to four intralesional applications of MA at 15-day intervals. Patients' age ranged from 3 to 90 years; fourteen were females. Intralesional treatment in the absence of any relevant toxicity was successful in 20 (83.3%) patients. Three patients required additional treatment with amphotericin B and one required systemic MA. None of the patients developed mucosal lesions when followed up to 60 months. Intralesional MA is an effective and less toxic alternative treatment of patients with CL and contraindication to systemic therapy.

A ten-year historic study of paranasal cavity endoscopy in patients with Leprosy

Leprosy is an infectious condition that has a chronic evolution caused by the Mycobacterium leprae. It very often attacks the nasal cavities mucosa independent of its clinical form, even before skin lesions or lesions to other parts of the body arise, in the presence or not of clinical complaints. Aim: To show the efficiency of nasal endoscopy to identify endonasal mucosa lesions and the importance of the Otorhinolaryngologist in the diagnosis and follow-up of Leprosy patients. Study Design: Clinical history study. Material and Method: a historic study was performed with 173 patient’s records without previous treatment from 1990 to 2000 at the Otorhinolaryngology Services, Instituto de Pesquisas Clinicas Hospital Evandro Chagas, Fiocruz. Results: All of the patients showed nasal lesions, 121 with and 52 without clinical complaints. Discussion: Nasal cavities endoscopy exam enabled early identification of the mucosa alteration in Leprosy patients as well as how to identify the evolution of the lesions. This type of exam also helps to establish local treatment. Conclusion: The evaluation and follow-up of Leprosy patients by the Otorhinolaryngologist in a multidisciplinary team are justified and offer the patient early diagnosis and specific treatment.

Estudo retrospectivo de dez anos em endoscopia das cavidades nasais de pacientes com hanseníase

A hanseníase é uma doença infecciosa de evolução crônica, causada pelo Mycobacterium leprae. Acomete com freqüência a mucosa das cavidades nasais, independentemente da forma clínica, antes mesmo do aparecimento de lesões na pele ou em outras partes do corpo, na presença ou não de queixas clínicas. OBJETIVO: Mostrar a eficácia da endoscopia nasal na identificação de lesões mucosas endonasais e a importância do especialista Otorrinolaringologista no diagnóstico e no acompanhamento dos pacientes com hanseníase. FORMA DE ESTUDO: Clínico retrospectivo. MATERIAL E MÉTODO: Realizou-se estudo retrospectivo de 173 prontuários de pacientes, sem tratamento prévio, durante o período de 1990 a 2000, no Serviço de Otorrinolaringologia do Instituto de Pesquisa Clínica do Hospital Evandro Chagas Fiocruz. RESULTADOS: Todos os pacientes apresentaram lesões nasais, sendo 121 com e 52 sem queixas clínicas. DISCUSSÃO: O exame endoscópico das cavidades nasais não só permitiu identificar precocemente alterações da mucosa em pacientes com hanseníase como também permitiu identificar a evolução das lesões. Este tipo de exame também auxilia na instituição do tratamento local. CONCLUSÃO: Justificam-se a avaliação e o acompanhamento de todos os pacientes com hanseníase pelo Otorrinolaringologista junto à equipe multidisciplinar, oferecendo ao paciente a precocidade no diagnóstico e o tratamento específico.

Retrospective study of 151 patients with cutaneous leishmaniasis treated with meglumine antimoniate

We retrospectively analyzed a series of 151 cases of cutaneous leishmaniasis treated between 1967 and 1982. One-hundred-and-thirty-nine (92%) patients presented with active lesions and were treated with daily doses of meglumine antimoniate: 81 adults received a 5-ml vial IM and 58 children received 1 to 5ml. Forty-five (32.4%) patients underwent continuous treatment with meglumine antimoniate for 25 to 116 days without rest intervals, and 94 (67.6%) intermittent treatment with 2 to 5 series of meglumine antimoniate. Intermittent series could include schedules of daily IM applications for 10 to 25 days each and intervals varying from 10 to 60 days. Antimony dose was calculated for 66 (47.5%) patients and ranged from 3.9 to 28.7 Sb5+/kg/day. Of these, 35 patients received >10mg and 31 patients <10mg Sb5+/kg/day. Median time of healing was longer for lesions on the legs and feet - 67.5 days versus 48.7 days (p < 0.001) for other sites. However, there were no significant differences in the median time of healing between adults and children, intermittent and continuous regimens or high and low antimony doses. Fifty-one patients were reassessed 5 to 14 years after treatment and showed no evidence of disease. These results support further investigation (clinical trials) on treatment using low doses of antimony.

Clinical and endoscopic findings in the mucosae of the upper respiratory and digestive tracts in post-treatment follow-up of paracoccidioidomycosis patients

Systematic examination of the upper respiratory and digestive tracts (URDT) was performed in a group of 80 paracoccidioidomycosis (PCM) patients submitted to post-treatment follow-up ranging from 8 months to 17 years. Mucosae of the URDT had been involved prior to specific treatment in 74 patients, distributed as follows: oropharynx, 50 (41 alone, 7 in association with the larynx, and 2 with the nasal mucosa); larynx, 30 (23 alone and 7 in association); and nasal mucosa, 3 (1 alone and 2 in association). Inactive lesions were observed in all the 50 patients with lesions of the oropharynx, 3 of whom with deforming scars (1 with retraction of the tongue and 2 with narrowing of the oral orifice). One case presented a destructive lesion, with perfuration of the palate. Of the other 46 cases, examination showed nacreous white striated scars which were nearly imperceptible in some cases and in others displayed partial retraction of anatomical structures without any alteration of their features. Patients presented a high rate of missing teeth. In 3 patients with involvement of the nasal mucosa, none of whom presented active PCM lesions, 2 still had nasal voices. In 30 patients with lesions of the larynx, 1 suffered a relapse of PCM and 2 developed epidermoid carcinoma. Of the other 27 cases, none of whom had active PCM lesions, 15 presented dysphonia, 3 were tracheotomized, and 9 were asymptomatic.