Relatório final de estágio de Enfermagem de Saúde Materna e Obstétrica: Fadiga materna e paterna aos 3 meses de pós-parto / Final report of Nursing and Obstetric Nursing: Maternal and paternal fatigue at 3 months postpartum

Introdução: A fadiga no pós-parto é uma diminuição da capacidade física e mental, falta de energia e diminuição da concentração (Henderson et al., 2019). Afeta ambos os elementos do casal e por sua vez condiciona as suas rotinas. Objetivo: Descrever a fadiga materna e paterna aos três meses de pós-parto. Metodologia: Trata-se de um estudo de nível 1 quantitativo do tipo exploratório-descritivo, partindo de uma amostra do tipo não probabilística em bola de neve, constituída por 31 mulheres e 6 homens no pós-parto. Após o parecer favorável da Comissão de Ética a recolha de dados foi realizada através de um questionário online, composto por questões sociodemográficas e obstétricas e pelas escalas Versão Portuguesa da versão reduzida da fadiga Pós-parto da Fatigue Symptom Checklist (FSC) para as mulheres e a versão portuguesa da Fatigue Assessment Scale (FAS) para os homens. Através do programa SPSS foram analisadas as frequências absolutas e relativas, média e desvio padrão. Resultados: Após a analise dos resultados recolhidos pôde verificar-se que a média da resposta a cada pergunta nas mulheres é muito próxima de 1, que é o valor máximo da escala FSC, podendo dizer-se que se sentem fatigadas. No que diz respeito à amostra recolhida nos homens, 10% respondeu ?Nunca? e 56% respondeu ?Algumas vezes? às questões da escala FAS, e apesar de terem médias inferiores também evidenciaram sinais de fadiga. Conclusão: É fundamental que o EESMO possa intervir para minimizar os fatores de risco no que diz respeito à fadiga pós-parto. Este estudo salienta a importância de realizar o acompanhamento das mães e dos pais, identificando os fatores que podem originar fadiga pós-parto e desenvolver ações e estratégias para ajudar estas famílias.

Renal Warm Ischemia in Organ Donors After Circulatory Death.

Chronic kidney disease is the most common type of organ failure worldwide, with a prevalence of 13.4% for all stages. Organ transplant is the only curative option for end-stage kidney failure. However, the shortage of organ donors remains a major obstacle in organ transplant, with donation after circulatory death being the most viable path to increasing the donor pool. The circumstances that surround this type of donation are different from donation after brain death, namely concerning warm ischemia times, which are longer and may preclude a successful transplant. This article describes the pathophysiology of warm ischemia and summarizes recent developments in technological and methodological practices that mitigate the mechanisms of warm ischemia. Anoxia, mitochondrial dysfunction, calcium overload, oxidative and nitrosative stress, immune response, and no reflow are the main mechanisms by which ischemia leads to cell death and organ dysfunction. In situ oxygenated recirculation, abdominal normothermic organ recirculation, abdominal hypothermic organ recirculation, and ex vivo machine perfusion ensure continued organ perfusion and prevent prolonged warm ischemia in organ donation. These practices, coupled with optimizations in the identification and assessment of potential donors after circulatory death, may lead to a significant increase in the number and success rates of organ transplant worldwide.

Effect of one session of aerobic exercise associated with abdominal laser therapy in lipolytic activity, lipid profile, and inflammatory markers.

BACKGROUND: Increased abdominal fat and sedentary lifestyles contribute to cardiovascular disease risk. The combination of exercise and low-level laser therapy (LLLT) appears to be an innovative method to increase the lipolytic rate of abdominal adipocytes, in order to reduce abdominal fat. OBJECTIVES: To evaluate the effect of one session of aerobic exercise associated with abdominal laser therapy in lipolytic activity, profile lipid, and inflammatory markers (C-reactive protein-CRP). METHODS: Experimental randomized controlled study in 36 participants of female sex divided into three groups: placebo group (PG) (n = 12), experimental group 1 (EG1) (n = 11), and experimental group 2 (EG2) (n = 13). The EG1 and EG2 performed the laser therapy protocol followed by 50 minutes of aerobic exercise on cycle ergometer, of 45%-55% of reserve heart rate; however, in EG2 the laser therapy was applied without power. The PG only performed the laser therapy protocol without power. The anthropometric measures were evaluated, and all participants were subject to blood samples at the beginning and at the end of the intervention for measure glycerol, lipid profile (total cholesterol, triglycerides, HDL, and LDL), and CRP. One-way ANOVA was used to compare the groups in the quantitative variables and Fisher's test to compare the groups in the qualitative variables. To compare the variables between moments (M0 and M1), we used the t test for paired samples. RESULTS: In the group that performed physical exercise and lipolytic laser and in the group that performs only physical exercise, there was a significant increase in glycerol mobilization between M0 and M1 (P < .001). The same did not occur in the placebo group. Regarding the CRP levels and lipidic profile, no significant differences were observed between moments in the experimental groups. CONCLUSION: It is concluded that one session of aerobic exercise associated with LLLT and one session of aerobic exercise appears to be able to increase the lipolytic activity. However, it appears that LLLT does not provide increased value to the aerobic physical exercise by itself in lipolysis process.

Molecular mechanisms underlying hyperoxia acute lung injury.

The management of acute hypoxemic respiratory failure frequently includes the use of supraphysiological fractions of inspired oxygen (FiO2), which can be beneficial in the short-term but not without risks in the long-term, causing acute lung injury (ALI). Over the last few years, much attention has been devoted to the intracellular signaling transduction pathways that lead to hyperoxia-induced cell damage, particularly MAP kinase cascades. Identification of involved signaling molecules and understanding of the regulation of the main signal transduction pathways might provide the basis for improving the outcome of patients under high FiO2 exposure through more effective therapeutic interventions. This review, which includes studies published from 1987 to 2015, presents an overview on recent progresses in the hyperoxia ALI field with special emphasis on potential therapeutic targets and clinical approaches based on the molecular mechanisms underlying hyperoxia-induced inflammation. Further studies are needed to gain deeper insight into controversial molecular mechanisms underlying hyperoxia-induced cell death, which may play a critical role in future pharmacological interventions, as well as into hyperoxia-induced cell damage, that could monitor and therefore prevent hyperoxia ALI.

Artificial placenta: Recent advances and potential clinical applications.

Lung immaturity remains a major cause of morbidity and mortality in extremely premature infants. Positive-pressure mechanical ventilation, the method of choice for respiratory support in premature infants, frequently promotes by itself lung injury and a negative impact in the circulatory function. Extracorporeal lung support has been proposed for more than 50 years as a potential alternative to mechanical ventilation in the treatment of severe respiratory failure of extremely premature infants. Recent advances in this field included the development of miniaturized centrifugal pumps and polymethylpentene oxygenators, as well as the successful use of pump-assisted veno-venous extracorporeal gas exchange systems in experimental artificial placenta models. This review, which includes studies published from 1958 to 2015, presents an update on the artificial placenta concept and its potential clinical applications. Special focus will be devoted to the milestones achieved so far and to the limitations that must be overcome before its clinical application. Notwithstanding, the artificial placenta stands as a promising alternative to mechanical ventilation in extremely premature infants. Pediatr Pulmonol. 2016;51:643-649. © 2016 Wiley Periodicals, Inc.