Lactation induction for transgender women and transfeminine people in health care: a scoping review / Indução da lactação para mulheres transgênero e pessoas transfemininas no cuidado à saúde: uma revisão de escopo

Abstract There are countless proven benefits of breastfeeding, and the demand for such a right in health for transfeminine people is rarely addressed in the literature, reinforcing inequities in health. The article aims to conduct a scoping review of lactation induction for transfeminine people in the health care context. Systematic literature review in six selected databases, looking for articles with terms related to lactation and transfeminine people. Data were extracted and analyzed, summarizing the main results in tables. Three hundred ninety articles were found. After the exclusion of the duplicates there was a selection by title/abstract and a following selection by the full reading of the remaining articles, considering the pre-determined exclusion and inclusion criteria. Twenty-one articles were included, published between 2018 and 2023. Among them, six are case reports with unprecedented information on the topic, and the others are publications in various formats. Lactation induction was achieved in all the case reports. There is a fragile and recent body of evidence affirming the success of lactation induction in transgender women. There is a necessity to support this demand by health professionals and robust studies to optimize necessary interventions.

Resumo São inúmeros os benefícios comprovados do aleitamento materno, e a demanda por tal direito em saúde para as pessoas transfemininas é pouco abordada na literatura, reforçando as iniquidades em saúde. O artigo objetiva realizar uma revisão de escopo sobre a indução da lactação para pessoas transfemininas no contexto de assistência à saúde. Revisão sistemática da literatura em seis bases de dados selecionadas, buscando artigos com termos relacionados à lactação e pessoas transfemininas. Os dados foram extraídos e analisados, resumindo os principais resultados em tabelas. Foram encontrados 390 artigos. Após a exclusão dos duplicados, procedeu-se à seleção por título/resumo e posterior seleção pela leitura na íntegra, considerando os critérios de exclusão e inclusão. Foram incluídos 21 artigos, publicados entre 2018 e 2023. Entre eles, seis são relatos de casos com informações inéditas sobre o tema, e os demais são publicações em diversos formatos. A indução da lactação foi alcançada em todos os relatos de casos. Existe um corpo de evidências frágil e recente que afirma o sucesso da indução da lactação em mulheres trans. Há necessidade de respaldar essa demanda por parte dos profissionais e estudos robustos para otimizar as intervenções necessárias.

Factores asociados a complicaciones por COVID-19 en trabajadores hospitalarios: estudio de cohorte retrospectivo / Factors associated with complications from COVID-19 in hospital workers: a retrospective cohort study

Introduction: SARS-CoV-2 infection in healthcare professionals represents a threat to the healthcare system. Objectives: To identify factors associated with complications from COVID-19 in healthcare workers infected by SARS-CoV-2, in a specialized national hospital level III in Peru in 2020. Methods: This is a retrospective cohort study. Health personnel who were working at Instituto Nacional Materno Perinatal of Peru participated. The clinical and epidemiological characteristics and results of the Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) test were collected from the medical records and epidemiological files. Simple and multiple regression models were used to estimate the risk factors of complications due to COVID-19. Results: We found 1048 suspected cases, and 26.2% had a confirmed SARS-CoV-2 infection. Of those infected, 20.8% had comorbidity, and 55% reported contact with COVID-19 patients in health care settings. Moreover, 27.4% of infected workers were administrative personnel, 24.1% were nursing technicians, 18.3% were nurses, and 13.1% were physicians. We also found that 24.1% presented complications from COVID-19, and three workers died. In a multiple regression, the risk factors for complications due to COVID-19 were the presence of comorbidity (risk ratio: 2.94; 95% confidence interval: 1.95 to 4.42), 30 years or older (1.28; 0.6 to 2.75), 60 years or older (2.04; 0.88 to 4.74), male sex (1.1; 0.71 to 1.7) and care work area (1.02; 0.06 to 2.62). Conclusions: The findings in the present study show an association between the presence of comorbidities and an increased risk of presenting complications due to COVID-19 in healthcare workers, regardless of age, sex and area of work.

Introducción: La infección por SARS-CoV-2 en profesionales sanitarios representa una amenaza para el sistema de salud. Objetivos: Identificar factores asociados a complicaciones por COVID-19 en trabajadores sanitarios, infectados por SARS-CoV-2 y que pertenecen a un hospital nacional especializado de tercer nivel de Perú en el año 2020. Métodos: Estudio de cohorte retrospectivo. Participaron trabajadores sanitarios infectados por SARS-CoV-2, que trabajaron en el Instituto Nacional Materno Perinatal entre abril y diciembre de 2020. Se recogieron características clínicas y epidemiológicas, más resultados de la prueba de reacción en cadena de la polimerasa con transcriptasa inversa (PCR-TR) a partir de historias clínicas y fichas clínico epidemiológicas. Se utilizó regresión simple y múltiple para estimar los riesgos relativos de complicaciones por COVID-19. Resultados: Se identificaron 1048 casos sospechosos, de ellos 26,2% tuvo infección confirmada de SARS-CoV-2. Del personal sanitario infectado, el 20,8% tuvo alguna comorbilidad, 55% manifestó atención a pacientes COVID-19, 27,4% fue personal administrativo, 24,1% técnico en enfermería, 18,3% licenciada de enfermería y 13,1% personal médico. El 24,1% presentó complicaciones por COVID-19 y tres trabajadores sanitarios fallecieron. En regresión múltiple, se obtuvo riesgos relativos para complicaciones por COVID-19 según presencia de comorbilidad (riesgo relativo: 2,94; intervalo de confianza 95%: 1,95 a 4,42), edad de 30 años a más ( 1,28; 95%: 0,6 a 2,75), 60 años a más ( 2,04; 95%: 0,88 a 4,74), sexo masculino ( 1,1; 95%: 0,71 a 1,7) y área laboral asistencial ( 1,02; 95%: 0,06 a 2,62). Conclusiones: Los hallazgos sugieren que en trabajadores sanitarios infectados por SARS-CoV-2, la presencia de comorbilidades está asociada a complicaciones por COVID-19, independientemente de la edad, el sexo y del área laboral.

Embolismo por cristales de colesterol con síndrome de disfunción multiorgánica / Cholesterol crystal embolism with multiorgan dysfunction syndrome

Resumen: La embolia por cristales de colesterol es una enfermedad sistémica caracterizada por la oclusión de pequeñas arterias debido al desprendimiento de los mismos desde las placas de ateroma formadas en las paredes de arterias principales. Este caso clínico corresponde a un paciente masculino de 77 años de edad con factores de riesgo de enfermedad vascular que ingresó al servicio de urgencias por disnea y ortopnea. Se diagnosticó un cuadro clínico de insuficiencia cardiaca aguda y recibió tratamiento médico con buena respuesta. Se realizó una cinecoronariografía que evidenció severa ateroesclerosis coronaria con enfermedad de tres vasos, recibió tratamiento endovascular con colocación de endoprótesis vasculares. Luego de 20 días el paciente evolucionó con deposiciones melénicas, oligoanuria y claudicación intermitente progresiva en ambos miembros inferiores. Se observó obstrucción del flujo arterial en ambas arterias pedias por ecografía doppler; las biopsias de la piel de los pies revelaron signos vasculares correspondientes a depósitos de cristales de colesterol. Se interpretó enfermedad por embolia de cristales de colesterol secundario a las maniobras de cateterización previa, que provocaron alteraciones multiorgánicas isquémicas y persistentes. Resulta interesante este padecimiento porque es un proceso grave que demanda alto grado de sospecha clínica, el diagnóstico definitivo se establece mediante biopsia de las lesiones cutáneas, el pronóstico depende de la extensión de la enfermedad y en la actualidad no existe un tratamiento específico.

Abstract: The cholesterol crystal embolism is a systemic disease characterized by the occlusion of small arteries due these crystals, which come from the atheroma plaques of the walls of major arteries. This clinical case corresponds to a 77-year-old male patient with risk factors for cardiovascular disease who entered at the emergency service due dyspnea and orthopnea. In the Coronary Unit, a clinical status of acute heart failure was diagnosed, receiving medical treatment with good response. It was decided to perform a coronary angiography which showed a severe coronary atherosclerosis with 3-vessel compromised and endovascular treatment was performed with stent placement. After 20 days, the patient evolved with melenic depositions oligoanuria and progressive intermittent claudication in both lower limbs. Obstruction of arterial flow was observed in both pedia arteries by doppler ultrasound. Skin biopsies of lower limbs revealed vascular signs of deposits of cholesterol crystals. It was recognized as a cholesterol crystal disease secondary to previous medical catheterization procedures, causing ischemia and persistent alterations in the digestive and renal systems as well as in the skin of the lower limbs. This is an important affection because it is a serious process that demands a high level of clinical suspicion, the definitive diagnosis is established through the biopsy of the cutaneous lesions and the prognosis depends on the extension of the disease. Nowadays, there is no specific medical treatment of this disease.

Detección molecular del gen BCR-ABL por RT-PCR en niños costarricenses con leucemia

Molecular detection of the BCR-ABL gen by RT-PCR In Costa Rican children with leukemia. Many leukemias could have chromosomic translocations and according to the transcripts formed by the genes involved, the patients present an specific phenotype of the leukemia. We show the first results of the investigation of the gen BCR-ABL using RT-PCR, in order to look for the t(9;22)(q34;q11) in pediatric leukemic children. We studied in total 55 patients, 6 (10.9%) of them were positive for that translocation. Two (3.63%) of the positive children had ALL and the other 4 (7.27%) presented CML, the genotyping analysis of the transcript was studied in these children. With the introduction of this methodology as part of the routine studies, the leukemic children could get in the future an specific diagnosis, that will be important to classify them in prognostic categories and to improve the detection of minimal residual disease. Rev. Biol. Trop. 56 (4): 1613-1618. Epub 2008 December 12.

Muchas leucemias pueden presentar traslocaciones cromosómicas, las cuales, de acuerdo a los transcriptos formados por los genes involucrados, originará un fenotipo leucémica variable. En este trabajo se muestran los primeros resultados de pacientes pediátricos con leucemia, a los cuales se les hizo el estudio molecular por RT-PCR y el genotipaje para el gen BCR-ABL producto de la t(9;22)(q34;q11). De las 55 muestras estudiadas, 6 (10.9%) fueron positivas para el transcripto mencionado. De las 6 positivas, 2(3.63%) de esos pacientes tenían LLA y 4 (7.27%) eran LMC. La introducción de esta metodología en el manejo rutinario de los niños con leucemia, servirá para establecer un diagnóstico más preciso, un pronóstico más certero y un seguimiento adecuado de la enfermedad mínima residual.

Câncer epitelial de ovário: análise de 10 anos no INCa e atualizaçäo / Ovarian ephitelial cancer: ten years review in INCa and actualization

Os autores fazem uma análise de 62 casos de câncer de ovário tratado ni INCa com intençäo curativa num período de 10 anos. A idade mediana foi de 49 anos e o aumento de volume abdominal foi o sintoma mais freqüentement observado. Oitenta e sete por cento dos casos foram a resposta clínica completa e, destes, 29 por cento recidivaram. Aos 48 meses, se encontrou sobrevida global de 71 por cento e uma sobrevida livre de doença de 62 por cento. Foi feita também análise dos fatores prognósticos que revelaram importâ para o estadiamento, a idade e o grau de difernciaçäo tumoral. Concluiu-se que a cirurgia deve ser completa sempre que possível e que a radioterapia é a melhor opçäo de tratamento complementar até o momento para os casos íniciais. Os autores fazem também uma breve revisäo da literatura sobre o tema.