Avaliação de alterações orais em pacientes submetidos a transplante de medula óssea

Bone marrow transplantation (BMT) is currently the best therapeutic option for patients with hematologic diseases, solid tumors or autoimmune disorders. It is characterized by intravenous infusion of hematopoietic stem cells in order to restore marrow function. However, this procedure requires concomitant immunosuppression treatment, which favors the development of certain complications, often manifested in the oral cavity. This study aimed to evaluate the incidence of oral changes in patients undergoing BMT and to correlate these results with clinical aspects related to the patients and the transplants performed. This is a prevalence study, with cross-sectional design, carried out in a BMT service at the Institute of Onco-Hematology of Natal (ION) and Natal Hospital Center. Data collection was based on questionnaires, clinical examination of the oral cavity and consultation in the medical records. The sample consisted of 51 patients undergoing BMT. After the analysis, was found a general status with good health conditions and presence of oral changes in about half of patients who composed the sample. The manifestations observed were, in decreasing order of frequency: mucositis; gingival alteration and thrombocytopenic purpura; mucosal pigmentation; lichenoid reaction and candidiasis. The oral changes were observed more frequently in cases of allogeneic TMO, in different periods post-transplant, without significant differences related to the source of cells. It was found statistically significant association between the presence of graft-versus-host disease (GVHD) and oral changes (p < 0,001). Therefore, it is concluded that there is a relatively high incidence of changes in oral cavity of patients receiving bone marrow transplantation, a fact which confirms the need to consider this site for examination, diagnosis, treatment and prognosis of possible complications of BMT

Influência do tratamento periodontal sobre os níveis da proteína c-reativa ultrassensível em pacientes com insuficiência renal crônica em fase de prétransplante

The present study evaluated the influence of non-surgical periodontal treatment on the levels of C- reactive protein (hsCRP) in patients with chronic renal failure (CRF) in pretransplant. We conducted a controlled and randomized trial to evaluate the periodontal condition and plasma concentrations of hsCRP, albumin and transferrin in 56 dialysis patients divided into two groups: experimental and control. The study was conducted at the dental clinic of Family and Community Health s Unit (USFC), located in Onofre Lopes University Hospital (HUOL), Federal University of Rio Grande do Norte (UFRN), from December 2010 to November 2011. Severe periodontitis was the type of periodontal disease more common, affecting 78.6% of patients. Periodontal conditions, evaluated through the means of probing depth, clinical attachment level, bleeding index and plaque index, proved to be uniform for both groups at the initial examination. There were no differences in levels of inflammatory markers between the two groups. The analysis of the concentrations of hsCRP allowed classifying study participants as at high risk of developing cardiovascular disease. After completion of periodontal treatment in the experimental group, there was a statistically significant reduction of the mean of all periodontal parameters assessed; however this improvement of periodontal health was not accompanied by changes in the levels of hsCRP, albumin and transferrin in the evaluation time. Given this, the periodontal treatment did not promote the reduction of systemic inflammatory burden and risk of cardiovascular complications in patients with CRF

Evidências de validade do Millon Behavioral Medicine Diagnostic na avaliação de aderência terapêutica em pacientes com insuficiência cardíaca crônica

Chronic heart failure (CHF) is the final common pathway of most diseases affecting the heart, being responsible for a high level of mortality and hospitalization, as well as significant reduction in quality of life of those affected. Interventions that claim to optimize patient adherence to their medical regimen, and improve self-care behavior, have proven effective in preventing unplanned admissions and improves the outcome for patients, however, studies have shown the problem of non-adherence, and some psychological instruments have been used to show that traces indicate difficulties with treatment adherence. Having shown this, the aim of this work is to evaluate the evidence of validity of the Millon Behavioral Medicine Diagnostic (MBMD) in a population of patients with CHF. The study included individuals with CHF, males and females, between the age of 18 and 85 years, treated in a reference hospital in the city of NatalRN. A total of 120 patients answered, in addition to the MBMD, another questionnaire structured with sociodemographic aspects and clinical itens. The results indicated that the parameter of the MBMD reliability was satisfactory the most of extracted factors, and some scale. In terms of the population studied, we could verify that the disease was more prevalent in men, but women had the highest average in indicators related to negative health habits and depressed mood. Younger pacients and those who had no partner had the highest averages in groups of items that dealt with feelings of sadness and discouragement. Hasn’t been observed differences related to negative health habits and problematic adherence among patients in different functional classes. More studies in this research line, with a larger population and from other regions of the country, are needed in order to expand the data presented here

Gravidade do olho seco em pacientes internados em unidade de terapia intensiva: análise de conceito e construção de definições

Dry eye syndrome is a multifactorial disease of the tear film, resulting from the instability of the lacrimal functional unit that produces volume change, up or tear distribution. In patients in intensive care the cause is enhanced due to various risk factors, such as mechanical ventilation, sedation, lagophthalmos, low temperatures, among others. The study's purpose is to build an assessment tool of Dry Eye Severity in patients in intensive care units based on the systematization of nursing care and their classification systems. The aim of this study is to build an assessment tool of Dry Eye Severity in hospitalized patients in Care Unit Intensiva.Trata is a methodological study conducted in three stages, namely: context analysis, concept analysis, construction of operational definitions and magnitudes of nursing outcome. For the first step we used the methodological framework for Hinds, Chaves and Cypress (1992). For the second step we used the model of Walker and Avant and an integrative review Whitemore seconds, Knalf (2005). This step enabled the identification of the concept of attributes, background and consequent ground and the construction of the settings for the result of nursing severity of dry eye. For the construction of settings and operational magnitudes, it was used Psicometria proposed by Pasquali (1999). As a result of context analysis, visualized from the reflection that the matter should be discussed and that nursing needs to pay attention to the problem of eye injury, so minimizing strategies are created this event with a high prevalence. With the integrative review were located from the crosses 19 853 titles, selected 215, and from the abstracts 96 articles were read in full. From reading 10 were excluded culminating in the sample of 86 articles that were used to analyze the concept and construction of settings. Selected articles were found in greater numbers in the Scopus database (55.82%), performed in the United States (39.53%), and published mainly in the last five years (48.82). Regarding the concept of analysis were identified as antecedents: age, lagophthalmos, environmental factors, medication use, systemic diseases, mechanical ventilation and ophthalmic surgery. As attributes: TBUT <10s, Schimer I test <5 mm in Schimer II test <10mm, reduced osmolarity. As consequential: the ocular surface damage, ocular discomfort, visual instability. The settings were built and added indicators such as: decreased blink mechanism and eyestrain.

Incidência e fatores de risco da retinopatia diabética em pacientes do Hospital Universitário Onofre Lopes, Natal-RN

Estudar a incidência e fatores de risco (tempo de doença e presença de hipertensão arterial sistêmica) para retinopatia diabética em 1002 pacientes encaminhados pelo Programa de Diabetes do Hospital Universitário Onofre Lopes no período de 1992 – 1995. Métodos: Estudo retrospectivo de pacientes com diagnóstico de diabetes mellitus encaminhados ao Setor de Retina do Departamento de Oftalmologia pelo Programa de Diabetes do Hospital Universitário e submetido, sob a supervisão do autor, a exame oftalmológico, incluindo medida da acuidade visual corrigida (tabela de Snellen), biomicroscopia do segmento anterior e posterior, tonometria de aplanação e oftalmoscopia binocular indireta sob midríase(tropicamida 1% + fenilefrina 10%). Foi realizada análise dos prontuários referente ao tempo de doenças e diagnostico clínico de hipertensão arterial sistêmica. Resultados: Dos 1002 diabéticos examinados (em 24 deles a fundoscopia foi inviável), 978 foram separados em 4 grupos: sem retinopatia diabética (SRD), 675 casos (69,01%); com retinopatia diabética não proliferativa (RDNP), 207 casos (21,16%); com retinopatia diabética proliferativa (RDP), 70 casos (7,15%); e pacientes já fotocoagulados (JFC), 26 casos (2,65%). Do total, 291 eram do sexo masculino (29%) e 711 do sexo feminino (71%). Os 4 grupos foram ainda avaliados quanto ao sexo, a faixa etária, a acuidade visual, tempo de doença, presença de catarata e hipertensão arterial sistêmica e comparados entre si. Com relação ao tipo de diabetes, 95 eram do tipo I (9,4%), 870 pacientes eram do tipo II (86,8%), e em 37 casos(3,7%) o tipo de diabetes não foi determinado. Conclusões: Comprovou-se que os pacientes com maior tempo de doença tinham maior probabilidade de desenvolver retinopatia diabética, e que a hipertensão arterial sistêmica não constituiu fator de risco em relação à diminuição da acuidade visual nos pacientes hipertensos

Aspectos da qualidade de vida de pacientes com coinfecção HIV/tuberculose

Investigar a qualidade de vida de pacientes com coinfecção HIV/ tuberculose e apreender as mudanças impostas para viver simultaneamente com estas doenças transmissíveis. Métodos: Pesquisa com abordagem qualiquantitativa, realizada em ambulatório especializado em Fortaleza, Brasil, entre 2009 e 2010, com 34 coinfectados. Para coleta de dados foi utilizada uma escala de qualidade de vida, denominada HAT-QoL que possui 42 itens e questões abertas para possibilitar perceber as mudanças em face das doenças. Resultados: A maioria dos participantes tinha tuberculose na forma pulmonar, eram homens, com pouca escolaridade. A qualidade de vida mostrou-se prejudicada nos domínios relacionados às questões econômicas, sexuais e de sigilo. Ainda, foi evidenciado, que a coinfecção impõe mudanças no cotidiano que corroboram e ampliam o comprometimento da qualidade de vida. Conclusão: Vivenciar a coinfecção, mesmo com terapêutica adequada, produz alterações na vida dos infectados, cujas repercussões podem ser amenizadas com intervenções que promovam a saúde