Rand Randall Martins

Liquid-base cytology: a new method for oestral cycle study in wistar's rats

OBJETIVOS: O objetivo deste estudo foi a padronizacao de uma tecnica de coleta e coloracao em meio liquido que alie a praticidade e a riqueza citologica, possibilitando uma maior reprodutividade e facilidade microscopica. METODOS: Ratas wistar (n=20) foram submetidas a coleta vaginal diaria em salina e o lavado fixado (eter/alcool) e corado em suspensao com solucao de azul de Evans 0,025%. A amostra foi concentrada por centrifugacao e observado sob objetiva de 40 x. RESULTADOS: Os esfregacos corados permitiram nitida diferenciacao das fases do ciclo hormonal (diestro, proestro, estro e metaestro); alem da diferenciacao dos tipos celulares em relacao ao seu grau de maturacao tendo como parâmetros o tamanho celular, relacao nucleo / citoplasma (RNC) e reacao tintorial. O estudo demonstrou a existencia de tres padroes celulares basicos: celulas com baixa RNC, acentuada cianofilia e pequeno tamanho; celulas com acrescimo na RNC, perda de cianofilia e maior volume citoplasmatico e celulas queratinizadas anucleadas em aspecto de escama. CONCLUSAO: A coloracao do material permitiu, alem da classificacao citologica, a possibilidade de quantificacao o que resultaria em um acompanhamento mais acurado do ciclo estral.OBJECTIVES The objective of this study was the standardization of a collection technique and staining in liquid-base that allies the pratical and cytological wealth, making possible a larger reproductibility and microscopic easiness. METHODS Female wistar rats (n = 20) were submitted to the daily vaginal collection in saline and fastened washed (ether/alcohol) and stained in suspension with a solution of Evans Blue 0.025%. The sample was pondered by centrifugation and observed under lens of 40 x. RESULTS The stained smears allowed clear differentiation of the phases of hormonal cycle (diestrus, proestrus, estrus and metestrus); besides the differentiation of the cellular types in relation to its maturation degree having as parameters the cellular size, nucleus/cytoplasm relationship (NCR) and ink reaction. The study demonstrated the existence of three basic cellular patterns: cells with low NCR, accentuated cyanophily and small size; cells with increment in NCR, cyanophilic loss and larger volume cytoplasmatic and without nuclei keratinization cells in squamous aspect. CONCLUSION The staining of the material allowed, besides the cytological classification, the quantification possibility that would result in a perfected accompaniment of the cycle estrous.

Potential intravenous drug incompatibilities in a pediatric unit

ABSTRACT Objective To investigate potential intravenous drug incompatibilities and related risk factors in a pediatric unit. Methods A cross-sectional analytical study conducted in the pediatric unit of a university hospital in Brazil. Data on prescriptions given to children aged 0-15 years from June to October 2014 were collected. Prescriptions that did not include intravenous drugs and prescriptions with incomplete dosage regimen or written in poor handwriting were excluded. Associations between variables and the risk of potential incompatibility were investigated using the Student’s t test and ANOVA; the level of significance was set at 5% (p<0.05). Relative risks were calculated for each drug involved in potential incompatibility with 95% confidence interval. Results A total of 222 children participated in the study; 132 (59.5%) children were male and 118 (53.2%) were aged between 0 and 2 years. The mean length of stay was 7.7±2.3 days. Dipyrone, penicillin G and ceftriaxona were the most commonly prescribed drugs. At least one potential incompatibility was detected in about 85% of children (1.2 incompatibility/patient ratio). Most incompatibilities detected fell into the non-tested (93.4%), precipitation (5.5%), turbidity (0.7%) or chemical decomposition (0.4%) categories. The number of drugs and prescription of diazepam, phenytoin, phenobarbital or metronidazole were risk factors for potential incompatibility. Conclusion Most pediatric prescriptions involved potential incompatibilities, with higher prevalence of non-tested incompatibilities. The number of drugs and prescription of diazepam, phenobarbital, phenytoin or metronidazole were risk factors for potential incompatibilities.

QTc interval prolongation in critically ill patients: Prevalence, risk factors and associated medications

Purpose To investigate the prevalence and risk factors of acquired long QT syndrome (LQTS) on admission to a general Intensive Care Unit (ICU), and to assess the risk of LQTS associated with prescribed medications. Methods Prospective observational, cross-sectional study approved by the Institutional Review Board. Between May 2014 and July 2016, 412 patients >18 years-old consecutively admitted to the ICU of a university hospital were included. LQTS was defined as a QT interval on the admission electrocardiogram corrected using Bazett’s formula (QTc) >460 ms for men and >470 ms for women. All medications administered within 24 hours before admission were recorded. Logistic regression was used. Results LQTS prevalence was 27.9%. In LQTS patients, 70.4% had ≥ 1 LQTS-inducing drug prescribed in the 24 hours prior to ICU admission versus 70.4% in non-LQTS patients (p = 0.99). Bradycardia and Charlson morbidity index score are independent risk factors for LQTS. Haloperidol (OR 4.416), amiodarone (OR 2.509) and furosemide (OR 1.895) were associated with LQTS, as well as another drug not yet described, namely clopidogrel (OR 2.241). Conclusions The LQTS is highly prevalent in critically ill patients, ICU patients are often admitted with LQTS-inducing medications, and patients with slow heart rate or with high Charlson comorbidity index should be evaluated for LQTS.

Use of off-label and unlicensed medicines in neonatal intensive care

Purpose To evaluate the use of off-label and unlicensed medicines in a neonatal intensive care unit (NICU) of a teaching maternity hospital specialized in high risk pregnancy. Methods A prospective cohort study was conducted between August 2015 and July 2016. All newborns admitted to the NICU who had at least one medication prescribed and a hospital stay longer than 24 hours were included. The classification of off-label and unlicensed drugs for the neonatal population was done according to the information of Food and Drug Administration. Results A total of 17421 medication items were analyzed in 3935 prescriptions of 220 newborns. The proportion of newborns exposed to off-label drugs was 96.4%, and to unlicensed medicines was 66.8%. About one-half (49.3%) of the medication items were off-label and 24.6% were unlicensed. The main reason for off-label and unlicensed classification was, respectively, frequency of administration and the administration of adaptations of pharmaceutical forms. Conclusions Although there are actions to encourage the development of pharmacological studies with neonates, this study observed a high rate of prescription and exposure of newborns to off-label and unlicensed drugs in NICUs and pointed out areas of neonatal therapy that require scientific investment.