Câncer do colo uterino: rastreamento, marcador biológico e polimorfismo genético

Existem fortes evidências de que os programas de rastreamento baseados em citologia resultaram em diminuição significativa da incidência e mortalidade por câncer do colo do útero, no entanto, um excesso substancial de tratamento de lesões intraepiteliais de baixo grau que dificilmente progrediriam para carcinoma cervical resulta da baixa especificidade do tradicional rastreio citológico. A detecção precoce das lesões através do rastreamento citológico e a avaliação do grau histológico em espécimes cervicais são fundamentais, entretanto não permitem identificar quais pacientes terão maior probabilidade de progressão para lesões de alto grau e carcinoma invasivo. A busca de potenciais marcadores de prognóstico; objetivando o entendimento da progressão das lesões intraepiteliais é de suma importância. Acredita-se que fatores imunoregulatórios, imunogenéticos e proteínas do ciclo celular estejam intimamente envolvidos no processo de carcinogênese. Considerando o exposto, a proposta do projeto foi inicialmente avaliar a eficácia da citologia oncológica no rastreamento do câncer cervical, foi investigado ainda o polimorfismo do gene do fator de transcrição FOXP3 e a expressão da proteína do ciclo celular P63 (P63) associados respectivamente a diagnóstico e prognóstico das lesões cervicais. Em um primeiro momento foi realizado estudo transversal que envolveu 3194 mulheres. As participantes foram submetidas à citologia e biópsia de colo dirigida por colposcopia e os resultados foram comparados para verificar-se a acurácia do teste de Papanicolaou na detecção de lesões intraepiteliais e câncer cervical. Posteriormente, realizou-se estudo comparativo do tipo observacional estratificado em três grupos: Grupo 1: 16 casos com diagnóstico histopatológico de metaplasia/cervicite, considerados normais, Grupo 2: 11 casos com lesão de baixo grau (LSIL) e Grupo 3: 15 casos com lesão de alto grau (HSIL) ou carcinoma epidermoide de colo. Um total de 42 participantes respondeu a um questionário epidemiológico padronizado sobre as características demográficas, hábitos pregressos, história reprodutiva e de comportamento sexual. Após exame colposcópico, foram coletados fragmentos de espécimes cervicais para a pesquisa da expressão proteica da P63 por imunohistoquímica. Amostras de sangue periférico foram coletadas para extração do DNA e detecção do polimorfismo do gene FOXP3. No primeiro estudo em que se avaliou a acurácia do teste de Papanicolaou, encontrou-se sensibilidade de 0,83, valor preditivo positivo (VPP) de 0,77 e especificidade de 0,23 no rastreamento das lesões cervicais e câncer de colo. viii Melhores resultados foram observados quando se avaliou a acurácia diagnóstica para lesões de alto grau e carcinoma com VPP de 0,99 e especificidade de 0,84.No estudo subsequente onde se comparou a expressão da proteína P63 observou-se maior número de núcleos marcados no grupo com lesões intraepiteliais de alto grau e câncer quando comparado ao grupo com biópsias negativas (p=0,0004). No último estudo pesquisou-se a associação do polimorfismo do gene FOXP3 com lesões intraepiteliais cervicais sendo evidenciada maior prevalência do genótipo heterozigoto, CT, no grupo com lesões de colo na histopatologia (p=0,027). Mulheres com lesões intraepiteliais de baixo ou alto grau e câncer de colo de útero apresentam maior expressão da proteína P63 e maior prevalência de genótipo heterozigoto do gene FOXP3 em comparação com as sem lesões cervicais. A associação da pesquisa da expressão da proteína e do polimorfismo do gene pode tornar os exames utilizados atualmente para a avaliação diagnóstica e prognóstica das lesões de colo uterino mais efetivos em detectar quais as mulheres com maior risco para progressão para câncer

Tratamento de fístulas enterocutâneas através de sistema a vácuo com alta pressão e dieta oral normal

Enterocutaneous fistulas are associated with prolonged hospital stay, high morbidity/mortality, and increase in hospital costs. This study aims to describe the use of a vacuum system and normal oral diet in dealing with this problem. Methods: Seventy-four consecutive patients with recent and defined external postoperative fistulas were analyzed. Abdominal imaging was used to exclude abscess and distal obstruction. The fistula tract was sealed with Foley catheter, connected to a negative pressure flask, changed daily for 5, 10 or 15 days, as necessary. Normal oral diet was permitted. Results: No patient died. Serum albumin and transferrin showed significantly higher levels at the end of treatment than at the beginning. The moderate and low-output fistulas had the best results (97% closed). Forty-eight (65%) fistulas closed after five days, 16(22%) after 10 days and 4(5%) after 15 days. Treatment failed in 6(8%) patients, who subsequently underwent surgery. Only one patient with low-output did not close her fistula. The cost of the treatment was US$ 41.75/day and it was considered cost effective. Conclusions: The vacuum system demonstrated good results in the treatment of fistulas. It included simplicity, low cost, short hospital stay, absence of skin breakdown, normal eating, good nutrition and activity patterns

Freqüência e etiologia das dermatomicoses em pacientes atendidos no Hospital Giselda Trigueiro, Natal, RN

Dermatomycoses are fungal infections that attack the skin, hair and nails, in addition to the mucosal and cutaneous-mucosal zones. Objective: Observe the frequency of dermatomycoses, identify etiological agents and establish an association between the results and sex. Age, collection site, time and lesion location. Methods: Between February, 2002 and December, 2004, samples were collected from patients at Giselda Trigueiro Hospital in Natal, Brazil, by lesion scraping and hair removal, following 70% alcohol disinfection, and submitted to direct and culture examination. Results: Of the 817 lesions collected, 325 (39.8%) were fungus positive, with the hair collection site yielding the highest number of positive results (65.8%) and the scalp and hair representing the most frequent lesion sites (65.9%). Negative results occurred mainly in the lower limbs (78.6%). Of the species identified, 55.9% were yeasts, 41.6% dermatophytes and 2.5% Fusarium spp. Non-albicans Candida was the most isolated yeast (43.3%), mainly in females (61.7%) over the age of 40 years (56.4%). T. rubrum was the most isolated dermatophyte (67.9%),notably in males (59.2%) in the 0-20 age group (44.7%). With respect to collection site, 73.9% of the dermatophytes were present in the skin and 61.1% of the yeasts in the nails. When assessing the collection site, the inguinocrural regional was 22.6% positive for dermatophytes, and the nails and hands, 41.8% for yeasts. Conclusions: The results obtained verified that: most of the positive lesions were found in the hair, whereas skin and nail lesions yielded more negative results; T. rubrum was the most isolated dermatophyte and non-albicans candida the most commonly found yeast; positivity was greater in males in the 0-20 year age group at the skin site and in the inguinocrural region, while yeasts were more frequent in females in the over-40 age group at the nail sites

Avaliação do sistema conservante em formulação com extrato hidroalcóolico de schinus terebinthifolius raddi nacardiaceae

Schinus terebinthifolius Raddi is used in the treatment of skin and mucosal injuries, infections of respiratory, digestive and genitourinary systems. Currently one of the biggest problems faced for the industry of phytopharmaceuticals with regard to the quality of raw materials is the microbial contamination. The aim this study was to evaluate the antimicrobial action of the hidroalcoholic extract of aroeira, beyond testing the effectiveness of the preservative system in hidrogel to the base of this extract. The extracts were prepared by maceration in the ratio of 1:10 of solvent plant/with alcohol 40%. The methods for microbial count were pour plate and test for specific microorganisms, analyzing in third copy each one of the samples. The antimicrobial activity of aroeira extracts was performed using an agar diffusion method, using strains of S. aureus, P. aeruginosa, E. coli, B. subtilis, C. albicans, C. tropicalis, C. krusei, C. guilliermondii, T. rubrum, M. gypseum, A. flavus and A. niger. The formula with aroeira was evaluated by the challenge test. This method consisted of artificial contamination the sample with separate inóculos of A. niger, C. albicans, E. coli e S. aureus aeruginosa and determinations of survivors for the method of counting for pour plate , during times 0, 24h, 48h, 7 days, 14 days, 21 days and 28 days. How much to the results, one verified that the extract of aroeira in the 13,5 concentration mg/mL presented antimicrobial activity for cepas of E. coli, B. subtilis, P. aeruginosa e S. aureus, producing inhibition zone, on average with 13 mm of diameter. However it did not present no fungi activity. The formula with aroeira containig both methylparaben and propylparaben showed a good efficacy in challenge test front to strains of A. niger, C. albicans, E. coli, S. aureus. The A criteria of European Pharmacopoeia, adopted in this work, was verified that this product revealed the good preservative efficacy for the challenge test, time interval of the 28 days. However, it is interesting to extend this study, in order to carry through the sped up stability and the test of shelf, to establish the validity of this formularization

Avaliação da composição química, atividade antioxidante, antibacteriana, antinoceptiva, antiinflamatória e toxicidade do extrato metanólico e frações de folhas de Spondias sp. (Anacardiaceae)

Spondias sp. (Anacardiaceae), popularly known as cajá-umbu, is an endemic plant from Northeastern Brazil, where their leaves are widely used in folk medicine to treat inflammatory processes, while their fruits have a great agro industrial potential. This study was designed to evaluate hepatoprotective, antinociceptive, antioxidant, antimicrobial and anti-inflammatory properties, as well as the acute toxicity and repeated dose 28, using a methanolic extract (MES), a fraction rich in flavonoids (FRF) and a precipitate from Spondias sp.leaves. The antioxidant activity of them was valued to evaluate their free radical scavenger capacity by DPPH test, whereas MES and FRF were used to evaluate while the preventive action on carbon tetrachloride (CCl4)-induced hepatotoxicity. Seven groups (n=5) of female Wistar rats were used as follows: control group, CCl4-intoxicated group treated with EMS (500 mg/kg) for 7 days, three CCl4-intoxicated groups treated with FRF (25, 50 and 75 mg/kg) for 7 days and the CCl4-intoxicated group treated with Legalon ® (silimarina; (phytotherapeutic reference) (50 mg/kg; 7 days). MES and FRF showed a protective action against liver injury induced by CCl4, being observed a significant reduction of serum enzyme activity marker of liver damage (alanine transaminase and aspartate transaminase). On the other hand, the lipid peroxidation (SRAT) decrease, as well as the increase of glutathione content and enzyme activity of antioxidant defense system (SOD, CAT, GPx) toward near normal values indicated the ability of EMS to restore the oxidative imbalance induced by CCl4. The histological analysis confirmed the hepatoprotection, compared to degenerative changes in CCl4-treated group. This hepatoprotetor effect was similar to that shown by Legalon®. The in vitro high antioxidant capacity of extract (93.16 ± 1.00%) showed analogous results to those obtained by Carduus marianus BHT (reference standard). This fact explains the obtained results in vivo. Although no antimicrobial activity was detected, EMS and FRF promoted the antinociceptive effect induced in the second phase by the intraplantar formalin test, evidencing the anti-inflammatory action; confirmed by the carrageenan-induced peritonitis model. The evaluation of the mechanical allodynia (CFA a 80%) demonstrated the involvement of the Spondias sp. chemical composition in the anti-inflammatory activity toward the acute processes. The acute exposure and repeated dose during 28 days did not produce significant changes in the parameters that evaluate toxicity. Together the experimental results reveal, that Spondias sp. leaf extracts have a promising potential in pharmaceutical area, and due to its non-toxic condition present efficiency and security

Dos atos confessos aos afetos não-ditos: Um olhar sob as múltiplas experiências femininas a partir da análise dos discursos jurídicos, jornalísticos e orais

Women, subjectiveness, experimentations. This paper walks through gender, sexuality, body and subjectivity, bounding as the focus denaturalize the representations of womanlinessstaff and manliness and the modeled subjectivity by normative discusses that shows the transcendency based on multiplicities of experiences, wishes and life way wattled by men and women from the Caicó City s society in the decades from 1900 to 1945. For this, it was adopted a dialogic methodology inlcluding bibliographic and theorist references as well as sources like articles from Jornal das Moças (Lady s Journal); defloration s crime processes, abortion, infanticide and body lesions; iconographic sources and Caicó citizen memories in the period commented. Based on that sources, this work analyze the discursive construction of feminine through Justice and Jornal das Moças that paved by sanitarian, normalizing and moralizing discourses has spread clichés and stereotypes of womanlinessstaff and manliness, which has resulted by to universalize the experiences feminines in polarities and binary oppositions regarding to manliness, it has delineated them as asexual, irrational, anesthesiaed for pleasure and biologically meant to home activities modeling subjectivities that did not create ways for the singularization processes. This polarities, effects of sexual regulatory practices and gender legitimate the representations of courtship, maternity and honor, that although it has been incorporated not passivant on the building of the poor men and women subjectivity, it did not support itself in view of socio-cultural and economic reality of the poorest society side. Therefore, on this work emerge a plurality of women who has transited past the public sphere, who interlaced amorous informal relationships, who has kept relationships before the marriage, who hás established multiples familiar arrangements and helpful networks, who was single mothers without being considered dishonored women by social groups, who made matrimonial agreements without the rules of a formal civil marriage, who made use of beverageey to provoke the menstruation constituting multiples ways to experiment the life. This subjective feminine experimentations turned it possible to notice that representations concerning about the body, sexuality, date, maternity and honor of this women has constituted itself while molecularies and particulares . It was the affection not commented of the feminine sexuality that turned it possible to analyze the construction of singular subjectivities as a opened process, continuous, active, begetting new lands, life ways and wishes cartographies

Paradigma constitucional brasileiro da livre concorrência e da defesa do consumidor face às estruturas de poder no mercado

The Federal Constitution of 1988, when taking care of the economical order, denotes special concern in the abuses of the economical power and the disloyal competition. The mark to mediate of all this is, in fact, the defense and the consumer's protection, once this is final addressee of whatever if it puts at the consumption market. The coming of the Law 8.078/90, Code of Protection and Defense of the Consumer, inaugurates a time of effective concern with the homogeneous individual interests originating from of the consumption relationships. In this point, the focus of main to face of the present work lives, in other words, the protection of the right to the individual property, especially manifests in the exercise of the trade freedom that keeps direct relationship with the respective social function the one that is destined. The code of the consumer's defense doesn't just take care of this, but also of the other star of the relationships of the consumption. When affirming in the interruption VI of the art. 4th that the national politics of those relationships, finds ballast in the prohibition and repression efficient of all of the abuses committed in the consumption relationships, keeping inherent relationship-causality in the economical order, sculpted for the article 170 in the Constitution of 1988. In the generic plan, the mark of the present work is to question concerning the limits of the trade freedom and previsible collisions with protection norms and the consumer's defense, as well as factual convergences of those small systems, especially in what he/she refers to the innate interests to the suppliers. In the specific plan, we aspirated to identify the protection device-commands to the actors of the trade relationship, capable to guarantee the free competition in a global economy of market, seeking especially the Well-being, for soon afterwards, in an analytical perspective, to discover the possible applications that it holds the Federal Constitution, in headquarters of economical freedoms. It was observed that the consumer today doesn't need only of laws that their needs, fruit of the vulnerability that it is him/her meditate innate. He/she lacks, yes, of effective mechanisms that prevent lesions that can be them impinged by the suppliers at the time in that you/they are useful to repair the damages when happened, punishing the author of the damage

Avaliação da gravidade do trauma em condutores de motocicleta vítimas de acidentes de trânsito no Rio Grande do Norte

Descriptive exploratory study, prospective, with quantitative approach, performed on the Monsenhor Walfredo Gurgel Hospital Complex (MWGHC), in Natal/RN, aiming to identify injuries by body area and wound severity on drivers who suffered motorcycle accidents, evaluate the severity of injuries and trauma on these drivers and identify the existence of association between wound and trauma severity and some of the accident s characteristics. The population comprised 371 motorcycle drivers, with data collected between October and December 2007. We used as instruments the Abberviated Injury Scale (AIS), Injury Severity Score (ISS) and the Glasgow Coma Scale (GCE1). The results show that, concerning characterization, there was a predominance of the male gender (88.4%), aged between 18 and 24 years (39.90%), originating from the Natal metropolitan region (55.79%), with fundamental-level instruction (51.48%), catholic (75.78%), married (47.98%). 23.18% work on commerce-related activities and 75.20% have income of up to 2 minimum wages. As for the accident s characteristics, the predominant shift was the afternoon (46.36%), received up to one hour after the event (50.67%), transported by countryside ambulances colleagues and relatives (51.21%), 25.34% had the accident on Sunday; 53.91% suffered falls and vehicle rolls; among the collisions there was a predominance of the motorcycle-automoblie type (28.03%); 52,6% were licensed and among these 50.76% had up to one year of license; 65.50% declared not having suffered previous accidents; 65.77% declared waring helmets in the time of the accident; 57.41% said not to have used drugs, and among those who used, alcohol was the most consumed (98.10%). The lowest score evaluated by GCS1 (3 to 8) was linked to drivers who suffered accidents on Saturday (10.3%), those who were not wearing helmets (14.29%) and the victims of motorcycle-pedestrian/animal crashes (13.33%). The body areas most affected had AIS between 1 and 3 (95.76%) and were: external surface (39.90%) and head/neck (33.20%). As for trauma severity, the highest scores (ISS>25) belonged to those who consumed alcohol (30.73%), suffered falls or vehicle rolls (48.9%) and those attended to 3 hours or longer after the accident (50%). We conclude that for motorcycle drivers who suffered accidents, age, gender, weekday, type of accident, use of drugs and the absence of helmet use signal both to the risk of occurrence of these events, as well as for the greater severity of injuries and trauma.

Úlcera de pressão em pacientes internados em um hospital universitário em Natal/RN: condições predisponentes e fatores de risco

The pressure ulcers (PU), also known as decubitus ulcers, are defined as injuries caused by the constant pressure exerted on a particular point of the body, causing impairment of blood supply with a decrease or interruption of tissue irrigation, causing occlusion of blood vessels and capillaries, ischemia and cell death. This is a descriptive study with longitudinal design, and panel type, with quantitative approach that aimed to examine the association between predisposing conditions (PC), intrinsic factors (IF) and extrinsic factors (EF) with the occurrence of PU, in hospitalized patients in the Intensive Care Unit (ICU), pain clinical, surgical clinical and neurology wards of a university hospital. The study population was composed of all patients who were restricted to bed during the period from December 2007 to February 2008. The study was approved by the Ethics Committee of HUOL / UFRN (No 135/07). The data-collection took place through a structured formulary of observation, data from medical records and physical examination of patients skins. The results were organized in SPSS 15.0 software, tabulated, categorized and analyzed by descriptive and inferential statistics. Of the 30 patients studied, 43.3% had been hospitalized in the pain clinical and surgical clinic wards, 20.0% in the ICU, 20.0% in the ICU / ward and 16.7% in neurology, being the length of hospitalization in those units of 7 to 18 days (63.3%) and from 19 to 30 days (36.7%), predominantly female and aged ≥ 60 years (60.0%). 19 PU were diagnosed in 43.3% of patients monitored, being 38.5% with one PU between 7 to 18 days and 46.2% with two or more between 19 to 30 days of hospitalization, showing significant relationship (ρ-value = 0029) between length of hospital stay and the number of PU. Was found an association of 35.7% of the PC (cardio-respiratory, hematological, metabolic and psychogenic), IF (age group, oedema, skin changes in humidity and change of body temperature) and EF (type of mattress and strength of body pressure) for all patients studied, statistically significant (ρ-value = 0001), between the average scores in patients with and without PU, with reason chance to 12.0 for the development of PU and there was moderate correlation ( r = 0618) in the presence of this association. Results show the influence of the multiplicity of factors and conditions on the occurrence of PU, which brings us to reflect on the assistance focused on prevention and reduction of these injuries which will encourage the reduction of hospitalization length, physical and psychological suffering, and the possibility of improving the clinical condition of the patient.

Caracterização do acidente de trânsito e gravidade do trauma: um estudo em vítimas de um hospital de emergência de Natal

Descriptive exploratory study, with quantitative approach and prospective data performed on the Monsenhor Walfredo Gurgel Hospital Complex (MWGH), in Natal/RN, aiming to classify the type of motor vehicle involved in the accident, the public roadway s user quality and the more frequent injuries; to evaluate the severity of trauma in traffic accident victims; characterized the severity of the injuries and the trauma, and the type of motor vehicle involved. The population comprises 605 traffic accident victims, with data collected between October and December 2007. We used as a support for the evaluation of severity of injuries and trauma the Glasgow Coma Scale (GCSl), the Condensed Abbreviated Injury Scale (CAIS) and the Injury Severity Score (ISS). The results show that 82.8% of the victims were male; 78.4% were aged 18 to 38; the victims originating from the State s Countryside prevailed (43.1%); 24.3% of the population had completed middle-level instruction; 23.1% worked on commerce and auxiliary activities; most (79.4%) was catholic; 48.8% were married/consensual union; 76.2% earned up to two monthly minimum wages; Sunday was the day with the most accidents (25.1%); 47.4% were attended to in under an hour after the event; the motorcycle on its own was responsible for 53.2% of the accidents; 42.3% were attended to by the SAMU; 61.8% were victims of crashes; over half (53.4%) used individual protection equipment (IPE); 49.4% were helmets and 4.0% the seatbelt; 61.3% were motorcycle drivers; 43.3% of the accidents took place in the afternoon shift; from 395 drivers, 55.2% were licensed, and 50.7% among those had been licensed for 1 to 5 years; 90.7% of the victims had GCS1 between 13 and 15 points at the time of evaluation; the body area most affected was the external surface (35.9%); 38.8% of the injuries were light or moderate (AIS=1 and AIS=2); 83.2% had light trauma (ISS between 1 and 15 points). In face of the results, we can conclude that there is a risk for the elevation of injury severity and trauma resulting from traffic accidents, when these events are related to certain variables such as gender, age, weekday, the interval between the accident and the first care, ingestion of drugs, type of accident, the public roadway s user quality, the use of IPE, day shift, body regions and the type of motor vehicle involved in the accident

Qualidade de vida de pessoas com úlceras venosas atendidos no ambulatório de um hospital universitário

Descriptive study aimed to analyze the quality of life (QOL) of patients with venous ulcers (UV) outpatient clinic of a university hospital in Natal / RN. The aim of the study population was composed of 50 patients with UV treated at the cardiology clinic of a university teaching hospital at the tertiary level. The study was approved by the Ethics Committee of the Federal University of Rio Grande do Norte (Protocol 279/09). Data collection was performed over a period of two months by the very a masters degree and an academic nursing through the application of a form concerning the socio-demographic, clinical, and health care, and the instruments WHOQOL and WHOQOL - old. The data were analyzed with SPSS 15.0, using descriptive and inferential statistics presented in the form of tables, charts and graphs. Of the surveyed, female predominance, age range 59 years, Catholic, low education, married, with up to 03 children, not working, retired, or with occupations requiring long periods in one position, wage income of up to 02 minimum wages, inadequate sleep, patients with chronic venous insufficiency and other chronic diseases such as diabetes and hypertension, were taking medications for treatment, being a minority to IVC. In patients with predominant only one injury, time of injury up to five years, inadequate rest, pain, edema and lesions colonized. The assistance the UV patients began treatment of the injury until four months after the onset of the ulcer, and services primary health care most wanted, access to angiologist by reference form, commuted by public transportation, received support regarding the treatment of injuries. The topical product most used in the lesion was healing, and few were using compression therapy. respondents suffer discrimination in society, showed changes in quality of life after the occurrence of ulcer in relation to leisure, pain, restriction of social / school / transportation; barring employment / financial / social ladder; Physical appearance / discrimination and restriction of domestic activity. These changes were related to the time of injury and found that the more chronic injury is the most negative changes occur in their QV (ρ = 0.000). Analyzing the characteristics of QV measured by the WHOQOL-bref, we found for the two general questions they are dissatisfied with their health (ρ = 0.023) and all areas have significant difference compared with the worst QV have the injury of more than 5 years (ρ = 0.000). The QV measured by the WHOQOL-old, we found that these patients had no changes from the time of injury. We conclude that the QV of patients with UV was considered unsatisfactory when compared to the time of injury on more than 5 years which shows that the quality of life worsens with time the chronic UV.

Custo-efetividade da terapia compressiva no processo de cicatrização de úlceras venosas

Analytical study of therapeutic nonrandomized intervention type, intra-group controlled, with the aim of analyzing the cost-effectiveness of compression therapy with manipulated Unna boot in relation to conventional therapy in the healing of venous ulcers (VU) of patients treated in ambulatory clinic. The study population was composed by patients with VU treated by angiologists in Surgical Clinic Ambulatory of the Onofre Lopes University Hospital (HUOL) with a sample of 18 patients. It obtained the assent of the HUOL Ethics in Research Committee (Protocol 276/09). Data collection was performed over a period of four months by the own master's student and 34 nursing students, through the application of the research instrument in the admission of patients to the study and in the ten subsequent evaluations, performed at the time of changing Unna boot, weekly, for a maximum period of 10 weeks. The data were analyzed with SPSS 15.0 software, using descriptive and inferential statistics, and presented as tables, charts and graphs. Among those surveyed, prevailed: females, mean age 57.6 years, low education and income levels, most retired, unemployed or off work, with the standing position more than six hours per day and up to eight hours daily of domestic or occupational activities. In health status profile of respondents there were predominantly sleep, rest and inadequate elevation of the lower limbs, no smoking and/or alcohol use, presence of hypertension and no use of drugs. Most presented the first VU for over 10 years, recurrences, present VU for more than five years, involvement of left leg, in malleolar and / or distal leg region, mild edema, hyperpigmentation, lipodermatosclerosis, telangiectasies, reticular and varicose veins, mild pain, serous exudate in moderate quantity, small lesions (up to 50cm2), with predominance of granulation tissue and / or epithelialization and demarcated, elevated and irregular borders, with crusts and macerated. Most patients reported that in the 10 weeks prior to admission, made bandages at home and / or Basic Health Unit and / or ambulatory, with nursing aides or technicians, daily, and on weekends or holidays, performed by patients themselves, using healing ointment on the lesion, being observed granulation / epithelialization and increase in VU prevalent in the 10 weeks of traditional treatment. After follow up with manipulated Unna boot, was observed a decrease of lesions in all study patients, with complete healing in 27.8% of those between 1 and 5 weeks of treatment, with satisfactory evolution of the lesions, pain and ankle and calf circumferences, and unsatisfactory development of the borders of ulcers, edema, sleep, rest and elevation of the lower limbs, especially in more chronic patients. Furthermore, patients who achieved total healing and exhibited the greatest percentage reduction of lesions had a higher number of wound healing factors (ρ = 0.01 and ρ = 0.027, respectively). The manipulated Unna boot showed better results in those patients with shorter duration of injury, leading them to a satisfactory outcome within a short period of treatment. After the cost-effectiveness analysis, we conclude that the manipulated Unna boot is more effective than conventional therapy in the healing process of VU and is more cost-effective in patients with shorter lesions (ρ = 0.001), shorter treatment (ρ = 0.000) and greater number of wound healing factors (ρ = 0.005).

A violência no contexto de um serviço de urgência: análise do processo de cuidar na visão das vítimas e profissionais de saúde em Natal/RN

Exploratory descriptive study, with a quantitative approach and prospective data, performed in Pronto Socorro Clóvis Sarinho (PSCS), in Natal/RN, aiming to analyze care given by the nursing and medical staff to victims of violence attended to in an emergency hospital in Natal/RN; to identify care given by the nursing and medical staff as viewed by the victims; to compare data observed during the process of care with the victim s view on the care given by the nursing and medical staff; to identify the existing knowledge on violence and the process of caring for victims and its relation with prejudice; to identify obstacles and perspectives for prevention during the process of caring for victims in the emergency services. The population consisted of 97 physicians, 16 nurses, 75 nursing technicians and assistants and 365 victims of violence, with data collected from April to May 2009. Out of 188 professionals, 52.1% are female; 32% were aged 41 to 50; 99.5% had given care to a victim of violence; 90.4% reported to have given care to patients under custody; among these, 17.3% felt prejudice; 55.3% stated they don t provide different care for assaulted victims and assailants, however 44.7% stated they do; 86.7% feel their workplace is unsafe; 61.7% denied the existence of any obstacle and 38.3% reported the existence of obstacles; among these, 26.1% referred to inadequate facilities; 37.8% believe reinforcing security and professional training are the main solutions. Among the 365 researched violence victims, 82.2% were assaulted; male (69.6%); aged 18 to 24 (24.9%); hailing from the Greater Natal area (89.9%); on 19.7% the event happened on Saturday; during the night (48.8%); victim of physical assault (61.4%); produced by body force (27.7%); 24.4% were injured in the head and neck. 57% had used some drug, among which alcohol was predominant (75.5%). On 621 observations performed during the victim care process, when compared to the report of assaulted victims, there was a statistical difference, at 5% significance level, regarding reception, resistance from the professionals, questioning about the violent event, providing of guidance, interaction with the patient and the understanding of receiving proper care, and care resolution. In comparisons involving the observed and the assailant victims reports, there was a statistical difference regarding the resence of resistance from the professionals, performance of necessary procedures and the nteraction with the patient and the understanding of receiving proper care and 58.1% reported the nursing team was the one that provided the best care. We conclude that professionals had lready given care to assailant patients, acknowledge the importance of knowing how the vent took place and acquired this preparation during their practice. The most often referred bstacles that hinder assistance were: inadequate facilities, material deficit and lack of rofessional preparation. As solutions for these problems, they cited the reinforcement of ecurity and professional training

Conhecimento do enfermeiro sobre o processo de cuidar do paciente com traumatismo cranioencefálico

Estudo de caráter exploratório e descritivo, de abordagem quantitativa, realizado num hospital de urgência hospitalar referência em traumatologia, em Natal/RN, com o objetivo de identificar o conhecimento do enfermeiro a respeito da ECGl para avaliação do nível de consciência e do processo de cuidar na fase pré-hospitalar e hospitalar às vítimas de TCE. A população constou de 44 enfermeiros e os dados foram coletados entre abril e maio de 2010. Os resultados mostram que, 35 (79,5%) dos enfermeiros eram do sexo feminino; 17 (38,64%) estavam na faixa etária entre 24 a 30 anos e 12 (27,27%) entre 51 a 60 anos; 25(56,82%) solteiros, 30 (68,18%) católicos e 25 (56,82%) sem filhos; 40 (90,90%) eram formados por instituições públicas, 18 (40,92%) tinham tempo de serviço na enfermagem acima de 21 anos e 14 (31,82%) até quatro anos; 18 (40,91%) estavam alocados nas UTIs e 13 (29,55%) atuavam em mais de um setor e 20 (65,90%) possuíam especialização. Dos que estavam mais especializados, 18 (40,92%) tinham tempo de serviço até quatro anos e 08 (34,48%) acima de 21 anos. Todos relataram ter prestado assistência às vítimas de TCE e 36 (81,82%) sentiam-se preparados; 35 (46,67%) adquiriram essas informações na prática e apenas 8 (10,67%) na graduação. Em relação a opinião dos pesquisados sobre os empecilhos que dificultam esta assistência, 23 (23,01%) relataram déficit de recursos humanos e 19 (20,65%) despreparo da equipe de enfermagem, estrutura física inadequada e recursos materiais precários. Como propostas de solução para os problemas, 26 (47,27%) sugeriram reforma na gestão e 13 (23,63%) referiram educação continuada. Em relação a ECGl, 40 (90,1%) afirmaram conhecê-la, 33 (82,50%) a utilizavam, 32 (80%) conheciam sua finalidade, 25 (62,5%) acertaram os indicadores fisiológicos e 36 (90%) classificaram corretamente a gravidade do TCE. Dos enfermeiros que utilizam a ECGl, 23 (92%) conheciam seus indicadores e classificação e 20 (60,61%) utilizavam uma vez por plantão. Em relação às dificuldades no manejo da ECGl, 11 (21,58%) não tinham nenhum problema; 10 (19,60%) citaram a falta de tempo e com o mesmo percentual responderam interpretação da resposta verbal nos pacientes intubados. Quanto ao conhecimento dos enfermeiros na descrição do processo de cuidar, 31 (70,45%) das respostas da fase pré e 35 (79,55%) da hospitalar não possuíam etapas importantes, sendo consideradas como incorretas. Quanto à afirmativa dos enfermeiros em estar, e realmente estar preparados para esta assistência, detectamos que daqueles que disseram estar preparados, apenas 12 (33,33%) acertaram todos os passos do atendimento pré hospitalar e 6 (16,67%) no atendimento hospitalar. Concluímos que diante dos resultados obtidos, os enfermeiros conhecem a ECGl, no entanto, necessitam de capacitação para sua melhor compreensão e utilização. Quanto ao conhecimento do processo de cuidar aos pacientes com TCE, é necessário modificar urgente esta realidade, especialmente na atenção às ações desenvolvidas pelo enfermeiro no âmbito hospitalar, onde as consequências das lesões secundárias, muitas delas evitadas com diagnóstico precoce e intervenções imediatas, podem acarretar incapacidades permanentes e prejudicar a qualidade de vida desses indivíduos

Assistência aos portadores de úlceras venosas: proposta de protocolo

Venous ulcers (VU), recurrent chronic wounds resulting from Chronic Venous Insufficiency (CVI), affect different age groups and would severely affect ambulation of patients. The lesions require treatment lasting and complex and are responsible for significant morbidity and mortality. Thus, this study aims to identify the important aspects covered in the scientific literature protocol for assisting patients with venous ulcers, identifying the issues to be proposed by the judges of the study (nurses, doctors and physiotherapists) to the protocol of care provided to patients venous ulcers and present the structure of protocol proposed by the judges of the study to assist patients with venous ulcers treated at a referral hospital of Rio Grande do Norte. This is a descriptive study using a quantitative approach, carried out at the dressings, located in the outpatient surgical clinic of the Hospital University Onofre Lopes (HUOL), located in East Sanitary District, Natal-RN. The sample consisted of 39 professionals, 30 nurses, seven doctors and two physical therapists, team members HUOL surgical clinic and other public and private institutions of Rio Grande do Norte and Jequié/Bahia. These professionals were the judges responsible for selecting the guidelines already proposed in the literature on VU protocols. Approved by the Ethics in Research HUOL (Report n.o 081/07), began the first stage of the study which consisted of reviewing the scientific literature about the relevant aspects to be included in a protocol for assisting patients with VU. These aspects were organized into a proposed questionnaire to the judges of the study. Following examination, held on the content validation with application of the Kappa (K), accepting a score higher than 0.80 and the Likert Scale, whereas rates from 4.0 to 5.0. The data collected were organized in Microsoft Excel and exported into Statistical Package for Social Sciences (SPSS) 15.0. The literature review included national and international scientific articles, thesis, dissertation and institutional protocols. Regarding the characterization of professional nurses predominated (76.1%), between 34 and 45 years (41.0%), female (79.5%), married/consensual union (46.2%), with specialization in VU care (61.5%), working in the hospital network (46.1%), with up to 5 years experience in VU (69.2%) and claiming to feel prepared to care for these injuries (92.3 %). With regard to aspects that had very good agreement (K ≥ 0.81), remained the items found in the literature with some modifications. In the analysis of the proposed evaluation items had very important, ranging from 4.1 (drug treatment) to 4.9 (patient assessment and care of the injury and the injured and perilesional skin). The proposition of the protocol is arranged in eleven items: A) Evaluation of patient and lesion, B) Registration and documentation, C) the wound and perilesional skin, D) an indication of coverage, E) Use of antibiotic and pain treatment, F) Surgical treatment of CVI, G) Drug treatment, H) Improving venous return and prevetion of recurrence, I) Referral of patients, J) Training and K) Reference and counter reference