This prospective cohort study aimed to identify the influence of nursing work overload on the occurrence of incidents without injury and adverse events in 399 patients hospitalized in Intensive Care Units (ICU). For data collection, a structured questionnaire was administered and an analysis of medical records was performed. In these admissions, approximately 78% of incidents without injury and adverse events in patients were related to the sphere of Nursing. These occurrences were attributed to overwork, increased the number of days of hospitalization and the risk of death of patients. It is essential that nursing managers work on the staff hospital management avoiding work overload to contribute for patient safety.

BackgroundVarious sociodemographic factors can affect the quality of life of medical students and interfere in their ability to study. A deeper understanding of these factors may facilitate improvements in learning and retention of medical students.MethodsWe conducted a cross-sectional study of 405 medical students, representing 65.3% of the total student body (years 1–6), at a private medical school in São Paulo, Brazil. Among the entire study group, 177 students (43.7%) were male, and 228 (56.3%) were female. The mean age was 23.55 years (SD = 3.98 years, range: 18–40). The World Health Organization Quality of Life-Biomedical Research and Education Facility (WHOQOL-BREF) scale was used to evaluate the following sociodemographic factors: age, sex, academic year, daily traveling time, housing conditions, smoking, weight, height, participant’s and his/her parents’ education background, students who had a degree or not and religious beliefs. The reliability of the WHOQOL-BREF was evaluated using Cronbach’s analysis, and the association of sociodemographic factors with quality of life was examined using multivariate regression analysis.Main ResultsQuality of life was significantly higher in medical students with religious beliefs (β 0.14 for psychological domain; β 0.11 for environmental domain) when compared with that in those with no religious beliefs. BMI was negative associated with QOL in medical students (β -0.11 for physical domain; β -18.9 for the psychological domain). In both male and female students, longer daily traveling time was negative related to QOL (β -0.11 for environmental domain). Having at least one parent who was a doctor was associated with a better quality of life (β 0.17 for environmental domain). Male students presented with significantly higher mean scores for three of the four domains evaluated (β 0.20 for physical domain; β 0.25 for psychological domain; β 0.14 for social domain).ConclusionThis study has provided novel insights into the effects of sociodemographic factors, physical traits, and religious beliefs on the quality of life of medical students. These findings may facilitate improvements in physical, psychological, and social support for medical students at a critical stage in their training, thereby providing tools for student better adjustment to medical school.

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Background: Few immunohematological studies have been done in myelodysplastic syndrome (MDS). Methods: Twenty-nine MDS patients were retrospectively evaluated with a direct antiglobulin test (DAT), antibody screening, serum electrophoresis and immunoelectrophoresis. Clinical and laboratory studies (hemoglobin level, reticulocyte count, DHL, total and indirect bilirubin) were done simultaneously, as well as the French-American-British subtype and bone marrow biopsy findings. Results: Alloantibodies were demonstrated in 17 patients (58.6%), autoantibodies in 10 (34.4%) patients and cold agglutinin in 18 (62%) patients. DAT was mediated by only IgG in 8 patients (80%), by IgG and C3 in 1 patient (10%) and by IgG, IgA and C3 in 1 (10%) patient. No hemolytic disease occurred in patients with autoantibodies. Increased serum gammaglobulin was observed in 16 (54.4%) patients. There was no correlation between the incidence of allo-/autoantibodies and the gammaglobulin level (p = 0.937) and the presence of lymphocyte infiltrates in bone marrow biopsies (p = 0.156). No significant difference was observed when the incidence of autoantibodies and number of red blood cell transfusions were compared (p = 0.334). Patients with refractory anemia and refractory anemia with ringed sideroblasts subtypes had a higher incidence of allo-/autoantibodies than other MDS subtypes (p = 0.03). Conclusion: Patients with MDS, in particular refractory anemia and refractory anemia with ringed sideroblasts have a high incidence of allo- and autoantibodies, probably related to intrinsic immune disorder, without clinical or laboratory hemolysis.

Gel microcolumn assay (GMA) is a modified serological technique that has been used for ABO and Rh typing, direct antiglobulin test (DAT), detecting alloantibodies, red cell phenotyping, and other applications. However, for DAT, the role of GMA is controversial. The purpose of this large study was to compare the performance of the conventional tube test (CTT) to GMA for detecting potentially significant antibodies coating red blood cells in vivo. From January 1996 to May 2002, we performed DATs by GMA and CTT on 9,862 blood samples submitted to our reference laboratory, using LISS/Coombs cards (DiaMed-Latino America, Lagoa Santa-MG, Brazil) for GMA and polyspecific and monospecific anti-IgG reagents for CTT. Acid eluates were prepared from all positive DAT samples. The specificity of eluates was determined by GMA. We detected nonconcordant results in 2,079 out of 3,163 positive DATs (65.7%). All of these tests were only positive in GMA. Sensitivity and specificity for DATs was 100% and 83.0% for gel, and 50.7% and 97.8% for tube, respectively. Based on this study GMA showed to be more sensitive than CTT for detecting potentially significant antibodies coating red blood cells in vivo.

Anti-D titration is the first step in the evaluation of the RhD-sensitized patient. Traditionally, anti-D titration has been performed by tube agglutination. Gel microcolumn assay is a method that has gained widespread usage throughout the world, mainly for ABO/Rh typing, unexpected antibody screening and direct antiglobulin tests. As gel assay has become widely used as a routine method to detect red blood cell alloantibodies, a critical anti-D titer needs to be established. Seventy-nine known blood samples with anti-D (titers 1-32) were titrated simultaneously by the conventional tube test and the gel microcolumn assay. Red blood cells (R0r phenotype) were used, with a final concentration of 3% for tube and 0.8% for gel. Serial twofold dilutions (2-2.048) were prepared for each technique, followed by reading in antiglobulin phase. Anti-D titration in the gel microcolumn assay showed significantly higher titers (mean 3.4-fold) than the conventional tube test in all samples studied. Based on these data, it was not possible to determine a critical titer for anti-D titration by the gel microcolumn assay.

IntroduçãoOs antígenos de grupos sanguíneos eritrocitários são estruturas macromoleculares localizados na superfície extracelular da membrana dos eritrócitos podendo ser de natureza carboidrato, proteína ou glicoproteína.1 Nos últimos anos, com o avanço dos estudos moleculares, dos 29 sistemas de grupos sanguíneos reconhecidos pela Sociedade Internacional de Transfusão Sanguínea, 2 os genes codificadores de 28 sistemas foram clonados e sequenciados. 3,4 Até o momento, 989 alelos de 39 genes de grupos sanguíneos foram identificados, 5 o que tem desvendado aspectos sobre a funcionalidade e importância da expressão das proteínas que carregam antígenos na membrana eritrocitária. Esta revisão tem como foco mostrar as funções bioló-gicas potenciais e os aspectos funcionais dos antígenos eritrocitários, que, didaticamente, podem ser classificados em: proteínas estruturais, transporte, receptores/moléculas de adesão, enzimática, complemento, proteínas regulatórias e outras, sendo que um antígeno eritrocitário pode apresentar mais que uma função. (Tabela 1 e Figura 1) Função EstruturalO representante desse grupo é o sistema de grupo sanguíneo Gerbich cujos antígenos estão expressos nas glicoproteínas de membrana tipo I, glicoforinas C e D (GPC e GPD). Ambas são altamente glicosiladas contribuindo para 6 O domínio citoplasmático de GPC/D interage com a proteína 4.1R e com a fosfoproteína 55 constituindo o maior sítio de ligação da base espectrina-actina no complexo de junções da membrana do esqueleto desempenhando função importante na estrutura eritrocitária, na manutenção da forma celular e na estabilidade mecânica da membrana.7 A ausência de ambas as proteínas leva ao raro fenótipo Leach (Ge-2,-3,-4), caracterizado pela estabilidade mecânica reduzida, distorção na forma discóide dos eritrócitos e níveis variados de eliptocitose. 8Além dos eritrócitos, as GPC e GPD estão expressas em fígado fetal, endotélio renal, cerebelo e íleo, porém em menores quantidades e com diferentes níveis de glicosilação; sugere-se que nesses tecidos desempenham funções análogas ao já descrito para linhagem eritróide.A glicoforina C também tem função de receptor (ver em receptor D). Função estrutural e transporte Sistema de Grupo Sanguíneo DiegoOs antígenos do sistema de grupo sanguíneo Diego estão localizados na banda 3, a principal e a mais abundante proteí-na integral na membrana dos eritrócitos com 10 6 cópias por célula. Os resíduos 1-403 da proteína banda 3 formam o domínio citoplasmático N-terminal, que funciona como um ponto de ancoragem para o citoesqueleto da membrana através de interações com as proteínas de membrana periféricas anquirina, 4.1R e 4.2, sendo esta a principal função deste domí-nio.10 Serve também como sítio de ligação para enzimas glicolíticas como gliceraldeído-3-fosfato dehidrogenase, fosfofrutoquinase e aldose, bem como para hemoglobina, catalase e hemicrones. 11Os resíduos 509-911 da banda 3 são responsáveis pelo domínio citoplasmático C-terminal, que atravessa a membrana de 12 a 14 vezes, gerando seis a sete alç...

Arg229 is invariant on external loop 4 and close to the Ala226Pro change specific for e/E polymorphism. The qualitative and quantitative alteration of e antigen defines Arg229 as a crucial component for e/E epitope presentation. Given a normal dose of c antigen, the disruption of f (Rh6) by Arg229 deletion suggests that external loop 4 is a major structural element contributing to the expression of RHCE cis interacting antigenic products.