No abstract

Acquired hemophilia A (AHA) is a rare bleeding disorder occurring mostly in elderly persons, caused by inhibition of factor VIII (FVIII). It is generally detected prior to surgery by an isolated prolonged activated partial thromboplastin time (aPTT) not correcting on mixing studies, with subsequent identification of reduced FVIII levels and presence of FVIII inhibitor. It is treated with hemostatics and immunosuppressants, which may increase the risk for life-threatening opportunistic infections.A 79-year-old woman with idiopathic acquired FVIII inhibition and severe bleeding presented with anemia, isolated and prolonged aPTT, low FVIII activity (<1%), and elevated FVIII inhibitor titer (471 Bethesda units per milliliter [BU/mL]). Initially, she was treated with recombinant activated factor VII and steroids. However, several hematomas appeared, one of which caused airway compression that required orotracheal intubation. Cyclophosphamide, rituximab (RTX), and activated prothrombin complex concentrate were initiated, resulting in clinical and laboratory resolution after five weeks. Cyclophosphamide and RTX were maintained for six and four weeks more, respectively. After 12 weeks of oral immunosuppression, the patient was readmitted due to antibiotic-resistant Pseudomonas aeruginosa sepsis, which resulted in death.Infection secondary to immunosuppression is the leading cause of death of patients with AHA. In AHA, combination therapy was shown to be more effective than monotherapy, but it was also identified to increase the risk of infection. Age, FVIII activity <1%, and FVIII inhibitor titers >20 BU are predictors of adverse events and poor prognosis in AHA patients. Additional studies are needed to clarify the ideal drug regimens and the need for prophylactic antibiotics in this population.

Hypertension and stress are the most prevalent risk factors in cardiovascular diseases, causing impact on quality of life of hypertensive patients. It is the aim of the study to assess the vulnerability to stress of hypertension patients and identify the factors of vulnerability to stress which interfere with quality of life of hypertension patients. Non experimental study, quantitative, transversal, descriptive and correlational. With a sample of 431 hypertension patients. Data collection took place from June to September 2012, through a questionnaire with questions concerning socio-demographic data, clinical, evaluation of the quality of life of hypertensive patients and evaluation of vulnerability to Stress. The main results are 43,15% were male, 56,84% female aged between 30 and 95 years old. There is influence of gender, age, marital status, education, employment status, cohabitation and monthly income, both in vulnerability to stress as in quality of life. Worse quality of life, female literacy, with average higher than male (M = 8,81 in mental status, M = 3,93 in somatic manifestations and M = 0,73 in overall impact). The vulnerability to stress has also an influence on the quality of life. 44,2% of hypertensive patients are vulnerable to stress, with percentage value for females (51,2%). It is essential to know the factors of vulnerability to stress predictors of quality of life of hypertension patients in order to operate and improve their quality of life.

Doriana Daroit e à Késia Rozzett pelas infinitas lições e pelo conhecimento compartilhado; Ao meu orientador, Valmir Emil Hoffmann, pela atenção, contribuição e tempo a mim dedicados; À minha família, em especial, aos meus pais por me apoiarem e acreditarem no meu potencial; Ao meu namorado, Daniel Lourenço, meu companheiro acadêmico e amigo para todas as horas; Às amigas de infância, Samara, Priscila e Ana Cláudia; e Às todas as minhas amigas da faculdade: