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.

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 com abordagem quantitativa. Foram realizadas entrevistas norteadas por um formulário específico com 27 familiares que acompanhavam as crianças com câncer.  Resultados: Segundo os familiares, a brinquedoteca propicia uma melhor qualidade de vida para as crianças, na medida em que diminui o estresse e atua como potencial meio socializador. Além disso, facilita a compreensão da condição que vivem, minimizando os temores recorridos pelos inúmeros procedimentos invasivos do tratamento, pela impossibilidade de frequentar a escola regularmente e pelo afastamento do convívio social. Conclusão: A brinquedoteca harmoniza o processo de dar continuidade ao desenvolvimento cognitivo da criança e atua nas potencialidades do paciente, incentivando-o a ser criativo, interagir com o próximo e ajudando a manter um equilíbrio emocional.

Introduction: Alcoholic Cardiomyopathy (ACM) is a disease with a difficult diagnosis. The real mechanisms related to its pathophysiology are not fully understood. Objective: The aims of this study were to investigate whether miR-133b and miR-138 could be associated with ACM. Method: Forty-four patients were included comprising 24 with ACM and 20 with cardiomyopathies of different etiologies (control group). Real-time PCR was performed to verify the relative expression among the studied groups. In the statistical analysis, the quantitative variables t-student Mann- Whitney and correlation of Pearson tests were carried out, while the qualitative variable comprised the chi-square test, with p<0.05 being considered statistically significant. Results: There was no association between clinical and sociodemographic characteristics of the groups. The patients with ACM presented downregulation of miR-133b in comparison with control patients (p=0.004). On the other hand, for the miR-138, there was no association when the ACM group was compared with the control group. The presence of miR-133b among cases and controls was not correlated with any of the echocardiographic parameters. However, the increase in the expression of miR-138 was correlated with an increase in the ejection fraction (r=0.28, p=0.01) and the diameter of the left atrium (r=0.23, p=0.04) in patients with ACM. Conclusion: The downregulation of miR-133b might be a marker for ACM and, in addition, miR- 138 could be used to correlate the increase in ejection fraction with and normalization of the diameter of the left atrium diameter in patients with this disease.