RESUMEN
INTRODUCTION: Warfarin continues to be the most widely used anticoagulant in clinical practice around the world for the prevention of thromboembolic events in patients with atrial fibrillation (AF). The evaluation of the quality of anticoagulation control, estimated by time in therapeutic range (TTR), is accepted as a good method to evaluate the quality of anticoagulation. The variability of TTR can be explained by the presence of variants of the CYP2C9 and VKORC1 genes. METHODS: This study examined the association between polymorphisms of the CYP2C9 and VKORC1 genes and control of oral anticoagulation, through TTR, in patients with AF. A cross-sectional study was conducted within a cohort follow-up. The study comprised of 317 patients with AF, using warfarin, who were followed up for one year. The genotyping of genes CYP2C9 (rs1057910), (rs1799853) and VKORC1 (rs923231) was performed by PCR in real time, using TaqMan probes. RESULTS: Patients who had variant genotypes for the CYP2C9*3 gene (rs1057910) presented higher TTR (TTR 81-100%) when compared to when compared to the <45% and 46-60% TTR groups (p=0.005 and p=0.002, respectively). Regarding VKORC1 (rs923231), patients who had the variant genotype for the VKORC1 (rs923231) gene also presented a higher TTR (TTR 81-100%), when when compared to the <45% and 46-60% TTR groups (p=0.005 and p=0.004, respectively). In a multivariate model, VKORC1 (rs923231) remained associated for comparisons with the TTR groups (<45% vs 81-100% groups, p=0.01; and 46-60% vs 81-100% groups, p=0.01). CONCLUSION: The genotypes of the CYP2C9*3 (AA) and VKORC1 -1639 (GG) genes were associated with the worst quality of anticoagulation control (TTR) in patients with AF using warfarin in the northeast of Brazil.
RESUMEN
Objetivo: Verificar a visão dos familiares sobre o uso da brinquedoteca como recurso terapêutico na assistência à criança com câncer. Métodos: Trata-se de um estudo transversal que utilizou uma amostra de conveniência. Foi aplicado um formulário específico, contendo questões direcionadas a conhecer o perfil sóciodemográfico dos acompanhantes (27 familiares que acompanhavam as crianças com câncer), dados pessoais da criança e sua relação com a brinquedoteca, além de questões direcionadas aos acompanhantes após observação da criança na brinquedoteca, as quais foram elaboradas considerando três escores de respostas. Resultados: Os familiares responderam que a brinquedoteca propicia uma melhor qualidade de vida para as crianças, na medida em que diminui o estresse e contribui para a melhoria do seu bem estar. Além disso, facilita a compreensão da condição que vivem, minimizando as dificuldades de aceitação do tratamento e melhorando o relacionamento com outras crianças e com os profissionais. Conclusão: Os resultados nos permite concluir que a brinquedoteca possibilita a continuidade do desenvolvimento cognitivo da criança, favorecendo as suas potencialidades, ajudando-as a compreender sua condição, melhorando a adesão ao tratamento, sua sociabilidade, minimizando o sofrimento e humanizando o processo de cura e recuperação (AU).
Objective: To verify the family members' view on the use of the toy library as a therapeutic resource in the care of children with cancer. Methods: This was a cross-sectional study using a convenience sample. A specific form was applied, containing questions considering three response scores and aimed at knowing the socio-demographic profile of the companions (27 family members who accompanied the children with cancer), the child's personal data and their relationship with the toy library, besides issues addressed to the companions After watching the child in the toy library. Results: 59.3% of family members answered that the toy library has a very relevant socializing role, helping in the relationship with other children and professionals. 55.6% of family members also stated that there was a change in the perception of the child in the face of his illness and for the majority of respondents (85.2%), the toy library helped to improve the child's well-being and reduce stress. Conclusion: The results allow us to conclude that the toy library allows the continuity of the child's cognitive development, favoring their potentialities, helping them understand their condition, improving adherence to treatment, sociability, minimizing suffering and humanizing the healing process and recovery (AU).