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Background and Aims: Considering the lack of knowledge regarding the influence of the variable number of repeats of 27 pb in intron 4 (4b/4a VNTR - rs61722009) of the endothelial nitric oxide synthase (eNOS) on the drug response, we assessed the influence of this polymorphism for the risk of upper gastrointestinal bleeding (UGIB). Methods: A case-control study, including 200 cases and 706 controls, was conducted in a Brazilian hospital complex. Cases were participants with UGIB diagnosis. Controls were participants admitted to surgical procedures not related to gastrointestinal problems. The 4b/4a VNTR was determined through polymerase chain reaction followed by fragment analysis. Conditional logistic regression models were designed. The additive interaction between the presence of the 4b/4a VNTR variant and the use of low-dose aspirin (LDA) and nonsteroidal anti-inflammatory drugs (NSAIDs) was calculated by fitting the Cox regression model through the parameters of Synergism index (S) and Relative Excess Risk Due To Interaction (RERI). Results: The presence of the 4b/4a VNTR variant did not increase the risk of UGIB: carriers of the 4a/4a genotype (OR=0.37, 95%CI: 0.09-1.45) and of the variant allele “4a” (OR=0.91, 95%CI: 0.55-1.51). The risk of UGIB in LDA users carriers of the wild genotype (OR=4.96, 95%CI: 2.04- 2.06) and the variant allele “4a” (OR=3.49, 95%CI: 1.18-10.38) is similar, as well as for NSAID users carriers of the wild genotype (OR=5.73, 95%CI: 2.61-12.60) and variant allele “4a” (OR=5.51, 95%CI: 1.42-15.82). No additive interaction was identified between the presence of the genetic variant and the use of LDA [RERI: -1.44 (95%CI: -6.02–3.14; S: 0.63 (95%CI: -1.97–1.15)] and NSAIDs [RERI: -0.13 (95%CI: -6.79–6.53; S: 0.97 (95%CI: -0.23–4.19)] on the UGIB risk. Conclusion: Our data suggests that there is no increase in the magnitude of UGIB risk in LDA and NSAIDs users’ carrying the variant allele “4a”.

BackgroundPatients with coronavirus disease-2019 (COVID-19) present varying clinical complications. Different viral load and host response related to genetic and immune background are probably the reasons for these differences. We aimed to sought clinical and pathological correlation that justifies the different clinical outcomes among COVID-19 autopsies cases.MethodsMinimally invasive autopsy was performed on forty-seven confirmed COVID-19 patients from May-July, 2020. Electronic medical record of all patients was collected and a comprehensive histopathological evaluation was performed. Immunohistochemistry, immunofluorescence, special stain, western blotting and post-mortem real-time reverse transcriptase polymerase chain reaction on fresh lung tissue were performed.ResultsWe show that 5/47 (10,6%) patients present a progressive decline in oxygenation index for acute respiratory distress syndrome (PaO2/FiO2ratio), low compliance levels, interstitial fibrosis, high α-SMA+ cells/protein expression, high collagens I/III deposition and NETs(P2/FiO2ratio, high pulmonary compliance levels, preserved elastic framework, increase thrombus formation and high platelets and D-dimer levels at admission (PConclusionsWe believe that categorization of patients based on these two phenotypes can be used to develop prognostic tools and potential therapies since the PaO2/FiO2ratio variation and D-dimer levels correlate with the underlying fibrotic or thrombotic pathologic process, respectively; which may indicate possible clinical outcome of the patient.

Objective: To assess the association between PTGS1 and NOS3 variant alleles and the risk to develop upper gastrointestinal bleeding (UGIB) secondary to complicated peptic disease.Methods: A case–control study was conducted in a Brazilian complex hospital from July 2016 to March 2020. Case: Patients with UGIB diagnosis. Control: Patients admitted for surgery not related to gastrointestinal disorders. Variables: UGIB (outcome), genetic variants in PTGS1 and NOS3 genes (independent), and sex, age, schooling, ethnicity, previous history of gastrointestinal disorders, Helicobacter pylori serology, comorbidity, drug therapy, and lifestyle (confounding). The single-nucleotide polymorphisms (SNPs) of the PTSG1 gene (rs1330344, rs3842787, rs10306114, and rs5788) and NOS3 gene (rs2070744 and rs1799983) were determined using the real-time polymerase chain reaction. Helicobacter pylori serology was determined through the chemiluminescence technique. Logistic regression models were built and deviations of allelic frequencies from Hardy–Weinberg equilibrium were verified.Results: 200 cases and 706 controls were recruited. Carriers of the AG genotype of rs10306114 (OR: 2.55, CI 95%: 1.13–5.76) and CA + AA genotypes of rs5788 (OR: 2.53, CI 95%: 1.14–5.59) were associated with an increased risk for the UGIB development. In nonsteroidal anti-inflammatory drugs (NSAIDs) users, the six variants evaluated modified the magnitude of the risk of UGIB, whereas in low-dose aspirin (LDA) users, an increased risk of UGIB was observed for four of them (rs1330344, rs10306114, rs2070744, and rs1799983). Personal ulcer history (p-value: < 0.001); Helicobacter pylori infection (p-value: < 0.011); NSAIDs, LDA, and oral anticoagulant use (p-value: < 0.001); and alcohol intake (p-value: < 0.001) were also identified as independent risk factors for UGIB.Conclusion: This study presents two unprecedented analyses within the scope of the UGIB (rs10306114 and rs2070744), and our findings showing an increased risk of UGIB in the presence of the genetic variants rs10306114 and rs5788, regardless of the drug exposure. Besides, the presence of the evaluated variants might modify the magnitude of the risk of UGIB in LDA/NSAIDs users. Therefore, our data suggest the need for a personalized therapy and drug use monitoring in order to promote patient safety.

BACKGROUND: Non-variceal upper gastrointestinal bleeding (NVUGIB) secondary to peptic ulcer disease is a medical digestive emergency and could be one of the most serious adverse drug reactions. OBJECTIVE: To identify the frequency of diagnosis of NVUGIB secondary to peptic ulcer disease. METHODS: Prospective and epidemiological study conducted in a tertiary referral Brazilian hospital, from July 2016 to December 2019. Upper gastrointestinal endoscopies (UGE) reports were evaluated daily. The diagnosis of NVUGIB secondary to peptic ulcer disease was defined through endoscopic findings of peptic ulcer and erosive gastric lesions, and clinical symptoms. The frequency of diagnosis of NVUGIB secondary to peptic ulcer disease was estimated through the ratio between the number of patients diagnosed and the number of patients underwent UGE in the same period. RESULTS: A total of 2,779 endoscopic reports (2,503 patients) were evaluated, and 178 patients were eligible. The total frequency of diagnosis of NVUGIB secondary to peptic ulcer disease was 7.1%. The annual frequency of diagnosis between 2017 and 2019 ranged from 9.3% to 5.7%. Most patients were men (72.8%); self-declared white (71.8%); older people (56.7%); and, had no familiar or personal history of gastrointestinal diseases (60.1%). 90% of the patients had a peptic ulcer and melena (62.8%). Patients made chronic use of low-dose aspirin (29.3%), other antiplatelet agents (21.9%) and, oral anticoagulants (11.2%); and non-steroidal anti-inflammatories use in the week a prior to the onset of clinical symptoms (25.8%). CONCLUSION: Seven in every 100 patients admitted and underwent UGE in a tertiary hospital were diagnosed with NVUGIB secondary to peptic ulcer disease. RESUMO CONTEXTO: A hemorragia digestiva alta não varicosa (HDANV) secundária à úlcera péptica é uma emergência médica digestiva e pode ser uma reação adversa a medicamento severa. OBJETIVO: Estimar a frequência de HDANV secundária à doença péptica. MÉTODOS: Estudo prospectivo e epidemiológico realizado em um hospital brasileiro terciário de referência, no período de julho de 2016 a dezembro de 2019. Os laudos de endoscopia gastrointestinal alta foram avaliados diariamente. O diagnóstico de HDANV secundária para úlcera péptica foi definido por achados endoscópicos de úlcera péptica e lesões gástricas erosivas e sintomas clínicos. A frequência de diagnóstico de HDANV secundária à úlcera péptica foi estimada por meio da razão entre o número de pacientes diagnosticados e o número de pacientes submetidos à endoscopia gastrointestinal alta no mesmo período. RESULTADOS: Um total de 2.779 laudos endoscópicos (2.503 pacientes) foram avaliados e 178 pacientes foram elegíveis. A frequência total de diagnóstico de HDANV secundária à úlcera péptica foi de 7,1%. A frequência anual de diagnósticos entre 2017 e 2019 variou de 9,3% a 5,7%. A maioria dos pacientes era do sexo masculino (72,8%); auto-declarado branco (71,8%); idoso (56,7%); e não possuía histórico familiar ou pessoal de doenças gastrointestinais (60,1%). 90% dos pacientes apresentaram úlcera péptica e melena (62,8%). Os pacientes faziam uso crônico de ácido acetilsalicílico como antiagregante plaquetário (29,3%), outros antiplaquetários (21,9%) e anticoagulantes orais (11,2%); e fizeram uso e uso de anti-inflamatórios não esteroidais na semana anterior ao início dos sintomas clínicos de HDANV (25,8%). CONCLUSÃO: Cerca de sete em cada 100 pacientes admitidos em um hospital terciário e submetidos à endoscopia gastrointestinal alta foram diagnosticados com HDANV secundária à úlcera péptica.

Background: Extemporaneous compounding (EC) involves the preparation of a therapeutic product for specific patient need. However, there is a potential relationship between this procedure and the occurrence of health incidents (HI). The use of trigger tools increases HI identification. Objective: This study assessed the performance of EC as a trigger to detect potential health incidents arising from this procedure. Method: A one-month observational and cross-sectional study was performed in internal medicine ward and intensive care unit of medium-sized hospital. Data collection was carried out in 5 stages: all triggered patients with dysphagia or enteral feeding tube with prescription of EC were included; EC executed in prescribed standardized drugs was observed; the procedure was compared with the hospital guide and scientific literature; HI monitoring and their evaluation using WHO and NCC MERP algorithms; a search for pharmaceutical alternatives (PA) that would avoid the observed EC. Results: 197 patients were recruited. Almost half of them were triggered by EC from 84 standardized drugs. 48 patients met the inclusion criteria. 28 adverse drug reactions, 01 therapeutic ineffectiveness, and 29 medication errors were identified. EC as a trigger tool showed a PPV value of 0.38. Only 24 drugs have PA available in the market, which could avoid one third of all observed EC. Conclusion: It was possible to detect potentially HI in one of two patients with enteral feeding tubes using EC as a trigger tool. The use of EC as a trigger tool contributes to identifying potential HI arising from drugs, which have not gotten pharmaceutical alternatives to be administered via enteral feeding tube.

Made available in DSpace on 2020-12-10T17:32:26Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-05-04 ProReitoria de Extensao Universitaria da UNESP (PROEX-UNESP) Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Introduction: A solid patient safety culture lies at the core of an effective event reporting system in a health care setting requiring a professional commitment for event reporting identification. Therefore, health care settings should provide strategies in which continuous health care education comes up as a good alternative. Traditional lectures are usually more convenient in terms of costs, and they allow us to disseminate data, information, and knowledge through a large number of people in the same room. Taking in consideration the tight money budgets in Brazil and other countries, it is relevant to investigate the impact of traditional lectures on the knowledge, skills, and attitudes to incident reporting system and patient safety culture. Objective: The study aim was to assess the traditional lecture impact on the improvement of health care professional competency dimensions (knowledge, skills, and attitudes) and on the number of health care incident reports for better patient safety culture. Participants and Methods: An open-label, nonrandomized trial was conducted in ninety-nine health care professionals who were assessed in terms of their competencies (knowledge, skills, and attitudes) related to the health incident reporting system, before and after education intervention (traditional lectures given over 3 months). Results: All dimensions of professional competencies were improved after traditional lectures (P < .05, 95% confidence interval). Conclusions: traditional lectures are helpful strategy for the improvement of the competencies for health care incident reporting system and patient safety. Univ Sao Paulo, Sao Paulo, Brazil Univ Estadual Paulista, Sao Paulo, Brazil Univ Estadual Paulista, Sao Paulo, Brazil CAPES: 001

Made available in DSpace on 2021-06-25T11:01:37Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-05-14 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Background: Prescription of calcium polystyrene sulfonate (CPS) has been considered a trigger with good performance to detect hyperkalemia related to adverse drug events (ADE). However, CPS prescription may underestimate the rate of ADE. Objective: To compare the performance of the serum potassium level (SPL) >5.0mEq/L and CPS triggers in detecting hyperkalemia related to ADE. Design and setting: A six-month cross-sectional study was conducted in a Brazilian medium-complexity public hospital. Methods: SPL Tests with results >5.0mEq/L and the prescriptions of CPS of all patients hospitalized in the internal medicine and infectious diseases wards were used as trigger tools to detect potential ADE. Primary outcome: patients with hyperkalemia related to ADE. Secondary outcomes: effectiveness of treatments and ADE. Variables analyzed were SPL tests, CPS prescriptions, treatments of hyperkalemia and comorbidities. Positive predictive values (PPV) of CPS and SPL triggers were calculated and compared. Results: In total 2,466 SPL tests were assessed, of which 513 were triggered (>5.0mEq/L). The tests triggered 198 patients with hyperkalemia, of whom 121 had hyperkalemia related to ADE (PPV=0.61). In total, 101 CPS prescriptions triggered tests in 35 patients with hyperkalemia, among whom 21 cases were related to ADE (PPV=0.60). SPL detected 204 ADE (PPV=0.40), while CPS prescription detected 22 (PPV=0.21). Seven pharmacological and four non-pharmacological treatments were identified. CPS showed the lowest effectiveness (PPV=0.71). Conclusion: SPL>5.0mEq/L increased the detection of ADE by 9.3-fold, the number of patients tracked with hyperkalemia related to ADE by 5.8-fold, and doubled the performance in detection of ADE in comparison with the prescription of the CPS trigger. Department of Drugs and Medicines School of Pharmaceutical Sciences São Paulo State University (UNESP) Department of Public Health Bauru School of Dentistry University of São Paulo (USP) University of São Paulo Ribeirão Preto Faculty of Pharmaceutical Sciences Department of Drugs and Medicines School of Pharmaceutical Sciences São Paulo State University (UNESP) CAPES: 001 FAPESP: 2018/07501-9

Non-variceal upper gastrointestinal bleeding (non-variceal UGIB) is a frequent and severe adverse drug reaction. Idiosyncratic responses due to genetic susceptibility to non-variceal UGIB has been suggested. A systematic review was conducted to assess the association between genetic polymorphisms and non-variceal UGIB. Twenty-one publications and 7134 participants were included. Thirteen studies evaluated genetic polymorphism in patients exposed to non-steroidal anti-inflammatory drugs, low-dose aspirin, and warfarin. Eight studies present at least one methodological problem. Only six studies clearly defined that the outcome evaluated was non-variceal UGIB. Genetic polymorphisms involved in platelet activation and aggregation, angiogenesis, inflammatory process, and drug metabolism were associated with risk of non-variceal UGIB (NOS3, COX-1; COX-2; PLA2G7; GP1BA; GRS; IL1RN; F13A1; CDKN2B-AS1; DPP6; TBXA2R; TNF-alpha; VKORC1; CYP2C9; and AGT). Further well-designed studies are needed (e.g., clear restriction to non-variceal UGIB; proper selection of participants; and adjustment of confounding factors) to provide strong evidence for pharmacogenetic and personalized medicine.

The nitric oxide/cyclic guanosine monophosphate (NO/cGMP) pathway has a significative influence in hemodynamic changes that occur in transplants. Classically, the ischemia-reperfusion syndrome (IRS) is characterized by hypotension and low vascular resistance, when cGMP and nitric oxide (NO) are increased, contributing to oxidative stress, within an inflammatory context. These mechanisms occur in several types of transplants, such as liver, heart, lungs, kidney, which are a therapeutic choice in several clinical conditions when conventional treatments failed. It is well known the significant relation between graft dysfunction or rejection and ischemia-reperfusion injury that is linked to inflammatory response and NO/cGMP pathway activation. This review aims to study the NO/cGMP pathway in solid organ transplants. Finally, we inquire whether physicians do not underestimate the NO/cGMP pathway.

Patient: Female, 65 Final Diagnosis: Clavicle Kirschner wire migration into left lung Symptoms: No symptoms Medication: — Clinical Procedure: Thoracotomy Specialty: Surgery Objective: Diagnostic/therapeutic accidents Background: Kirschner wires are often used to perform osteosynthesis. Migration through tissue of these wires is a rare but well-known occurrence. Case Report: A 65-year-old female presented with light intensity pain complaints in the upper left chest area; personal history included left clavicle fracture 20 years ago that was treated surgically with fixation using a K-wire. Chest radiography showed the presence of metallic foreign body in the left pulmonary apex. An exploratory axillary thoracotomy was performed, and the foreign body was extracted by a pneumotomy. Conclusions: To obtain satisfactory results with a K-wire, some peculiarities in their application should be respected. The time from orthopedic surgery of the collarbone to migration into the chest of the metal rod used can vary from one day to nearly 20 years. Although the migration mechanism remains unclear, it is likely that it involves shoulder movements, breathing movements, negative intrathoracic pressure, gravitational force, or local bone resorption. Caution should be exercised when orthopedic pins and wires are used for the fixation of fractures and dislocations of the shoulder girdle. If there is migration of the wire, it should be removed immediately to avoid sudden and fatal complications.

Introdução: A segurança é considerada um pilar da qualidade dos cuidados à saúde e seu sucesso depende do comprometimento individual e coletivo. Porém, seu ensino é incipiente nas faculdades de medicina brasileiras. Objetivo: Avaliar o impacto de intervenção sobre segurança do paciente no conhecimento e atitude dos alunos de medicina. Métodos: Conduziu-se estudo do tipo pré-pós intervenção de janeiro a novembro de 2017. Todos os estudantes de graduação de medicina do 6° ano que realizaram estágio no hospital sob estudo foram incluídos. A intervenção compreendeu acolhimento, aula expositiva, estágio e aplicação de questionário para avaliar conhecimento e atitude sobre erro humano e segurança do paciente, que foi aplicado em 3 momentos: antes da aula e do estágio, imediatamente após a aula e após 15 dias da aula e término do estágio. As notificações de incidentes foram analisadas. Resultados: Participaram 98 (100%) estudantes, dos quais 62% eram do sexo masculino, idade média de 25,8 anos. Após a intevenção, observou-se melhora significativa no conhecimento sobre a inevitabilidade do erro em saúde e a caracterização do profissional envolvido no incidente. As atitudes auto-referidas melhoraram significativamente em relação necessidade de apoio institucional, abordagem sistêmica e adoção de práticas seguras para prevenção de erros; comunicação sobre riscos e erros para superiores, paciente e familiares e que apenas os médicos podem analisar os incidentes. Conclusão: A intervenção foi efetiva para aumentar o conhecimento dos estudantes sobre cultura de segurança, porém limitou-se na mudança de atitude, pois não evidenciou a notificação de incidentes em saúde.

Carolina Dagli-Hernandez,1 Rosa Camila Lucchetta,1 Tales Rubens de Nadai,2 José Carlos Fernandez Galduróz,3 Patricia de Carvalho Mastroianni1 1Department of Drugs and Medications, School of Pharmaceutical Sciences of the UNESP – Univ Estadual Paulista, Araraquara, 2Department of Surgery and Anatomy, Americo Brasiliense State Hospital, 3Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil Objectives: To evaluate which indirect method for assessing adherence best reflects highly active antiretroviral therapy (HAART) effectiveness and the factors related to adherence. Method: This descriptive, cross-sectional study was performed in 2012 at a reference center of the state of São Paulo. Self-report (simplified medication adherence questionnaire [SMAQ]) and drug refill parameters were compared to the viral load (clinical parameter of the effectiveness of pharmacotherapy [EP]) to evaluate the EP. The “Cuestionario para la Evaluación de la Adhesión al Tratamiento Antiretroviral” (CEAT-VIH) was used to evaluate factors related to adherence and the EP and, complementarily, patient self-perception of adherence was compared to the clinical parameter of the EP. Results: Seventy-five patients were interviewed, 60 of whom were considered as adherent from the clinical parameter of the EP and ten were considered as adherent from all parameters. Patient self-perception about adherence was the instrument that best reflected the EP when compared to the standardized self-report questionnaire (SMAQ) and drug refill parameter. The level of education and the level of knowledge on HAART were positively correlated to the EP. Forgetfulness, alcohol use, and lack of knowledge about the medications were the factors most frequently reported as a cause of nonadherence. Conclusion: A new parameter of patient self-perception of adherence, which is a noninvasive, inexpensive instrument, could be applied and assessed as easily as self-report (SMAQ) during monthly drug refill, since it allows monitoring adherence through pharmaceutical assistance. Therefore, patient adherence to HAART could be evaluated using self-perception (CEAT-VIH) and the viral load test. Keywords: health literacy, anti-HIV agents, patient compliance, antiretroviral therapy, highly active, acquired immunodeficiency syndrome

Made available in DSpace on 2019-10-06T16:45:21Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-01-01. Added 1 bitstream(s) on 2021-07-15T15:23:51Z : No. of bitstreams: 1 S1807-59322019000100259.pdf: 945018 bytes, checksum: 6ce7697fd18323909d5b3b7fa5cb64f8 (MD5) OBJECTIVES: Evaluate adherence to the therapeutic prophylaxis protocol for venous thromboembolism (VTE) as well as the costs of this practice. METHODS: A descriptive and cross-sectional study was conducted at a State General Hospital in Brazil through reports of drug dispensions, prescriptions and risk stratification of patients. Adherence to the VTE prophylaxis protocol was monitored. The tests for VTE diagnosis measured the adherence to therapeutic prophylaxis treatment, and the purchase prices of the drugs went into the calculation of drug therapy costs. The level of adherence to prescriptions for VTE prophylaxis in the hospital was classified as adherence, non-adherence and justified non-adherence when compared with the protocol. RESULTS: Protocol adherence was observed for 50 (30.9%) patients, and non-adherence was observed for 63 (38.9%) patients, generating an additional cost of $180.40/month. Justified non-adherence in 49 (30.2%) patients generated $514.71/month in savings due to a reduction in the number of daily administrations of unfractionated heparin while still providing an effective method for preventing VTE. Twenty-six patients stratified as having medium to high risk of VTE who did not receive prophylaxis were identified, generating $154.41 in savings. However, these data should be evaluated with caution since the risks and outcomes associated with not preventing VTE outweigh the economy achieved from not prescribing a drug when a patient needs it. The only case of VTE identified during the study period was related to justified non-adherence to the protocol. CONCLUSION: The protocol is based on scientific evidence that describes an effective therapy to prevent VTE. However, the protocol should be updated because the justifications for non-adherence are based on scientific evidence, and this justified non-adherence generates savings and yields effective disease prevention. Departamento de Farmacos e Medicamentos Faculdade de Ciencias Farmaceuticas Universidade Estadual de Sao Paulo (UNESP) BR Departamento de Ciencias Farmaceuticas Faculdade de Ciencias Farmaceuticas de Ribeirao Preto Universidade de Sao Paulo BR Departamento de Cirurgia e Anatomia Faculdade de Medicina de Ribeirao Preto Universidade de Sao Paulo BR Departamento de Farmacos e Medicamentos Faculdade de Ciencias Farmaceuticas Universidade Estadual de Sao Paulo (UNESP) BR

Made available in DSpace on 2019-10-04T23:10:30Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-01-01. Added 1 bitstream(s) on 2019-10-09T18:34:33Z : No. of bitstreams: 1 S0080-62342018000100443.pdf: 208660 bytes, checksum: 7756403076320153806d10dcf11c92f0 (MD5) Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Programa de Apoio ao Desenvolvimento Cientifico, Faculty of Pharmaceutical Sciences, Universidade Estadual Paulista Objective: The purpose was to identify the barriers of underreporting, the factors that promote motivation of health professionals to report, and strategies to enhance incidents reporting. Method: Group conversations were carried out within a hospital multidisciplinary team. A mediator stimulated reflection among the subjects about the theme. Sixty-five health professionals were enrolled. Results: Complacency and ambition were barriers exceeded. Lack of responsibility about culture of reporting was the new barrier observed. There is a belief only nurses should report incidents. The strategies related to motivation reported were: feedback; educational intervention with hospital staff; and simplified tools for reporting (electronic or manual), which allow filling critical information and traceability of management risk team to improve the quality of report. Conclusion: Ordinary and practical strategies should be developed to optimize incidents reporting, to make people aware about their responsibilities about the culture of reporting and to improve the risk communication and the quality of healthcare and patient safety. Univ Estadual Paulista, Fac Ciencias Farmaceut, Campus Araraquara Rodovia Araraquara Jau,Km 1 S-N, BR-14800903 Araraquara, SP, Brazil Univ Sao Paulo, Fac Med Ribeirao Preto, Dept Cirurgia & Anat, Hosp Estadual Amer Brasiliense, Ribeirao Preto, SP, Brazil Univ Estadual Paulista, Fac Ciencias Farmaceut, Campus Araraquara Rodovia Araraquara Jau,Km 1 S-N, BR-14800903 Araraquara, SP, Brazil CAPES: 014301/2013-00 FAPESP: 2013/10263-9

The mechanisms by which pH influences vascular tone are not entirely understood, but evidence suggests that the endothelium is involved. Here, we aimed to study the in vitro vascular responses induced by extracellular hypercapnic acidification (HA), as well as the endothelium-dependent mechanisms that are involved in the responses. We bubbled a mixture of CO 2 (40%)/O 2 (60%) in an organ bath; we constructed a pH-response curve (pH range 7.4–6.6) and registered isometric force simultaneously. Aortic rings from rats were pre-contracted with phenylephrine (10 −6 M) and incubated for 30 min in the presence of different chemicals. The relaxations induced by HA occurred in rings with endothelium were: 1) Partially inhibited by indomethacin (10 −5 M) (PGI 2 pathway inhibitor); 2) Strongly inhibited by NO pathways: L-NAME (10 −4 M) and L-NMMA (10 −4 M) (no specific NO synthase inhibitors); L-Nil (10 −3 M) (specific iNOS inhibitor); ODQ (10 −4 M) (specific guanylate cyclase inhibitor), and; 4) Inhibit by tetraethylammonium (10 −3 M) (non-specific potassium channel inhibitor), glibenclamide (10 −5 M) (specific K AT P inhibitor), aminopyridine (10 −3 M) (specific Kv inhibitor) and apamin (10 −6 M) (specific SKCa inhibitor). In conclusion: 1) HA causes endothelium-dependent relaxation; 2) Indomethacin failed in blocking this relaxation, but the method limitation does not allow ruling out some prostanoid role; 3) The HA vessel relaxation is mediated via cGMP/NO, and; 4) The hyperpolarization occurs by the action of potassium SK Ca , K ATP and K v channels without relying on BK Ca channels.

Highlights • We treat four patients with delayed traumatic diaphragmatic hernia. • All surgeries were large and delicate clinical management. • All patients had excellent outcomes. • If these injuries had been diagnosed early surgical approaches would be less invasive., Introduction Diaphragmatic rupture is an infrequent complication of trauma, occurring in about 5% of those who suffer a severe closed thoracoabdominal injury and about half of the cases are diagnosed early. High morbidity and mortality from bowel strangulation and other sequelae make prompt surgical intervention mandatory. Case presentation Four Brazilian men with a delayed diagnosis of a rare occurrence of traumatic diaphragmatic hernia. Patient one had diaphragmatic rupture on the right side of thorax and the others three patients on the left thoracic side, all they had to approach by a laparotomy and some approach in the chest, either thoracotomy or VATS. This injuries required surgical repositioning of extensively herniated abdominal viscera and intensive postoperative medical management with a careful control of intra-abdominal pressure. Discussion The negative pressure of the thoracic cavity causes a gradually migration of abdominal contents into the chest; this sequestration reduces the abdomen’s ability to maintain the viscera in their normal anatomical position. When the hernia is diagnosed early, the repair is less complicated and requires less invasive surgery. Years after the initial trauma, the diaphragmatic rupture produces dense adhesions between the chest and the abdominal contents. Conclusions All cases demonstrated that surgical difficulty increases when diaphragmatic rupture is not diagnosed early. It should be noted that when trauma to the thoraco-abdominal transition area is blunt or penetrating, a thorough evaluation is required to rule out diaphragmatic rupture and a regular follow-up to monitor late development of this comorbidity.

Early cancer diagnosis, new therapies that increased survival of patients, besides the increasingly elderly population are some factors would be associated with possible cancer dissemination in patients under cardiopulmonary bypass (CPB) cardiac surgery. Also, the benefits, and risks, regarding long-term survival, have not yet been established. Therefore, cardiac surgery morbimortality may be superior in patients with cancer disease. Also, immunologic and inflammatory changes secondary to CPB can also increase tumor recurrence. After a brief introduction and CPB immunologic the two main topic subjects included: 1) Combined heart surgery and lung resection and; 2) Possible influence of neoplasia type. After observing the relative literature scarcity, we keep the opinion that “CPB has a modest association with cancer progression” and that “CPB and cancer dissemination should be a logical but unlikely association.”

Made available in DSpace on 2018-12-11T17:37:04Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-06-01 Purpose: The purpose of this study was to assess whether prophylaxis for digestive disorders with omeprazole is a risk factor for adverse drug events (ADEs) and kidney impairment. Methods: This was a 9-month, prospective, double-blinded cohort study performed in a Brazilian public hospital. All inpatients 18 years or older admitted during the period of data collection were divided into 2 cohorts. The first group comprised 200 patients receiving prophylaxis for digestive disorders with omeprazole. A total of 54 inpatients who received treatment with omeprazole and whose indication was not approved by the Brazilian Sanitary Agency and the US Food and Drug Administration were excluded. The second group comprised 219 inpatients without a prescription for omeprazole. Follow-up was performed until discharge and included assessment of medical records, medical prescriptions, laboratory data, and pharmaceutical anamnesis. The primary end point was kidney impairment. The variables monitored were kidney function (serum creatinine and urea levels as well as glomerular filtration rate), hepatic function (alanine aminotransferase and aspartate aminotransferase levels), pharmacotherapy, magnesium levels, and imputation of ADEs. With the aid of algorithms of World Health Organization and the National Coordinating Council for Medication Error Reporting and Prevention, we assessed the causality of adverse drug reactions (ADRs) and the seriousness of medication errors (ADEs), respectively. Findings: Prophylaxis for digestive disorders with omeprazole (P = 0.019) and sex (P = 0.010) were considered risk factors for increased serum creatinine level via multivariate logistic regression even with concomitant use of nephrotoxic drugs (P = 0.252). Six ADEs related to omeprazole were identified: 2 ADRs (1 possible and 1 definite), 2 medication errors (nonserious), 1 therapeutic failure, and 1 drug-drug interaction. Implications: Prophylaxis for digestive disorders with omeprazole and male sex may contribute to the development of kidney impairment because both result in increased serum creatinine levels. Therefore, pharmacotherapeutic follow-up of male patients diagnosed with kidney disorders should be considered to identify potential drug-drug interactions early. This follow-up can prevent worsening clinical conditions and/or contraindicate prophylactic use of omeprazole. ClinicalTrials.gov identifier: NCT02278432. Americo Brasiliense State Hospital Americo Brasiliense São Paulo State University (UNESP) School of Pharmaceutical Sciences Araraquara Department of Surgery and Anatomy Ribeirão Preto School of Medicine University of São Paulo São Paulo State University (UNESP) School of Pharmaceutical Sciences Araraquara

Made available in DSpace on 2018-12-11T17:08:39Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-04-01 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Purpose This study explored the performance of trigger in detecting adverse drug reactions (ADRs), the confounding variables impairing the causal association of the ADRs, and the underreporting rate by hospital health professionals. Methods A 6-month cross-sectional study was conducted in a public general hospital. Data collection was conducted in 2 stages: (1) screening of patient hospitalizations to identify suspected ADRs with 9 triggers developed by the Institute of Healthcare Improvement; and (2) chart review to perform the causality assessment of the suspected ADRs identified, to describe the confounding variables associated with detection of suspected ADRs that were not drug induced, and to analyze the positive predictive value of triggers in recognizing ADRs. To estimate the underreporting rate, ADRs detected by using the tool were compared with ADRs reported by health professionals during the same period. Findings During the study period, 3318 hospitalizations were analyzed. A total of 837 suspected ADRs were identified. However, after causality assessment, 356 were definite ADRs. Confounding variables associated with the detection-suspected ADRs were related to the clinical conditions of inpatients. The use of triggers contributed to increased ADR detection by 10.5%. The performance ranged from 0.00 to 0.75, with an overall positive predictive value of 0.43. Six ADRs were spontaneously reported, of which just 1 was also detected by using the trigger tool. Only 1 of 356 potential ADRs was reported by health professionals. Implications Findings show that the use of triggers contributes to detecting ADRs underreported by health professionals. However, confounding variables impaired the performance of the tool because they underestimated the causal association. Furthermore, both methods are complementary to early recognition of drug-induced harm and should be applied together in health institutions to contribute to policies of risk management, drug safety, and optimization of pharmacotherapy. School of Pharmaceutical Sciences UNESP-Univ Estadual Paulista Department of Drugs and Medicines School of Pharmaceutical Sciences USP–University of São Paulo Americo Brasiliense State Hospital Department of Surgery and Anatomy Ribeirão Preto School of Medicine University of São Paulo University of Aveiro Department of Medical Sciences & Institute for Biomedicine–iBiMED CAPES Foundation Ministry of Education of Brazil Brasília – DF 70040-020 School of Pharmaceutical Sciences UNESP-Univ Estadual Paulista Department of Drugs and Medicines

Background We herein present a case in which a Toxoplasma cyst was found in a transbronchial biopsy specimen from an immunocompetent patient with negative serology for the parasite. Case presentation An 18-year-old Brazilian man presented with a 1-week history of dyspnea and fever and was diagnosed with right lower lobe pneumonia. He began inpatient treatment with intravenous antibiotics. During treatment, a bronchoscopy with bronchoalveolar lavage and transbronchial biopsy was performed. Anatomopathological examination of the transbronchial biopsy showed a small fragment of lung parenchyma with discrete septal thickening and a rounded structure, suggestive of a pseudocyst containing Toxoplasma gondii bradyzoites. However, serological tests were negative for immunoglobulin G and immunoglobulin M. Conclusions Bronchoscopy is a minimally invasive, effective diagnostic and therapeutic method. Despite the fact that the Toxoplasma pseudocyst in the present case was not the cause of the patient’s comorbidities, bronchoscopy with transbronchial biopsy allowed for an incidental diagnosis of a Toxoplasma pseudocyst with minimal invasiveness.

The present text was motivated by the difficulties faced by our postgraduate students when using airways studies protocols and will take into consideration the three mechanisms of relaxation: (I) guanosine 3,5-cyclic monophosphate (cGMP)/NO-dependent; (II) adenosine 3,5-cyclic monophosphate (cAMP)/PGI2-dependent, and (III) hyperpolarization-dependent. Tracheal rings are studied in an organ bath containing a gassed physiological salt solution, usually at a temperature of 37 °C. An agent or procedure that causes contraction [acetylcholine (Ach) or metacholine] of the smooth muscle is needed before study airway dilator drugs. The presented airways studies protocols are useful to study the bronchial epithelial-dependent reactivity.

The mechanisms by which pH influences vascular tone are not entirely understood, but evidence suggests that the endothelium is involved. Here, we aimed to study the in vitro vascular responses induced by extracellular hypercapnic acidification (HA), as well as the endothelium-dependent mechanisms that are involved in the responses. We bubbled a mixture of CO1) HA causes endothelium-dependent relaxation; 2) Indomethacin failed in blocking this relaxation, but the method limitation does not allow ruling out some prostanoid role; 3) The HA vessel relaxation is mediated via cGMP/NO, and; 4) The hyperpolarization occurs by the action of potassium SK

Background We investigated, previously, the mechanism by which extracellular acidification promotes relaxation in rat thoracic aorta. These studies suggested that extracellular acidosis promotes vasodilation mediated by NO, KATP and SKCa, and maybe other K+ channels in isolated rat thoracic aorta. This study was carried out to investigate the paxilline-mediated hyperpolarization induced by acid exposure. Results The relaxation response to HCl-induced extracellular acidification (7.4–6.5) was measured in rat aortic rings pre-contracted with phenylephrine (PE, 10−6 M). The vascular reactivity experiments were performed in endothelium-intact and denuded rings, in the presence of paxilline (10−6 M), which is an inhibitor of high calcium conductance potassium BKCa channels. In rings with endothelium, paxilline inhibits relaxation, triggered by acidification at all pH values lower than 7.2 and had no effect on rings without endothelium, showing that the activation of BKCa is endothelium-dependent. Conclusion High conductance potassium channel activation induced by acid exposure is endothelium-dependent.

PURPOSE:To create in vitro a model to generate acidosis by CO2bubbling "organ chambers", which would be useful for researchers that aim to study the effects of acid-base disturbs on the endothelium-dependent vascular reactivity.METHODS:Eighteen male Wistar rats (230-280g) were housed, before the experiments, under standard laboratory conditions (12h light/dark cycle at 21°C), with free access to food and water. The protocol for promoting in vitro respiratory acidosis was carried out by bubbling increased concentrations of CO2. The target was to achieve an ideal way to decrease the pH gradually to a value of approximately 6.6.It was used, initially, a gas blender varying concentrations of the carbogenic mixture (95% O2 + 5% CO2) and pure CO2.RESULTS:1) 100% CO2, pH variation very fast, pH minimum 6.0; 2) 90%CO2 pH variation bit slower, pH minimum6.31; 3) 70%CO2, pH variation slower, pH minimum 6.32; 4) 50% CO2, pH variation slower, pH minimum 6:42; 5) 40 %CO2, Adequate record, pH minimum 6.61, and; 6) 30 %CO2 could not reach values below pH minimum 7.03. Based on these data the gas mixture (O2 60% + CO2 40%) was adopted,CONCLUSION: This gas mixture (O2 60% + CO2 40%) was effective in inducing respiratory acidosis at a speed that made, possible the recording of isometric force.

Introduction Primary osteomyelitis of the sternum is a rare condition, which accounts for 0.3% of all cases of osteomyelitis reported in the literature. The diagnosis requires a high degree of suspicion and confirmation by percutaneous biopsy. The treatment consists of resection of the periosteum and affected bone. Despite reports of successful conservative treatment using antibiotics alone, early surgical intervention plus bacterial control is the definitive treatment; it reduces morbidity, and is the most cost-effective approach for the patient. We report a case of primary osteomyelitis surgically treated with debridement and antibiotics, followed by hyperbaric oxygen therapy. Case presentation A 39-year-old Brazilian man without a significant medical history presented with primary osteomyelitis. After a normal chest radiograph and normal laboratory test results, he was treated with 2 weeks of nonsteroidal anti-inflammatory drugs. One month later a presumptive diagnosis of Tietze syndrome was made and he was prescribed prednisolone (60mg/day) for 3 weeks. The following month he presented to our service with swelling, redness, and warmth in the area between his left third and fourth ribs. Subsequent magnetic resonance imaging revealed a large collection of liquid (8.8×6.8×20.2cm) in his chest wall, between the body and the manubrium of the sternum. An area of soft, friable tissue with a large amount of pus was found in his sternum during surgical debridement. Subsequent treatment consisted of antibiotic therapy using metronidazole and cefotaxime plus hyperbaric oxygen therapy. On postoperative day 10 the incision was sutured. The patient was discharged on postoperative day 15 on a regimen of oral ciprofloxacin, and completed hyperbaric oxygen therapy as an out-patient. Conclusions The satisfying outcome of this patient reflects the quick action to promote surgical debridement and use of antibiotics, which are both recommended treatments. The closure of the wound in 10 days after debridement suggests that the hyperbaric oxygen therapy might have indirectly, but not conclusively, aided in the premature closure of the wound, avoiding a longer healing by second intention or muscle flap rotation closure.

Suspension laryngoscopy is one of the most common otolaryngological procedures for the diagnosis and surgical approach to the larynx. However, most thoracic surgeons are not familiar with the procedure and seldom use it. The indications for its use are similar to those for that of rigid bronchoscopy (dilatation, endoprosthesis insertion, and tumor resection). It can be performed in children and adults. Suspension laryngoscopy is an alternative when rigid bronchoscopy is unavailable and is therefore a viable option for use at smaller facilities. In this communication, we describe the technique and the applications of suspension laryngoscopy in thoracic surgery.

In order to investigate the effects of monoaminergic neurons of the dorsal raphe nucleus (DRN) and locus coeruleus (LC) on the elaboration and control of sweet-substance-induced antinociception, male albino Wistar rats weighing 180–200 g received sucrose solution (250 g/L) for 7–14 days as their only source of liquid. After the chronic consumption of sucrose solution, each animal was pretreated with unilateral microinjection of ibotenic acid (1.0 μg/0.2 μL) in the DRN or in the LC. The tail withdrawal latencies of the rats in the tail-flick test were measured immediately before and 7 days after this treatment. The neurochemical lesion of locus coeruleus, but not of DRN neural networks with ibotenic acid, after the chronic intake of sweetened solution, decreased the sweet-substance-induced antinociception. These results indicate the involvement of noradrenaline-containing neurons of the LC in the sucrose-induced antinociception. We also consider the possibility of DRN serotonergic neurons exerting some inhibitory effect on the LC neural networks involved with the elaboration of the sweet-substance-induced antinociception.

Background and Purpose: There is a remarkable paucity of studies analyzing the role of the endothelium-derived relaxing factors on the vascular effects of organophosphates. This study was carried out to evaluate the vascular effects of malathion and the role of nitric oxide (NO) and prostacyclin (PGI2). Methods: Vascular reactivity measuring isometric forces in vitro (‘organ chambers') and flow cytometry (cells loaded with DAF-FM DA) were used. Results: In rat thoracic aorta segments contracted with phenylephrine (Phe) (10-7 mol/l), malathion (10-10 to 10-5 mol/l) induced concentration-dependent relaxation in arteries with intact endothelium (n = 7; p < 0.05). Malathion-mediated relaxation was blocked by N-nitro-L-arginine methyl ester (L-NAME; 10-4 mol/l), a nonspecific NO synthase inhibitor, and/or indomethacin (10-5 mol/l), a nonspecific cyclooxygenase inhibitor (n = 10, p < 0.05). In thoracic aorta rings, with and without endothelium, Phe (10-10 to 10-5 mol/l) evoked concentration-dependent contraction, which was reduced in the presence of malathion. In rings with or without endothelium, incubated with malathion, L-NAME and indomethacin, the Phe-induced contraction was restored. The role of NO was confirmed using flow cytometry. Malathion evokes endothelium-dependent relaxation through the M1 muscarinic receptor, since this relaxation was clearly blocked by atropine (M1 and M2 blocker) and pirenzepine (M1 blocker), but was less blocked by gallamine (M2 blocker) or 4-DAMP (M3 blocker). Conclusions: These findings suggest that the organophosphate compound effects on vascular reactivity depend of NO and PGI2.

In vitro studies have demonstrated organophosphate-mediated vasodilator effects, suggesting that organophosphates may have peripheral activity independent of acetylcholinesterase inhibition. To eva...

Introduction The presence of benign thyroid tissue that is located on the side of the neck is extremely rare and not related to the development of the thyroid, and it is difficult to differentiate it from thyroid carcinoma metastasis. The parasitic thyroid nodule occurs when thyroid tissue located in the lateral neck has no relationship or association with the lymph nodes, and may be defined as a thyroid nodule entirely separate from the thyroid or attached to it by a narrow pedicle, presenting the same histology and in the same facial plane as the thyroid, and should not be associated with lymph nodes. Case presentation A 40-year-old Brazilian man without significant past medical history presented with a large volume multinodular thyroid goiter that caused deformity and symptoms suggestive of cervical spine compression. He underwent a total thyroidectomy. His thyroid function was normal. Ultrasonography showed a heterogeneous thyroid nodule measuring 3.7cm to the right from midline and 3.3cm to the left from midline that was associated with two nodules in the left submandibular area measuring 1.43cm and 1.52cm. Fine needle aspiration confirmed the benign nature of the gland and thyroid tissue etiology of the two submandibular nodules, located in level II of the neck. Since the ectopic thyroid tissue in his lateral neck was suggestive of metastasis of occult primary thyroid carcinoma, the patient underwent a total thyroidectomy plus a left modified radical neck dissection with preservation of level I. The diagnosis of multinodular goiter associated with two parasitic thyroid nodules was confirmed by immunohistochemistry. Conclusions We conclude that the parasitic thyroid nodule should be included in the differential diagnosis of lateral neck masses. The diagnosis and differentiation of these nodules from metastatic adenopathies of differentiated thyroid carcinoma has important therapeutic and prognostic implications, and can lead to avoidance of unnecessary surgeries.

Introdução: Episódios de Hemorragia Digestiva Alta (HDA) são causa frequente de busca por atendimento médico de urgência. Diversos escores para estratificação de risco foram desenvolvidos para prever desfechos clinicamente relevantes. Dentre estes escores, há evidências de que o Glasgow-Blatchford Score (GBS) tenha a maior acurácia. Objetivos: Descrever a utilização do GBS num centro terciário de emergência brasileiro e avaliar sua utilidade clínica. Métodos: Estudo descritivo analítico transversal, com auditoria de Endoscopias Digestivas Altas (EDAs) realizadas durante um período consecutivo de 2 anos, coleta dos dados destes pacientes, identificação daqueles que apresentavam HDA, estratificação em grupos de alto e baixo risco e subsequente aplicação do GBS. Principais resultados avaliados: Sensibilidade, especificidade, valores preditivo positivo e preditivo negativo para diferentes valores do escore, e comparação da acurácia do GBS em prever desfechos graves (grupo de alto risco) com o escore de Rockall completo (CRS) e préendoscópico (PRS). Resultados: 612 episódios de HDA foram avaliados, com valores do GBS calculados e variando entre 0 e 21, com média de 9,97. O valor do escore ≤2 foi identificado como ideal para prever sobrevivência sem necessidade de intervenção ou hemotransfusão (sensibilidade de 99,8%, especificidade de 23,8%, valor preditivo positivo de 74% e valor preditivo negativo de 97,9%). O GBS teve melhor desempenho (área sob a curva ROC (Receiver Operating Characteristic, ou Curva Característica de Operação do Receptor) - AUROC 0,87) em prever pacientes de alto risco (necessidade de intervenção, hemotransfusão ou óbito) que os escores PRS (0,70) e CRS (0,76). Conclusão: O GBS é aplicável em um centro de urgência brasileiro, e os resultados corroboram os dados da literatura internacional: o escore tem utilidade clínica e tem maior acurácia que os escores de Rockall (completo e pré-endoscópico) para previsão de desfechos de alto risco (óbito, necessidade de hemotransfusão ou intervenção para conter o sangramento). Introduction: Episodes of Upper Gastrointestinal Bleeding (UGIB) are a frequent cause of search for urgent medical care. Several scores for risk stratification have been developed to predict clinically relevant outcomes. Among these scores, there is evidence that the Glasgow Blatchford Score (GBS) has the highest accuracy. Objectives: To describe the use of GBS in a Brazilian tertiary emergency center and to evaluate its clinical usefulness. Methods: Cross-sectional analytical descriptive study: audit of Upper Gastrointestinal Endoscopies (UGIE) performed over a consecutive period of 2 years, data collection of these patients, identification of those who had UGIB, stratification in high- and low-risk groups and subsequent application of GBS. Main outcomes: Sensitivity, specificity, positive and negative predictive values for different score values, and comparison of GBS accuracy to predict severe outcomes (high-risk group) with the complete (CRS) and pre-endoscopic (PRS) Rockall score. Results: 612 episodes of UGIB were evaluated, with GBS values calculated and ranging from 0 to 21, with an average of 9.97. The value of the score been ≤2 was identified as ideal to predict survival without the need for intervention or blood transfusion (sensitivity of 99.8%, specificity of 23.8%, positive predictive value of 74% and negative predictive value of 97.9%). The GBS performed better (area under the ROC curve (Receiver Operating Characteristic) - AUROC 0.87) in predicting high risk patients (need for intervention, blood transfusion or death) than the PRS (0.70) and CRS (0.76) scores. Conclusion: GBS is applicable in a Brazilian emergency center, and the results corroborate the data from the international literature: the score has clinical utility and has greater accuracy than Rockall scores (complete or pre-endoscopic) for predicting high risk outcomes (death, need for hemotransfusion or intervention to stop the bleeding).

Introdução: o número de ajuizamento de ações trabalhistas no Brasil sobe a cada ano. O fenômeno impacta diretamente na eficiência organizacional e, os processos da Gestão de Pessoas (GP) têm se mostrado uma opção de intervenção neste contexto. Objetivo: identificar quais processos da GP tem maior relevância nas reclamações trabalhistas. Método: estudo exploratório e retrospectivo, a partir de uma amostra de todas as reclamações trabalhistas ajuizadas contra uma Organização Social da área da saúde de 08/2010 até 12/2018, caracterizadas e posteriormente analisadas de forma quantitativa e qualitativa. Resultados: foi constatado que o número de reclamações trabalhistas aumentou com o passar dos anos, com redução no ano de 2018, após a aprovação da Reforma Trabalhista pela Lei nº 13.467 e que os processos da GP que apresentaram maior relevância nas ações foram: recompensar (47%) e manter (37%) pessoas. Conclusões: a legislação trabalhista intervém diretamente nas relações de trabalho de maneira arbitrária e impositiva, ocasionando a defesa de causas muitas vezes já ultrapassadas pela realidade atual da sociedade e das organizações. Isso pode explicar o volume de pedidos ligados aos processos de recompensar e manter da GP. O estudo também reconheceu a possível diminuição no ajuizamento de ações em razão da reforma trabalhista e a influência do agrupamento dos pedidos em ações advindas de um mesmo escritório na amostra analisada. Introduction: the number of employee grievances in Brazil increases every year. This phenomenon has a direct impact on organizational efficiency and the processes of People Management (PM) have direct access to act in that context. Objective: identify what PM processes have greater relevance in employee grievances. Method: an exploratory and retrospective study, with a sample of all labor claims against a social organization from 08/2010 to 12/2018, characterized and later analyzed quantitatively and qualitatively. Results: it was observed that the number of labor claims increased with the passage of the years, with reduction in the year 2018 after the approval of labor reform and the processes of PM that present greater relevance in the organization are: reward (47%) and retain (37%) people. Conclusions: labor legislation intervenes directly in labor relations in an arbitrary and enforceable way, leading to the defense of causes that are often outdated by the current reality of our society and organizations. Which influences in the volume of orders linked to PM reward and retain processes. The study also recognized the possible decrease in employee grievances due to labor reform and the influence of a group of requests in employee grievances that came from a same office in the analyzed sample.